Correlation between anemia, unintentional weight loss and inflammatory status on cancer-related fatigue and quality of life before chemo and radiotherapy

Impact of prophylactic percutaneous endoscopic gastrostomy tube placement on treatment tolerance in head and neck cancer patients treated with cetuximab plus radiation

OBJECTIVE

We conducted a retrospective analysis to evaluate the efficacy and safety of cetuximab plus radiation with or without prophylactic percutaneous endoscopic gastrectomy in locally advanced squamous cell carcinoma of the head and neck patients who were not suitable to receive platinum.

PATIENTS AND METHODS

We reviewed the case records of 27 locally advanced squamous cell carcinoma of the head and neck patients treated with cetuximab plus radiation (RT) between January 2013 and July 2014. No patient was able to receive platinum because of renal dysfunction or other contraindications. Patients received an initial dose of cetuximab of 400 mg/m(2), followed by weekly doses of 250 mg/m(2). The total dose of radiotherapy was 66-70 Gy in five daily fractions of 2-2.12 Gy per week.

RESULTS

The incidence of leukopenia was significantly higher in patients without percutaneous endoscopic gastrectomy placement than in those with (67.5% vs. 7%, P = 0.002). The incidence of Grade 3 or 4 mucositis tended to be higher in patients without percutaneous endoscopic gastrectomy placement than in those with (83% vs. 47%, P = 0.058). Five of twelve patients without percutaneous endoscopic gastrectomy placement required interruption of treatment. More patients without percutaneous endoscopic gastrectomy placement had significantly >10% weight loss than patients with (75% vs. 27%, P = 0.013). The overall response rate was 56% in all patients. The 1-year progression-free survival rate was 30.6% in all patients.

CONCLUSIONS

Prophylactic percutaneous endoscopic gastrectomy-feeding tube placement could reduce the incidence of severe toxicities, including mucositis and weight loss, and avoid RT interruption. These results require confirmation in a larger study.

The biology of cancer-related fatigue: a review of the literature

PURPOSE

Understanding the etiology of cancer-related fatigue (CRF) is critical to identify targets to develop therapies to reduce CRF burden. The goal of this systematic review was to expand on the initial work by the National Cancer Institute CRF Working Group to understand the state of the science related to the biology of CRF and, specifically, to evaluate studies that examined the relationships between biomarkers and CRF and to develop an etiologic model of CRF to guide researchers on pathways to explore or therapeutic targets to investigate.

METHODS

This review was completed by the Multinational Association of Supportive Care in Cancer Fatigue Study Group-Biomarker Working Group. The initial search used three terms (biomarkers, fatigue, cancer), which yielded 11,129 articles. After removing duplicates, 9145 articles remained. Titles were assessed for the keywords "cancer" and "fatigue" resulting in 3811 articles. Articles published before 2010 and those with samples <50 were excluded, leaving 75 articles for full-text review. Of the 75 articles, 28 were further excluded for not investigating the associations of biomarkers and CRF.

RESULTS

Of the 47 articles reviewed, 25 were cross-sectional and 22 were longitudinal studies. More than half (about 70 %) were published recently (2010-2013). Almost half (45 %) enrolled breast cancer participants. The majority of studies assessed fatigue using self-report questionnaires, and only two studies used clinical parameters to measure fatigue.

CONCLUSIONS

The findings from this review suggest that CRF is linked to immune/inflammatory, metabolic, neuroendocrine, and genetic biomarkers. We also identified gaps in knowledge and made recommendations for future research.

Longitudinal study of cancer-related fatigue in patients with colorectal cancer

BACKGROUND

Dynamic changes of cancer-related fatigue (CRF) among hospitalized patients with colorectal cancer were determined.

MATERIALS AND METHODS

This longitudinal, descriptive study involved 96 hospitalized patients with colorectal cancer, all recruited from a tertiary general hospital in Guangzhou, China. Patients completed questionnaires three times to assess the degree of fatigue, and measurement points were within one week of admission, at 2 to 3 days after surgery and 3 weeks after surgery.

RESULTS

Significant differences among the three measurement points (p<0.01) were observed. The scores of fatigue in the second survey were the highest, followed by the third and first surveys. Colon cancer patient scores were higher than those of rectal cancer patients with a significant difference (p<0.05). Colorectal patients experienced different degrees of fatigue at different periods during hospitalization.

CONCLUSIONS

This study highlights the importance of interventions that are carefully tailored to patients based on the characteristics at different periods to alleviate fatigue.

A systematic review of health-related quality of life instruments in patients with cancer cachexia

PURPOSE

Assessing the health-related quality of life (HRQOL) of cancer patients with cachexia is particularly important because treatments for cachexia are currently aimed at palliation and treatment efficacy must be measured in ways other than survival. The aim of this systematic review was to evaluate HRQOL assessment in cancer patients with cachexia.

METHODS

Using guidance from the Centre for Reviews and Dissemination, relevant databases were searched from January 1980 to January 2012 with terms relating to cancer, cachexia and HRQOL for papers including adult cancer patients with cachexia or documented weight loss at baseline.

RESULTS

We found one cachexia-specific instrument, the Functional Assessment of Anorexia/Cachexia Therapy, but the tool has not been fully validated, does not cover all the relevant domains and the consensus-based standards for the selection of health status measurement instruments checklist highlighted a number of weaknesses in the methodological quality of the validation study. Sixty-seven studies assessed HRQOL in cachectic or weight-losing cancer patients. Most used generic cancer HRQOL instruments, limiting the amount of useful information they provide. A modified version of the Efficace minimum data checklist demonstrated that the quality of reporting on HRQOL tool use was inadequate in many of the studies. A negative relationship between HRQOL and weight loss was found in 23 of the 27 studies which directly examined this.

CONCLUSION

There is a pressing need for a well-designed HRQOL tool for use with this patient group in both clinical trials and clinical practice.