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Borean M, Shani K, Brown MC, Chen J, Liang M, Karkada J, Kooner S, Doherty MK, O'Kane GM, Jang R, Elimova E, Wong RK, Darling GE, Xu W, Howell D, Liu G. Development and evaluation of screening dysphagia tools for observational studies and routine care in cancer patients. Health Sci Rep 2018; 1:e48. [PMID: 30623085 PMCID: PMC6266365 DOI: 10.1002/hsr2.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/01/2018] [Accepted: 04/05/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Dysphagia can be associated with significant morbidity in cancer patients. We aimed to develop and evaluate dysphagia screener tools for use in observational studies (phase 1) and for routine symptom monitoring in clinical care (phase 2). METHODS Various dysphagia or odynophagia screening questions, selected after an expert panel reviewed the content, criterion, and construct validity, were compared with either functional assessment of cancer therapy - esophageal cancer (FACT-E) Swallowing Index Cut-Off Values or to questions adapted from the Patient Reported Outcomes for Common Terminology Criteria for Adverse Events. Sensitivity, specificity, and patient acceptability were assessed. RESULTS In Phase 1 (n = 178 esophageal cancer patients), the screening question "How are you currently eating?" had the highest sensitivities and specificities against various Swallowing Index Cut-Off Value cut-offs, with the best optimal cutoff associated with weight loss (80% sensitivity and 75% specificity). In phase 2 (255 head and neck, gastro-esophageal, and thoracic cancer patients), a single question screener ("Do you experience any difficulty or pain upon swallowing?") versus a Patient Reported Outcomes for Common Terminology Criteria for Adverse Events-like gold standard generated sensitivities between 86% and 94% and specificities between 93% and 100%. This screening question (+/- follow-up questions) had a median completion time of under 2 minutes, and >90% of patients were willing to complete the survey electronically, did not feel that survey made clinic visit more difficult, and did not find the questions upsetting or distressful. CONCLUSION Our results demonstrate that these screener tools ("How are you currently eating?", "Do you experience any difficulty or pain upon swallowing?") can effectively screen dysphagia symptoms without increasing cancer outpatient clinic burden, both in observational studies and for routine clinical monitoring.
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Affiliation(s)
- Michael Borean
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Kishan Shani
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - M. Catherine Brown
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Judy Chen
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Mindy Liang
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Joel Karkada
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Simranjit Kooner
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Mark K. Doherty
- Odette Cancer CentreUniversity of TorontoTorontoOntarioCanada
| | - Grainne M. O'Kane
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Raymond Jang
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Elena Elimova
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Rebecca K. Wong
- Department of Radiation Oncology, Princess Margaret HospitalUniversity of TorontoTorontoOntarioCanada
| | - Gail E. Darling
- Department of Thoracic SurgeryUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Doris Howell
- Psychosocial Oncology, Princess Margaret Cancer Centre, Lawrence Bloomberg School of NursingUniversity of TorontoTorontoOntarioCanada
| | - Geoffrey Liu
- Division of Medical Oncology Princess Margaret Cancer Centre and Departments of Medicine and Epidemiology, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Department of Epidemiology, Dalla Lana School of Public Health, Departments of Medicine and Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
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Wood LJ, Nail LM, Perrin NA, Elsea CR, Fischer A, Druker BJ. The Cancer Chemotherapy Drug Etoposide (VP-16) Induces Proinflammatory Cytokine Production and Sickness Behavior–like Symptoms in a Mouse Model of Cancer Chemotherapy–Related Symptoms. Biol Res Nurs 2016; 8:157-69. [PMID: 17003255 DOI: 10.1177/1099800406290932] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cancer chemotherapy–related symptoms such as fatigue, malaise, loss of interest in social activities, difficulty concentrating, and changes in sleep patterns can lead to treatment delays, dose reductions, or termination and have a profound effect on the physical, psychosocial, and economic aspects of quality of life. Clinicians have long suspected that these symptoms are similar to those associated with “sickness behavior,” which is triggered by the production of the inflammatory cytokines IL-1β, TNF-α, and IL-6 by macrophages and other cells of the innate immune system in response to immune challenge. The p38 mitogen-activated protein kinase (p38 MAPK) plays a central role in the production of these cytokines and consequently the induction of sickness behavior. Several cancer chemotherapy drugs have been shown to activate p38 MAPK, but whether these drugs can also induce the production of inflammatory cytokines to cause sickness behavior is unknown. The aim of this study was to determine whether the cancer chemotherapy drug etoposide (VP-16), which is known to activate p38 MAPK, could induce inflammatory cytokine production by murine macrophages and sickness-like behaviors when injected into mice. VP-16 activated p38 MAPK and induced IL-6 production in murine macrophages in a p38 MAPK– dependent manner. VP-16 administration rapidly increased serum levels of IL-6 in healthy mice and induced sickness-like behaviors as evidenced by a decrease in food intake, body weight, hemoglobin level, and voluntary wheel-running activity. These findings support the idea that the induction of IL-1β, TNF-α, and IL-6 by cancer chemotherapy drugs underlies the fatigue and associated symptoms experienced by people undergoing cancer chemotherapy.
