Functional loss in daily activity in ovarian cancer patients undergoing chemotherapy

Systematic Review of the Literature on Multiple Co-occurring Symptoms in Patients Receiving Treatment for Gynecologic Cancers

OBJECTIVE

Patients with gynecologic cancers experience a very high symptom burden that has a negative impact on their quality of life. This systematic review aims to identify the common co-occurring symptoms, the prevalence of common symptoms, common instruments used to measure symptoms, associated risk factors, and the symptom burden in patients with gynecologic cancers.

DATA SOURCES

A search of four databases (ie, PubMed, Embase, Web of Science, and CINAHL) was done from January 1, 2012, through September 5, 2022. A qualitative synthesis of the extant literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA 2020).

CONCLUSION

A total of 118 studies met the prespecified inclusion criteria. Ninety-six symptoms were assessed across these studies. The top six symptoms and their grand mean prevalence rates were lack of energy (64.4%), fatigue (62.1%), abdominal pain (53.3%), depression (52.6%), concentration dysfunction (52.0%), and drowsiness (51.9%). Numerous methodologic challenges were evident across studies. Future research needs to develop a disease-specific symptom assessment measure, evaluate for risk factors associated with a higher symptom burden, and determine the impact of multiple symptoms on patient outcomes.

IMPLICATION FOR NURSING PRACTICE

The results are relevant for oncology clinicians to assess patients with gynecologic cancers for the presence of common symptoms and risk factors for higher symptom burden in the patients and to offer effective management interventions.

Prolonged Endurance Exercise Adaptations Counteract Doxorubicin Chemotherapy-Induced Myotoxicity in Mice

Doxorubicin (DOX) is a potent chemotherapeutic agent widely used for various types of cancer; however, its accumulation causes myotoxicity and muscle atrophy. Endurance exercise (EXE) has emerged as a vaccine against DOX-induced myotoxicity. However, potential molecular mechanisms of EXE-mediated myocyte protection for the unfavorable muscle phenotype remain unelucidated. In addition, most studies have identified the short-term effects of DOX and EXE interventions, but studies on the prolonged EXE effects used as adjuvant therapy for chronic DOX treatment are lacking. Twelve-week-old adult male C57BL/6J mice were assigned to four groups: sedentary treated with saline (SED-SAL, n = 10), endurance exercise treated saline (EXE-SAL, n = 10), sedentary treated with doxorubicin (SED-DOX, n = 10), and endurance exercise treated with doxorubicin (EXE-DOX, n = 10). Mice were intraperitoneally injected with DOX (5 mg/kg) or saline five times biweekly for eight weeks, while a treadmill running exercise was performed. Body composition was assessed and then soleus muscle tissues were excised for histological and biochemical assays. Our data showed that DOX aggravated body composition, absolute soleus muscle mass, and distinct pathological features; also, TOP2B upregulation was linked to DOX-induced myotoxicity. We also demonstrated that EXE-DOX promoted mitochondrial biogenesis (e.g., citrate synthase). However, no alterations in satellite cell activation and myogenesis factors in response to DOX and EXE interventions were observed. Instead, SED-DOX promoted catabolic signaling cascades (AKT-FOXO3α-MuRF-1 axis), whereas EXE-DOX reversed its catabolic phenomenon. Moreover, EXE-DOX stimulated basal autophagy. We showed that the EXE-mediated catabolic paradigm shift is likely to rescue impaired muscle integrity. Thus, our study suggests that EXE can be recommended as an adjuvant therapy to ameliorate DOX-induced myotoxicity.

Limitations in Activities of Daily Living Among Spanish Women Diagnosed With Endometriosis

IMPORTANCE

Understanding the impact of endometriosis symptoms on patients' activities of daily living (ADLs) is a priority to establish effective and personalized intervention programs.

OBJECTIVE

To explore limitations in ADLs and instrumental ADLs (IADLs) and their association with pelvic pain (PP), chronic fatigue, and pain-catastrophizing thoughts among women with endometriosis.

DESIGN

Cross-sectional study.

SETTING

Spain.

PARTICIPANTS

Two hundred thirty women with endometriosis. Outcomes and Measures: Information regarding performance of ADLs (Barthel Index) and IADLs (Lawton-Brody questionnaire), PP intensity (Numeric Rating Scale), chronic fatigue (Piper Fatigue Scale), and pain-catastrophizing thoughts (Pain Catastrophizing Scale) was gathered. Multivariate regression analyses were created, and mediating effects of fatigue and pain-catastrophizing thoughts on the association between PP and ADL and IADL limitations were assessed.

RESULTS

The prevalence of limitations in at least one ADL and one IADL was 22.6% (95% confidence interval [CI] [17.2, 28.1]) and 39.1% (95% CI [32.8, 45.5]), respectively. Limitations in bowel continence, housework, shopping, and meal preparation were reported most frequently. Women reporting severe PP showed higher risk for ADL (odds ratio [OR] = 3.33, 95% CI [1.10, 10.10]) and IADL (OR = 7.99, 95% CI [2.86, 22.34]) limitations. Chronic fatigue and pain-catastrophizing thoughts were also positively related to ADL-IADL limitations, showing a mediating effect on the association between PP and ADL-IADL limitations.

CONCLUSIONS AND RELEVANCE

This study reveals the widespread presence of difficulties in ADL-IADL performance among women with endometriosis, with some symptoms underlying these difficulties in occupational performance. This study points to the need for cost-effective occupational therapy interventions for affected women. What This Article Adds: This research shows that the occupational performance of women with endometriosis is frequently impaired; therefore, the effectiveness of occupational therapy interventions should be addressed in the near future.

Physical and functional well-being and symptoms of ovarian cancer in women undergoing first-line of chemotherapy: a one-year follow-up

PURPOSE

Clinicopathological features and chemotherapy can influence the quality of life (QOL), women with ovarian cancer. This study aimed to evaluate the physical and functional well-being, and ovarian cancer-specific effects scores reported from QOL questionnaire among women with ovarian cancer at the time of in their initial diagnosis and access the scores trajectory of women receiving neoadjuvant and adjuvant chemotherapy.

METHODS

This prospective study used cross-sectional analysis at baseline and longitudinal analysis from baseline to 12-month post-chemotherapy. QOL was evaluated at the baseline, at sixth cycle and 12-month post-chemotherapy using FACT-O questionnaire. Clinicopathological features and chemotherapy regime were evaluated and tested for associations with QOL measures.

RESULTS

Of the 38 women enrolled in this study, 27 (80.1%) completed the questionnaire for 12 months. The multivariate linear regression results suggest, at the baseline, women with advance stage and presence of post-surgery residual disease showed lower scores in physical and functional well-being, ovarian cancer-specific effects, and FACT-O TOI domains (p < 0.05). Longitudinal analysis spanning over 12 months showed an improvement in mean physical well-being, functional well-being, and ovarian cancer-specific effects scores, independent of chemotherapy received (p < 0.05).

CONCLUSIONS

At the baseline, the clinicopathological features such as stage, presence of post-surgery residual disease, and type of chemotherapy correlated with on QOL scores. At one-year follow-up, women who underwent chemotherapy showed improvement in QOL regardless of the type of chemotherapy they received. Future prospective study with a larger group is recommended.