The experience of a sore mouth and associated symptoms in patients with cancer receiving outpatient chemotherapy

Prognostic factors for return to work in breast cancer survivors

BACKGROUND

Breast cancer is the most common type of cancer in women around the world. Large numbers of people diagnosed with breast cancer are working at the time of diagnosis. Accumulating evidence suggests that breast cancer survivors participate less often in paid work compared to others. Return to work among breast cancer survivors is multifactorial. It is currently unknown which factors are associated with return to work in breast cancer survivors. Therefore, it is important to systematically review and synthesize the literature on the association between sociodemographic, breast cancer-related, other health-related, personal, and work-related factors and return to work in this group of people.

OBJECTIVES

The objective is to systematically review and synthesize the literature on the association between sociodemographic, breast cancer-related, other health-related, personal, and work-related factors and return to work in the 24 months following breast cancer diagnosis among breast cancer survivors having paid work at the time of diagnosis.

SEARCH METHODS

The search strategy included electronic searches in OVID/MEDLINE, Embase.com, EBSCOhost/CINAHL with Full Text, EBSCOhost/PsycINFO, Clarivate Analytics/Web of Science Core Collection and Wiley/Cochrane Library from inception up to 20 January 2023, as well as handsearching references of relevant reviews, included studies, and Google Scholar.

SELECTION CRITERIA

The following inclusion criteria were applied: - The type of study is a prospective cohort study, retrospective cohort study with time lag between assessment of prognostic factor and outcome, or prognosis study based on a randomized controlled trial. - The study sample included people diagnosed with breast cancer, having paid work at the time of their breast cancer diagnosis. - At least one variable as specified in our variable framework was studied. - Return to work (yes/no), or time to return to work was assessed somewhere between one and 24 months of follow-up. - The article type is an original research article (commentaries, reviews, and editorials were excluded). - Full text of the article is available. - The article was published in a peer-reviewed journal.

DATA COLLECTION AND ANALYSIS

Study characteristics and estimates of unadjusted and adjusted associations between one of the variables from the pre-defined variable framework and return to work were extracted. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. When at least four adjusted or four unadjusted measures of association (e.g. Odds Ratio (OR)) were available and more or less comparable in terms of how the measures of association were included in the analysis of the original study, a meta-analysis was conducted.

MAIN RESULTS

The systematic searches yielded 14,799 records with 2 identified via other sources. The systematic searches yielded 8486 references after duplicates were removed. We assessed 280 full-text articles for eligibility and excluded 249, including one article that was classified as 'awaiting classification' as it required professional translation. This left 31 articles based on 19 cohorts that fulfilled our inclusion criteria. Seven of the 19 studies could be included in one or more meta-analyses with a total of 2473 participants. All but one study were conducted in either Europe or the USA. The return to work rate ranged from 56% to 88%. From our prespecified variable framework, altogether 35 variables were studied in one or more included studies as prognostic factors. From these, we could combine five factors in the meta-analyses. - We found low-quality evidence that higher age is associated with lower odds of return to work in an adjusted analysis (pooled adjusted OR 0.96, 95% confidence interval (CI) 0.94 to 0.98; 4 studies, 1333 participants). - We found low-quality evidence that lower level of education is associated with lower odds of return to work in an unadjusted analysis (pooled unadjusted OR 0.40, 95% CI 0.29 to 0.55; 4 studies, 1680 participants), but not in an adjusted analysis (pooled adjusted OR 0.60, 95% CI 0.33 to 1.08; 4 studies, 1147 participants). - We found low-quality evidence that not having a partner is not associated with return to work in an unadjusted analysis (pooled unadjusted measures of association: 0.91 95% CI 0.67 to 1.23; 4 studies, 1680 participants). - We found low-quality evidence that receiving chemotherapy was associated with lower odds of return to work in an unadjusted analysis (pooled unadjusted measures of association: 0.48, 95% CI 0.31 to 0.73; 5 studies, 1766 participants). - We found low-quality evidence that receiving radiotherapy is not associated with return to work, respectively (pooled unadjusted measures of association: 1.03, 95% CI 0.64 to 1.17; 4 studies, 1680 participants). Due to the low number of included studies that measured the outcome, time to return to work, it was not possible to pool data of these studies.

