Symptoms experienced by cancer patients during the first year from diagnosis: patient and informal caregiver ratings and agreement

Distinct Shortness of Breath Profiles in Oncology Outpatients Undergoing Chemotherapy

CONTEXT

Shortness of breath is a distressing symptom that occurs in 10% to 70% of oncology patients. Despite this broad range in its occurrence, little is known about inter-individual variability in shortness of breath and associated risk factors among patients receiving chemotherapy.

OBJECTIVES

Identify subgroups of patients with distinct shortness of breath profiles; evaluate for differences among these subgroups in demographic and clinical characteristics; evaluate for differences among symptom dimensions of shortness of breath, and evaluate for differences in quality of life outcomes.

METHODS

Outpatients (n=1338) completed questionnaires six times over two chemotherapy cycles. Occurrence of shortness of breath was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath profiles.

RESULTS

Four distinct shortness of breath profiles were identified (None [70.5%], Decreasing [8.2%], Increasing [7.8%], High [13.5%]). Risk factors for membership in High class included: history of smoking, self-reported diagnosis of lung disease, having lung cancer, and receipt of a higher number of cancer treatments. Compared to the None class, High class reported poorer physical, psychological, and social functioning.

CONCLUSIONS

Almost 14% of patients with heterogeneous types of cancer receiving chemotherapy had persistently high occurrence rates of shortness of breath for almost two months. In addition, compared to the Decreasing and Increasing classes, the High class' episodes of shortness of breath were more frequent and more severe. Clinicians need to assess all oncology patients for shortness of breath and provide targeted interventions.

Analysing the influencing factors on caregivers' burden among amyotrophic lateral sclerosis patients in China: a cross-sectional study based on data mining

OBJECTIVES

There is significant burden on caregivers of patients with amyotrophic lateral sclerosis (ALS). However, only a few studies have focused on caregivers, and traditional research methods have obvious shortcomings in dealing with multiple influencing factors. This study was designed to explore influencing factors on caregiver burden among ALS patients and their caregivers from a new perspective.

DESIGN

Cross-sectional study.

SETTING

The data were collected at an affiliated hospital in Guangzhou, Guangdong, China.

PARTICIPANTS

Fifty-seven pairs of patients with ALS and their caregivers were investigated by standardised questionnaires.

MAIN OUTCOME MEASURES

This study primarily assessed the influencing factor of caregiver burden including age, gender, education level, economic status, anxiety, depression, social support, fatigue, sleep quality and stage of disease through data mining. Statistical analysis was performed using SPSS 24.0, and least absolute shrinkage and selection operator (LASSO) regression model was established by Python 3.8.1 to minimise the effect of multicollinearity.

RESULTS

According to LASSO regression model, we found 10 variables had weights. Among them, Milano-Torinos (MITOS) stage (0-1) had the highest weight (-12.235), followed by younger age group (-3.198), lower-educated group (2.136), fatigue (1.687) and social support (-0.455). Variables including sleep quality, anxiety, depression and sex (male) had moderate weights in this model. Economic status (common), economic status (better), household (city), household (village), educational level (high), sex (female), age (older) and MITOS stage (2-4) had a weight of zero.

CONCLUSIONS

Our study demonstrates that the severity of ALS patients is the most influencing factor in caregiver burden. Caregivers of ALS patients may suffer less from caregiver burden when the patients are less severe, and the caregivers are younger. Low educational status could increase caregiver burden. Caregiver burden is positively correlated with the degree of fatigue and negatively correlated with social support. Hopefully, more attention should be paid to caregivers of ALS, and effective interventions can be developed to relieve this burden.

Communication in Oncology Outpatient Clinic Settings: Congruence of Quality of Life Assessment between Patient-Physician and Patient-Caregiver Dyads

Objectives

The aims of this study were to investigate the congruence of HRQOL reports between patient-physician and patient-caregiver dyads and to determine the association of variables, if any, with the congruence between dyads.

Methods

This correlational study with a cross-sectional design first approached physicians who provided care for patients with advanced cancer at the participating institution. Then, participating physicians' patients and their caregivers were recruited. All participants were required to independently fill out an HRQOL questionnaire during their outpatient visits. Descriptive statistics, weighted kappa, Wilcoxon signed-rank test, and linear regression were employed for data analysis.

Results

A total of 52 patient-physician and 27 patient-caregiver dyads were examined. Patients suffered from considerable problems in all three HRQOL domains: symptom, functioning, and overall HRQOL. The patients' level of agreement was moderate with the caregivers and fair with the physicians. A significant relationship was found between several patient-related variables and disagreement.

