Methodology and results of a pain-assessment process for patients receiving radiation therapy treatment.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 105-105
Author(s):  
Angela McDuffie ◽  
Eleanor Elizabeth Harris ◽  
Anita Proctor ◽  
Leann Potter ◽  
Timothy Barnes ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Pain Assessment ◽  
Radiation Treatment ◽  
Performance Status ◽  
Assessment Process ◽  
Successful Implementation ◽  
Patient Pain ◽  
Therapy Treatment

105 Background: Patients receiving radiation therapy treatment often exhibit pain as a consequence of their cancer or treatment, and is a major factor affecting the patient’s quality of life and functional status. Accreditation standards require pain to be assessed and managed, which are key components in successful implementation of a radiation therapy plan of care. Multifactorial causes for cancer pain, the subjective nature of pain assessment, and the protracted nature of radiation delivery make it necessary to routinely evaluate patient pain using quantifiable metrics. These evaluations can then be used to develop and evaluate effectiveness of interventional strategies. Methods: Internal “spot check” chart review in early 2015 showed deficits in 16 of 37 charts (43.2%) reviewed for pain assessments, revealing documentation well below the required threshold (95%). As a result, the Department of Radiation Therapy revised the process for the accepted 10-point intensity scale to evaluate patient pain. This revised process included staff re-education, workflow adjustments, and nursing evaluation prior to, during, and the end of the radiation treatment course using a standardized pain scale form. Documentation was accomplished by means of vital sign template encounter tool used by Nursing at the time of initial consult, for weekly on-treatment visits (OTVs), and end of treatment (EOT) encounter. Results: Data were monitored for the period of April-June 2015 and reported as a continuous quality improvement (CQI) activity to the department’s Quality Committee. Amassed data showed a total of 186 unduplicated patients were treated during this period, and 181 (97.3%) were assessed for pain. Conclusions: Ongoing monitoring is an important strategy to assure complete evaluation, treatment and outcomes of patient pain while receiving radiation treatment. A clearly defined and quantifiable process is important to facilitate monitoring and ongoing pain management. Improvements in consistency of pain assessment and management promote enhanced focus on patient pain and contribute to delivery of care, and patient quality of life and performance status.

scholarly journals Prevention and correction of radiation dermatitis with basic skin care: doctor and patient consensus

2021 ◽  
pp. 167-172
Author(s):  
D. A. Khlanta ◽  
D. S. Romanov
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Radiation Treatment ◽  
Negative Impact ◽  
Clinical Manifestations ◽  
External Beam Radiation ◽  
Radiation Dermatitis ◽  
Beam Radiation ◽  
Post Radiation

External beam radiation therapy is widely used by doctors around the world as one of the most common form of cancer treatment. The radiotherapy can help reduce the treatment aggression as compared with the surgical intervention in a large number of clinical situations, which ensures that the patient's quality of life will be decreased to a lesser extent in the after-treatment period. However, like the vast majority of anticancer treatments, the radiation therapy has a number of side effects, which are classified into acute radiation reactions and post-radiation injuries. Among them is radiation dermatitis, which is one of the most common adverse reactions to the radiotherapy. This complication manifests as erythema, as well as hyperpigmentation, dry and itchy skin, hair loss. In addition to the obvious negative impact on the patient's quality of life, some of the above factors can result in the development of a secondary skin infection. As one of the most frequent post-radiation complications, radiation dermatitis places radiotherapists before a challenge to reduce the incidence rates of this side effect, as well as to decrease the intensity of its clinical manifestations if it occurs. This challenge suggests the search for targeted drugs aimed to prevent and treat clinical symptoms. To date, dermatocosmetic products that are used to relieve skin manifestations of radiation treatment complications is an alternate option of the effective solution to the problem of radiation dermatitis. In the described clinical case, we assess the experience of using some of the dermatocosmetic products in a patient with a florid form of radiation dermatitis. 

Outpatient intra-arterial chemotherapy without radiation therapy for stages II and III oral cancer: A new treatment to improve quality of life and reduce irradiation-related complications.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17567-e17567
Author(s):  
Masatoshi Ohmae ◽  
Itsuro Kato ◽  
Yusei Fujita ◽  
Hiroo Takaoka ◽  
Noritoshi Meshii ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Oral Cancer ◽  
Regional Lymph Node ◽  
Performance Status ◽  
Superficial Temporal Artery ◽  
Dry Mouth ◽  
Occipital Artery ◽  
Curative Effect

