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Valko PO, Siddique A, Linsenmeier C, Zaugg K, Held U, Hofer S. Prevalence and predictors of fatigue in glioblastoma: a prospective study. Neuro Oncol 2014; 17:274-81. [PMID: 25006033 DOI: 10.1093/neuonc/nou127] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The main goal of this study was to assess frequency, clinical correlates, and independent predictors of fatigue in a homogeneous cohort of well-defined glioblastoma patients at baseline prior to combined radio-chemotherapy. METHODS We prospectively included 65 glioblastoma patients at postsurgical baseline and assessed fatigue, sleepiness, mean bedtimes, mood disturbances, and clinical characteristics such as clinical performance status, presenting symptomatology, details on neurosurgical procedure, and tumor location and diameter as well as pharmacological treatment including antiepileptic drugs, antidepressants, and use of corticosteroids. Data on fatigue and sleepiness were measured with the Fatigue Severity Scale and the Epworth Sleepiness Scale, respectively, and compared with 130 age- and sex-matched healthy controls. RESULTS We observed a significant correlation between fatigue and sleepiness scores in both patients (r = 0.26; P = .04) and controls (r = 0.36; P < .001). Only fatigue appeared to be more common in glioblastoma patients than in healthy controls (48% vs 11%; P < .001) but not the frequency of sleepiness (22% vs 19%; P = .43). Female sex was associated with increased fatigue frequency among glioblastoma patients but not among control participants. Multiple linear regression analyses identified depression, left-sided tumor location, and female sex as strongest associates of baseline fatigue severity. CONCLUSIONS Our findings indicate that glioblastoma patients are frequently affected by fatigue at baseline, suggesting that factors other than those related to radio- or chemotherapy have significant impact, particularly depression and tumor localization.
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Affiliation(s)
- Philipp O Valko
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.O.V., S.H.); Department of Oncology, University Hospital Zurich, Zurich, Switzerland (A.S., S.H.); Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland (C.L., K.Z.); Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (K.Z.); Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland (U.H.)
| | - Asim Siddique
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.O.V., S.H.); Department of Oncology, University Hospital Zurich, Zurich, Switzerland (A.S., S.H.); Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland (C.L., K.Z.); Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (K.Z.); Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland (U.H.)
| | - Claudia Linsenmeier
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.O.V., S.H.); Department of Oncology, University Hospital Zurich, Zurich, Switzerland (A.S., S.H.); Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland (C.L., K.Z.); Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (K.Z.); Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland (U.H.)
| | - Kathrin Zaugg
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.O.V., S.H.); Department of Oncology, University Hospital Zurich, Zurich, Switzerland (A.S., S.H.); Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland (C.L., K.Z.); Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (K.Z.); Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland (U.H.)
| | - Ulrike Held
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.O.V., S.H.); Department of Oncology, University Hospital Zurich, Zurich, Switzerland (A.S., S.H.); Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland (C.L., K.Z.); Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (K.Z.); Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland (U.H.)
| | - Silvia Hofer
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland (P.O.V., S.H.); Department of Oncology, University Hospital Zurich, Zurich, Switzerland (A.S., S.H.); Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland (C.L., K.Z.); Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (K.Z.); Horten Center for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland (U.H.)
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Abstract
The occurrence of pain in cancer survivors may be debilitating. These pain syndromes may be of different types, including neuropathic pain. The research related to cancer management has been done extensively in certain areas, but such research in cancer survivors is still lacking. The chronic pain in cancer survivors is not only under-reported but also under-treated. The assessment of pain in cancer survivors is multifaceted because of many domains like physical, social and psychological. Usually, the pain management may be considered similar to that for chronic noncancer pain, but with a caveat that such pain may at times be indicative of cancer recurrence. The multidisciplinary and multimodal management is essential for such neuralgic pain in cancer survivors. This may require a balanced combination of pharmacological and nonpharmacological techniques, including psychological support. The overall goal that remains in such patients for pain management is to improve the quality of life. Here we review certain pertinent aspects of neuropathic pain in cancer survivors.