Conclusion

These patients with advanced cancer experienced a compromised HRQOL, warranting immediate attention. When there are barriers to obtaining a patient's self-report, clinicians may consider caregivers as a reasonable source. Patients with special characteristics need additional attention because their problems may be at a greater risk of being overlooked.

Barriers to Pain Management: Incongruence in Black Cancer Caregiving Dyads

CONTEXT

To effectively manage cancer pain, there is a need to understand how caregiving dyads appraise symptoms. Dyadic appraisal of symptoms influences whether the dyad perceives the patient's pain is managed well and whether they are on the same page with their appraisal. Beliefs can act as barriers to the dyadic appraisal.

OBJECTIVES

This secondary data analysis examined incongruence within Black cancer caregiving dyads regarding beliefs about pain management and potential medication side effects using the Barriers Questionnaire-13. Associated factors were also examined.

METHODS

Guided by the Theory of Dyadic Illness Management, dyadic multilevel modeling was conducted with data from 60 Black cancer caregiving dyads to determine the dyadic appraisal of beliefs about pain management and potential medication side effects, which includes the average perception of barriers within the dyad (i.e., dyadic average) and the dyadic incongruence (i.e., gap between patient and caregiver).

RESULTS

On average, Black cancer caregiving dyads reported moderate barriers regarding pain management (2.262 (SE=0.102, P<0.001) and medication side effects (2.223 (SE=0.144, P<0.001). There was significant variability across dyads regarding barriers to pain management and medication side effects. Lower patient education and higher patient-reported pain interference were significantly associated with more perceived barriers to pain management and potential medication side effects. Incongruence within dyads regarding barriers to pain management and medication side effects were significantly associated with the caregiver's report of patient's pain interference.

CONCLUSION

Findings suggest the importance of appraisal that includes both members of Black cancer caregiving dyads regarding pain management.

Congruence of pain perceptions between Black cancer patients and their family caregivers

PURPOSE

This cross-sectional study evaluated congruence in pain assessment among Black cancer patients taking opioids for pain and their family caregivers and the effects of patient-reported depressive symptoms and cognitive complaints on the congruence.

METHODS

Patient-reported pain scores (current, average, and worst pain severity and pain interference) and caregiver proxy scores were independently assessed (Brief Pain Inventory). Patient-reported depressive symptoms (Patient Health Questionnaire-8) and cognitive complaints (Cognitive Difficulties Scale) were also assessed. Paired t-test, intraclass correlation coefficient (ICC), and Bland-Altman (BA) plots were used to evaluate group and dyad level congruence in pain assessment. The influence of patient depressive symptoms and cognitive complaints on congruence was examined using bivariate analyses and BA plots.

RESULTS

Among 50 dyads, 62% of patients and 56% of caregivers were female. Patients were older than caregivers (57 vs. 50 years, p = .008). Neither statistically significant (t-test) nor clinically relevant mean differences in pain severity and interference were found at a group level. At the dyad level, congruence was poor in pain now (ICC = 0.343) and average pain severity (ICC = 0.435), but moderate in worst pain severity (ICC = 0.694) and pain interference (ICC = 0.603). Results indicated better congruence in pain severity between patients with depressive symptoms and their caregivers, compared to patients without depressive symptoms. Patient CDS scores had no significant correlations with score differences between patients and caregivers in any pain variables.

CONCLUSION

Congruence varied depending on how the analysis was done. More information is needed to understand pain assessment between patients and caregivers.

Concordance between paediatric self-reports and parent proxy reports on fatigue: A multicentre prospective longitudinal study

PURPOSE

To investigate the degree of concordance on fatigue assessment between children and adolescents with cancer and their parents, and its changes over time.

METHOD

Multicentre longitudinal study.

RESULTS

Data from 134 dyads were analysed. The mean age of patients was 11.7 years; caregivers had a mean age of 44.1 years. Almost 90% of patients already reported mild or moderate fatigue at the time of diagnosis, decreasing to 69.7% after one year. Concordance on the total fatigue improved over time for the total sample, moving from moderate at the time of diagnosis to good concordance after one year.

CONCLUSIONS

This was the first study with a longitudinal design investigating concordance between paediatric self-reports and parent proxy reports on fatigue. It showed how concordance between proxies and patients changed over time reaching a good level after one year from the cancer diagnosis.

What symptoms tell us: A multiple case study of oncology consultations

OBJECTIVES

While patients' symptom experiences have been widely investigated, there is a lack of contextualized studies investigating how symptoms circulate in the medical consultation, how patients present them, what they convey, how physicians respond, and how patients and physicians negotiate with each other to find ways to address them. The aim of this study is to explore patients and physicians handling of symptoms throughout oncological consultations with a multiple case study approach.

