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Ribas Y, Bonet M, Torres L, Núñez M, Esther Jovell-Fernández E, Aranda E, Andreyev HJ. Bowel dysfunction in survivors of gynaecologic malignancies. Support Care Cancer 2020; 28:5501-5510. [PMID: 32172408 DOI: 10.1007/s00520-020-05402-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/04/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess the prevalence of bowel dysfunctions after treatment for gynaecological cancer and the impact on the quality of life. METHODS We identified a cohort of 217 eligible women treated with radiotherapy (RT) with curative intention, alone or as combined treatment, for gynaecological malignancies at three institutions in Catalonia (Spain). Demographic, diagnosis and treatment modality were reviewed. Patients were sent validated questionnaires to assess bowel function and a set of questions asking on the changes after RT in bowel function, urinary function, sexuality, pain and lymphoedema. RESULTS Questionnaires were returned by 109 patients (50.2%) with a mean age of 65 ± 11 years. Of them, 71.8% had been treated for endometrial cancer and 28.2% for cervical cancer. Overall, 42.7% of patients reported bowel dysfunction, affecting their quality of life in 36% of cases. Symptoms were more frequent in patients who had undergone external beam RT compared to brachytherapy. The most common symptom was defecatory urgency which was reported by more than 40% of patients according to the St Mark's score, although it was less common in other questionnaires. Overall, faecal incontinence ranged between 10 and 15%, and usual loose stools and diarrhoea were reported by 13.5% and 5.1%, respectively. CONCLUSION Prevalence of bowel symptoms after treatment of gynaecological malignancies is high. A systematic evaluation using validated questionnaires should be performed in order to allow the decision-making process and also because there are a number of treatments available to improve the quality of life of cancer survivors.
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Affiliation(s)
- Yolanda Ribas
- Department of Surgery, Consorci Sanitari de Terrassa, 08227, Terrassa, Barcelona, Spain.
| | - Marta Bonet
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Reus, Spain.,Department of Radiation Oncology, Hospital Universitari Arnau de VIlanova, Lleida, Spain
| | - Laura Torres
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Miriam Núñez
- Department of Radiation Oncology, Consorci Sanitari de Terrassa, Terrassa, Spain.,Department of Radiation Oncology, Institut Català d'Oncologia, L'Hospitalet de LLobregat, Spain
| | | | - Eduard Aranda
- Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
| | - H Jervoise Andreyev
- Department of Gastroenterology, Lincoln County Hospital, United Lincolnshire Hospitals Trust, Lincoln, UK
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Cox-Martin E, Anderson-Mellies A, Borges V, Bradley C. Chronic pain, health-related quality of life, and employment in working-age cancer survivors. J Cancer Surviv 2019; 14:179-187. [PMID: 31828603 DOI: 10.1007/s11764-019-00843-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/29/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE This study estimated the prevalence of cancer-related pain in working-age cancer survivors (age 25-64 years) and evaluated differences in demographic and clinical variables in those with and without pain. We also investigated the impact of cancer-related pain on health-related quality of life (HRQoL) and employment outcomes in this population. METHODS We used cross-sectional data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS). Analyses were conducted with a sample of 1702 cancer survivors who completed treatment. All analyses were conducted using procedures to account for the complex sampling design of the BRFSS. RESULTS Nearly 17% (95% CI [13.94-19.58]) of working-age cancer survivors reported experiencing cancer-related pain. Among those who experienced pain, the majority were female, white, non-Hispanic, married/partnered, and non-employed, with breast as the most common cancer disease site. Those with cancer-related pain experienced more physically unhealthy days (adjusted rate ratio [aRR] 1.63, 95% CI [1.16-2.28]), mentally unhealthy days (aRR 1.52, 95% CI [1.02-2.26]), and activity interference (aRR 2.15, 95% CI [1.53-3.02]). Cancer-related pain decreased the odds of being employed, but only in female survivors (adjusted odds ratio 0.34, 95% CI [0.22-0.54]). CONCLUSION Cancer-related chronic pain is a prevalent, long-term condition that is negatively associated with HRQoL and employment in working-age cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Clinical interventions targeting chronic pain may improve HRQoL in working-age cancer survivors and employment outcomes, particularly in women.