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Affiliation(s)
- Rakesh Garg
- Department of Anaesthesiology, Pain & Palliative Care, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
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153
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Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ. Psychological and behavioral approaches to cancer pain management. J Clin Oncol 2014; 32:1703-11. [PMID: 24799497 PMCID: PMC4031190 DOI: 10.1200/jco.2013.54.4825] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This review examines evidence for psychological factors that affect pain across the cancer continuum from diagnosis through treatment and long-term survivorship or end of life. Evidence is convincing that emotional distress, depression, anxiety, uncertainty, and hopelessness interact with pain. Unrelieved pain can increase a desire for hastened death. Patients with cancer use many strategies to manage pain, with catastrophizing associated with increased pain and self-efficacy associated with lower pain reports. A variety of psychological and cognitive behavioral treatments can reduce pain severity and interference with function, as indicated in multiple meta-analyses and high-quality randomized controlled trials. Effective methods include education (with coping skills training), hypnosis, cognitive behavioral approaches, and relaxation with imagery. Exercise has been tested extensively in patients with cancer and long-term survivors, but few exercise studies have evaluated pain outcomes. In survivors post-treatment, yoga and hypnosis as well as exercise show promise for controlling pain. Although some of these treatments effectively reduce pain for patients with advanced disease, few have been tested in patients at the end of life. Given the clear indicators that psychological factors affect cancer pain and that psychological and behavioral treatments are effective in reducing varying types of pain for patients with active disease, these methods need further testing in cancer survivors post-treatment and in patients with end-stage disease. Multidisciplinary teams are essential in oncology settings to integrate analgesic care and expertise in psychological and behavioral interventions in standard care for symptom management, including pain.
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Affiliation(s)
- Karen L Syrjala
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC.
| | - Mark P Jensen
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - M Elena Mendoza
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Jean C Yi
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Hannah M Fisher
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
| | - Francis J Keefe
- Karen L. Syrjala and Jean C. Yi, Fred Hutchinson Cancer Research Center; Karen L. Syrjala, Mark P. Jensen, and M. Elena Mendoza, University of Washington, Seattle, WA; and Hannah M. Fisher and Francis J. Keefe, Duke University, Durham, NC
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154
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Aaronson NK, Mattioli V, Minton O, Weis J, Johansen C, Dalton SO, Verdonck-de Leeuw IM, Stein KD, Alfano CM, Mehnert A, de Boer A, van de Poll-Franse LV. Beyond treatment - Psychosocial and behavioural issues in cancer survivorship research and practice. EJC Suppl 2014. [PMID: 26217166 PMCID: PMC4250535 DOI: 10.1016/j.ejcsup.2014.03.005] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The population of cancer survivors has grown steadily over the past several decades. Surviving cancer, however, is not synonymous with a life free of problems related to the disease and its treatment. In this paper we provide a brief overview of selected physical and psychosocial health problems prevalent among cancer survivors, namely pain, fatigue, psychological distress and work participation. We also address issues surrounding self-management and e-Health interventions for cancer survivors, and programmes to encourage survivors to adopt healthier lifestyles. Finally, we discuss approaches to assessing health-related quality of life in cancer survivors, and the use of cancer registries in conducting psychosocial survivorship research. We highlight research and practice priorities in each of these areas. While the priorities vary per topic, common themes that emerged included: (1) Symptoms should not be viewed in isolation, but rather as part of a cluster of interrelated symptoms. This has implications for both understanding the aetiology of symptoms and for their treatment; (2) Psychosocial interventions need to be evidence-based, and where possible should be tailored to the needs of the individual cancer survivor. Relatively low cost interventions with self-management and e-Health elements may be appropriate for the majority of survivors, with resource intensive interventions being reserved for those most in need; (3) More effort should be devoted to disseminating and implementing interventions in practice, and to evaluating their cost-effectiveness; and (4) Greater attention should be paid to the needs of vulnerable and high-risk populations of survivors, including the socioeconomically disadvantaged and the elderly.
