Urgent referral to specialist services for patients with cancer symptoms: a cause for concern or oversimplifying a complex issue?

188 Background: Multiple symptoms are common and often severe in patients with cancer. Identification of symptoms which cluster may serve to elucidate the pathophysiology of the disease and aid in symptom management. Our aim was to define symptom clusters occurring among cancer outpatients receiving chemotherapy. Methods: New and returning patients referred to a supportive oncology clinic (SOC) from our health system’s oncologists from November 2011 through May 2014 completed the Condensed Memorial Symptom Assessment Scale plus a sexual dysfunction structured assessment. Data were collected prospectively from 323 consecutive initial visits. Patients rated from 0-4 how bothersome 15 cancer symptoms were; symptoms were then graded as present (1+) or absent (0). Hierarchical cluster analysis with average linkage was used to identify symptom clusters. The absolute value of the correlation between symptoms was used as the measure of similarity between pairs of symptoms. A correlation of ≥0.6 was used to define the final clusters. A symptom cluster was defined as two or more symptoms that predictably occur together. Results: Three clusters were identified: 1. Psychological (worrying, feeling sad, feeling nervous); 2. Treatment-related (lack of energy, feeling drowsy, difficulty concentrating, dry mouth, constipation); 3. Gastrointestinal (weight loss, lack of appetite, nausea). Pain, difficulty sleeping, shortness of breath, and loss of interest did not cluster with any symptom. Gastrointestinal symptoms are important within the clusters. The prevalence of worrying, feeling sad, and feeling nervous did not cluster with lack of energy or difficulty in sleeping, nor pain with worrying or feeling sad. Conclusions: Three symptom clusters were identified as showing high absolute correlation: a psychological cluster, treatment-related cluster, and gastrointestinal cluster. Identifying symptom clusters may promote our understanding of the pathophysiology of cancer, help prioritize effective pharmacotherapies, and identify drugs likely to help more than one symptom.

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The Symptom Experience of Jordanian Patients With Cancer

Journal of Global Oncology ◽

10.1200/jgo.18.54100 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 70s-70s

Author(s):

S. Omran

Keyword(s):

Nursing Education ◽

Demographic Data ◽

Symptom Experience ◽

Symptom Scale ◽

Cross Sectional ◽

Convenience Sample ◽

Ongoing Research ◽

Cancer Symptoms ◽

Patients With Cancer ◽

Quality Of Life Scale

Background: An individual's symptom experience and ability to function in everyday life are increasingly being acknowledged as important health outcomes for individuals with cancer. Unrelieved symptoms continue to be prevalent and persistent among patients with cancer. Aim: The purpose of the study is to describe the symptom experience of Jordanian patients with cancer. Methods: A descriptive cross-sectional design and self-administered questionnaires was used to guide data collection from a convenience sample of Jordanian patients attending two hospitals for treatment of cancer or cancer symptoms. Jordanian adults with any cancer diagnosis documented in their medical record, being informed about her/his diagnosis, currently receiving cancer or supportive therapy will be enrolled in this study. Data were collected using the demographic and clinical characteristics data sheet, the Cancer Symptom Scale, and the Multidimensional Quality of Life Scale-Cancer. Demographic data will be analyzed using descriptive statistics. Results: The research questions will be analyzed using means, SDs, frequencies, and percentages. Analysis of results in progress. Conclusion: Knowing which symptoms are causing the most distress for patients will assist nurses in prioritizing their care and providing the much needed support and education for patients with cancer. Continued attention on treating these symptoms should be the focus of ongoing research as well as nursing education both in service areas and in schools of nursing.