METHODS

Five consultations, purposively selected from an existing dataset of audiotaped consultations with patients with advanced cancer, were analyzed by means of an inductive analytical approach based on a sensitive framework from the literature.

RESULTS

Patients' symptoms showed multiple dimensions such as medical, cognitive, emotional, psychological, interactional, symbolic, experiential, and existential.

SIGNIFICANCE OF RESULTS

Different symptom dimensions remained unnoticed and unaddressed in the consultations. The physician-centered symptom approach that was observed leads to consumed time and missed opportunities for relationship building with the patient. Physicians showed a lack of sensitivity regarding the multiple dimensions of symptoms. Based on the findings, strategies for a more comprehensive symptom approach can be conceived.

Comparing Symptom Ratings by Staff and Family Carers in Residents Dying in Long-Term Care Facilities in Three European Countries, Results From a PACE Survey

CONTEXT

Symptom management is essential in the end-of-life care of long-term care facility residents.

OBJECTIVES

To study discrepancies and possible associated factors in staff and family carers' symptom assessment scores for residents in the last week of life.

METHODS

A postmortem survey in Belgium, The Netherlands, and Finland: staff and family carers completed the End-of-Life in Dementia-Comfort Assessment in Dying scale, rating 14 symptoms on a one-point to three-point scale. Higher scores reflect better comfort. We calculated mean paired differences in symptom, subscale, and total scores at a group level and inter-rater agreement and percentage of perfect agreement at a resident level.

RESULTS

Mean staff scores significantly reflected better comfort than those of family carers for the total End-of-Life in Dementia-Comfort Assessment in Dying (31.61 vs. 29.81; P < 0.001) and the physical distress (8.64 vs. 7.62; P < 0.001) and dying symptoms (8.95 vs. 8.25; P < 0.001) subscales. No significant differences were found for emotional distress and well-being. The largest discrepancies were found for gurgling, discomfort, restlessness, and choking for which staff answered not at all, whereas the family carer answered a lot, in respectively, 9.5%, 7.3%, 6.7%, and 6.1% of cases. Inter-rater agreement κ ranged from 0.106 to 0.204, the extent of perfect agreement from 40.8 for lack of serenity to 68.7% for crying.

CONCLUSION

There is a need for improved communication between staff and family and discussion about symptom burden in the dying phase in long-term care facilities.

How do family-caregivers of patients with advanced cancer provide symptom self-management support? A qualitative study

PURPOSE

The family-caregiver role is of critical importance to the success of symptom-related self-management of patients with advanced cancer. This study examined the perspectives of patients and family-caregivers regarding the role of the family-caregiver in symptom-related self-management support ( SMS).

METHODS

Semi-structured interviews were conducted in patients with advanced cancer experiencing significant symptom burden and their family-caregivers. An inductive content analysis approach was used to analyse data.

RESULTS

Eleven patients and ten family caregivers were included. Identified themes were 1) engaging in specific symptom-related SMS; 2) interacting with health care professionals; and 3) balancing patient need versus expectation. These themes were applicable to both the family-caregiver and patient cohorts, regardless of the individual symptom profile of each patient.

CONCLUSIONS

The role of family-caregivers of patients with advanced cancer is complex and varied in providing symptom-related SMS at home; often requiring family-caregivers to have diverse knowledge and skills in the management of a range of cancer-related symptoms. Health care professionals can support family-caregivers by anticipating needs, tailoring evidence-based information to those needs, and ensuring family-caregivers have an appropriate contact point for advice or help.

Korean red ginseng for cancer-related fatigue in colorectal cancer patients with chemotherapy: A randomised phase III trial

BACKGROUND

Cancer-related fatigue (CRF) is a common symptom and has a negative impact on prognosis in cancer patients. CRF could be improved by Korean red ginseng (KRG).

PATIENTS AND METHODS

For this randomised and double-blinded trial, colorectal cancer patients who received mFOLFOX-6 were randomly assigned to either KRG 2000 mg/day (n = 219) or placebo (n = 219) for 16 weeks. CRF was evaluated using the mean area under the curve (AUC) change from baseline of brief fatigue inventory (BFI) as the primary endpoint. Fatigue-related quality of life, stress, and adverse events were evaluated as secondary endpoints.

RESULTS

In the full analysis group, KRG up to 16 weeks improved CRF by the mean AUC change from baseline of BFI compared to placebo, particularly in "Mood" and "Walking ability" (P = 0.038, P = 0.023, respectively). In the per-protocol group, KRG led to improved CRF in the global BFI score compared with the placebo (P = 0.019). Specifically, there were improvements in "Fatigue right now," "Mood," "Relations with others," "Walking ability," and "Enjoyment of life" at 16 weeks (P = 0.045, P = 0.006, P = 0.028, P = 0.003, P = 0.036, respectively). In subgroups of female patients, ≥60 years old, with high compliance (≥80%) or more baseline fatigue, the beneficial effects of KRG were more enhanced than that of placebo. Although neutropenia was more frequent in KRG than placebo, the incidence of all adverse events was similar.