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Affiliation(s)
- Emily Cox-Martin
- Division of Medical Oncology, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave., Aurora, CO, 80045, USA.
| | - Amy Anderson-Mellies
- Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, 80045, USA
| | - Virginia Borges
- Division of Medical Oncology, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave., Aurora, CO, 80045, USA
| | - Cathy Bradley
- University of Colorado School of Public Health, Department of Health Systems, Management, and Policy, University of Colorado Cancer Center, 13001 E. 17th Pl, Aurora, CO, 80045, USA
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Guo Q, Cai S, Qian J, Tian Y. Dose optimization strategy of sacrum limitation in cervical cancer intensity modulation radiation therapy planning. Medicine (Baltimore) 2019; 98:e15938. [PMID: 31192929 PMCID: PMC6587599 DOI: 10.1097/md.0000000000015938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/28/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the dose optimization strategy for the sacrum to reduce the risk of pelvic insufficiency fracture (PIF).Using a retrospective study design, we analyzed data from 28 patients with cervical cancer who underwent postoperative adjuvant radiotherapy in our department from June 2017 to January 2018. Among these patients, 20 (71.4%) underwent external beam radiation therapy in the pelvic lymphatic drainage area (node-negative patients). Overall, 8 patients (28.6%) underwent radiotherapy in the pelvic lymphatic drainage area with a simultaneous integrated boost (node-positive patients). Furthermore, 20 patients were assigned to 2 groups of plans according to the prescribed doses of 5000 and 4500 cGy/25. Each group had 3 plans according to 3 different dose limit conditions: "pelvic bones and sacrum unlimited," "pelvic bones limited," and "pelvic bones + sacrum limited." The irradiation dose of the sacrum and pelvis was analyzed in three limited optimization models.The planning target volume conformity index and homogeneity index, based on different optimization modes in the 4500 and 5000 cGy plans, showed no significant differences. The D50% and Dmean of the pelvis + sacrum limited mode were significantly lower than those of the pelvic limited mode (P < .001). The dose of the sacrum and pelvis in the 4500 cGy plan in the lymphatic drainage area was significantly lower than that of the 5000 cGy plan (P < .001). In the lymph node boost group, the irradiation dose of the sacrum and pelvis was significantly increased (P ≤ .001).Increasing the limitation of the sacrum, on the basis of pelvic bone limitation, in cervical cancer intensity-modulated radiation therapy can significantly reduce the dose to the sacrum. Compared with the dose of 5000 cGy to the lymphatic drainage area, the dose of 4500 cGy was the largest influencing factor to reduce the dose to the sacrum.
