|
1
|
Lee MK, Basch E, Mitchell SA, Minasian LM, Langlais BT, Thanarajasingam G, Ginos BF, Rogak LJ, Mendoza TR, Bennett AV, Schrag D, Mazza GL, Dueck AC. Reliability and validity of PRO-CTCAE® daily reporting with a 24-hour recall period. Qual Life Res 2023; 32:2047-2058. [PMID: 36897529 PMCID: PMC10241696 DOI: 10.1007/s11136-023-03374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE The standard recall period for the patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE®) is the past 7 days, but there are contexts where a 24-hour recall may be desirable. The purpose of this analysis was to investigate the reliability and validity of a subset of PRO-CTCAE items captured using a 24-hour recall. METHODS 27 PRO-CTCAE items representing 14 symptomatic adverse events (AEs) were collected using both a 24-hour recall (24 h) and the standard 7 day recall (7d) in a sample of patients receiving active cancer treatment (n = 113). Using data captured with a PRO-CTCAE-24h on days 6 and 7, and 20 and 21, we computed intra-class correlation coefficients (ICC); an ICC ≥ 0.70 was interpreted as demonstrating high test-retest reliability. Correlations between PRO-CTCAE-24h items on day 7 and conceptually relevant EORTC QLQ-C30 domains were examined. In responsiveness analysis, patients were deemed changed if they had a one-point or greater change in the corresponding PRO-CTCAE-7d item (from week 0 to week 1). RESULTS PRO-CTCAE-24h captured on two consecutive days demonstrated that 21 of 27 items (78%) had ICCs ≥ 0.70 (day 6/7 median ICC 0.76), (day 20/21 median ICC 0.84). Median correlation between attributes within a common AE was 0.75, and the median correlation between conceptually relevant EORTC QLQ-C30 domains and PRO-CTCAE-24 h items captured on day 7 was 0.44. In the analysis of responsiveness to change, the median standardized response mean (SRM) for patients with improvement was - 0.52 and that for patients with worsening was 0.71. CONCLUSION A 24-hour recall period for PRO-CTCAE items has acceptable measurement properties and can inform day-to-day variations in symptomatic AEs when daily PRO-CTCAE administration is implemented in a clinical trial.
Collapse
Affiliation(s)
- M K Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - E Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | | | - B T Langlais
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | | | - B F Ginos
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - L J Rogak
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - A V Bennett
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - D Schrag
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - G L Mazza
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - A C Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
|
2
|
Lee S, Mendoza TR, Burner DN, Muldong MT, Wu CCN, Arreola-Villanueva C, Zuniga A, Greenburg O, Zhu WY, Murtadha J, Koutouan E, Pineda N, Pham H, Kang SG, Kim HT, Pineda G, Lennon KM, Cacalano NA, Jamieson CHM, Kane CJ, Kulidjian AA, Gaasterland T, Jamieson CAM. Novel Dormancy Mechanism of Castration Resistance in Bone Metastatic Prostate Cancer Organoids. Int J Mol Sci 2022; 23:ijms23063203. [PMID: 35328625 PMCID: PMC8952299 DOI: 10.3390/ijms23063203] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022] Open
Abstract
Advanced prostate cancer (PCa) patients with bone metastases are treated with androgen pathway directed therapy (APDT). However, this treatment invariably fails and the cancer becomes castration resistant. To elucidate resistance mechanisms and to provide a more predictive pre-clinical research platform reflecting tumor heterogeneity, we established organoids from a patient-derived xenograft (PDX) model of bone metastatic prostate cancer, PCSD1. APDT-resistant PDX-derived organoids (PDOs) emerged when cultured without androgen or with the anti-androgen, enzalutamide. Transcriptomics revealed up-regulation of neurogenic and steroidogenic genes and down-regulation of DNA repair, cell cycle, circadian pathways and the severe acute respiratory syndrome (SARS)-CoV-2 host viral entry factors, ACE2 and TMPRSS2. Time course analysis of the cell cycle in live cells revealed that enzalutamide induced a gradual transition into a reversible dormant state as shown here for the first time at the single cell level in the context of multi-cellular, 3D living organoids using the Fucci2BL fluorescent live cell cycle tracker system. We show here a new mechanism of castration resistance in which enzalutamide induced dormancy and novel basal-luminal-like cells in bone metastatic prostate cancer organoids. These PDX organoids can be used to develop therapies targeting dormant APDT-resistant cells and host factors required for SARS-CoV-2 viral entry.