CONCLUSIONS

KRG could be safely combined with mFOLFOX-6 chemotherapy in colorectal cancer patients, and reduced CRF compared with placebo.

A Reflection on the Experience with Conducting a Clinical Audit Aimed at Optimizing Pain Assessment in Cancer Patients in Sri Lanka

Context:

One of the principle obstacles identified in suboptimal management of pain in worldwide cancer patients is inadequate assessment of pain which in turn leads to poor management. In Sri Lanka, this is heralded by the lack of medical or nursing professionals qualified in Palliative Medicine/Care to date in Sri Lanka.

Aim:

The aims of this clinical audit were to raise awareness and optimize the assessment of pain among resident patients of a tertiary care cancer hospital by oncology doctors.

Methods:

A simple “pain and associated symptom chart” was designed for the doctors of the tertiary care cancer institution to document pain experienced by resident cancer patients in terms of intensity, both upon admission and on daily clerking. The expected standards were 100% documentation for each, regardless of the presence of pain on a visual analog scale (0–10). Documentation of the site and character of pain were expected to be 80% each.

Results:

Despite conducting three audit cycles with staff training and clarifications in between, the pain assessment practices did not be improve significantly (P > 0.05). In the third/ultimate audit cycle, it was noted that 23.5% of the charts were marked as “0” pain intensity upon admission and have been neglected thereafter.

Conclusions:

Pain assessment practices of the tertiary care oncology unit concerned was suboptimal. Therefore, it is of utmost importance to explore obstacles and incorporate pain assessment as a mandatory routine practice in clinical oncology units.

Changes in the Occurrence, Severity, and Distress of Symptoms in Patients With Gastrointestinal Cancers Receiving Chemotherapy

CONTEXT

Studies on multiple dimensions of the symptom experience of patients with gastrointestinal cancers are extremely limited.

OBJECTIVE

Purpose was to evaluate for changes over time in the occurrence, severity, and distress of seven common symptoms in these patients.

METHODS

Patients completed Memorial Symptom Assessment Scale, six times over two cycles of chemotherapy (CTX). Changes over time in occurrence, severity, and distress of pain, lack of energy, nausea, feeling drowsy, difficulty sleeping, and change in the way food tastes were evaluated using multilevel regression analyses. In the conditional models, effects of treatment group (i.e., with or without targeted therapy), age, number of metastatic sites, time from cancer diagnosis, number of prior cancer treatments, cancer diagnosis, and CTX regimen on enrollment levels, as well as the trajectories of symptom occurrence, severity, and distress were evaluated.

RESULTS

Although the occurrence rates for pain, lack of energy, feeling drowsy, difficulty sleeping, and change in the way food tastes declined over the two cycles of CTX, nausea and numbness/tingling in hands/feet had more complex patterns of occurrence. Severity and distress ratings for the seven symptoms varied across the two cycles of CTX.

CONCLUSIONS

Demographic and clinical characteristics associated with differences in enrollment levels as well as changes over time in occurrence, severity, and distress of these seven common symptoms were highly variable. These findings can be used to identify patients who are at higher risk for more severe and distressing symptoms during CTX and to enable the initiation of preemptive symptom management interventions.

The Relationship between Perception of Social Support and Fatigue in Patients with Cancer

Background:

Fatigue is one of the most common issues related to cancer. Social support has direct effects on health status and coping with illness. This study investigated the relationship between the perception of social support and fatigue in patients with cancer.

Materials and Methods:

This descriptive/correlational study was conducted in Omid Hospital in Isfahan, Iran in 2014. One hundred and twenty-five cancer patients receiving chemotherapy were included in the study. Study participants were selected using consecutive sampling. Data were collected using the Cancer Fatigue Scale (CFS), Perceived Social Support Scale, and a demographic characteristics questionnaire. The collected data were analyzed using descriptive and analytical statistical tests in SPSS software.

Results:

Mean (SD) of patients’ fatigue and perceived social support scores were 40.63 (11.59) out of 100 and 49.33 (7.85) out of 100, respectively. The Pearson correlation coefficient showed an inverse relationship between fatigue and social support, however, this relationship was not significant. Multiple regression test was used to detect which dimension of perceived social support was a better predictor of the reduction in fatigue score. This test showed that the best predictor was informational support (B = −0.35, p = 0.004).