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Leysen L, Adriaenssens N, Nijs J, Pas R, Bilterys T, Vermeir S, Lahousse A, Beckwée D. Chronic Pain in Breast Cancer Survivors: Nociceptive, Neuropathic, or Central Sensitization Pain? Pain Pract 2018; 19:183-195. [DOI: 10.1111/papr.12732] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 07/07/2018] [Accepted: 07/29/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Laurence Leysen
- Pain in Motion International Research Group; Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Nele Adriaenssens
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Department of Oncology; University Hospital Brussels; Brussels Belgium
| | - Jo Nijs
- Pain in Motion International Research Group; Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Department of Physical Medicine and Physiotherapy; University Hospital Brussels; Brussels Belgium
| | - Roselien Pas
- Pain in Motion International Research Group; Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Thomas Bilterys
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Sofie Vermeir
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Astrid Lahousse
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - David Beckwée
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Frailty in Ageing Research Department; Vrije Universiteit Brussel; Brussels Belgium
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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Olsson M, Steineck G, Enskär K, Wilderäng U, Jarfelt M. Sexual function in adolescent and young adult cancer survivors—a population-based study. J Cancer Surviv 2018; 12:450-459. [DOI: 10.1007/s11764-018-0684-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
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Olsson M, Enskär K, Steineck G, Wilderäng U, Jarfelt M. Self-Perceived Physical Attractiveness in Relation to Scars Among Adolescent and Young Adult Cancer Survivors: A Population-Based Study. J Adolesc Young Adult Oncol 2018; 7:358-366. [PMID: 29373051 DOI: 10.1089/jayao.2017.0089] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Cancer treatment may result in various effects that last long after treatment has been concluded. The purpose of this study was to explore to what extent scars affect adolescents and young adults postcancer treatment. METHODS In this population-based study, a study-specific questionnaire was developed by a method used in several previous investigations carried out by our research group, Clinical Cancer Epidemiology. Question development involved expert validation by professionals from oncology units, midwives, epidemiologists, and statisticians. The questionnaire was developed in collaboration with adolescent and young adult cancer survivors. The topics covered in the questionnaire were as follows: psychosocial health, body image and sexuality, fertility, education, work, and leisure. The web-based questionnaire was sent to teenage and young adult cancer survivors and matched controls in Sweden. RESULTS In this study, the relative risk of feeling less attractive due to scars was higher both for female cancer survivors RR 1.48, CI 1.05-2.08 and male cancer survivors RR 1.90, CI 1.15-3.13 compared to controls. The feeling of attractiveness was negatively related to the size of scars in both cancer and control groups. In a logistic regression analysis, significant associations were found between age, education, exercise, depression, and the feeling of low attractiveness due to scars. CONCLUSIONS The results of this study provide a basis for care interventions for teenage and young adult cancer patients during and after cancer treatment. Further research is needed on care interventions to reduce, if possible, the impact of scars.
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Affiliation(s)
- Maria Olsson
- 1 Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Goteborg, Sweden
| | - Karin Enskär
- 2 Department of Nursing Science, School of Health Sciences, Jönköping University , Jonkoping, Sweden
| | - Gunnar Steineck
- 3 Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Goteborg, Sweden
| | - Ulrica Wilderäng
- 3 Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Goteborg, Sweden
| | - Marianne Jarfelt
- 4 Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Goteborg, Sweden
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8
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Bakar Y, Tuğral A. Lower Extremity Lymphedema Management after Gynecologic Cancer Surgery: A Review of Current Management Strategies. Ann Vasc Surg 2017; 44:442-450. [PMID: 28483624 DOI: 10.1016/j.avsg.2017.03.197] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 11/26/2022]
Abstract
Lymphedema can be described as an accumulation of protein-rich fluid in interstitial spaces. It affects patients in multiple aspects. Gynecologic cancer survivors might experience lower extremity lymphedema after cancer surgery or treatment. In literature, most of the studies have been performed on upper extremity lymphedema. As gynecologic cancer malignancies have increased in the recent years, treatment options and related complications have been gaining attention in studies. In this manner, this review focused on the management of lower extremity lymphedema after gynecologic surgery. Studies indicated that the incidence of lower extremity lymphedema ranges between 2.4% and 41% after pelvic lymph node dissection in patients with gynecologic malignancies. Thus, management of lower extremity lymphedema in patients after gynecologic cancer surgery is an important issue. Complex decongestive therapy method is still the gold standard of lymphedema management. Controlling, evaluating, and preventing the risk factors are also substantial points; hence, it is very important to provide accurate knowledge in the management of lower extremity lymphedema.
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Affiliation(s)
- Yeşim Bakar
- Lymphedema Education and Management Department, Abant Izzet Baysal University, School of Physical Therapy and Rehabilitation, Bolu, Turkey
| | - Alper Tuğral
- Lymphedema Education and Management Department, Abant Izzet Baysal University, School of Physical Therapy and Rehabilitation, Bolu, Turkey.