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Affiliation(s)
- Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vittorio Mattioli
- O.U. Anesthesiology, Intensive Care, Pain and Palliative Care, Experimental Unit of Psycho-Oncology, National Cancer Research Center 'Giovanni Paolo II', Bari, Italy
| | - Ollie Minton
- Palliative Medicine, Division of Population Health Sciences and Education, St. George's University of London, London, United Kingdom
| | - Joachim Weis
- Department of Psychosocial Oncology, Clinic for Tumor Biology, University of Freiburg, Freiburg, Germany
| | - Christoffer Johansen
- Cancer Late Effects Research, Oncology, Finsencenteret, RIgshospitalet, University of Copenhagen & Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Susanne O Dalton
- Unit of Survivorship Research, The Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology, Head and Neck Surgery, VU University Medical Center and Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Kevin D Stein
- Behavioral Research Center, Intramural Research Department, American Cancer Society, Atlanta, GA, USA
| | - Catherine M Alfano
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health (NIH)/Department of Health and Human Services (DHHS), Bethesda, MD, USA
| | - Anja Mehnert
- Section of Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Angela de Boer
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Centre of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Comprehensive Cancer Centre of the Netherlands, Eindhoven, The Netherlands
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155
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Yokoo M, Akechi T, Takayama T, Karato A, Kikuuchi Y, Okamoto N, Katayama K, Nakanotani T, Ogawa A. Comprehensive assessment of cancer patients' concerns and the association with quality of life. Jpn J Clin Oncol 2014; 44:670-6. [PMID: 24829467 DOI: 10.1093/jjco/hyu060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Comprehensive assessment of perceived concerns can be used to guide supportive care appropriate to individual cancer patients. This study sought to determine the prevalence of cancer patients' concerns and the degree to which these concerns contribute to patients' quality of life. METHODS Participants were patients with all types of cancer, who completed an Internet survey questionnaire regarding comprehensive concerns about physical, psychological, psychosocial and economic aspects of having cancer. The questionnaire was based on the newly developed Comprehensive Concerns Assessment Tool and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. RESULTS We obtained complete data from 807 patients. Factors related to 'self-management' concerns were the most common (61.2%), followed by concerns about 'psychological symptoms' (48.5%), 'medical information' (46.2%), 'daily living' (29.9%), 'pain' (17.6%), 'constipation' (15.6%) and other 'physical symptoms' (15.2%). Multiple regression analysis revealed that all concerns except those about 'medical information' significantly contributed to quality of life. CONCLUSIONS Cancer patients' concerns were shown to be multidimensional and significantly associated with quality of life. Thus, assessment of patients' concerns should be multidimensional in nature, and a multidisciplinary care team should help patients improve their quality of life.
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Affiliation(s)
- Minori Yokoo
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center East Hospital, Kashiwa, Chiba
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City Graduate School of Medical Sciences, Nagoya, Aichi
| | - Tomoko Takayama
- Cancer Information Service Division, Center for Cancer Control and Information Service, National Cancer Center, Tsukiji, Tokyo
| | - Atsuya Karato
- Patient Support Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake, Tokyo
| | - Yuki Kikuuchi
- Department of Patient and Family Support, Shikoku Cancer Center, Matsuyama, Ehime
| | - Naoyuki Okamoto
- Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan
| | - Kayoko Katayama
- Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa, Japan
| | - Takako Nakanotani
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center East Hospital, Kashiwa, Chiba
| | - Asao Ogawa
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center East Hospital, Kashiwa, Chiba
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156
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Beckjord EB, Reynolds KA, van Londen GJ, Burns R, Singh R, Arvey SR, Nutt SA, Rechis R. Population-level trends in posttreatment cancer survivors' concerns and associated receipt of care: results from the 2006 and 2010 LIVESTRONG surveys. J Psychosoc Oncol 2014; 32:125-51. [PMID: 24364920 DOI: 10.1080/07347332.2013.874004] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED There is a need to better understand the posttreatment concerns of the nearly 14 million survivors of cancer alive in the United States today and their receipt of care. Using data from 2,910 posttreatment survivors of cancer from the 2006 or 2010 LIVESTRONG Surveys, the authors examined physical, emotional, and practical concerns, receipt of care, and trends in these outcomes at the population level. RESULTS 89% of respondents reported at least one physical concern (67% received associated posttreatment care), 90% reported at least one emotional concern (47% received care), and 45% reported at least one practical concern (36% received care). Female survivors, younger survivors, those who received more intensive treatment, and survivors without health insurance often reported a higher burden of posttreatment concerns though were less likely to have received posttreatment care. These results reinforce the importance of posttreatment survivorship and underscore the need for continued progress in meeting the needs of this population. Efforts to increase the availability of survivorship care are extremely important to improve the chances of people affected by cancer living as well as possible in the posttreatment period.