AUTHORS' CONCLUSIONS

We found that higher age and receiving chemotherapy may be associated with lower odds of returning to work in breast cancer survivors (low-quality evidence; for chemotherapy, only pooled unadjusted results were available). Results regarding educational level are inconclusive. We furthermore found that there was no statistically significant adjusted association between having a partner and receiving radiotherapy (low-quality evidence; only unadjusted results were available). Further research is warranted to identify those breast cancer survivors who are at higher risk of not returning to work, so that they can receive timely support.

Association between physical activity and health-related quality of life: time to deterioration model analysis in lung adenocarcinoma

BACKGROUND AND PURPOSE : Health-related quality of life (HRQoL) is a key aspect of care for cancer survivors that can be improved by physical activity. Our aim was to explore the relationship between physical activity and time to deterioration (TTD) of the HRQoL in patients with lung adenocarcinoma (LUAD).

METHODS

We conducted a hospital-based prospective study. The International Physical Activity Questionnaire long-form (IPAQ-L) was used to investigate the pre-treatment physical activity levels, and the EORTC Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30) and EORTC Quality of Life Questionnaire-Lung Cancer (EORTC QLQ-LC13) were used to assess HRQoL at baseline and during follow-up. The QoLR package was used to calculate the HRQoL scores and determine TTD events (minimal clinically important difference=5 points). The effect of physical activity on the HRQoL was assessed using Cox regression analysis.

RESULTS

For EORTC QLQ-C30, TTD events of physical functioning (PF) and dyspnea (DY) in functional scales and symptom scales were the most common during follow-up. Pre-treatment physical activity was found to significantly delay TTD of insomnia (HR=0.635, 95%CI: 0.437-0.922, P=0.017) and diarrhea (HR=0.475, 95%CI: 0.291-0.774, P=0.003). For EORTC QLQ-LC13 scales, deterioration of dyspnea (LC-DY) was the most common event. Physical activity was found to delay the TTD of dyspnea (HR=0.654, 95%CI: 0.474-0.903, P=0.010), sore mouth (HR=0.457, 95%CI: 0.244-0.856, P=0.015), and dysphagia (HR=0.315, 95%CI: 0.172-0.580, P<0.001).

CONCLUSIONS

Pre-treatment physical activity of LUAD patients may delay the TTD of multiple HRQoL indicators in EORTC QLQ-C30 and EORTC QLQ-LC13.

IMPLICATION FOR CANCER SURVIVORS

Health-related quality of life (HRQoL) is a key aspect of care for cancer survivors (someone who is living with or beyond cancer), that can be improved by physical activity. Our aim was to explore the relationship between physical activity and time to deterioration (TTD) of the HRQoL in patients with lung adenocarcinoma (LUAD).

Analysis of the influence of parenteral cancer chemotherapy on the health condition of oral mucosa

AIM OF THE STUDY

The present study was aimed at estimating the prevalence of oral complications in cancer patients receiving chemotherapy.

MATERIAL AND METHODS

The study was conducted on a group of 58 patients treated with chemotherapy (study group). The control group consisted of 30 healthy patients. Dental status and oral mucosa were examined using the criteria of the National Cancer Institute Toxicity Criteria Scale. The levels of stimulated and unstimulated saliva flow were analysed.

RESULTS

In the group of patients treated with chemotherapy, 59% of patients had inflammatory changes of the soft tissues of the mouth, such as erythema, erosions, or ulcers, which were discovered during dental examination. Such changes occurred in only 10% of patients in the control group. Six of the patients treated with chemotherapy reported pain with intensity was so severe that it caused swallowing difficulties. Patients in the study group frequently complained about the presence of dry mouth, taste disturbances, nausea, and vomiting. These symptoms occurred in 70% of patients undergoing oncological treatment. In both stimulated and unstimulated saliva secretion, the rates were significantly lower in patients from the research group, when compared to the control group.