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Risk Factors for Pelvic Insufficiency Fractures in Locally Advanced Cervical Cancer Following Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 97:1032-1039. [DOI: 10.1016/j.ijrobp.2017.01.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/14/2016] [Accepted: 01/09/2017] [Indexed: 12/24/2022]
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10
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Clinical implementation of coverage probability planning for nodal boosting in locally advanced cervical cancer. Radiother Oncol 2017; 123:158-163. [PMID: 28190601 DOI: 10.1016/j.radonc.2017.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To implement coverage probability (CovP) for dose planning of simultaneous integrated boost (SIB) of pathologic lymph nodes in locally advanced cervical cancer (LACC). MATERIAL AND METHODS CovP constraints for SIB of the pathological nodal target (PTV-N) with a central dose peak and a relaxed coverage at the perimeter were generated for use with the treatment planning system Eclipse: PTV-N D98 >90%, CTV-N D98 >100% and CTV-N D50 >101.5% of prescribed dose. Dose of EBRT was 45Gy/25 fx with a SIB of 55-57.5Gy depending on expected dose from brachytherapy (BT). Twenty-five previously treated patients with 47 boosted nodes were analysed. Nodes were contoured on cone beam CT (CBCT) and the accumulated dose in GTV-NCBCT and volume of body, pelvic bones and bowel receiving >50Gy (V50) were determined. RESULTS Nearly all nodes (89%) were visible on CBCT and showed considerable concentric regression during EBRT. Total EBRT and BT D98 was >57 GyEQD2 in 98% of the visible nodes. Compared to treatment plans aiming for full PTV-N coverage, CovP significantly reduced V50 of body, bones and bowel (p<0.001) CONCLUSION: CovP is clinically feasible for SIB of pathological nodes and significantly decreases collateral SIB dose to nearby OAR.
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van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage 2016; 51:1070-1090.e9. [PMID: 27112310 DOI: 10.1016/j.jpainsymman.2015.12.340] [Citation(s) in RCA: 935] [Impact Index Per Article: 116.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/10/2015] [Accepted: 12/23/2015] [Indexed: 12/17/2022]
Abstract
CONTEXT Cancer pain has a severe impact on quality of life and is associated with numerous psychosocial responses. Recent studies suggest that treatment of cancer pain has improved during the last decade. OBJECTIVES The aim of this review was to examine the present status of pain prevalence and pain severity in patients with cancer. METHODS A systematic search of the literature published between September 2005 and January 2014 was performed using the databases PubMed, Medline, Embase, CINAHL, and Cochrane. Articles in English or Dutch that reported on the prevalence of cancer pain in an adult population were included. Titles and abstracts were screened by two authors independently, after which full texts were evaluated and assessed on methodological quality. Study details and pain characteristics were extracted from the articles with adequate study quality. Prevalence rates were pooled with meta-analysis; meta-regression was performed to explore determinants of pain prevalence. RESULTS Of 4117 titles, 122 studies were selected for the meta-analyses on pain (117 studies, n = 63,533) and pain severity (52 studies, n = 32,261). Pain prevalence rates were 39.3% after curative treatment; 55.0% during anticancer treatment; and 66.4% in advanced, metastatic, or terminal disease. Moderate to severe pain (numerical rating scale score ≥5) was reported by 38.0% of all patients. CONCLUSION Despite increased attention on assessment and management, pain continues to be a prevalent symptom in patients with cancer. In the upcoming decade, we need to overcome barriers toward effective pain treatment and develop and implement interventions to optimally manage pain in patients with cancer.
