Symptom clusters of gastrointestinal cancer patients undergoing radiotherapy using the Functional Living Index-Emesis (FLIE) quality-of-life tool

Auriculotherapy may help to reduce gastrointestinal reactions and improve quality of life post chemotherapy

AIM

To compare the effectiveness of auriculotherapy in managing nausea and vomiting caused by platinum-based chemotherapy METHODS: 96 patients with gastrointestinal cancer undergoing platinum chemotherapy were randomly divided into three groups, with 32 patients in each group. The control group received conventional treatment, including 5-hydroxytryptamine 3 receptor antagonist and routine nursing care; the remaining two groups received additional auricular point sticking or ear scraping. The outcomes measured included the incidence and frequency of acute and delayed nausea and vomiting, severity of nausea, appetite, and quality of life function index 24 h and 5 d post chemotherapy.

RESULTS

Statistically significant differences were observed in the incidence and frequency of acute and delayed nausea and vomiting, severity of nausea, appetite, and life function index of nausea and vomiting at 24 h and 5 d post chemotherapy (P < 0.05); the efficacy of treatment in the ear scraping and auricular point sticking groups was better than that of the control group (P < 0.05). Moreover, the ear scraping group experienced a more effective reduction in acute nausea and vomiting than that in the auricular point sticking group (P < 0.05), and auricular point sticking showed better results in managing delayed nausea and vomiting and improving appetite and quality of life 5 d post chemotherapy (P < 0.05).

CONCLUSIONS

Auricular point sticking and ear scraping effectively treat chemotherapy-induced nausea and vomiting (CINV). Ear scraping is more effective for acute CINV, whereas auricular point sticking is more effective for delayed CINV, with the distinct advantages of enhancing appetite and quality of life for each type of CINV.

Temporal relationship between symptom cluster and quality of life in rectal cancer patients after laparoscopic anus-preserving surgery

Although it is generally recognized that symptom clusters and quality of life are related, major ambiguity arises from the difficulty in determining their causal relationship. The present study aimed to investigate longitudinal causal relationships between symptom clusters and quality of life. 128 patients with rectal cancer from Nanchong City, Sichuan Province who underwent laparoscopic anus-preserving surgery completed 4 follow-up visits, and the survey time point are 2 weeks after surgery (T1), 1 month after surgery (T2), 3 months after surgery (T3), and 6 months after surgery (T4). We used the Anderson Gastrointestinal Cancer Symptom Assessment Scale and the Colorectal Cancer Quality of Life Measurement Scale to evaluate the patient's symptom incidence, symptom severity, and quality of life at four time points respectively. After extracting symptom clusters by symptom, we constructed A four-wave cross-lagged model analyzed the causal relationship between symptom clusters and quality of life. Our research results show that the patients with rectal cancer treated by laparoscopic anus-preserving surgery have four symptom clusters during the 6 months after surgery, which are named sickness symptom cluster, gastrointestinal symptom cluster, psychological-sleep symptom cluster and Psycho-therapy related symptom clusters. Pearson correlation analysis showed that symptom clusters and quality of life were negatively correlated. The cross-lagged path effect coefficient shows that the impact of quality of life on symptom clusters is stronger than the impact of symptom clusters on quality of life (β = - 0.164 to - 0.713, P<0.05). The four-wave cross-lagged model showed that quality of life can significantly negatively predict the sickness symptom cluster and gastrointestinal symptom cluster, but this relationship is not bidirectional. Only T3 quality of life significantly negatively predicted the psycho-sleep symptom cluster, and the reverse path was also not observed. These findings provide evidence that decreases in quality of life levels precede increases in symptom cluster severity. There is a one-way temporal correlation between symptom clusters and quality of life. The decrease in quality of life leads to an increase in the severity of symptom clusters. The improvement in overall quality of life is expected to alleviate the distress of symptom clusters.

The prophylactic antiemetic therapies in management of differentiated thyroid cancer patients with radioactive iodine therapy: a single-center, non-randomized clinical trial

Objective

The present study was to investigate three different single-drug regimens to show which was more effective to reduce radioactive iodine therapy (RAI) associated nausea and vomiting, and to compare the occurrence of long-term gastrointestinal diseases after RAI therapy.