Collapse
MESH Headings
- Androgens/pharmacology
- Angiotensin-Converting Enzyme 2/genetics
- Angiotensin-Converting Enzyme 2/metabolism
- Animals
- Benzamides/pharmacology
- Bone Neoplasms/genetics
- Bone Neoplasms/metabolism
- Bone Neoplasms/secondary
- COVID-19/genetics
- COVID-19/metabolism
- COVID-19/virology
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/genetics
- Gene Expression Profiling/methods
- Gene Expression Regulation, Neoplastic/drug effects
- Gene Expression Regulation, Neoplastic/genetics
- Humans
- Male
- Mice
- Nitriles/pharmacology
- Organoids/metabolism
- Phenylthiohydantoin/pharmacology
- Prostatic Neoplasms/genetics
- Prostatic Neoplasms/metabolism
- Prostatic Neoplasms/pathology
- Prostatic Neoplasms, Castration-Resistant/genetics
- Prostatic Neoplasms, Castration-Resistant/metabolism
- Prostatic Neoplasms, Castration-Resistant/pathology
- Receptors, Virus/genetics
- Receptors, Virus/metabolism
- SARS-CoV-2/metabolism
- SARS-CoV-2/physiology
- Serine Endopeptidases/genetics
- Serine Endopeptidases/metabolism
- Transplantation, Heterologous
- Virus Internalization
Collapse
Affiliation(s)
- Sanghee Lee
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
- Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Theresa R. Mendoza
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - Danielle N. Burner
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - Michelle T. Muldong
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - Christina C. N. Wu
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA; (G.P.); (K.M.L.)
| | - Catalina Arreola-Villanueva
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - Abril Zuniga
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - Olga Greenburg
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - William Y. Zhu
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - Jamillah Murtadha
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - Evodie Koutouan
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - Naomi Pineda
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - Hao Pham
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | - Sung-Gu Kang
- Department of Urology, Korea University College of Medicine, Seongbuk-Gu, Seoul 02841, Korea;
| | - Hyun Tae Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
| | - Gabriel Pineda
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA; (G.P.); (K.M.L.)
| | - Kathleen M. Lennon
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA; (G.P.); (K.M.L.)
| | - Nicholas A. Cacalano
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA;
| | - Catriona H. M. Jamieson
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
- Department of Urology, Korea University College of Medicine, Seongbuk-Gu, Seoul 02841, Korea;
| | - Christopher J. Kane
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
| | | | - Terry Gaasterland
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92093, USA;
- Institute for Genomic Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Christina A. M. Jamieson
- Department of Urology, University of California San Diego, La Jolla, CA 92093, USA; (S.L.); (T.R.M.); (D.N.B.); (M.T.M.); (C.A.-V.); (A.Z.); (O.G.); (W.Y.Z.); (J.M.); (E.K.); (N.P.); (H.P.); (C.J.K.)
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; (C.C.N.W.); (C.H.M.J.)
- Correspondence: ; Tel.: +1-858-534-2921
| |
Collapse
|
|
3
|
Jamieson CA, Muldong MT, Lee S, Wu CN, Burner DN, Mendoza TR, Arreola C, Zuniga A, Cacalano NA, Jamieson CH, Kane CJ, Kulidjian AA. Abstract 6109: Enzalutamide treatment of patient derived bone metastatic prostate cancer xenograft models implanted in the bone resulted in durable progression to castration resistant prostate cancer (CRPC). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-6109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Upon diagnosis of castration-resistant prostate cancer (CRPC), 84% of patients present with metastases and their survival rate is 28% despite improvements in treatment options. PCSD1, a patient-derived xenograft from a prostate cancer bone metastasis replicated the donor patient's CRPC and was resistant to the anti-androgen drug, bicalutamide, in the bone niche. To further understand the mechanisms of androgen deprivation therapy (ADT) resistance, we treated PCSD1 and PCSD13, a novel patient derived xenograft model from a small cell prostate cancer bone metastasis, with the more potent anti-androgen, Enzalutamide.