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157
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Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N, Oeffinger KC, Paice JA, Stubblefield MD, Syrjala KL. Pain in cancer survivors. J Clin Oncol 2014; 32:1739-47. [PMID: 24799477 DOI: 10.1200/jco.2013.52.4629] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed.
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Affiliation(s)
- Paul A Glare
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Pamela S Davies
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Esmé Finlay
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Amitabh Gulati
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Dawn Lemanne
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Natalie Moryl
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kevin C Oeffinger
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Judith A Paice
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael D Stubblefield
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karen L Syrjala
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
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158
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Living with cancer-related uncertainty: associations with fatigue, insomnia, and affect in younger breast cancer survivors. Support Care Cancer 2014; 22:2489-95. [PMID: 24728586 DOI: 10.1007/s00520-014-2243-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Uncertainty in cancer patients and survivors about cancer-related symptoms, treatment, and disease course has been related to poorer mental and physical health. However, little is known about whether cancer-related uncertainty relates with specific disease and treatment-related outcomes such as fatigue, insomnia, and affect disruptions. In this paper, we report these associations in younger survivors aged 50 years or less, a population increasing in prevalence. METHODS Participants included 313 breast cancer survivors (117 African-Americans and 196 Caucasians) who were aged 24 to 50 years and were 2 to 4 years posttreatment. Self-reported cancer-related uncertainty (Mishel Uncertainty in Illness Scale-Survivor Version), fatigue (Piper Fatigue Scale-Revised), insomnia (Insomnia Severity Index), and negative and positive affect (Positive and Negative Affect Schedule (PANAS)) measures were collected upon study entry. RESULTS Hierarchical regression analyses controlled for relevant sociodemographic variables include the following: race, age, years of education, number of children, employment status, marital status, monthly income, smoking status, family history of cancer, endorsement of treatment-induced menopause, and religiosity. Over and above these factors, higher cancer-related uncertainty was significantly associated with more self-reported fatigue (β = .43), insomnia (β = .34), negative affect (β = .43), as well as less positive affect (β = -.33), all ps < .01. CONCLUSIONS Younger breast cancer survivors who are 2-4 years posttreatment experience cancer-related uncertainty, with higher levels associated with more self-reported psychophysiological disruptions. Cancer survivors who present in clinical settings with high uncertainty about recurrence or management of long-term effects of treatment may thus benefit from assessment of fatigue, insomnia, and affect.
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159
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Sanoff HK, Deal AM, Krishnamurthy J, Torrice C, Dillon P, Sorrentino J, Ibrahim JG, Jolly TA, Williams G, Carey LA, Drobish A, Gordon BB, Alston S, Hurria A, Kleinhans K, Rudolph KL, Sharpless NE, Muss HB. Effect of cytotoxic chemotherapy on markers of molecular age in patients with breast cancer. J Natl Cancer Inst 2014; 106:dju057. [PMID: 24681605 DOI: 10.1093/jnci/dju057] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Senescent cells, which express p16 (INK4a) , accumulate with aging and contribute to age-related pathology. To understand whether cytotoxic agents promote molecular aging, we measured expression of p16 (INK4a) and other senescence markers in breast cancer patients treated with adjuvant chemotherapy. METHODS Blood and clinical information were prospectively obtained from 33 women with stage I to III breast cancer at four time points: before anthracycline-based chemotherapy, immediately after anthracycline-based chemotherapy, 3 months after anthracycline-based chemotherapy, and 12 months after anthracycline-based chemotherapy. Expression of senescence markers p16 (INK4a) and ARF mRNA was determined using TaqMan quantitative reverse-transcription polymerase chain reaction in CD3(+) T lymphocytes, telomere length was determined by Southern analysis, and senescence-associated cytokines were determined by enzyme-linked immunosorbent assay. Findings were independently assessed in a cross-sectional cohort of 176 breast cancer survivors enrolled a median of 3.4 years after treatment; 39% previously received chemotherapy. All statistical tests were two-sided. RESULTS In prospectively analyzed patients, expression of p16 (INK4a) and ARF increased immediately after chemotherapy and remained elevated 12 months after treatment. Median increase in log2 p16 (INK4a) was 0.81 (interquartile range = 0.28-1.62; Wilcoxon signed-rank P < .001), or a 75% absolute increase in expression, equivalent to the increase observed over 14.7 years of chronological aging. ARF expression was comparably increased (P < .001). Increased expression of p16 (INK4a) and ARF was associated with dose-dense therapy and hematological toxicity. Expression of two senescence-associated cytokines (VEGFA and MCP1) was durably increased by adjuvant chemotherapy. Telomere length was not affected by chemotherapy. In a cross-sectional cohort, prior chemotherapy exposure was independently associated with a log2-increase in p16 (INK4a) expression of 0.57 (repeated measures model, P < .001), comparable with 10.4 years of chronological aging. CONCLUSIONS Adjuvant chemotherapy for breast cancer is gerontogenic, inducing cellular senescence in vivo, thereby accelerating molecular aging of hematopoietic tissues.