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New guidelines for urgent referral of patients with cancer

BMJ ◽

10.1136/bmj.320.7247.1476 ◽

2000 ◽

Vol 320 (7247) ◽

pp. 1476-1476 ◽

Cited By ~ 1

Author(s):

N. Summerton

Keyword(s):

Patients With Cancer ◽

Urgent Referral ◽

New Guidelines

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Challenges and perceptions of cancer patients attending a tertiary care center during COVID 19 Pandemic Era: Patient’s Perspective

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i6.30621 ◽

2020 ◽

Vol 11 (6) ◽

pp. 15-20

Author(s):

Yashna Gupta ◽

Laxman Pandey ◽

Pankaj Kumar Garg ◽

Amit Sehrawat ◽

Sweety Gupta ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Cross Sectional ◽

Cancer Symptoms ◽

Patients With Cancer ◽

Patient’S Perspective ◽

Hospital Patients ◽

Anticancer Treatment ◽

The Government ◽

Immunocompromised State

Background: Patients with cancer are more susceptible to acquire SARS-Cov-2 infection due to their immunocompromised state related to the disease and anticancer treatment. There is a lack of literature assessing the patient’s perspective of the present crisis and its impact on their treatment. Aims and Objective: The present study aimed to address the challenges and sufferings faced by patients with cancer during their treatment in the current COVID-19 pandemic era. Materials and Methods: A single-institute, cross-sectional questionnaire-based observational study was conducted in a tertiary care teaching hospital. Patients attending the Oncology outpatient department were enrolled in the study. Results: One hundred patients (64 males, 36 females) with a mean age of 47.17 years (range-24-71) participated in the study. The majority of patients (89%) were aware of the COVID 19 symptoms and did not confuse them with cancer symptoms. Most of them were aware of preventive measures like frequent hand washing, sanitizer usage, and face masks to reduce the risk of infection. Almost half of them encountered difficulties in commuting to the Hospital. Most (83%) of them were worried about treatment delay and disease progression due to the COVID-19 pandemic. Almost half of the patients (54%) were fearful of acquiring the infection from the radiotherapy machine and immobilizing devices. Two-third of the patients (64%) were afraid to carry the virus back to their homes. Awareness regarding our Hospital’s teleconsultation facility was limited among patients. Conclusion: The present study underscores the success of ongoing COVID-19 awareness programs run by the government. However, there is an urgent need to address the various challenges encountered by patients with cancer. The strengthening of telemedicine facilities may reduce the in-person visits made by the patients.

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The association between the coronavirus disease 2019 (COVID-19) pandemic and quality of life and depression symptoms in patients with advanced lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12122 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12122-12122

Author(s):

Lauren Heuer ◽

Kathryn Elizabeth Post ◽

Emily R. Gallagher ◽

Chardria Trotter ◽

Madeleine Elyze ◽

...

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Regression Models ◽

Advanced Lung Cancer ◽

Depression Symptoms ◽

Newly Diagnosed ◽

Cancer Symptoms ◽

Patients With Cancer ◽

The Relationship

12122 Background: It is unclear whether patients with cancer experience greater distress as a result of the COVID-19 pandemic. Thus, we assessed the relationship of the COVID-19 pandemic with quality of life (QOL) and depression symptoms in patients newly diagnosed with advanced lung cancer. Methods: We conducted a cross-sectional study of patients with advanced lung cancer enrolled in two multisite randomized supportive care trials. We enrolled adult patients within 12 weeks of diagnosis of advanced lung cancer and an Eastern Cooperative Oncology Group (ECOG) Performance Status from 0 to 3 across 23 institutions in the United States. At the time of enrollment, participants completed the Functional Assessment of Cancer Therapy-Lung (FACT-L), which includes four wellbeing subscales (i.e., physical, social, emotional, and functional) as well as lung cancer symptoms, and the Patient Health Questionnaire-9 (PHQ-9) to assess their QOL and depression symptoms, respectively. We compared QOL and depression symptoms between participants enrolled prior to COVID-19 (i.e., those enrolled in the following time periods: March 2018 to January 2019 and March 2019 to January 2020) and during the COVID-19 pandemic (March 2020 to January 2021). We used linear regression models adjusting for age, race, gender, and time since diagnosis of advanced cancer to examine the relationship between the period of enrollment and patients’ QOL and depression symptoms. Results: A total of 860 patients were included in this analysis (665 participants enrolled prior to COVID-19 and 195 participants during COVID-19). The two cohorts did not differ significantly with respect to baseline demographic factors [Mean age 65.4 (SD = 11.4), 51.9% female]. In multivariate regression models, enrollment during COVID-19 was not associated with physical (B = -0.16, SE = 0.52, P = 0.763), social (B = -0.48, SE = 0.39, P = 0.217), emotional (B = -0.16, SE = 0.41, P = 0.693), functional (B = -0.83, SE = 0.55, P = 0.128) wellbeing, or lung cancer symptoms (B = -0.11, SE = 0.44, P = 0.806). Enrollment during COVID-19 was not associated with overall QOL (FACT-L: B = -1.32, SE = 1.69, P = 0.436) or depression symptoms (PHQ-9: B = -0.02, SE = 0.45, P = 0.973). Conclusions: Despite the prevailing belief that COVID-19 has negatively impacted QOL and distress in patients with cancer, we found no differences in QOL or depression symptoms in patients newly diagnosed with advanced lung cancer during the COVID-19 pandemic compared to those diagnosed prior to the pandemic. These findings suggest that factors other than the COVID-19 pandemic, such as patients’ experience with their cancer, contribute to their QOL and depression symptoms.