Methods: PDX cells were implanted into male Rag2−/−γc−/− mice intra-femorally (IF) or subcutaneously (SC). Mice with established tumors were treated o.g. for 4-5 weeks with Enzalutamide (10mg/kg/day) or Vehicle control. Tumor growth was measured bi-weekly with calipers and in vivo bioluminescence (IVIS). Tumors were analyzed using FACS, RNASeq, whole exome sequencing (WES) and Oncoscan.
Results: PCSD1 and PCSD13 tumors were resistant to enzalutamide when implanted in the femur bone but not sub-cutaneously. When the enzalutamide-resistant tumor cells from the bone were re-injected sub-cutaneously they retained their enzalutamide resistance in contrast to treatment-naïve PCSD1 SC tumors. Transcriptomic analysis revealed significant modulation of WNT5A, EMT and neuronal programs. Single cell analyses revealed heterogeneous sub-populations that behave as cancer stem cells in 3D organoid cultures. Genome-wide CNV analysis of patient bone metastasis samples from the same patient obtained 10 months apart and his xenografts revealed extensive CNVs which were highly conserved between the patient samples and xenografts.
Conclusions: Our PDX models demonstrated that the bone niche promotes tumor growth and malignant progression even when treated with the potent anti-androgen, enzalutamide. These PDX models of bone metastatic prostate cancer were resistant to enzalutamide in the femur bone (IF) but sensitive in the sub-cutaneous environment (SC). Enzalutamide resistance in the bone produced a permanent change in the tumor cells that was retained when re-injected in the sub-cutaneous location. This elucidates the importance of utilizing in vivo patient derived models to gain a better understanding of why the bone niche supports tumor growth.
Citation Format: Christina A.M. Jamieson, Michelle T. Muldong, Sanghee Lee, Christina N. Wu, Danielle N. Burner, Theresa R. Mendoza, Catalina Arreola, Abril Zuniga, Nicholas A. Cacalano, Catriona H. Jamieson, Christopher J. Kane, Anna A. Kulidjian. Enzalutamide treatment of patient derived bone metastatic prostate cancer xenograft models implanted in the bone resulted in durable progression to castration resistant prostate cancer (CRPC) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6109.
Collapse
|
|
4
|
Lee S, Burner DN, Mendoza TR, Muldong MT, Arreola C, Wu CN, Cacalano NA, Kulidjian AA, Kane CJ, Jamieson CAM. Establishment and Analysis of Three-Dimensional (3D) Organoids Derived from Patient Prostate Cancer Bone Metastasis Specimens and their Xenografts. J Vis Exp 2020. [PMID: 32065165 DOI: 10.3791/60367] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Three-dimensional (3D) culture of organoids from tumor specimens of human patients and patient-derived xenograft (PDX) models of prostate cancer, referred to as patient-derived organoids (PDO), are an invaluable resource for studying the mechanism of tumorigenesis and metastasis of prostate cancer. Their main advantage is that they maintain the distinctive genomic and functional heterogeneity of the original tissue compared to conventional cell lines that do not. Furthermore, 3D cultures of PDO can be used to predict the effects of drug treatment on individual patients and are a step towards personalized medicine. Despite these advantages, few groups routinely use this method in part because of the extensive optimization of PDO culture conditions that may be required for different patient samples. We previously demonstrated that our prostate cancer bone metastasis PDX model, PCSD1, recapitulated the resistance of the donor patient's bone metastasis to anti-androgen therapy. We used PCSD1 3D organoids to characterize further the mechanisms of anti-androgen resistance. Following an overview of currently published studies of PDX and PDO models, we describe a step-by-step protocol for 3D culture of PDO using domed or floating basement membrane (e.g., Matrigel) spheres in optimized culture conditions. In vivo stitch imaging and cell processing for histology are also described. This protocol can be further optimized for other applications including western blot, co-culture, etc. and can be used to explore characteristics of 3D cultured PDO pertaining to drug resistance, tumorigenesis, metastasis and therapeutics.