Method

We performed a single-center, non-randomized clinical trial among patients who underwent RAI therapy from March 2016 to July 2022. Enrolled patients were divided into four cohorts based on the date of the treatment. cohort 1, with no preventive antiemetics; cohort 2, received 20 mg of pantoprazole per day for 3 days; cohort 3, received a 10 mg metoclopramide tablet two times daily for 3 days; cohort 4, oral ondansetron, 8 mg, twice daily for 3 days. The primary endpoints were proportion of patients who experience vomiting episodes and nausea during the 7-day hospital period. Secondary end points included Functional Living Index Emesis (FLIE) quality-of life questionnaires and the occurrence of gastrointestinal diseases.

Results

A total of 1755 patients were analyzed, comprised of 1299 (74.0%) women and 456 (26.0%) men, with a median age of 44 years (range 18-78 years). The characteristics of patient were similar within the four groups. 465 (26.4%) patients developed RAI-associated nausea, and 186 (14.4%) patients developed RAI-associated vomiting. The rate of nausea was significantly decreased in the patients who were taking ondansetron when compared with the other cohorts (P<0.05), while the rate of vomiting (≥6 episodes) was slightly lower. As secondary endpoint, FLIE measures ondansetron scored highly compared to other cohorts, from baseline (mean score of 110.53 ± 17.54) to day 7 (mean score of 105.56 ± 12.48). In addition, 48 (2.7%) patients were found to be with gastrointestinal diseases at the end of one year follow up. Multiple RAI therapy and higher dose of I-131 per body weight revealed a significantly independent risk factors of developing gastrointestinal disorders.

Conclusions

In conclusion, the present study demonstrated that short-term ondansetron could be an effective prophylactic agent in controlling RAI-associated nausea and vomiting. Furthermore, the risk of developing gastrointestinal disorders was significantly higher for patients with multiple RAI therapy and higher dose of I-131 per body weight.

Impact of body weight-based dosing of palonosetron and ondansetron on postoperative nausea and vomiting following laparoscopic sleeve gastrectomy: a randomized, double-blind study

BACKGROUND

Postoperative nausea and vomiting (PONV) is a frequent adverse effect following laparoscopic sleeve gastrectomy. Palonosetron with a standard dosing (75 μg) schedule has been questioned due to its low efficiency in obese patients. This study aimed to investigate the effectiveness and safety of the body weight-based dosing of palonosetron in managing PONV following laparoscopic sleeve gastrectomy.

METHODS

A single-center, prospective, double-blinded randomized study was conducted between August 2021 and December 2021. Patients who underwent laparoscopic sleeve gastrectomy were prospectively recruited in the study. One hundred patients were randomly divided into palonosetron (Group P) and ondansetron (Group O). The demographic and clinical variables were recorded. The primary outcome of the study was the incidence of PONV between the two groups during the hospitalization. The secondary outcomes were the number of rescue anti-emetic and analgesic medications and the Functional Living Index-Emesis scores.

RESULTS

There were 50 patients in each group (Group P and Group O). There were significant differences in the scores of POVN, nausea, and vomiting favoring Group P. In Group P, the rate of patients using rescue anti-emetics was significantly lower. The incidence of complete response and proportion of patients with higher Functional Living Index-Emesis scores were significantly higher in patients using palonosetron.

CONCLUSIONS

The use of palonosetron significantly reduced the incidence of PONV following laparoscopic sleeve gastrectomy. There was a significant improvement in the scores of Functional Living Index-Emesis in patients using palonosetron.

Co-occurrence of symptoms after radiochemotherapy in locally advanced cervix cancer patients: a cluster analysis

BACKGROUND

State of the art combined radiochemotherapy and image-guided brachytherapy for locally advanced cervical cancer (LACC) has shown improved disease control and survival as well as a significant reduction of organ related morbidity. However, LACC cancer survivors are still experiencing a spectrum of symptoms. The aim of this study was to identify co-occurring symptoms in cervix cancer survivors by using patient-reported outcome and physician assessed morbidity.