Conclusions:

Results showed a negative relationship between fatigue and perceived social support in cancer patients undergoing chemotherapy. Therefore, social support interventions can help reduce fatigue.

Systematic bias in cancer patient-reported outcomes: symptom 'orphans' and 'champions'

INTRODUCTION

Patient-reported outcomes are an integral part of modern healthcare. We report a comparison of symptom item content from several validated cancer instruments to that of a published checklist, and identify the important differences this revealed.

METHODS

We defined orphans as any symptom not assessed in any of the six selected instruments; champions, in contrast, were present in all six. An empirically derived cancer multisymptom checklist was used.Three symptom categories were identified Orphan-absent from all 6,Champion-present in all 6,Intermediate-underreported. The contents of each validated instrument were cross-referenced against the checklist.

RESULTS

Eighteen (39%) checklist symptoms were orphans. Five (11%) were champions: fatigue, pain, anorexia, dyspnoea and nausea. Of the 46 checklist symptoms, 23 (50%) were inconsistently recorded. All 18 orphan symptoms were clinically important checklist symptoms. Common gastrointestinal and neuropsychological symptoms that pose great clinical management challenges were among the orphan symptoms.

CONCLUSIONS

Of 46 checklist cancer symptoms, over a third were orphans. All orphan symptoms were rated as clinically important and distressing by checklist. Only 5 checklist symptoms were champions: fatigue, pain, anorexia, dyspnoea and nausea. Important-but usually omitted-symptoms included early satiety (6 of 6) and weight loss (5 of 6). The bias appears to disproportionately affect gastrointestinal and neuropsychiatric symptoms. Symptom studies should specifically report the limitations and account for the inherent item bias of any instrument used.

Development and testing of the patient-reported chemotherapy indicators of symptoms and experience: patient-reported outcome and process indicators sensitive to the quality of nursing care in ambulatory chemotherapy settings

BACKGROUND

Outcome indicators are increasingly advocated to demonstrate the impact of high-quality care; however, generic measures do not encompass outcomes relevant to specialist areas.

OBJECTIVE

The aim of this study was to develop an outcome measure (Patient-Reported Chemotherapy Indicators of Symptoms and Experience [PR-CISE]) for use in ambulatory chemotherapy settings and assess its feasibility, acceptability, and preliminary efficacy in clinical practice.

METHODS

Three areas were covered by PR-CISE--symptom management, safe medication administration, and experience of supportive care. Outcome selection was guided by review of evidence and reference groups of users, clinicians, and experts. Over 12 weeks, PR-CISE was distributed to patients receiving ambulatory chemotherapy at 10 cancer centers. Data were analyzed descriptively and with case mix adjustment using regression-based models.

RESULTS

There were 2466 responses. There was variability across centers in terms of symptom experience and support provided. Across the whole sample, 25% reported moderate or severe nausea; however, rates varied between centers (25%-75%). Similar results emerged for other symptoms. When asked about support for symptom management, 80% reported that chemotherapy nurses asked about and were aware of symptom severity and provided useful information/advice. Once again, there was substantial variability between centers. Unexplained variation remained after case mix adjustment, suggesting that differences may be "real" rather than caused by population differences. Stakeholders planned to make changes to care delivery based on data on their performance.

CONCLUSIONS

We successfully developed and tested indicators assessing the quality of care provided in ambulatory chemotherapy services.

IMPLICATIONS

Results show that monitoring outcomes demonstrate potential differences in care quality and provide a stimulus to improve the experience and health of patients.

Interventions for cough in cancer

BACKGROUND

This is an updated version of the original Cochrane review first published in Issue 9, 2010 on "Interventions for cough in cancer". Cough is a common symptom in patients with malignancies, especially in patients with lung cancer. Cough is not well controlled in clinical practice and clinicians have few management options to treat it.

OBJECTIVES

The primary objective was to determine the effectiveness of interventions, both pharmacological and non-pharmacological, (other than chemotherapy and external beam radiotherapy) in the management of cough in malignant disease (especially in lung cancer).

SEARCH METHODS

For this update, we searched for relevant studies in CENTRAL and DARE (The Cochrane Library); MEDLINE; EMBASE; PsycINFO; AMED and CINAHL to 9 June 2014. In addition, we searched for ongoing trials via the metaRegister of controlled trials (mRCT), ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and the UK Clinical Research Network Study Portfolio.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) and clinical trials (quasi-experimental trials and trials where there is a comparison group but no mention of randomisation) in participants with primary or metastatic lung cancer or other cancers.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the titles and abstracts of all studies for inclusion, and extracted data from all included studies independently before reaching consensus. A third review author arbitrated on any disagreement. Meta-analysis was not attempted due to the heterogeneity of the studies.