Collapse
Affiliation(s)
- Sanghee Lee
- Department of Urology, University of California, San Diego; Moores Cancer Center, University of California, San Diego
| | - Danielle N Burner
- Department of Urology, University of California, San Diego; Moores Cancer Center, University of California, San Diego
| | - Theresa R Mendoza
- Department of Urology, University of California, San Diego; Moores Cancer Center, University of California, San Diego
| | - Michelle T Muldong
- Department of Urology, University of California, San Diego; Moores Cancer Center, University of California, San Diego
| | - Catalina Arreola
- Department of Urology, University of California, San Diego; Moores Cancer Center, University of California, San Diego
| | - Christina N Wu
- Moores Cancer Center, University of California, San Diego; Department of Medicine, University of California, San Diego
| | | | - Anna A Kulidjian
- Moores Cancer Center, University of California, San Diego; Department of Orthopedic Surgery, University of California, San Diego
| | - Christopher J Kane
- Department of Urology, University of California, San Diego; Moores Cancer Center, University of California, San Diego
| | - Christina A M Jamieson
- Department of Urology, University of California, San Diego; Moores Cancer Center, University of California, San Diego;
| |
Collapse
|
|
5
|
Shah JJ, Feng L, Thomas SK, Berkova Z, Weber DM, Wang M, Qazilbash MH, Champlin RE, Mendoza TR, Cleeland C, Orlowski RZ. Siltuximab (CNTO 328) with lenalidomide, bortezomib and dexamethasone in newly-diagnosed, previously untreated multiple myeloma: an open-label phase I trial. Blood Cancer J 2016; 6:e396. [PMID: 26871714 PMCID: PMC4771967 DOI: 10.1038/bcj.2016.4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/04/2016] [Indexed: 01/01/2023] Open
Abstract
The safety and efficacy of siltuximab (CNTO 328) was tested in combination with lenalidomide, bortezomib and dexamethasone (RVD) in patients with newly-diagnosed, previously untreated symptomatic multiple myeloma. Fourteen patients were enrolled in the study, eleven of whom qualified to receive therapy. A majority of patients (81.8%) completed the minimal number or more of the four required cycles, while two patients completed only three cycles. The maximum tolerated dose (MTD) of siltuximab with RVD was dose level −1 (siltuximab: 8.3 mg/kg; bortezomib: 1.3 mg/m2; lenalidomide: 25 mg; dexamethasone: 20 mg). Serious adverse events were grade 3 pneumonia and grade 4 thrombocytopenia, and no deaths occurred during the study or with follow-up (median follow-up 28.1 months). An overall response rate, after 3–4 cycles of therapy, of 90.9% (95% confidence interval (CI): 58.7%, 99.8%) (9.1% complete response (95% CI: 0.2%, 41.3%), 45.5% very good partial response (95% CI: 16.7%, 76.6%) and 36.4% partial response (95% CI: 10.9%, 69.2%)) was seen. Two patients withdrew consent, and nine patients (81.8%) opted for autologous stem cell transplantation.
Collapse
Affiliation(s)
- J J Shah
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S K Thomas
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Z Berkova
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D M Weber
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Wang
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M H Qazilbash
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R E Champlin
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - T R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
|
6
|
Anderson KO, Giralt SA, Mendoza TR, Brown JO, Neumann JL, Mobley GM, Wang XS, Cleeland CS. Symptom burden in patients undergoing autologous stem-cell transplantation. Bone Marrow Transplant 2007; 39:759-66. [PMID: 17438588 DOI: 10.1038/sj.bmt.1705664] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients who undergo autologous peripheral blood stem cell (PBSC) transplantation experience multiple symptoms that adversely affect quality of life. We assessed symptoms during the acute phase of autologous PBSC transplantation to determine the severity of individual symptoms and to determine overall symptom profiles in 100 patients with multiple myeloma or non-Hodgkin's lymphoma. Study subjects completed the blood and marrow transplantation module of the M. D. Anderson Symptom Inventory before hospitalization, during conditioning, on day of transplantation, at nadir (the time of lowest white blood cell count) and on day 30 post-transplantation. Additional symptom, quality-of-life and medical status measures were collected. Symptom means were mild at baseline, intensified during conditioning, peaked at nadir and decreased by day 30. At nadir, the most severe symptoms for the entire patient sample were lack of appetite, fatigue, weakness, feeling sick, disturbed sleep, nausea and diarrhea. Cancer diagnosis was a significant predictor of changes in symptoms over time. The patterns of fatigue, pain, sleep disturbance and lack of appetite were significantly different for patients with multiple myeloma as compared with patients with non-Hodgkin's lymphoma.