A literature synthesis of symptom prevalence and severity in persons receiving active cancer treatment

PURPOSE

Patients with cancer experience acute and chronic symptoms caused by their underlying disease or by the treatment. While numerous studies have examined the impact of various treatments on symptoms experienced by cancer patients, there are inconsistencies regarding the symptoms measured and reported in treatment trials. This article presents a systematic review of the research literature of the prevalence and severity of symptoms in patients undergoing cancer treatment.

METHODS

A systematic search for studies of persons receiving active cancer treatment was performed with the search terms of "multiple symptoms" and "cancer" for studies involving patients over the age of 18 years and published in English during the years 2001 to 2011. Search outputs were reviewed independently by seven authors, resulting in the synthesis of 21 studies meeting criteria for generation of an Evidence Table reporting symptom prevalence and severity ratings.

RESULTS

Data were extracted from 21 multi-national studies to develop a pooled sample of 4,067 cancer patients in whom the prevalence and severity of individual symptoms was reported. In total, the pooled sample across the 21 studies was comprised of 62% female, with a mean age of 58 years (range 18 to 97 years). A majority (62%) of these studies assessed symptoms in homogeneous samples with respect to tumor site (predominantly breast and lung cancer), while 38% of the included studies utilized samples with mixed diagnoses and treatment regimens. Eighteen instruments and structured interviews were including those measuring single symptoms, multi-symptom inventories, and single symptom items drawn from HRQOL or health status measures. The MD Anderson Symptom Inventory was the most commonly used instrument in the studies analyzed (n = 9 studies; 43%), while the Functional Assessment of Cancer Therapy, Hospital Anxiety and Depression Subscale, Medical Outcomes Survey Short Form-36, and Symptom Distress Scale were each employed in two studies. Forty-seven symptoms were identified across the 21 studies which were then categorized into 17 logical groupings. Symptom prevalence and severity were calculated across the entire cohort and also based upon sample sizes in which the symptoms were measured providing the ability to rank symptoms.

CONCLUSIONS

Symptoms are prevalent and severe among patients with cancer. Therefore, any clinical study seeking to evaluate the impact of treatment on patients should consider including measurement of symptoms. This study demonstrates that a discrete set of symptoms is common across cancer types. This set may serve as the basis for defining a "core" set of symptoms to be recommended for elicitation across cancer clinical trials, particularly among patients with advanced disease.

Dietary and nutritional needs of patients after therapy for head and neck cancer

BACKGROUND

The number of cancer survivors in the general population is increasing. Oral and dental status affects patients' quality of life and oral function, which, in turn, may affect nutritional intake and general health. The authors review the importance of oral health and the role of the oral health care provider in supporting dietary intake and providing nutritional guidance.

METHODS

The authors provide a brief review of oral complications of therapy and nutritional guidelines for patients with head and neck cancer.

RESULTS

Oral adverse effects of head and neck cancer treatment include salivary gland dysfunction, taste change, orofacial pain and mucosal sensitivity, oral infection, tissue defects and necrosis, trismus and fibrosis, progressive dental and periodontal disease, and problems with prosthesis function.

CONCLUSIONS

Managing oral adverse effects of treatment may have an impact on dietary and nutritional intake, as well as on quality of life. Dietary modifications may be needed because of the patient's oral function and may include modification of food texture and flavor, as well as the use of dietary supplements.

CLINICAL IMPLICATIONS

As part of the patient's health care team, dental care professionals should be aware of the oral adverse effects of cancer therapy, as well as their role in recognizing and treating the resulting oral conditions. In addition, they should provide guidance to patients to support their oral dietary and nutritional intake.