Effects of curative-intent lung cancer therapy on functional exercise capacity and patient-reported outcomesHa, Duc; Ries, Andrew L.; Lippman, Scott M.; Fuster, Mark M.
doi: 10.1007/s00520-020-05294-3pmid: 31965306
PurposeLung cancer treatment can lead to negative health consequences. We analyzed the effects of curative-intent lung cancer treatment on functional exercise capacity (EC) and patient-reported outcomes (PROs).MethodsWe performed a prospective, observational cohort study of consecutive patients with stage I–IIIA lung cancer undergoing curative-intent therapy and assessed functional EC (primary outcome, six-minute walk distance (6MWD)), cancer-specific quality of life (QoL) (secondary outcome, European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC-QLQ-C30) summary score), and exploratory outcomes including dyspnea (University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ)) and fatigue Brief Fatigue Inventory (BFI)) symptoms before and at 1 to 3 months post-treatment. We analyzed the time effect of treatment on outcomes using multivariable generalized estimating equations.ResultsIn 35 enrolled participants, treatment was associated with a clinically meaningful and borderline-significant decline in functional EC ((mean change, 95% CI) 6MWD = − 25.4 m (− 55.3, + 4.47), p = 0.10), clinically meaningful and statistically significant higher dyspnea (UCSD SOBQ = + 13.1 (+ 5.7, + 20.6), p = 0.001) and fatigue (BFI = + 10.0 (+ 2.9, + 17.0), p = 0.006), but no clinically meaningful or statistically significant change in cancer-specific QoL (EORTC-QLQ-C30 summary score = − 3.4 (− 9.8, + 3.0), p = 0.30).ConclusionsAmong the first prospective analysis of the effect of curative-intent lung cancer treatment on functional EC and PROs, we observed worsening dyspnea and fatigue, and possibly a decline in functional EC but not cancer-specific QoL at 1 to 3 months post-treatment. Interventions to reduce treatment-related morbidities and improve lung cancer survivorship may need to focus on reducing dyspnea, fatigue, and/or improving functional EC.
Guideline concordant care for prevention of acute chemotherapy-induced nausea and vomiting in children, adolescents, and young adultsBeauchemin, Melissa; Sung, Lillian; Hershman, Dawn L.; Weng, Chunhua; Dupuis, L. Lee; Schnall, Rebecca
doi: 10.1007/s00520-020-05310-6pmid: 31974769
PurposePrescribing guideline-recommended anti-emetics is an effective strategy to prevent CINV. However, the rate of guideline-concordant care is not well-understood. The purpose of this study was to describe the proportion of pediatric, adolescent, and young adult patients receiving HEC or MEC who received guideline-concordant antiemetic prophylaxis for acute CINV and to identify potential predictors of guideline-concordant antiemetic prophylaxis.MethodsUsing electronic health record data from 2016 through 2018, a retrospective single-institution cohort study was conducted to investigate how often patients less than 26 years of age receiving moderately or highly emetogenic chemotherapy receive guideline-concordant prophylaxis for acute CINV. Guideline-concordant care was defined according to guidelines from the Pediatric Oncology Group of Ontario for patients < 18 years and the American Society of Clinical Oncology for those ≥ 18 years. Independent variables included: sex, age, insurance status, race, ethnicity, cancer type, chemotherapy regimen, clinical setting, chemotherapy emetogenicity, and patient location. Predictors of receiving guideline-concordant care were determined using multiple logistic regression.ResultsOf 180 eligible patients, 65 (36.1%) received guideline-concordant care. In multivariable analysis, being treated in adult oncology setting (aOR 14.3, CI95 5.3–38.6), with a cisplatin-based regimen (aOR 3.5, CI951.4–9.0), solid tumor diagnosis (aOR 2.2, CI95 1.0–4.8), and commercial insurance (aOR 2.4, CI95 1.1–5.2) were associated with significantly higher likelihood of receiving guideline-concordant care.ConclusionsMulti-level factors were associated with receiving guideline concordant care for prevention of CINV in children, adolescents, and young adults receiving emetogenic chemotherapy. These findings can inform current efforts to optimize implementation strategies for supportive care guidelines.