MAIN RESULTS

For the original version of the review, 17 studies met the inclusion criteria and examined either brachytherapy, laser or photodynamic therapy (eight studies) or a variety of pharmacological therapies (nine studies). Overall, there was an absence of credible evidence and the majority of studies were of low methodological quality and at high risk of bias. Brachytherapy in a variety of doses seemed to improve cough in selected participants, suggesting that possibly the lowest effective dose should be used to minimise side effects. Photodynamic therapy was examined in one study and, while improvements in cough were observed, its role in relationship to other therapies for cough was unclear. Some indication of positive effect was observed with morphine, codeine, dihydrocodeine, levodropropizine, sodium cromoglycate and butamirate citrate linctus (cough syrup), although all studies had significant risk of bias. For this update, we did not identify any additional trials for inclusion. Two ongoing trials were identified but no study results were available.

AUTHORS' CONCLUSIONS

No new trials were included since the publication of the original version of this review, while 11 new studies that were identified were eventually excluded from this review. Therefore, our conclusions remain unchanged. No practice recommendations could be drawn from this review. There is an urgent need to increase the number and quality of studies evaluating the effects of interventions for the management of cough in cancer.

Nonpain Symptom Prevalence and Intensity of Inpatients With Moderate to Severe Cancer Pain in China

Objectives:

To identify prevalence and severity of nonpain symptoms and to clarify possible influences on each nonpain symptom.

Methods:

The study used a descriptive survey design. Chinese version of the Edmonton Symptom Assessment System was used. Patients’ demographic and pain characteristics were collected.

Results:

The most common symptoms reported were loss of appetite (94.3%) followed by insomnia (93.3%), and tiredness (91.6%). Prevalence rates of nonpain symptom were all above 70% except “thinking clearly.” Prevalence and severity of nonpain symptoms varied by gender, age, primary cancer, and pain characteristics, especially intensity, number of breakthrough pain episodes per day, and number of pain sites.

Conclusions:

Most inpatients with cancer pain experienced concurrent nonpain symptoms. Comprehensive symptom assessment and intervention managing multiple symptoms are essential for these inpatients.

Wisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2

BACKGROUND

Safe, effective interventions to improve cancer-related fatigue (CRF) are needed because it remains a prevalent, distressing, and activity-limiting symptom. Based on pilot data, a phase III trial was developed to evaluate the efficacy of American ginseng on CRF.

METHODS

A multisite, double-blind trial randomized fatigued cancer survivors to 2000mg of American ginseng vs a placebo for 8 weeks. The primary endpoint was the general subscale of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) at 4 weeks. Changes from baseline at 4 and 8 weeks were evaluated between arms by a two-sided, two-sample t test. Toxicities were evaluated by self-report and the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) provider grading.

RESULTS

Three hundred sixty-four participants were enrolled from 40 institutions. Changes from baseline in the general subscale of the MFSI-SF were 14.4 (standard deviation [SD] = 27.1) in the ginseng arm vs 8.2 (SD = 24.8) in the placebo arm at 4 weeks (P = .07). A statistically significant difference was seen at 8 weeks with a change score of 20 (SD = 27) for the ginseng group and 10.3 (SD = 26.1) for the placebo group (P = .003). Greater benefit was reported in patients receiving active cancer treatment vs those who had completed treatment. Toxicities per self-report and CTCAE grading did not differ statistically significantly between arms.

CONCLUSIONS

Data support the benefit of American ginseng, 2000mg daily, on CRF over an 8-week period. There were no discernible toxicities associated with the treatment. Studies to increase knowledge to guide the role of ginseng to improve CRF are needed.

The Manchester cough in lung cancer scale: the development and preliminary validation of a new assessment tool

CONTEXT

Cough is a common distressing symptom in lung cancer patients. Its assessment is hampered by the lack of a validated scale to measure the complex cough experience in this population.

OBJECTIVES

To describe the development and preliminary validation of a scale to measure cough in lung cancer patients.

METHODS

In the first phase, collection of qualitative data from patient interviews, a review of literature, and identification of noncancer cough scales resulted in the development of a pool of 30 items. This item pool was tested for appropriateness of content and breadth of coverage with 18 patients with lung cancer and 25 health care professionals. The second phase was the operationalization/phrasing of items. The final phase was the scale's field testing with 139 patients, 49 of whom repeated the assessment after one week.

RESULTS

The first phase led to the deletion of several items and the addition of four, resulting in a final scale for field testing of 21 items. In the field testing, the scale was decreased to 10 items, eliminating items on psychometric grounds. The final scale's Cronbach alpha (internal consistency) was 0.86, item to total correlations ranged from 0.40 to 0.76, and test-retest reliability was high (intraclass correlation=0.83).