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Affiliation(s)
- Hanna K Sanoff
- Affiliations of authors: Lineberger Comprehensive Cancer Center (HKS, AMD, JK, CT, JS, JGI, LAC, AD, B-BG, SA, NES, HBM), Department of Medicine (HKS, TAJ, GW, LAC, NES, HBM), Department of Genetics (JK, CT, NES), and Department of Biostatistics (JGI), University of North Carolina, Chapel Hill, NC; Department of Medicine, University of Virginia, Charlottesville, VA (PD); Department of Medical Oncology and Therapeutics Research, City of Hope Cancer Center, Duarte, CA (AH); Leibniz Institute for Age Research, Fritz Lipmann Institute, Jena, Germany (KK, KLR)
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Nekhlyudov L, Aziz NM, Lerro C, Virgo KS. Oncologists' and primary care physicians' awareness of late and long-term effects of chemotherapy: implications for care of the growing population of survivors. J Oncol Pract 2014; 10:e29-36. [PMID: 24222054 PMCID: PMC3948708 DOI: 10.1200/jop.2013.001121] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The population of cancer survivors is large and growing. Yet after successful completion of treatment, many experience chemotherapy-related late or long-term effects (LEs). The extent to which physicians are aware of LEs is unknown. METHODS We conducted a nationally representative survey of 1,130 oncologists and 1,072 primary care providers (PCPs). Respondents were asked to select the LEs they had either observed or seen reported for five chemotherapy agents used to treat breast and colon cancers. We described and compared oncologists' and PCPs' awareness of the specified LEs. Using multivariate logistic regression models, we determined predictors of physicians' awareness of the main LEs associated with the agents. RESULTS Almost all oncologists (95%) reported awareness of cardiac dysfunction as an LE of doxorubicin and peripheral neuropathy as an LE of paclitaxel (97%) and oxaliplatin (97%). These LEs were reported by 55%, 27%, and 22% of PCPs, respectively. Most oncologists reported awareness of premature menopause (71%) and secondary malignancies (62%) as LEs of cyclophosphamide, compared with only 15% and 17% of PCPs, respectively. Main LEs associated with all four agents were identified by 65% of oncologists and only 6% of PCPs. CONCLUSION Although more than half of PCPs were aware of cardiac dysfunction as an LE of doxorubicin, awareness of other LEs was limited. Because PCPs may not be directly exposed to chemotherapy-related LEs, oncologists must communicate this information to PCPs as patients transition to primary care settings. Education for all providers caring for the growing population of cancer survivors is needed.