e17567 Background: We developed a superselective intra-arterial chemotherapy (iaCT) approach to oral cancer, in which an intra-arterial catheter is retrogradely inserted through the superficial temporal artery and/or occipital artery with concurrent radiation therapy (RT). This approach remarkably improves the curative effect, but it decreases patients’ quality of life (QOL) because of prolonged hospitalization, severe stomatitis, lifelong dry mouth, dysgeusia, and radiation osteonecrosis of the maxillo-mandibular bone. Methods: This study assessed our new outpatient iaCT (op-iaCT) approach involving a subcutaneous infusion reservoir without concurrent RT. We included 23 patients, 11 with stage II and 12 with stage III oral cancer, and they were treated with the op-iaCT approach without concurrent RT. Using this approach, the chemotherapeutic agent was intra-arterially administered at the Outpatient Chemotherapy Center of Rinku General Medical Center. Results: The response rate to this approach was 100%, and all patients had a complete response. Four patients with secondary regional lymph node metastasis underwent neck dissection. Twenty patients were disease-free without an irradiation-related complication, whereas 3 patients died of distant metastasis (2) or local recurrence (1). With the exception of ambulatory visits twice per week for 3 weeks, patients’ activities of daily living (ADLs) were mostly unaffected. Moreover, patients rarely complained of dry mouth or dysgeusia, and they were free from radiation osteonecrosis after cancer therapy. Additionally, they did not develop oral dysfunction related to radical operation. Conclusions: In this approach, the catheter is implanted subcutaneously; therefore, common catheter-related issues rarely occur, resulting in good maintenance of ADLs. Moreover, patients can avoid the side effects of RT. Consequently, patient’s QOL improves and medical expenses decrease. Thus, our new op-iaCT approach improves QOL and the curative effect in patients with oral cancer if their ambulatory and performance status is good.

A review of radiation genomics: integrating patient radiation response with genomics for personalised and targeted radiation therapy

2018 ◽  
Vol 18 (02) ◽  
pp. 198-209 ◽  
Author(s):  
Lu Xu ◽  
Beverley Osei ◽  
Ernest Osei
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Radiation Dose ◽  
Adverse Effects ◽  
Treatment Response ◽  
Cancer Patients ◽  
Genetic Variants ◽  
Radiation Treatment ◽  
Genomic Data

AbstractBackgroundThe success of radiation therapy for cancer patients is dependent on the ability to deliver a total tumouricidal radiation dose capable of eradicating all cancer cells within the clinical target volume, however, the radiation dose tolerance of the surrounding healthy tissues becomes the main dose-limiting factor. The normal tissue adverse effects following radiotherapy are common and significantly impact the quality of life of patients. The likelihood of developing these adverse effects following radiotherapy cannot be predicted based only on the radiation treatment parameters. However, there is evidence to suggest that some common genetic variants are associated with radiotherapy response and the risk of developing adverse effects. Radiation genomics is a field that has evolved in recent years investigating the association between patient genomic data and the response to radiation therapy. This field aims to identify genetic markers that are linked to individual radiosensitivity with the potential to predict the risk of developing adverse effects due to radiotherapy using patient genomic information. It also aims to determine the relative radioresponse of patients using their genetic information for the potential prediction of patient radiation treatment response.Methods and materialsThis paper reports on a review of recent studies in the field of radiation genomics investigating the association between genomic data and patients response to radiation therapy, including the investigation of the role of genetic variants on an individual’s predisposition to enhanced radiotherapy radiosensitivity or radioresponse.ConclusionThe potential for early prediction of treatment response and patient outcome is critical in cancer patients to make decisions regarding continuation, escalation, discontinuation, and/or change in treatment options to maximise patient survival while minimising adverse effects and maintaining patients’ quality of life.

scholarly journals MELADERM-trial: Melatonin cream against acute radiation dermatitis in patients with early breast cancer

2019 ◽  
Vol 2 (1) ◽  
pp. 32-43 ◽  
Author(s):  
Dennis Zetner ◽  
Claus Kamby ◽  
Faisal Mahmood ◽  
Jacob Rosenberg
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Radiation Therapy ◽  
Early Breast Cancer ◽  
Radiation Treatment ◽  
Controlled Trial ◽  
Acute Radiation ◽  
Radiation Dermatitis ◽  
Double Blind

Radiation dermatitis following radiation therapy in the treatment of early breast cancer can lead to discontinuation or prolongation of treatment and an impaired quality of life. Melatonin has been demonstrated to protect against radiation injury. The aim of this study is to investigate whether melatonin can protect against radiation dermatitis when applied topically in women receiving radiation therapy for early breast cancer. This study will be a randomized, placebo-controlled, double-blind controlled trial. Patients will apply the melatonin or placebo preparation topically twice daily for the duration of their radiation therapy. Our objective outcomes will be the Radiation Therapy Oncology Group’s acute radiation morbidity scoring criteria for skin, image analysis of clinical photographs, and use of steroid cream for radiation dermatitis. Subjective outcomes will be quality of life questionnaires developed by the European Organisation for Research and Treatment of Cancer. Outcomes will be measured throughout the five weeks of radiation treatment and be followed up for another three weeks. According to sample-size calculations and inclusion schedule, we intend to include a total of 80 evaluable patients. We will analyze the primary outcomes using parametric and non-parametric tests where applicable. Secondary outcomes will be analyzed by a mixed linear model. Most patients with breast cancer who undergo radiation therapy will develop radiation dermatitis as a result of the therapy. Should our intervention provide better outcomes, many patients could obtain a better quality of life. We expect topical melatonin treatment to have little or no adverse effects, to be easy to apply, and not to interfere with the anti-tumor efficacy of the radiation therapy.