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Affiliation(s)
- Marieke H J van den Beuken-van Everdingen
- Center of Expertise for Palliative Care, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Anesthesiology and Pain Management, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
| | - Laura M J Hochstenbach
- School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Health Services Research, Maastricht University (UM), Maastricht, The Netherlands
| | - Elbert A J Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; School of Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Medical Oncology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Daisy J A Janssen
- Center of Expertise for Palliative Care, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Research and Education, Center of Expertise for Chronic Organ Failure, CIRO+, Horn, The Netherlands
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Functional Impairment and Physical Activity Adherence Among Gynecologic Cancer Survivors. Int J Gynecol Cancer 2016; 26:381-8. [DOI: 10.1097/igc.0000000000000620] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Lundstedt D, Gustafsson M, Steineck G, Sundberg A, Wilderäng U, Holmberg E, Johansson KA, Karlsson P. Radiation Therapy to the Plexus Brachialis in Breast Cancer Patients: Analysis of Paresthesia in Relation to Dose and Volume. Int J Radiat Oncol Biol Phys 2015; 92:277-83. [PMID: 25765147 DOI: 10.1016/j.ijrobp.2015.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 12/03/2014] [Accepted: 01/13/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE To identify volume and dose predictors of paresthesia after irradiation of the brachial plexus among women treated for breast cancer. METHODS AND MATERIALS The women had breast surgery with axillary dissection, followed by radiation therapy with (n=192) or without irradiation (n=509) of the supraclavicular lymph nodes (SCLNs). The breast area was treated to 50 Gy in 2.0-Gy fractions, and 192 of the women also had 46 to 50 Gy to the SCLNs. We delineated the brachial plexus on 3-dimensional dose-planning computerized tomography. Three to eight years after radiation therapy the women answered a questionnaire. Irradiated volumes and doses were calculated and related to the occurrence of paresthesia in the hand. RESULTS After treatment with axillary dissection with radiation therapy to the SCLNs 20% of the women reported paresthesia, compared with 13% after axillary dissection without radiation therapy, resulting in a relative risk (RR) of 1.47 (95% confidence interval [CI] 1.02-2.11). Paresthesia was reported by 25% after radiation therapy to the SCLNs with a V40 Gy ≥ 13.5 cm(3), compared with 13% without radiation therapy, RR 1.83 (95% CI 1.13-2.95). Women having a maximum dose to the brachial plexus of ≥55.0 Gy had a 25% occurrence of paresthesia, with RR 1.86 (95% CI 0.68-5.07, not significant). CONCLUSION Our results indicate that there is a correlation between larger irradiated volumes of the brachial plexus and an increased risk of reported paresthesia among women treated for breast cancer.
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Affiliation(s)
- Dan Lundstedt
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden.
| | - Magnus Gustafsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Steineck
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Agnetha Sundberg
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulrica Wilderäng
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Erik Holmberg
- Regional Cancer Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karl-Axel Johansson
- Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden
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Bray TS, Kaczynski A, Albuquerque K, Cozzi F, Roeske JC. Role of image guided radiation therapy in obese patients with gynecologic malignancies. Pract Radiat Oncol 2014; 3:249-55. [PMID: 24674394 DOI: 10.1016/j.prro.2012.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 09/11/2012] [Accepted: 09/13/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE We investigated the effect of body mass index on setup errors by analyzing daily shifts required in treating patients undergoing image guided radiation therapy (IGRT) for gynecologic malignancies. METHODS AND MATERIALS Forty successive patients treated with daily kV-based IGRT for gynecologic malignancies between April 2009 and June 2012 were identified. Directional setup corrections were analyzed according to patient body mass index. Random and systematic setup errors were calculated. Image acquisition dose was estimated by performing ionization chamber measurements in a phantom. RESULTS Obese patients had larger random setup errors, particularly in the right-left (R-L) direction, with a setup error of 7.6 mm, versus 3.9 mm for nonobese patients. The range of individual patient random errors in the R-L direction was 1.5 to 7.6 mm among nonobese patients versus 2.0 to 17.0 mm among obese patients (P = .03, F-test). For obese patients, daily IGRT prevented treating outside the planning target volume in 33% of fractions, versus 16% in the nonobese group (P = .001). The mean total image acquisition dose from daily kV-IGRT was approximately 3 cGy, versus 150 cGy if daily megavoltage portal imaging were used to correct for erratic setup errors. CONCLUSIONS Daily kV-based IGRT in obese patients allows for correction of erratic setup error and minimizes excess dose from portal imaging.