Collapse
Affiliation(s)
- K O Anderson
- Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
| | | | | | | | | | | | | | | |
Collapse
|
|
7
|
Cleeland CS, Portenoy RK, Rue M, Mendoza TR, Weller E, Payne R, Kirshner J, Atkins JN, Johnson PA, Marcus A. Does an oral analgesic protocol improve pain control for patients with cancer? An intergroup study coordinated by the Eastern Cooperative Oncology Group. Ann Oncol 2005; 16:972-80. [PMID: 15821119 DOI: 10.1093/annonc/mdi191] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cancer pain is highly prevalent and commonly undertreated. This study was designed to determine whether dissemination of a clinical protocol for pain management would improve outcomes in community oncology practices. PATIENTS AND METHODS A pain management protocol was developed based on accepted guidelines. After baseline assessment, oncology practices were randomly assigned to 'analgesic protocol' (AP) sites, where oncologists implemented the guidelines in a group of lung or prostate cancer patients, or to 'physician discretion' (PD) sites, where customary treatment was continued. Patients treated on protocol and a comparison group of patients with pain due to breast cancer or myeloma were monitored for change in pain using the Brief Pain Inventory, and for change in other symptoms or mood. RESULTS The protocol terminated early because of poor accrual. We compared groups using proportions of patients who had no or mild pain at follow-up. Although measures of protocol adherence did not suggest the occurrence of major practice change, the proportion of lung or prostate cancer patients with no or mild pain increased significantly from baseline for those treated at AP sites compared with those treated at PD sites. There was no significant difference between the breast and myeloma patients treated at AP sites versus those treated at PD sites. CONCLUSION A protocol for cancer pain management can improve pain control. Diffusion of these benefits to other patients was not confirmed. Given the small sample size, these findings require confirmation in a larger trial.
Collapse
Affiliation(s)
- C S Cleeland
- The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
8
|
Abstract
BACKGROUND The aim of this study was to evaluate the severity and patterns of fatigue during preoperative chemoradiation therapy for locally advanced rectal cancer and determine whether there are predictors for patients who develop severe fatigue. METHODS Seventy-two patients with resectable rectal cancer received chemoradiation (total radiation dose, 45 gray/25 fractions to the pelvis; continuous infusion of 5-fluorouracil [300 mg/m(2)]). The Brief Fatigue Inventory (BFI), a measure that categorizes fatigue severity on a 0-10 scale, was administered weekly during treatment. Severe fatigue was defined as 7-10 on the "worst level of fatigue" item. Demographics, disease information, toxicities, and blood counts were collected. Descriptive statistics, repeated measure analysis of variance, and multiple regression were used to examine fatigue and its correlates. RESULTS Fatigue increased in 67% of patients during chemoradiation (CTX/XRT). The mean fatigue score increased from 3.16 before treatment to 4.62 at the end of treatment. A significant linear trend suggested that fatigue progressively got worse during CTX/XRT (F = 16.497, P < 0.001). However, 18% of patients experienced severe fatigue before CTX/XRT; this was predicted by uncontrolled pain (r(2) = 0.321; F = 16.52; P < 0.001). During CTX/XRT, uncontrolled diarrhea was the only predictor for increased fatigue (r(2) = 0.182; F = 7.77; P < 0.01). Approximately one-third of patients had severe fatigue, which impaired their function at the end of CTX/XRT. CONCLUSIONS Preoperative chemoradiation therapy for patients with rectal cancer was associated with progressive fatigue during therapy. Based on identified predictors for fatigue, more active pain management before CXT/XRT and bowel management during CTX/XRT might reduce cancer-related fatigue in these patients.