The Head and Neck Radiotherapy Questionnaire: a morbidity/quality-of-life instrument for clinical trials of radiation therapy in locally advanced head and neck cancer.

1993 ◽  
Vol 11 (5) ◽  
pp. 863-872 ◽  
Author(s):  
G P Browman ◽  
M N Levine ◽  
D I Hodson ◽  
J Sathya ◽  
R Russell ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Radiation Therapy ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Performance Status ◽  
Locally Advanced ◽  
Skin Toxicity ◽  
Head And Neck Radiotherapy

PURPOSE The purpose of this study was to develop and validate an instrument for clinical trials to measure radiation-related acute morbidity and quality of life from the perspective of patients with head and neck cancer (HNC) treated with radiotherapy. METHODS The Head and Neck Radiotherapy Questionnaire (HNRQ) was developed by a panel of health care workers and patients, was pretested in a pilot study of HNC patients, and was validated in a randomized double-blind trial of concomitant fluorouracil (FUra) infusional therapy (1.2 g/m2 per 24 hours) or saline placebo administered for 72 hours in the first and third weeks of a 6 1/2-week course of radiation therapy. The HNRQ was validated against existing toxicity and performance status indices, all of which were measured weekly for the 6 1/2 weeks of treatment and for 4 weeks posttreatment. RESULTS There were three a priori constructs: (1) that the HNRQ scores would conform to a shallow U-shaped pattern to reflect declining quality of life (increasing morbidity) during radiation and recovery posttreatment; (2) that the HNRQ would correlate with existing toxicity indices (World Health Organization [WHO] stomatitis, Byfield stomatitis, WHO skin toxicity, Eastern Cooperative Oncology Group [ECOG] and Karnofsky performance status); and (3) that the HNRQ would discriminate between FUra and placebo groups. The HNRQ and its domain scores all showed a change from baseline reflecting increased morbidity during radiation (analysis of variance [ANOVA], P < .00001). The HNRQ correlated well with all other indices (r > or = .60), and domain scores correlated best with other indices that assess the same symptom complex (eg, HNRQ skin domain and WHO skin toxicity index, r = .77). There was a significant difference in HNRQ scores between the FUra and placebo groups during radiation (ANOVA, P = .0007), and all HNRQ domains also discriminated between the treatment groups. CONCLUSION The HNRQ is a valid measure of acute morbidity due to radiation therapy in patients with locally advanced HNC, and may be useful as an outcome measure for future clinical trials of radiation treatment strategies.

A pilot study of patient quality of life during radiation therapy treatment

1994 ◽  
Vol 3 (4) ◽  
pp. 267-272 ◽  
Author(s):  
D. J. Johnson ◽  
L. Casey ◽  
B. Noriega
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Pilot Study ◽  
Therapy Treatment

Alternative ways to improving the quality of life in combination treatment for high-grade glioma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e14031-e14031
Author(s):  
Ivan A. Popov ◽  
Alla I. Shikhlyarova ◽  
Elena M. Frantsiyants ◽  
Eduard E. Rostorguev ◽  
Marina A. Engibaryan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Magnetic Field ◽  
Radiation Therapy ◽  
Radiation Treatment ◽  
Karnofsky Performance Status ◽  
The Body ◽  
Steady Increase ◽  
High Grade ◽  
Number Of Patients