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Affiliation(s)
- Tracy S Bray
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois.
| | - Adelaide Kaczynski
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois
| | - Kevin Albuquerque
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois
| | - Francesca Cozzi
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois
| | - John C Roeske
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois
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Perception of body odor-an overlooked consequence of long-term gastrointestinal and urinary symptoms after radiation therapy for prostate cancer. J Cancer Surviv 2013; 7:652-8. [PMID: 23975611 DOI: 10.1007/s11764-013-0304-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/05/2013] [Indexed: 02/03/2023]
Abstract
PURPOSE This study was conducted to investigate the association of long-term gastrointestinal and urinary symptoms with perceived fecal or urine body odor after radiation therapy for prostate cancer and its effect on survivors' quality of life. METHODS We used a study-specific questionnaire to measure the occurrence of long-term gastrointestinal and urinary symptoms, the perception of fecal or urine body odor, and quality of life (QoL) 2 to 14 years after radiation therapy for prostate cancer. The questionnaire was sent to 895 eligible survivors who assessed symptom occurrence and QoL in the previous 6 months. RESULTS We received a filled-in questionnaire from 874 (89 %) men. For the long-term gastrointestinal symptoms, 11/13 were associated with the perception of fecal body odor. For the long-term urinary symptoms, 11/11 were associated with the perception of urine body odor. Men who perceived fecal or urine body odor had a lower quality of life, a lower physical health, and more frequent feelings of depression compared with those who did perceive such body odor. CONCLUSION Long-term gastrointestinal and urinary symptoms after prostate irradiation are associated with the perception of fecal or urine body odor leading to a reduced quality of life. IMPLICATIONS FOR CANCER SURVIVORS Disabling body odor after pelvic irradiation needs to be acknowledged in the clinic. Interventions to prevent long-term symptoms may serve the benefit of avoiding fecal or urine body odor after radiation therapy for prostate cancer.
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Lower limb lymphedema in gynecological cancer survivors--effect on daily life functioning. Support Care Cancer 2013; 21:3063-70. [PMID: 23812496 DOI: 10.1007/s00520-013-1879-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Lower limb lymphedema (LLL) is a common condition after pelvic cancer treatment but few studies have evaluated its effect on the quality of life and its consequences on daily life activities among gynecological cancer survivors. METHODS We identified a cohort of 789 eligible women, treated with pelvic radiotherapy alone or as part of combined treatment of gynecological cancer, from 1991 to 2003 at two departments of gynecological oncology in Sweden. As a preparatory study, we conducted in-depth interviews with gynecological cancer survivors and constructed a study-specific questionnaire which we validated face-to-face. The questionnaire covered physical symptoms originating in the pelvis, demographic, psychological, and quality of life factors. In relation to the lymph system, 19 questions were asked. RESULTS Six hundred sixteen (78 %) gynecological cancer survivors answered the questionnaire and participated in the study. Thirty-six percent (218/606) of the cancer survivors reported LLL. Overall quality of life was significantly lower among cancer survivors with LLL. They were also less satisfied with their sleep, more worried about recurrence of cancer, and more likely to interpret symptoms from the body as recurrence. Cancer survivors reported that LLL kept them from physical activity (45 %) and house work (29 %) and affected their ability to partake in social activities (27 %) or to meet friends (20 %). CONCLUSION Lower limb lymphedema has a negative impact on quality of life among gynecological cancer survivors, affecting sleep and daily life activities, yet only a few seek professional help.