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Affiliation(s)
- Lisa J Wood
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR 97239, USA.
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Anand D, Escalante CP. Ongoing Screening and Treatment to Potentially Reduce Tyrosine Kinase Inhibitor-Related Fatigue in Renal Cell Carcinoma. J Pain Symptom Manage 2015; 50:108-17. [PMID: 25701692 DOI: 10.1016/j.jpainsymman.2015.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/20/2015] [Accepted: 02/02/2015] [Indexed: 01/03/2023]
Abstract
CONTEXT Renal cell carcinoma (RCC) represents 1% to 4% of adult malignancies, and approximately 33% of patients with RCC present with metastatic disease and have a poor prognosis. Better understanding of RCC tumor biology has led to the development of several molecularly targeted agents, such as tyrosine kinase inhibitors (TKIs), to manage advanced disease. Although evolving data suggest these drugs may be beneficial in RCC, they are associated with significant toxicities. Cancer-related fatigue (CRF) is one of the most common toxicities associated with the TKIs used in RCC. OBJECTIVES To review the incidence, pathophysiology, and management of CRF in patients with RCC who are undergoing targeted therapy with TKIs. METHODS A comprehensive database search was performed using PubMed, Ovid, Embase, and MEDLINE. References of all cited articles also were reviewed. Data from articles published between 1975 and June 2014 were considered. A narrative review regarding the incidence, pathophysiology, and management of CRF in patients with RCC undergoing targeted therapy with TKIs was performed. RESULTS CRF is one of the most common TKI toxicities in patients with metastatic RCC and often is the dose-limiting toxicity. Management of TKI-related CRF can be difficult and may necessitate various nonpharmacologic and pharmacologic interventions. CONCLUSION TKI-related CRF in patients with RCC is a highly distressing complication of cancer therapy. CRF can substantially influence drug compliance, the ability to maximally treat, and quality of life. It is important to recognize this common, yet frequently underdiagnosed complication and initiate appropriate management strategies, to increase the likelihood for optimal outcomes.