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Affiliation(s)
- Larissa Nekhlyudov
- Harvard Medical School and Harvard Vanguard Medical Associates, Boston MA; National Institute of Nursing Research, Bethesda, MD; Yale University School of Public Health, New Haven, CT; and Rollins School of Public Health, Emory University, Atlanta, GA
| | - Noreen M. Aziz
- Harvard Medical School and Harvard Vanguard Medical Associates, Boston MA; National Institute of Nursing Research, Bethesda, MD; Yale University School of Public Health, New Haven, CT; and Rollins School of Public Health, Emory University, Atlanta, GA
| | - Catherine Lerro
- Harvard Medical School and Harvard Vanguard Medical Associates, Boston MA; National Institute of Nursing Research, Bethesda, MD; Yale University School of Public Health, New Haven, CT; and Rollins School of Public Health, Emory University, Atlanta, GA
| | - Katherine S. Virgo
- Harvard Medical School and Harvard Vanguard Medical Associates, Boston MA; National Institute of Nursing Research, Bethesda, MD; Yale University School of Public Health, New Haven, CT; and Rollins School of Public Health, Emory University, Atlanta, GA
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161
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Wang XS, Zhao F, Fisch MJ, O’Mara AM, Cella D, Mendoza TR, Cleeland CS. Prevalence and characteristics of moderate to severe fatigue: a multicenter study in cancer patients and survivors. Cancer 2014; 120:425-32. [PMID: 24436136 PMCID: PMC3949157 DOI: 10.1002/cncr.28434] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/30/2013] [Accepted: 09/16/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND The effective management of fatigue in patients with cancer requires a clear delineation of what constitutes nontrivial fatigue. The authors defined numeric cutpoints for fatigue severity based on functional interference and described the prevalence and characteristics of fatigue in patients with cancer and survivors. METHODS In a multicenter study, outpatients with breast, prostate, colorectal, or lung cancer rated their fatigue severity and symptom interference with functioning on the M. D. Anderson Symptom Inventory numeric scale of 0 to 10. Ratings of symptom interference guided the selection of numeric rating cutpoints between mild, moderate, and severe fatigue levels. Regression analysis identified significant factors related to reporting moderate=severe fatigue . RESULTS The statistically optimal cutpoints were 4 for moderate fatigue and 7 for severe fatigue. Moderate=severe fatigue was reported by 983 of 2177 patients (45%) undergoing active treatment and was more likely to occur in patients receiving treatment with strong opioids (odds ratio [OR], 3.00), those with a poor Eastern Cooperative Oncology Group performance status (OR, 2.00), those who had >5% weight loss within 6 months (OR, 1.60), those who were receiving >10 medications (OR, 1.58), those with lung cancer (OR, 1.55), and those with a history of depression (OR, 1.42). Among survivors (patients with complete remission or no evidence of disease, and not currently receiving cancer treatment), 29% of patients (150 of 515 patients) had moderate=severe fatigue that was associated with poor performance status (OR, 3.48) and a history of depression (OR, 2.21). CONCLUSIONS The current study statistically defined fatigue severity categories related to significantly increased symptom interference. The high prevalence of moderate=severe fatigue in both actively treated patients with cancer and survivors warrants the promoting of the routine assessment and management of patient-reported fatigue.
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Affiliation(s)
- Xin Shelley Wang
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fengmin Zhao
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael J. Fisch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Tito R. Mendoza
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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162
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Abstract
With the favorable trend regarding survival of cancer in the Western world, there is an increasing focus among patients, clinicians, researchers, and politicians regarding cancer survivors' health and well-being. Their number is rapidly growing and more than 3 % of the adult populations in Western countries have survived cancer for 5 years or more. Cancer survivors are at increased risk for a variety of late effects after treatment, some life-threatening such as secondary cancer and cardiac diseases, others might negatively impact on their daily functioning and quality of life. The latter might include fatigue, anxiety disorders and difficulties returning to work while depression does not seem to be more common among survivors than in the general population. Still, the majority of survivors regain their health and social functioning. The field of cancer survivorship research has been rapidly growing. Models for follow-up care of cancer survivors have been proposed, but how to best integrate the knowledge of the field into clinical practice with adequate follow-up of cancer survivors at risk for developing late effects is still an unsolved question.
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Affiliation(s)
- Cecilie E Kiserud
- National Resource Center for late effects after Cancer Treatment, Oslo University Hospital, Radiumhospitalet, 4953 Nydalen, 0424, Oslo, Norway,
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163
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Mocciaro F, Di Mitri R, Renna S, Orlando A. Acute-severe fatigue after anti-TNFα treatment: an early insidious side effect. J Crohns Colitis 2013; 7:e704-5. [PMID: 23953236 DOI: 10.1016/j.crohns.2013.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 07/20/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy.