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Nurse-led care for the management of side effects of pelvic radiotherapy: what does it achieve? Curr Opin Support Palliat Care 2012; 6:60-8. [PMID: 22246041 DOI: 10.1097/spc.0b013e32834f6a95] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW To describe what a nurse-led clinic can achieve, focusing on gastrointestinal side effects after pelvic radiotherapy. This article illustrates how a structured approach for management and treatment of late gastrointestinal symptoms after pelvic radiotherapy can be used as a model for other nurse-led clinics. RECENT FINDINGS A large majority of cancer survivors treated for gynaecological, rectal and anal cancer suffer from physical symptoms from the bowels, the urinary bladder and the genitals. These long-term side effects lead to impairment of social functioning, sexual dysfunction and lowered quality of life. A structured model for the comprehensive management of cancer survivors can help care givers to offer patients treated with pelvic radiotherapy, methods that could help them to more fully restore physical health. SUMMARY Nurses play an important role in the rehabilitation of cancer patients, improving patients' quality of life and psychosocial well being, and they are in the best position to provide continuity during the tailoring of rehabilitation care.
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Lundstedt D, Gustafsson M, Steineck G, Alsadius D, Sundberg A, Wilderäng U, Holmberg E, Johansson KA, Karlsson P. Long-term symptoms after radiotherapy of supraclavicular lymph nodes in breast cancer patients. Radiother Oncol 2012; 103:155-60. [DOI: 10.1016/j.radonc.2011.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 12/12/2011] [Accepted: 12/19/2011] [Indexed: 12/25/2022]
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Waldenström AC, Olsson C, Wilderäng U, Dunberger G, Lind H, Alevronta E, al-Abany M, Tucker S, Åvall-Lundqvist E, Johansson KA, Steineck G. Relative importance of hip and sacral pain among long-term gynecological cancer survivors treated with pelvic radiotherapy and their relationships to mean absorbed doses. Int J Radiat Oncol Biol Phys 2012; 84:428-36. [PMID: 22365620 DOI: 10.1016/j.ijrobp.2011.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the relative importance of patient-reported hip and sacral pain after pelvic radiotherapy (RT) for gynecological cancer and its relationship to the absorbed doses in these organs. METHODS AND MATERIALS We used data from a population-based study that included 650 long-term gynecological cancer survivors treated with pelvic RT in the Gothenburg and Stockholm areas in Sweden with a median follow-up of 6 years (range, 2-15) and 344 population controls. Symptoms were assessed through a study-specific postal questionnaire. We also analyzed the hip and sacral dose-volume histogram data for 358 of the survivors. RESULTS Of the survivors, one in three reported having or having had hip pain after completing RT. Daily pain when walking was four times as common among the survivors compared to controls. Symptoms increased in frequency with a mean absorbed dose >37.5 Gy. Also, two in five survivors reported pain in the sacrum. Sacral pain also affected their walking ability and tended to increase with a mean absorbed dose >42.5 Gy. CONCLUSIONS Long-term survivors of gynecological cancer treated with pelvic RT experience hip and sacral pain when walking. The mean absorbed dose was significantly related to hip pain and was borderline significantly related to sacral pain. Keeping the total mean absorbed hip dose below 37.5 Gy during treatment might lower the occurrence of long-lasting pain. In relation to the controls, the survivors had a lower occurrence of pain and pain-related symptoms from the hips and sacrum compared with what has previously been reported for the pubic bone.