e14031 Background: The steady increase in the rates of high-grade gliomas (HGG) and poor results of antitumor therapy actualizes the problems of improving surgical and chemoradiation treatment, as well as accompanying therapy technologies for managing secondary disorders of neurological, cognitive, and adaptive status of neurooncological patients. Transcranial magnetotherapy (TMT) helps managing disorders of brain activity at the level of systemic and local regulation, including the mechanisms of formation of general anti-stress reactions of the body, as the basis for improving the quality of life. The purpose of the study was to improve the quality of life of patients with HGG receiving surgical and radiation treatment with TMT. Methods: Neurological and cognitive functions were analyzed in 50 patients with HGG after TMT (1 - ultra-low-frequency magnetic field on the projection of the hypothalamus, 0.3-3.0-9.0 Hz, induction 3 mT; 2 - pulsed magnetic field on the tumor bed, 0.3-3.0-9.0 Hz, induction 15 mT) in the early postoperative period and with radiation therapy, total boost dose 60 Gy, 30 fractions. The results were evaluated with the Bartel, Karnofsky, MoCA and NIHSS scales. Types of general adaptive reactions were identified according to the criteria of the cellular composition of blood by Garkavi. Results: 84% patients after TMT had no neurological symptoms (NIHSS scale), vs. 48% in controls. The number of patients without cognitive dysfunctions (MoCA scale) before radiation therapy was 3.4 times higher than the control values and exceeded them by 4.0 times after radiotherapy. Similar positive dynamics was observed when testing with the Bartel scale, with mild (88.0±4.7% vs. 45.5±10.6% in controls; p < 0.05) and moderate (12±6.5% vs. 45.5±10.6% in controls; p < 0.05) dependence on others in everyday life, and testing with the Karnofsky performance status in patients with the index 90 (60±7.1% in the main group vs. 27.3±9.5% in controls; p < 0.05), in which the symptoms of the disease were insignificant. A 3.4-fold decrease in the frequency of acute stress (S) development was registered, with increased coefficient (C) of antistress (AS) reactions (C = AS/S) by 3.0 times relative to the control values. Conclusions: Antistress mechanisms of the integral response to TMT involved neurological and cognitive recovery, contributing to early rehabilitation and improving the quality of life. The reported study was funded by RFBR, project number 19-315-90082\19.

scholarly journals Trans sodium crocetinate with temozolomide and radiation therapy for glioblastoma multiforme

2017 ◽  
Vol 126 (2) ◽  
pp. 460-466 ◽  
Author(s):  
John L. Gainer ◽  
Jason P. Sheehan ◽  
James M. Larner ◽  
David R. Jones
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Radiation Therapy ◽  
Glioblastoma Multiforme ◽  
Phase I ◽  
Phase Ii ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Serious Adverse Events

OBJECTIVE A new drug, trans sodium crocetinate (TSC), has been developed to enhance the delivery of oxygen to hypoxic tissues. Cancerous tumors, such as glioblastoma multiforme (GBM), are very hypoxic, and it has been suggested that radiation therapy (RT) is more beneficial if tumors are better oxygenated. A Phase I/II clinical trial was conducted to determine the effect of adding TSC to RT sessions. METHODS An open, single-arm clinical trial incorporating the standard of care (SOC) for GBM was conducted at 18 clinical sites. There were 6 weeks of RT consisting of 2 Gy/day for 5 days/week, beginning after an initial resection or stereotactic biopsy to confirm GBM. Temozolomide (TMZ), 75 mg/m2, was given before each RT session. The TSC, 0.25 mg/kg, was intravenously administered around 45 minutes before an RT session 3 days/week, usually on Monday, Wednesday, and Friday. A Phase I run-in period included 2 cohorts. The first cohort contained 3 patients who were given a half dose of the intravenous TSC (that is, 0.25 mg/kg, 3 times per week for only the first 3 weeks of RT). After a Safety Monitoring Committee (SMC) had verified that no dose-limiting toxicity (DLT) had occurred, a second cohort of 6 patients was given the same dosage of TSC but for the full 6 weeks of RT. After the SMC verified that no DLTs had occurred, Phase II began, with the administration of the full 18 doses of TSC. Fifty additional patients were enrolled during Phase II. Following the completion of RT, the patients rested for a month. After that, SOC TMZ chemotherapy (150–200 mg/m2) was administered for 5 days of the 1st week of 6 monthly cycles. No TSC was administered during this chemotherapy phase or later in the trial. Any other follow-up therapies were administered at the discretion of the individual investigators. RESULTS Kaplan-Meier analysis showed that 36% of the full-dose TSC patients were alive at 2 years, compared with historical survival values ranging from 27% to 30% for the SOC. Survival for the biopsy-only subset of patients was 40%, as compared with 42.9% for those patients having a complete resection before treatment. In addition, 2 of the 3 Phase I, Cohort 1 patients survived at 2 years. Contrast MRI data suggested that considerable pseudoprogression had occurred. Both Karnofsky Performance Status (KPS) scores and quality of life (QOL) questionnaires indicated that a good quality of life existed for most patients throughout the trial. No serious adverse events occurring in the trial were attributed to TSC. CONCLUSIONS This trial contained a single arm consisting of 59 patients. The results strongly suggested that adding TSC during RT is beneficial for the treatment of GBM. Trans sodium crocetinate offers a novel, easily implemented way to combat hypoxia in tumor tissue. Clinical trial registration no.: NCT01465347 (clinicaltrials.gov)

Sign in / Sign up

Export Citation Format

Share Document