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165
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Coyne PJ, Wan W, Dodson P, Swainey C, Smith TJ. A trial of Scrambler therapy in the treatment of cancer pain syndromes and chronic chemotherapy-induced peripheral neuropathy. J Pain Palliat Care Pharmacother 2013; 27:359-64. [PMID: 24143893 PMCID: PMC4378693 DOI: 10.3109/15360288.2013.847519] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neuropathic pain is common among cancer patients and often difficult to treat. This study used Scrambler therapy, a patient-specific electrocutaneous nerve stimulation device, to treat cancer patients with pain. Patients received Scrambler therapy for 10 sessions (one daily) over a two-week period. The primary outcome was changed in pain numerical rating scale (NRS) at one month; secondary outcomes were changes in the Brief Pain Inventory and European Organization for Treatment and Cancer QLC-CIPN-20(EORTC CIPN-20), over time. Thirty-nine patients, mean age 56.5 yr, 16 men and 23 women, were treated over an 18-month period for an average of 9.3 days each. The "now" pain scores reduced from 6.6 before treatment to 4.5 at 14 days, 4.6, 4.8, and 4.6 at 1, 2, and 3 months, respectively (p < 0.001). Clinically important and statistically significant improvements were seen in average, least, and worst pain; BPI interference with life scores, and motor and sensory scales on the EORTC CIPN-20. No adverse effects were observed. In this single arm trial, Scrambler therapy appeared to relieve cancer-associated chronic neuropathic pain both acutely and chronically, and provided sustained improvements in many indicators of quality of life.
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166
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The impact of supportive nursing care on the needs of men with prostate cancer: a study across seven European countries. Br J Cancer 2013; 109:2121-30. [PMID: 24064968 PMCID: PMC3798964 DOI: 10.1038/bjc.2013.568] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/12/2013] [Accepted: 08/26/2013] [Indexed: 11/12/2022] Open
Abstract
Background: Prostate cancer is for many men a chronic disease with a long life expectancy after treatment. The impact of prostate cancer therapy on men has been well defined, however, explanation of the consequences of cancer treatment has not been modelled against the wider variables of long-term health-care provision. The aim of this study was to explore the parameters of unmet supportive care needs in men with prostate cancer in relation to the experience of nursing care. Methods: A survey was conducted among a volunteer sample of 1001 men with prostate cancer living in seven European countries. Results: At the time of the survey, 81% of the men had some unmet supportive care needs including psychological, sexual and health system and information needs. Logistic regression indicated that lack of post-treatment nursing care significantly predicted unmet need. Critically, men's contact with nurses and/or receipt of advice and support from nurses, for several different aspects of nursing care significantly had an impact on men's outcomes. Conclusion: Unmet need is related not only to disease and treatment factors but is also associated with the supportive care men received. Imperative to improving men's treatment outcomes is to also consider the access to nursing and the components of supportive care provided, especially after therapy.
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167
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Johnson W, Cadogan MP. Clinical Considerations for Care of Older Adult Cancer Survivors. J Gerontol Nurs 2013; 39:8-12. [DOI: 10.3928/00989134-20130808-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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168
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Salani R. Survivorship planning in gynecologic cancer patients. Gynecol Oncol 2013; 130:389-97. [DOI: 10.1016/j.ygyno.2013.05.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/13/2013] [Accepted: 05/16/2013] [Indexed: 01/01/2023]
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169
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Beehler GP, Rodrigues AE, Kay MA, Kiviniemi MT, Steinbrenner L. Lasting Impact: Understanding the Psychosocial Implications of Cancer Among Military Veterans. J Psychosoc Oncol 2013; 31:430-50. [DOI: 10.1080/07347332.2013.798762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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170
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Abstract
Many cancer survivors suffer from chronic pain related to treatment. Pain management in the survivor is similar to chronic noncancer pain, with the important caveat that new or worsening pain must be promptly assessed for malignancy. This article reviews cancer survivorship, identifies common pain problems, and discusses strategies for management.