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Affiliation(s)
- Ann-Charlotte Waldenström
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Lundstedt D, Gustafsson M, Steineck G, Malmström P, Alsadius D, Sundberg A, Wilderäng U, Holmberg E, Johansson KA, Karlsson P. Risk factors of developing long-lasting breast pain after breast cancer radiotherapy. Int J Radiat Oncol Biol Phys 2011; 83:71-8. [PMID: 22079722 DOI: 10.1016/j.ijrobp.2011.05.065] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/14/2011] [Accepted: 05/22/2011] [Indexed: 01/01/2023]
Abstract
PURPOSE Postoperative radiotherapy decreases breast cancer mortality. However, studies have revealed a long-lasting breast pain among some women after radiotherapy. The purpose of this study was to identify risk factors that contribute to breast pain after breast cancer radiotherapy. METHODS AND MATERIALS We identified 1,027 recurrence-free women in two cohorts of Swedish women treated for breast cancer. The women had breast-conserving surgery and postoperative radiotherapy, the breast was treated to 48 Gy in 2.4-Gy fractions or to 50 Gy in 2.0-Gy fractions. Young women received a boost of up to 16 Gy. Women with more than three lymph node metastases had locoregional radiotherapy. Systemic treatments were given according to health-care guidelines. Three to 17 years after radiotherapy, we collected data using a study-specific questionnaire. We investigated the relation between breast pain and potential risk modifiers: age at treatment, time since treatment, chemotherapy, photon energy, fractionation size, boost, loco-regional radiotherapy, axillary surgery, overweight, and smoking. RESULTS Eight hundred seventy-seven women (85%) returned the questionnaires. Among women up to 39 years of age at treatment, 23.1% had breast pain, compared with 8.7% among women older than 60 years (RR 2.66; 95% CI 1.33-5.36). Higher age at treatment (RR 0.96; 95% CI 0.94-0.98, annual decrease) and longer time since treatment (RR 0.93; 95% CI 0.88-0.98, annual decrease) were related to a lower occurrence of breast pain. Chemotherapy increased the occurrence of breast pain (RR 1.72; 95% CI 1.19-2.47). In the multivariable model only age and time since treatment were statistically significantly related to the occurrence of breast pain. We found no statistically significant relation between breast pain and the other potential risk modifiers. CONCLUSIONS Younger women having undergone breast-conserving surgery with postoperative radiotherapy report a higher occurrence of long-lasting breast pain compared to older women. Time since treatment may decrease the occurrence of pain.
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Affiliation(s)
- Dan Lundstedt
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Late symptoms in long-term gynaecological cancer survivors after radiation therapy: a population-based cohort study. Br J Cancer 2011; 105:737-45. [PMID: 21847122 PMCID: PMC3171018 DOI: 10.1038/bjc.2011.315] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: We surveyed the occurrence of physical symptoms among long-term gynaecological cancer survivors after pelvic radiation therapy, and compared with population-based control women. Methods: We identified a cohort of 789 eligible gynaecological cancer survivors treated with pelvic radiation therapy alone or combined with surgery in Stockholm or Gothenburg, Sweden. A control group of 478 women was randomly sampled from the Swedish Population Registry. Data were collected through a study-specific validated postal questionnaire with 351 questions concerning gastrointestinal and urinary tract function, lymph oedema, pelvic bones and sexuality. Clinical characteristics and treatment details were retrieved from medical records. Results: Participation rate was 78% for gynaecological cancer survivors and 72% for control women. Median follow-up time after treatment was 74 months. Cancer survivors reported a higher occurrence of symptoms from all organs studied. The highest age-adjusted relative risk (RR) was found for emptying of all stools into clothing without forewarning (RR 12.7), defaecation urgency (RR 5.7), difficulty feeling the need to empty the bladder (RR 2.8), protracted genital pain (RR 5.0), pubic pain when walking indoors (RR 4.9) and erysipelas on abdomen or legs at least once during the past 6 months (RR 3.6). Survivors treated with radiation therapy alone showed in general higher rates of symptoms. Conclusion: Gynaecological cancer survivors previously treated with pelvic radiation report a higher occurrence of symptoms from the urinary and gastrointestinal tract as well as lymph oedema, sexual dysfunction and pelvic pain compared with non-irradiated control women. Health-care providers need to actively ask patients about specific symptoms in order to provide proper diagnostic investigations and management.
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