Collapse
Affiliation(s)
- X S Wang
- Pain Research Group,The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
| | | | | | | | | | | | | | | |
Collapse
|
|
9
|
Abstract
Cancer-related fatigue is now the most prevalent symptom of cancer, occurring in 60-90% of patients. Fatigue has been identified by cancer patients as a factor influencing functionality and quality of life. Our objectives in developing a fatigue specialty clinic at The University of Texas M. D. Anderson Cancer Center were to improve our patients' quality of life by decreasing fatigue; educate health care providers, patients, and patients' families about cancer-related fatigue; develop an appropriate clinical and diagnostic evaluation for this symptom; correlate objective measures of fatigue with its clinical evaluation; and develop innovative treatment plans for cancer-related fatigue. This article describes the general clinic design and operations and the preliminary analysis of the first 40 patients evaluated in the fatigue clinic.
Collapse
Affiliation(s)
- C P Escalante
- Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
10
|
Abstract
The increasing number of palliative care patients necessitates a simple, reliable instrument to routinely measure outcomes among hospice patients. We tested the utility of the Brief Hospice Inventory (BHI) to assess outcomes of hospice patients and estimations of patients' outcomes by nurse caregivers. In a prospective study, 145 home-based hospice patients were enrolled in the study from VistaCare Hospice. During the first week of admission, patients and nurse caregivers completed the BHI, which assessed patients' symptoms, satisfaction with care, and quality of life. Factor analysis supported a two-factor structure for the BHI for patients and caregivers, including a symptom subscale and quality of life subscale. Patients with severe symptoms showed improvement on the symptom subscale, but not the quality of life subscale, during the first 2 weeks after admission. The BHI shows utility in measuring hospice patients' symptom severity and quality of life over time.
Collapse
Affiliation(s)
- H Guo
- Pain Research Group, The University of Texas M. D. Anderson Cancer Center, 1100 Holcombe Blvd. Houston, TX 77030, USA
| | | | | | | |
Collapse
|
|
11
|
Abstract
BACKGROUND The purpose of this project was to develop the M. D. Anderson Symptom Inventory (MDASI), a brief measure of the severity and impact of cancer-related symptoms. METHODS A list of symptoms was generated from symptom inventories and by panels of clinicians. Twenty-six symptoms and 6 interference items were rated by a validation sample of 527 outpatients, a sample of 30 inpatients from the blood and bone marrow transplantation service, and a cross-validation sample of 113 outpatients. Clinical judgment and statistical techniques were used to reduce the number of symptoms. Reliability, validity, and sensitivity of the MDASI were examined. RESULTS Cluster analysis, best subset analysis, and clinical judgment reduced the number of symptoms to a "core" list of 13 that accounted for 64% of the variance in symptom distress. Factor analysis demonstrated a similar pattern in both outpatient samples, and two symptom factors and the interference scale were reliable. Expected differences in symptom pattern and severity were found between patients with "good" versus "poor" performance status and between patients in active therapy and patients who were seen for follow-up. Patients rated fatigue-related symptoms as the most severe. Groups of patients classified by disease or treatment had severe symptoms that were not on the "core" list. CONCLUSIONS The core items of the MDASI accounted for the majority of symptom distress reported by cancer patients in active treatment and those who were followed after treatment. The MDASI should prove useful for symptom surveys, clinical trials, and patient monitoring, and its format should allow Internet or telephone administration.
Collapse
Affiliation(s)
- C S Cleeland
- Pain Research Group, Division of Anesthesiology and Critical Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
| | | | | | | | | | | | | |
Collapse
|
|
12
|
Abstract
BACKGROUND The purpose of this project was to develop the M. D. Anderson Symptom Inventory (MDASI), a brief measure of the severity and impact of cancer-related symptoms. METHODS A list of symptoms was generated from symptom inventories and by panels of clinicians. Twenty-six symptoms and 6 interference items were rated by a validation sample of 527 outpatients, a sample of 30 inpatients from the blood and bone marrow transplantation service, and a cross-validation sample of 113 outpatients. Clinical judgment and statistical techniques were used to reduce the number of symptoms. Reliability, validity, and sensitivity of the MDASI were examined. RESULTS Cluster analysis, best subset analysis, and clinical judgment reduced the number of symptoms to a "core" list of 13 that accounted for 64% of the variance in symptom distress. Factor analysis demonstrated a similar pattern in both outpatient samples, and two symptom factors and the interference scale were reliable. Expected differences in symptom pattern and severity were found between patients with "good" versus "poor" performance status and between patients in active therapy and patients who were seen for follow-up. Patients rated fatigue-related symptoms as the most severe. Groups of patients classified by disease or treatment had severe symptoms that were not on the "core" list. CONCLUSIONS The core items of the MDASI accounted for the majority of symptom distress reported by cancer patients in active treatment and those who were followed after treatment. The MDASI should prove useful for symptom surveys, clinical trials, and patient monitoring, and its format should allow Internet or telephone administration.