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171
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Stover AM, Reeve BB, Piper BF, Alfano CM, Smith AW, Mitchell SA, Bernstein L, Baumgartner KB, McTiernan A, Ballard-Barbash R. Deriving clinically meaningful cut-scores for fatigue in a cohort of breast cancer survivors: a Health, Eating, Activity, and Lifestyle (HEAL) Study. Qual Life Res 2013; 22:2279-92. [PMID: 23420495 DOI: 10.1007/s11136-013-0360-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE To empirically determine clinically meaningful cut-scores on the 0-10 response scale of the revised Piper Fatigue Scale (PFS-R) and its shorter version (PFS-12). Breast cancer survivors were classified (i.e., none, mild, moderate, or severe fatigue) based on the cut-scores, and relationships between these cut-scores and decrements in health-related quality of life (HRQOL) were examined. METHODS A total of 857 breast cancer survivors, stages in situ-IIIa, from the Health, Eating, Activity, and Lifestyle (HEAL) Study were eligible. Survivors completed the PFS-R, SF-36, and a sexual health scale approximately 3 years after diagnosis. Multivariate analysis of covariance was used to examine five fatigue severity cut-score models, controlling for demographics, clinical characteristics, comorbidity, and antidepressant use. Multivariate regression was used to examine HRQOL decrements by cut-score category. RESULTS Analyses supported two similar fatigue severity cut-score models for the PFS-R and PFS-12: Model A.) none (0), mild (1-3), moderate (4-6), and severe (7-10); and Model D.) none (0), mild (1-2), moderate (3-5), and severe (6-10). For every threshold increase in fatigue severity, clinically meaningful decrements in physical, mental, and sexual health scores were observed, supporting construct validity of the fatigue cut-scores. CONCLUSION Standardized fatigue cut-scores may enhance interpretability and comparability across studies and populations and guide treating planning.
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Affiliation(s)
- Angela M Stover
- Department of Health Behavior, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
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172
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Maher EJ. Managing the consequences of cancer treatment and the English National Cancer Survivorship Initiative. Acta Oncol 2013; 52:225-32. [PMID: 23237053 DOI: 10.3109/0284186x.2012.746467] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In 2007 the English National Cancer Survivorship initiative was launched as a partnership between a national charity, Macmillan Cancer Support, the English Department of Health (DH) and the quality improvement agency NHS Improvement. The initiative involved a number of work streams, one of which was to improve the detection and management of the Consequences of adult cancer Treatment (COT). MATERIAL AND METHODS The adult COT group took evidence from a range of stakeholders and published a vision and work programme focused on awareness raising, linking self- administered questionnaires to routine activity data collection and testing new models of care with a particular focus on pelvic cancers. RESULTS Key outputs include national media campaigns, publications demonstrating the value of linking cancer treatment episodes to routine recording of chronic illness, identification of sensitive Patient Reported Outcome Measures (PROMs) items for use in national surveys, evidence reviews and published national guidelines, together with the development of a three level risk stratified model of care. Pilot testing with survivors treated for pelvic cancers, and adult survivors with radiation-induced brachial plexopathy has been completed. CONCLUSION Early results suggest that a systematic approach to the prevention, detection and management of some treatment-related consequences can significantly improve the ability of patients to manage their conditions. As a result of these findings, new services have now been commissioned by the NHS, initially for those with complex problems.
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Affiliation(s)
- E J Maher
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
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173
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Abstract
The impact of oncologic treatments on fertility and menopausal symptoms is often significant for patients with cancer. Surgery, radiation, and chemotherapy can all damage the reproductive organs or the hypothalamic pituitary axis that controls them, impairing fertility and causing hormonally mediated symptoms such as hot flashes. Understanding these risks and strategies to mitigate them may substantially improve cancer survivorship care. For both female and male patients who desire a future biologic child, there are a variety of fertility preservation techniques that should be considered. For cancer survivors who experience menopausal symptoms, lifestyle changes may be beneficial, and hormonal and nonhormonal pharmacologic agents are well proven to reduce symptom burden.
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Affiliation(s)
- Kathryn J. Ruddy
- All authors: Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Ann H. Partridge
- All authors: Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
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174
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Ganz PA, Earle CC, Goodwin PJ. Journal of Clinical Oncology Update on Progress in Cancer Survivorship Care and Research. J Clin Oncol 2012; 30:3655-6. [DOI: 10.1200/jco.2012.45.3886] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Patricia A. Ganz
- Fielding School of Public Health and David Geffen School of Medicine, University of California, Los Angeles; Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Craig C. Earle
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Pamela J. Goodwin
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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