Toward a theoretical understanding of young female cancer survivors’ decision-making about family-building post-treatmentBenedict, Catherine; Hahn, Alexandria L.; McCready, Alyssa; Kelvin, Joanne F.; Diefenbach, Michael; Ford, Jennifer S.
doi: 10.1007/s00520-020-05307-1pmid: 31993754
PurposeFamily-building after gonadotoxic treatment often requires in vitro fertilization, surrogacy, or adoption, with associated challenges such as uncertain likelihood of success, high costs, and complicated laws regulating surrogacy and adoption. This study examined adolescent and young adult female (AYA-F) survivors’ experiences and decision-making related to family-building after cancer.MethodsSemi-structured interviews explored fertility and family-building themes (N = 25). Based on an a priori conceptual model, hypothesis coding and grounded theory coding methods guided qualitative analysis.ResultsParticipants averaged 29 years old (SD = 6.2) were mostly White and educated. Four major themes were identified: sources of uncertainty, cognitive and emotional reactions, coping behaviors, and decision-making. Uncertainty stemmed from medical, personal, social, and financial factors, which led to cognitive, emotional, and behavioral reactions to reduce distress, renegotiate identity, adjust expectations, and consider “next steps” toward family-building goals. Most AYA-Fs were unaware of their fertility status, felt uninformed about family-building options, and worried about expected challenges. Despite feeling that “action” was needed, many were stalled in decision-making to evaluate fertility or address information needs; postponement and avoidance were common. Younger AYA-Fs tended to be less concerned.ConclusionAYA-Fs reported considerable uncertainty, distress, and unmet needs surrounding family-building decisions post-treatment. Support services are needed to better educate patients and provide opportunity for referral and early preparation for potential challenges. Reproductive counseling should occur throughout survivorship care to address medical, psychosocial, and financial difficulties, allow time for informed decision-making, and the opportunity to prepare for barriers such as high costs.
Kinesiophobia contributes to pain-related disability in breast cancer survivors: a cross-sectional studyVan der Gucht, Elien; Dams, Lore; Meeus, Mira; Devoogdt, Nele; Beintema, Annemarie; Penen, Frauke; Hoelen, Wouter; De Vrieze, Tessa; De Groef, An
doi: 10.1007/s00520-020-05304-4pmid: 31953624
PurposePain is one of the most prevalent problems reported by breast cancer survivors. As this long-lasting complication can result in disabilities on all different domains of functioning, we aimed to clarify the contribution of different factors (pain-related factors, psychosocial factors, and fatigue) to pain-related disability in female breast cancer survivors.MethodsSeventy women who had completed their primary breast cancer treatment were included in this cross-sectional study. The following outcome measures were evaluated as independent variables for their contribution to pain-related disability (measured by the Pain Disability Index, with a maximum score of 70): pain intensity, self-reported symptoms of central sensitization, fatigue, illness beliefs, pain catastrophizing, and kinesiophobia. At first, bi- and multivariable regression methods were conducted. Secondly, a stepwise regression analysis was performed to determine the explained variance of the PDI.ResultsMean score on the PDI was 16 at 4.5 years post-surgery. Multivariable regression analysis revealed higher levels of kinesiophobia as the main contributor to pain-related disability. Ultimately, stepwise regression showed that up to 40% of variance in pain-related disability could be explained by kinesiophobia, negative perceptions related to illness consequences, and pain catastrophizing.ConclusionThis study shows that breast cancer survivors portray moderate self-reported pain-related disability. Kinesiophobia emerged as the main contributor to pain-related disability at this time point, which could shine a light on the improvement of treatment modalities for pain management in this population.
Pain, fatigue and depression symptom cluster in survivors of prostate cancerBaden, Manisha; Lu, Liya; Drummond, Frances J.; Gavin, Anna; Sharp, Linda
doi: 10.1007/s00520-019-05268-0pmid: 31980895
PurposePain, fatigue and depression are common sequelae of a cancer diagnosis. The extent to which these occur together in prostate cancer survivors is unknown. We (i) investigated prevalence of the pain-fatigue-depression symptom cluster and (ii) identified factors associated with experiencing the symptom cluster among prostate cancer survivors.MethodsMen in Ireland diagnosed with prostate cancer 2–18 years previously were identified from population-based cancer registries and sent postal questionnaires. Cancer-related pain and fatigue were measured using the EORTC QLQ-C30 and depression using the DASS-21. Cut-offs to define ‘caseness’ were pain ≥ 25, fatigue ≥ 39 and depression ≥ 10. Associations between survivor-related factors, clinical variables and specific prostate cancer physical symptoms and the symptom cluster were assessed using multivariate logistic regression.ResultsA total of 3348 men participated (response rate = 54%). Twenty-four percent had clinically significant pain, 19.7% had clinically significant fatigue, and 14.4% had depression; 7.3% had all three symptoms. In multivariate analysis, factors significantly associated with the symptom cluster were living in Northern Ireland, experiencing back pain at diagnosis and being affected by incontinence, loss of sexual desire, bowel problems, gynecomastia and hot flashes post-treatment. There was a strong association between the cluster and health-related quality of life.ConclusionsThe pain-fatigue-depression symptom cluster is present in 1 in 13 prostate cancer survivors. Physical after-effects of prostate cancer treatment are associated with this cluster. More attention should be paid to identifying and supporting survivors who experience multiple symptoms; this may help health-related quality of life improve among the growing population of prostate cancer survivors.