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Real-world patient-reported and clinical outcomes of BNT162b2 mRNA COVID-19 vaccine in patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6510 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6510-6510

Author(s):

Ishwaria Mohan Subbiah ◽

Loretta A. Williams ◽

Angela Peek ◽

Sanjay Shete ◽

Bruno Palma Granwehr ◽

...

Keyword(s):

Clinical Outcomes ◽

Real World ◽

Interim Analysis ◽

Vaccine Dose ◽

Post Dose ◽

Cancer Symptoms ◽

Patients With Cancer ◽

Vaccine Trials ◽

Patient Reported ◽

Observational Cohort

6510 Background: Most COVID-19 (C19) vaccine trials excluded patients with active cancer. Here, we report our real-world patient-reported and clinical outcomes of BNT162b2 mRNA C19 vaccine in patients with cancer. Methods: Our institutional Data-Driven Determinants for COVID-19 Oncology Discovery Effort (D3CODE) follows a longitudinal observational cohort of pts w cancer getting C19 vaccine. Pts complete a validated PRO tool, MD Anderson Symptom Inventory (MDASI, 13 core, 6 interference plus 17 items of symptoms from prior vaccine trials) pre-dose 1, then daily x 6d, then weekly, then on day of dose 2, then daily x 6d, then weekly x 3w. Demographics, cancer variables, prior immune checkpoint inhibitors (ICI), C19 status pre- & post-vaccine are aggregated via Syntropy platform: Palantir Foundry. Primary outcome is incidence of PRO symptoms bw dose 1 & 2 across AYA 15-39y, mid-age 40-64y & senior 65y+ cohorts. Secondary outcomes include PRO symptom incidence post-dose 2, post-vaccine change in cancer symptoms, post-vaccine symptom severity based on prior ICI, and confirmed C19 > 7 days post-dose 2. First planned 8-wk interim analysis is reported here. Results: 6388 pts w cancer (4973 w mets) received a BNT162b2 vaccine dose (4811 both doses, 1577 received one & await dose 2). Overall, median age 64y (range 16-95y); 382 AYAs, 2927 mid-age, 3079 seniors (65-70y n = 1158, 70-79y n = 1521, 80-89y n = 378, 90y+ n = 22). 4099 (64%) are White, 823 (13%) AA, 791 (12%) Hispanic, 441 (7%) Asians. Primary cancers: breast (1397), GU (821), heme (775), thoracic/HN (745), and CRC (385). Prior to dose 1, 1862 had no prior systemic tx while 4526 pts did including 3243 who had only non-IO tx (chemo, targeted tx), 1,283 had immunotherapy including 857 who had ICIs prior to dose 1. Patient-reported symptoms after C19 Vaccine: Of 6388 pts, 4714 (74% response rate, median age 67y, range 16-95y) completed 16485 PRO surveys. After 2 doses, seniors reported lower mean scores vs mid-age or AYAs on 22 of 36 symptoms including injection site pain, palpitations, itch, rash, malaise, fevers/chills, arthralgia, myalgia, headache, pain, fatigue, nausea, disturbed sleep, distress (p < 0.05). Pts w prior ICIs had higher severity of itch, rash (p < 0.05) from baseline after both dose 1 & 2 vs pts without systemic tx. Post dose 1, pts with prior ICI had higher increase in fatigue, malaise, itch, rash, myalgia, anorexia from their baseline vs pts without systemic tx (p < 0.05). C19 Outcomes: Of 6388 pts, 616 had a C19 test at any time post-dose 1: 23 (0.36%) tested positive of whom 20 (0.3%) were between dose 1 & 2; two (0.031%) were within 7 days post-dose 2, and one patient (0.016%) tested positive 16 days after dose 2, requiring admission. Conclusions: This real-world observational cohort demonstrates post-vaccine symptom burden and outcomes in patients with cancer. Second interim analysis is planned at 16 weeks.