Collapse
Affiliation(s)
- C S Cleeland
- Pain Research Group, Division of Anesthesiology and Critical Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
| | | | | | | | | | | | | |
Collapse
|
|
13
|
Anderson KO, Mendoza TR, Valero V, Richman SP, Russell C, Hurley J, DeLeon C, Washington P, Palos G, Payne R, Cleeland CS. Minority cancer patients and their providers: pain management attitudes and practice. Cancer 2000; 88:1929-38. [PMID: 10760771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND The goals of the current studies were: 1) to determine the pain treatment needs of socioeconomically disadvantaged African-American and Hispanic patients with recurrent or metastatic cancer and 2) to assess the attitudes of health care professionals who treat them. METHODS In the first study 108 African-American and Hispanic patients with metastatic or recurrent cancer and pain completed a survey about their pain intensity, pain interference, and attitudes toward analgesic medications. Physicians also rated their patients' pain and the adequacy of the patients' current analgesic prescriptions was assessed. In the second study 55 physicians and nurses who treat these patients completed a questionnaire regarding cancer pain and its management in their practice settings. RESULTS Approximately 28% of the Hispanic and 31% of the African-American patients received analgesics of insufficient strength to manage their pain. Although the majority of patients received appropriate analgesics, 65% reported severe pain. Physicians underestimated pain severity for 64% of the Hispanic and 74% of the African-American patients. Physicians were more likely to underestimate the pain severity of female patients than male patients. Inadequate pain assessment, patient reluctance to report pain, and lack of staff time were perceived as barriers to pain management. CONCLUSIONS Although the data suggest recent improvements in analgesic prescribing practices for African-American and Hispanic cancer patients, the majority of patients reported high levels of pain and limited pain relief from analgesic medications. Inadequate pain assessment remains a major barrier to optimal cancer pain treatment.
Collapse
Affiliation(s)
- K O Anderson
- Pain Research Group, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
14
|
Wang XS, Cleeland CS, Mendoza TR, Engstrom MC, Liu S, Xu G, Hao X, Wang Y, Ren XS. The effects of pain severity on health-related quality of life: a study of Chinese cancer patients. Cancer 1999; 86:1848-55. [PMID: 10547560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND The health-related functioning of patients with cancer is compromised by several factors, including the disease process, treatment, and the various symptoms that are produced by both disease and treatment. This study was designed to specify the relationship between patients' pain severity and their self-reported quality of life. METHODS The study enrolled 216 consecutive consenting adult patients from 2 Chinese cancer centers with pathologically-diagnosed metastatic cancer who could understand and complete the self-report measures. The majority had cancer-related pain and were receiving analgesics. The Chinese version of the Brief Pain Inventory was used to assess the severity and interference of pain. A Chinese translation of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used to assess health-related functional status. Patients' physicians completed a form that indicated characteristics of the patients' cancer, Eastern Cooperative Oncology Group performance status, pain, and current pain treatment. RESULTS Increasing severity of pain was associated with worsening health-related functioning, even when an estimate of disease severity was taken into account. The correlation between pain severity and impairment was nonlinear. The functional health and well-being of cancer patients with no or mild pain was significantly less impaired than that of patients with moderate or severe pain. The impairment of patients with moderate and severe pain did not differ. CONCLUSIONS Pain severity is an important variable to be taken into account when quality of life outcome measures are considered. The functioning of cancer patients with well-controlled (mild) pain did not differ significantly from that of patients without pain. Providing pain relief should significantly improve the functional status of cancer patients.