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Affiliation(s)
- Deepa Anand
- Department of General Internal Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Carmen P Escalante
- Department of General Internal Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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The cancer rehabilitation journey: barriers to and facilitators of exercise among patients with cancer-related fatigue. Phys Ther 2010; 90:1135-47. [PMID: 20558566 DOI: 10.2522/ptj.20090278] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Despite the evidence to support exercise as an effective management strategy for patients with cancer-related fatigue (CRF), many of the general cancer population are sedentary. OBJECTIVE The aim of this study was to explore the barriers to and facilitators of exercise among a mixed sample of patients with CRF. DESIGN An exploratory, descriptive, qualitative design was used. METHODS Purposive sampling methods were used to recruit patients with CRF who were representative of the cancer trajectory, that is, survivors of cancer and patients in palliative care who were recently diagnosed and undergoing treatment. Focus group discussions were transcribed verbatim and analyzed using a grounded theory approach. Lower-level concepts were identified and ordered into subcategories. Related subcategories then were grouped to form the main categories, which were linked to the core category. RESULTS Five focus groups were conducted with 26 participants. Within the core category of the cancer rehabilitation journey were 3 main categories: (1) exercise barriers, (2) exercise facilitators, and (3) motivators of exercise. Exercise barriers were mainly related to treatment side effects, particularly fatigue. Fatigue was associated with additional barriers such as physical deconditioning, social isolation, and the difficulty of making exercise a routine. Environmental factors and the timing of exercise initiation also were barriers. Exercise facilitators included an exercise program being group-based, supervised, individually tailored, and gradually progressed. Exercise motivators were related to perceived exercise benefits. CONCLUSIONS Individuals with CRF have numerous barriers to exercise, both during and following treatment. The exercise facilitators identified in this study provide solutions to these barriers and may assist with the uptake and maintenance of exercise programs. These findings will aid physical therapists in designing appropriate exercise programs for patients with CRF.
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Prue G, Allen J, Gracey J, Rankin J, Cramp F. Fatigue in gynecological cancer patients during and after anticancer treatment. J Pain Symptom Manage 2010; 39:197-210. [PMID: 19995675 DOI: 10.1016/j.jpainsymman.2009.06.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 06/01/2009] [Accepted: 07/13/2009] [Indexed: 11/18/2022]
Abstract
CONTEXT Research has indicated that individuals with gynecological cancer experience severe fatigue. OBJECTIVES This longitudinal survey aimed to analyze the fatigue experienced over the course of one year by a gynecological cancer population, to determine if the fatigue was more severe than that reported by females without cancer, and to identify variables associated with cancer-related fatigue (CRF). METHODS Data were collected over a 12-month period before, during, and after anticancer treatment. Fatigue was assessed using the Multidimensional Fatigue Symptom Inventory-Short Form. Participants with cancer also completed the Rotterdam Symptom Checklist. RESULTS Sixty-five cancer patients (mean age = 57.4 years, standard deviation [SD] = 13.9) and 60 control subjects (mean age = 55.4 years, SD = 13.6) participated. Descriptive analysis and repeated measurements modeling indicated that the cancer participants reported worse fatigue than the noncancer individuals before, during, and after anticancer treatment (P < 0.001) and that the level of fatigue in persons with cancer changed with time (P = 0.02). A forward stepwise regression demonstrated that psychological distress level was the only independent predictor of CRF during anticancer treatment (P < 0.00), explaining 44% of the variance in fatigue. After treatment, both psychological distress level (P < 0.00) and physical symptom distress (P = 0.03) were independent predictors of fatigue, accounting for 81% of the variance. CONCLUSION Psychological distress level is an important indicator of CRF in gynecological cancer. Interventions focused on the reduction of psychological distress may help alleviate CRF.
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Affiliation(s)
- Gillian Prue
- Institute of Nursing Research, University of Ulster, Newtownabbey, Co. Antrim, BT37 0QB, United Kingdom.