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Testicular cancer: symptoms for urgent referral are identified

BMJ ◽

10.1136/bmj.k2900 ◽

2018 ◽

pp. k2900

Author(s):

Jacqui Wise

Keyword(s):

Testicular Cancer ◽

Cancer Symptoms ◽

Urgent Referral

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Methodologic Issues in the Measurement of Cytokines to Elucidate the Biological Basis for Cancer Symptoms

Biological Research For Nursing ◽

10.1177/1099800410379497 ◽

2010 ◽

Vol 13 (1) ◽

pp. 15-24 ◽

Cited By ~ 26

Author(s):

Stephanie Gilbertson-White ◽

Bradley E. Aouizerat ◽

Christine Miaskowski

Keyword(s):

Intervention Studies ◽

Research Study ◽

Sickness Behavior ◽

Careful Consideration ◽

Symptom Clusters ◽

Cancer Symptoms ◽

Patients With Cancer ◽

Specimen Collection ◽

Underlying Mechanisms

Multiple concurrent symptoms are highly prevalent in patients with cancer. However, little is known about the relationships among these symptoms and their underlying mechanisms. A number of cytokines that are involved in the development of sickness behavior are hypothesized to be a mechanism for symptom clusters. Measurement of these cytokines would provide valuable information that could be used to elucidate mechanisms underlying the development of symptom clusters and the identification of potential targets for intervention studies. In this article, the authors explore several issues that warrant careful consideration when designing a research study involving the use of a cytokine as a biomarker in symptom cluster research. These issues include which molecules to measure, which specimens to collect, the timing of specimen collection and processing, and which technologies to use to measure the biomarker and the sensitivity and specificity of the assay system. The article begins with a brief discussion of cytokines and sickness behavior and the role of the cytokines in cancer-related symptoms.

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Rates of cannabis use in patients with cancer

Current Oncology ◽

10.3747/co.25.3983 ◽

2018 ◽

Vol 25 (3) ◽

pp. 219 ◽

Cited By ~ 20

Author(s):

K. Martell ◽

A. Fairchild ◽

B. LeGerrier ◽

R. Sinha ◽

S. Baker ◽

...

Keyword(s):

Health Care ◽

Sex Education ◽

Response Rate ◽

Education Level ◽

Comprehensive Assessment ◽

Cannabis Use ◽

Cancer Symptoms ◽

Patients With Cancer ◽

Related Symptom ◽

Reasons For Use

Background A comprehensive assessment of cannabis use by patients with cancer has not previously been reported. In this study, we aimed to characterize patient perspectives about cannabis and its use.Methods An anonymous survey about cannabis use was offered to patients 18 years of age and older attending 2 comprehensive and 2 community cancer centres, comprising an entire provincial health care jurisdiction in Canada (ethics id: hreba-17011).Results Of 3138 surveys distributed, 2040 surveys were returned (65%), with 1987 being sufficiently complete for analysis (response rate: 63%).Of the respondents, 812 (41%) were less than 60 years of age; 45% identified as male, and 55% as female; and 44% had completed college or higher education.Of respondents overall, 43% reported any lifetime cannabis use. That finding was independent of age, sex, education level, and cancer histology. Cannabis was acquired through friends (80%), regulated medical dispensaries (10%), and other means (6%). Of patients with any use, 81% had used dried leaves. Of the 356 patients who reported cannabis use within the 6 months preceding the survey (18% of respondents with sufficiently complete surveys), 36% were new users. Their reasons for use included cancer-related pain (46%), nausea (34%), other cancer symptoms (31%), and non-cancer-related reasons (56%).Conclusions The survey demonstrated that prior cannabis use was widespread among patients with cancer (43%). One in eight respondents identified at least 1 cancer-related symptom for which they were using cannabis.

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