CONCLUSION

We have developed a promising tool to assess cough in lung cancer, but this needs validation, and future studies should determine whether this is a sensitive and responsive tool. A fully validated tool can be used in the clinical assessment of cough in cancer patients, and as a unidimensional impact scale in the measurement of cough as an outcome in intervention studies.

Anxiety and symptom assessment in Turkish gynecologic cancer patients receiving chemotherapy

Diagnosis and treatment procedures in cancers and resulting anxiety negatively affect the individual and the family. Particularly treatment methods may generate psychological symptoms. The aim of this study was to determine the level of such symptoms in Turkish gynecologic cancer patients receiving chemotherapy. A total of 41 patients who were referred to our gynecologic oncology research clinic between January-March 2012, receiving 3 months or more chemotherapy and who agreed to participate were enrolled in study. All the data were collected using a personal information form, Edmonton Symptom Assesment System and State-Trait Anxiety Inventory. Patients received highest point average from fatigue symptom (6.53±2.67) and lowest point average from dyspnea (1.53±3.03) according to Edmonton Symptom Assesment System. The mean State Anxiety score of patients was 43.1±9.77 and mean Trait Anxiety score was 46.7±7.01. Comparing symptoms of patients and mean State Anxiety score it was found that there was a statistically significant corelation with symptoms like pain (p<0.05), sadness (p<0.001), insomnia (p<0.05), state of well being (p<0.001) and dyspnea (p<0.05). Similarly comparing symptoms of patients and mean Trait Anxiety score demonstrated significant correlations for fatigue (p<0.05), sadness (p<0.01), insomnia (p<0.01) and state of well-being (p<0.01). As a result, patients with gynecological cancers experienced symptoms related to chemotherapy and a moderate level of anxiety. In accordance, appropriate interventions should recommended for the evaluation and improvement of anxiety and symptoms related to treatment in cancer patients.

Qualitative research into the symptom experiences of adult cancer patients after treatments: a systematic review and meta-synthesis

PURPOSE

This review paper aimed to draw together the findings of qualitative research into the symptom experience of adult cancer patients in order to develop a better understanding of symptom experiences following cancer treatment.

METHODS

Systematic review and meta-synthesis techniques were used to identify, appraise and synthesise the relevant literature.

RESULTS

A thematic account of shared symptom experiences reported across papers is presented. Four main themes are discussed: interaction with health services, changing relationships, changing self and coping. In addition the range of symptoms reported across qualitative cancer research is highlighted.

CONCLUSIONS

Unexpected symptoms can have negative effects on patients who need to be better prepared for long-term symptom experiences. In addition, it is important to acknowledge that patients' symptom experiences do not happen in isolation and should be addressed holistically within the context of patients' lives.

Symptom prevalence and management of cancer patients in Lebanon

CONTEXT

Cancer patients experience a great number of distressing physical and psychological symptoms. In Lebanon, there are no available data on symptom prevalence and symptom management in adults with cancer.

OBJECTIVES

The aim of this study was to determine the prevalence of symptoms and the effectiveness of treatment received as reported by patients.

METHODS

The study used a cross-sectional, descriptive survey design. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Memorial Symptom Assessment Scale were translated to Arabic and used; data were collected from adult Lebanese cancer patients at the American University of Beirut Medical Center.

RESULTS

A total of 200 cancer patients participated in the study; the majority were female with breast cancer and mean age was 54 years. The cognitive functioning domain of the EORTC QLQ-C30 scale was found to have the highest score and social functioning the lowest. The most prevalent symptom was lack of energy. Nausea and pain were the symptoms most treated. Males reported better quality of life (QoL), physical functioning, and role functioning than females; females reported more fatigue, pain, and appetite loss than males. Higher physical and psychological symptoms were correlated with lower health status, QoL, and functioning.

CONCLUSION

Although this sample reported a fair QoL and social functioning, many symptoms were highly prevalent and inadequately treated. Symptoms were found to negatively affect QoL and functioning. Based on these results, providing adequate symptom management and social support to Lebanese cancer patients is highly recommended.