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Kim JEE, Dodd MJ, Aouizerat BE, Jahan T, Miaskowski C. A review of the prevalence and impact of multiple symptoms in oncology patients. J Pain Symptom Manage 2009; 37:715-36. [PMID: 19019626 PMCID: PMC2688644 DOI: 10.1016/j.jpainsymman.2008.04.018] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 04/14/2008] [Accepted: 04/19/2008] [Indexed: 11/16/2022]
Abstract
Findings from several studies suggest that oncology patients undergoing active treatment experience multiple symptoms, and that these symptoms can have a negative effect on patient outcomes. However, no systematic review has summarized the findings from studies that assessed multiple symptoms in these patients. Therefore, the purposes of this review were to: 1) compare and contrast the characteristics of the three most commonly used instruments to measure multiple symptoms; 2) summarize the prevalence rates for multiple symptoms in studies of oncology patients receiving active treatment; 3) describe the relationships among selected demographic, disease, and treatment characteristics and multiple symptoms; and 4) describe the relationships between the occurrence of multiple symptoms and patient outcomes (i.e., functional status, quality of life). Only 18 studies were found that met the inclusion criteria for this review. The majority of the studies were cross-sectional with sample sizes that ranged from 26 to 527. Approximately 40% of patients experienced more than one symptom. However, little is known about the relationships between demographic and clinical characteristics and the occurrence of multiple symptoms. Findings from this review suggest that the occurrence of multiple symptoms is associated with decreased functional status and quality of life. However, given the large number of oncology patients who undergo active treatment each year, additional research is warranted on the prevalence and impact of multiple symptoms. Only when this descriptive research is completed with homogenous samples of patients in terms of cancer diagnoses and treatments can intervention studies for multiple symptoms be developed and tested.
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Affiliation(s)
- Jung-Eun Esther Kim
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Marylin J. Dodd
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Bradley E. Aouizerat
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Thierry Jahan
- School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
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Pavic M, Sève P, Rousset H, Debourdeau P. [Management of cancer-related fatigue]. Presse Med 2008; 37:957-66. [PMID: 18329242 DOI: 10.1016/j.lpm.2007.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 09/12/2007] [Accepted: 09/26/2007] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Cancer-related fatigue is very common but its management remains frustrating. We thus sought to review current knowledge in this field: epidemiologic data, pathophysiological mechanisms, assessment, and treatment. METHODS We queried the Medline database for all articles on this topic published between 1997 and 2007 and analyzed the articles published in English and French, as well as some of the essential earlier work. RESULTS Approximately 60 to 96% of patients treated for cancer report fatigue. The prevalence of fatigue that persists after the disease is considered to be in remission is substantial. Fatigue is a multidimensional problem with biological, psychological, social, and personal aspects. Physical causes must be systematically considered (comorbidities, anemia, and endocrine disorders), but most cases remain unresolved. Many may be attributed to deconditioning. There is not now any pharmacological therapy that treats this symptom effectively. Some psychostimulants are being tested, but the initial results of the studies are contradictory. Exercise is the intervention for which there is the most evidence of effectiveness. CONCLUSION Cancer-related fatigue is a very common symptom for which no specific cause can usually be identified. In this situation, rest may be more harmful than exercise.
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Affiliation(s)
- Michel Pavic
- Service de médecine interne - oncologie, Hôpital d'instruction des armées Desgenettes, F-69003 Lyon, France.
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Abstract
Cancer-related fatigue (CRF) is either a symptom or a syndrome depending on criteria for diagnosis. CRF is present in 20% to 30% of long-term cancer survivors and 80% to 90% during treatment and at the end of life. Assessment requires determining the presence, severity, and interference with daily activities. Different descriptors for fatigue (eg, tiredness, lack of vigor) measure different patient experiences. Associated factors such as depression, pain, insomnia, dyspnea, anemia, and deconditioning worsen CRF and should be treated if present. Associated factors that contribute to the severity of fatigue differ depending on the stage of cancer. Pharmacologic interventions include recombinant erythropoietin, psychostimulants, corticosteroid, anti-inflammatory drugs other than steroids, and L-carnitine. Advances in the management of CRF will require an understanding of the underlying mechanism before target-specific therapies can be developed.
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Affiliation(s)
- Mellar P Davis
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, 9500 Euclid Avenue, R35,Cleveland, OH 44195, USA.
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Abstract
Chronic fatigue often occurs in aging and in various neurological, psychiatric and systemic diseases. The available therapies in modern medicine are limited. The exploration of potential alternative therapies from traditional medicine is reviewed, as there are several botanicals with experimental evidence of efficacy based on animal models and clinical studies.
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Affiliation(s)
- Binu Tharakan
- Plummer Movement Disorders Center, Department of Neurology, Scott and White Clinic and the Texas A&M University System, HSC College of Medicine, Temple, Texas, USA
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