Collapse
Affiliation(s)
- X S Wang
- Pain Research Group, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
|
15
|
Abstract
BACKGROUND Fatigue is a major disease and treatment burden for cancer patients. Several scales have been created to measure fatigue, but many are long and difficult for very ill patients to complete, or they are not easy to translate for non-English speaking patients. The Brief Fatigue Inventory was developed for the rapid assessment of fatigue severity for use in both clinical screening and clinical trials. METHODS The study enrolled 305 consecutive, consenting adult inpatients and outpatients with cancer who could understand and complete the self-report measures used in the study. The same instruments also were administered to 290 community-dwelling adults to obtain a comparison sample. Research staff completed a form that indicated the primary site and stage of the cancer, rated the Eastern Cooperative Oncology Group performance status of the patient, described the characteristics of the pain, and described the current pain treatment being provided to the patients. RESULTS The BFI was shown to be an internally stable (reliable) measure that tapped a single dimension, best interpreted as severity of fatigue. It correlated highly with similar fatigue measures. Greater than 98% of patients were able to complete it. A range of scores defining severe fatigue was identified. CONCLUSIONS The BFI is a reliable instrument that allows for the rapid assessment of fatigue level in cancer patients and identifies those patients with severe fatigue.
Collapse
Affiliation(s)
- T R Mendoza
- Pain Research Group, The University of Texas M. D. Anderson Cancer Center, Houston, USA
| | | | | | | | | | | | | |
Collapse
|
|
16
|
Abstract
We describe the development of a Chinese version of the Brief Pain Inventory (BPI-C) and demonstrate its reliability and validity. We also report the use of the BPI-C in a three hospital study of cancer pain and its treatment. As with other language versions of the BPI, factor analysis of the BPI-C items results in a two factor solution that satisfies the criteria of reproducibility, interpretability and fit in a confirmatory setting. The first factor consists of the four pain severity scales, while the seven pain interference scales comprised the second factor. The BPI-C proved to be a reliable measure of both the severity and impact of pain in patients with cancer. Coefficient alpha for the pain severity and pain interference items were 0.894 and 0.915, respectively. The sample (N = 147) was gathered at three cancer treatment hospitals in Beijing. The patients from these hospitals reported higher levels of pain severity and pain interference compared with patients in similar studies done at the time (1991-1992) in the United States and France. This was in keeping with the finding that a larger proportion (67%) of the cancer patients in these Beijing hospitals were judged to have inadequate analgesia as assessed by the Pain Management Index (PMI), an estimate of adherence to the World Health Organization (WHO) guidelines for cancer pain management.
Collapse
Affiliation(s)
- X S Wang
- Department of Neurology, University of Wisconsin, Madison 53705, USA
| | | | | | | |
Collapse
|
|
17
|
Cleeland CS, Nakamura Y, Mendoza TR, Edwards KR, Douglas J, Serlin RC. Dimensions of the impact of cancer pain in a four country sample: new information from multidimensional scaling. Pain 1996; 67:267-73. [PMID: 8951920 DOI: 10.1016/0304-3959(96)03131-4] [Citation(s) in RCA: 177] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We investigated the question of how cultural and linguistic backgrounds affect relationships among ratings (reported by patients with metastatic cancer) of pain's interference with such functions as activity, mood, and sleep. Multidimensional scaling (MDS) was used to analyze ratings of pain interference from a sample consisting of four culturally and linguistically different groups from the US (n = 1106), France (n = 324), the Philippines (n = 267), and China (n = 146). Patients all completed the Brief Pain Inventory, a self-report measure of pain and its interference with function. For each of these samples, MDS solutions consistently revealed two interpretable dimensions. In all samples, one dimension represented affect and the other dimension represented activity. The dimensions were consistently interpretable across all four samples and across three levels of pain severity ('mild', 'moderate', and 'severe'). The dimensions were most prominent when pain was moderate, rather than mild (when little interference was produced) or severe (when all domains were highly interfered with). These dimensions may have utility in the study of the epidemiology of pain and of the effectiveness of pain treatment. They may also be useful in clinical assessment to describe different patterns of pain interference.
Collapse
Affiliation(s)
- C S Cleeland
- Department of Neurology, University of Wisconsin, Madison, USA
| | | | | | | | | | | |
Collapse
|