Determination of cutpoints for low and high number of symptoms in patients with advanced cancer

While patients with advanced cancer experience a wide range of symptoms, no work has been done to determine an optimal cutpoint for a low versus a high number of symptoms. Analytic approaches that established clinically meaningful cutpoints for the severity of cancer pain and fatigue provided the foundation for this study. The purpose of this study was to determine the optimal cutpoint for low and high numbers of symptoms using a range of potential cutpoints and to determine if those cutpoints distinguished between the two symptom groups on demographic and clinical characteristics and depression, anxiety, and quality of life (QOL). Patients with advanced cancer (n=110) completed a symptom assessment scale, and measures of depression, anxiety, and QOL. Combinations of cutpoints were tested to yield one- and two-cutpoint solutions. Using analysis of variance for QOL scores, the F-ratio that indicated the highest between-group difference was determined to be the optimal cutpoint between low and high number of symptoms. A cutpoint of ≤ 12 symptoms (i.e., 0-12 is low, 13-32 is high) was the optimal cutpoint for total number of symptoms. Significant differences in depression, anxiety, and QOL scores validated this cutpoint. Psychological symptoms had higher occurrence rates in the high symptom group. Findings suggest that a threshold exists between a low and a high number of symptoms in patients with advanced cancer. Psychological symptoms were significantly different between patients in the low versus high symptom groups and may play an important role in QOL outcomes in patients with advanced cancer.

Symptom experience and regaining normality in the first year following a diagnosis of head and neck cancer: a qualitative longitudinal study

INTRODUCTION

Symptom experiences and their interference with life are not well-researched in head and neck cancer patients. The aim of the study was to explore and understand the experience of receiving treatment for head and neck cancer with particular focus on symptom experiences over a one year period from diagnosis.

METHODS

A qualitative study design was used with a heterogeneous sample of 16 patients with head and neck cancer. Interviews, conducted at four time points over 12 months, provided a total of 50 interview datasets.

RESULTS

Key themes derived include nutritional concerns, tiredness, and experiences related to the radiotherapy mask and regaining normality. These data highlight issues of importance in the first year of living with head and neck cancer: impact of nutritional changes on the lives of patients, including weight loss, dysphagia, xerostomia and taste changes; debilitation from ongoing fatigue; unpreparedness for and distress from the radiotherapy mask; and attempts to maintain a normal life amidst the interference of symptoms.

CONCLUSION

Multitude of symptoms impact the patients' life, particularly nutritional symptoms and fatigue, and interfere with the patients' survivorship and quality of life. The changing nature of symptoms over the first year from diagnosis in head and neck cancer patients and the identified issues in the attempt to normalize their lives need to be incorporated more fully into the supportive care of head and neck cancer patients in order to improve their experience and enhance their survivorship.

The experience of cough in patients diagnosed with lung cancer

PURPOSE

The aim of this study was to explore the patient experience of cough in a population of patients with lung cancer.

METHODS

A qualitative exploratory study design was developed and elicited the views of 26 patients with lung cancer who had current or past experience with cough.

RESULTS

The data's four themes highlight the complex and distressing nature of cough, including its interaction with other symptoms, such as breathlessness, fatigue and sleep disturbance. A theme around descriptions of cough suggests typically a dry tickly cough and highlights mechanical and environmental triggers for cough. The theme around the effects of cough in daily life shows the impact of cough in socialising, the embarrassment from cough and the psychological effects experienced by patients. The last theme focuses on strategies for coping with and managing cough, showing the perceived ineffectiveness of current antitussives and the patients' use of a variety of approaches on an ad hoc basis to try to manage their cough often unsuccessfully.

CONCLUSION

Cough has not received the same attention as other cancer symptoms, which means that patients' experience of a distressing and difficult symptom is often unnoticed by health care professionals. More clinical and research attention in this debilitating symptom is necessary.

Clinical expert guidelines for the management of cough in lung cancer: report of a UK task group on cough

BACKGROUND

Cough is a common and distressing symptom in lung cancer patients. The clinical management of cough in lung cancer patients is suboptimal with limited high quality research evidence available. The aim of the present paper is to present a clinical guideline developed in the UK through scrutiny of the literature and expert opinion, in order to aid decision making in clinicians and highlight good practice.

METHODS

Two systematic reviews, one focusing on the management of cough in respiratory illness and one Cochrane review specifically on cancer, were conducted. Also, data from reviews, phase II trials and case studies were synthesized. A panel of experts in the field was also convened in an expert consensus meeting to make sense of the data and make clinical propositions.

RESULTS

A pyramid of cough management was developed, starting with the treatment of reversible causes of cough/specific pathology. Initial cough management should focus on peripherally acting and intermittent treatment; more resistant symptoms require the addition of (or replacement by) centrally acting and continuous treatment. The pyramid for the symptomatic management starts from the simpler and most practical regimens (demulcents, simple linctus) to weak opioids to morphine and methadone before considering less well-researched and experimental approaches.

CONCLUSION

The clinical guidelines presented aim to provide a sensible clinical approach to the management of cough in lung cancer. High quality research in this field is urgently required to provide more evidence-based recommendations.