MATERIALS AND METHOD

EMBRACE I is a multicenter prospective observational study with 1416 LACC patients (2008-2015). Information on physician-assessed morbidity and patient-reported outcome was assessed at baseline and at regular follow-ups up with the CTCAE v.3 and EORTC-C30/CX24, respectively. Patients with at least 2 years of follow-up were included and data from 3 months to 2 years was used in the analysis. Factor analysis was used on both EORTC and CTCAE data with symptoms and follow-ups as observations. The extracted factors represent clusters of symptoms. Subsequently, regression models were built to investigate associations between the symptom clusters and QOL.

RESULTS

The analysis included 742 patients. Despite the differences in the definition of physician-assessed and patient-reported symptoms, similar clusters are identified by the two assessment methods. Three main organ-related clusters are recognized for urinary, gastro-intestinal and vaginal morbidity. Furthermore, a general symptoms cluster where fatigue, pain, insomnia, neuropathy, and hot flashes have large weights is found. Lastly, a cluster with nausea, vomit and lack of appetite is also identified. The general, gastrointestinal and nausea clusters show significant associations with general QOL.

CONCLUSIONS

This analysis on both PRO and physician-assessed morbidity found a cluster associated with general symptoms and organ-related symptom clusters (urinary, gastrointestinal, vaginal). This shows that LACC survivors experience a variety of co-occurring symptoms. Our analysis also shows that the cluster of general symptoms is associated with a decrease in QOL.

Symptom Clustering and Its Effect on Functional Status in Lymphoma Patients

Aim

The study aimed to determine the effect of symptom clustering and its effect on functional status in patients with lymphoma.

Method

This descriptive study was conducted with 109 patients with lymphoma in the Hematology Clinic, Hematology Outpatient Clinic, and Chemotherapy Day Unit of a university hospital. Personal information form, Memorial Symptom Assessment Scale to assess symptoms, and the Functional Assessment of Cancer Therapy-Lymphoma to assess functional status were used in data collection. Frequency, percentage, arithmetic mean, significance test of difference between two means, Mann-Whitney U test, one-way analysis of variance, Kruskal Wallis analysis of variance, Pearson's correlation test, Cronbach's alpha internal consistency test, and cluster analysis were used to evaluate the data.

Results

According to the Memorial Symptom Assessment Scale, the most common psychological symptoms in these patients were sleep disturbance, feeling sad and worried; whereas, their physical symptoms were pain, nausea, and dry mouth. Based on the results of the Functional Assessment of Cancer Therapy-Lymphoma Scale, it was found that the functional lives of the patients were negatively affected due to pain, low energy, feeling sad, worrying about the deterioration of the condition, fatigue and pain in certain parts of the body. In the frequency and severity subscales of Memorial Symptom Assessment Scale, gastrointestinal system symptoms were collected more intensively in the first clusters. Physical and psychological symptoms were regularly distributed in the distress subscale.

Conclusion

As the symptom frequency, severity and distress subscales of Memorial Symptom Assessment Scale increased in lymphoma patients, their functional status deteriorated.

Impact of radiation-induced nausea and vomiting on quality of life

PURPOSE

Radiotherapy-induced nausea and vomiting is a common side effect of radiotherapy. It is well-established that nausea and vomiting have a negative impact on quality of life, but the relative influence of each of symptom is infrequently reported. This study aimed to compare the effects of nausea and vomiting on quality of life in cancer patients receiving palliative radiotherapy.

METHODS

The Functional Living Index-Emesis (FLIE) is a quality of life questionnaire developed in the chemotherapy-induced nausea and vomiting setting. The FLIE consists of 18 questions, half of which address nausea and half of which address vomiting. Three prospective studies on the efficacy of various anti-emetic medications conducted at our center used the FLIE to assess radiotherapy-induced nausea and vomiting at various time points during and after palliative radiotherapy. FLIE data from these three studies were combined for the present analysis. Univariate and multivariate analyses were conducted to assess the relationships between nausea and vomiting, time of FLIE completion, and patient-reported quality of life.

RESULTS

Nausea and vomiting scores both decreased patients' quality of life. Multivariate modeling showed that both symptoms significantly influenced patients' ability to enjoy meals. Nausea was also associated with increased hardship for the patient, while vomiting imposed more difficulty on the patients' loved ones.

CONCLUSIONS

Nausea and vomiting both significantly influence quality of life. Nausea seems to impact the patient more directly, whereas vomiting affects those closest to the patient.