Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

Background: Cancer and its therapy is commonly associated with a variety of side effects that impact eating behaviors that reduce nutritional intake. This review will outline potential causes of chemotherapy and radiation damage as well as approaches for the amelioration of the side effects of cancer during therapy. Methods: Information for clinicians, patients, and their caregivers about toxicity mitigation including nausea reduction, damage to epithelial structures such as skin and mucosa, organ toxicity, and education is reviewed. Results: How to anticipate, reduce, and prevent some toxicities encountered during chemotherapy and radiation is detailed with the goal to improve eating behaviors. Strategies for health care professionals, caregivers, and patients to consider include (a) the reduction in nausea and vomiting, (b) decreasing damage to the mucosa, (c) avoiding a catabolic state and muscle wasting (sarcopenia), and (d) developing therapeutic alliances with patients, caregivers, and oncologists. Conclusions: Although the reduction of side effects involves anticipatory guidance and proactive team effort (e.g., forward observation, electronic interactions, patient reported outcomes), toxicity reduction can be satisfying for not only the patient, but everyone involved in cancer care.

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A novel patient-reported outcomes instrument assessing the side effects of peanut oral immunotherapy

Annals of Allergy Asthma & Immunology ◽

10.1016/j.anai.2020.07.027 ◽

2021 ◽

Vol 126 (1) ◽

pp. 61-68

Author(s):

Diane M. Turner-Bowker ◽

Jessica J. Jalbert ◽

Meaghan Krohe ◽

Andrew Yaworsky ◽

Masami T. Kelly ◽

...

Keyword(s):

Side Effects ◽

Patient Reported Outcomes ◽

Oral Immunotherapy ◽

Patient Reported

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Use of online survivorship care plans by young adult cancer survivors: Patient characteristics and patient reported outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.55 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 55-55

Author(s):

Dava Szalda ◽

Marilyn M. Schapira ◽

Linda A. Jacobs ◽

Carolyn Vachani ◽

James M. Metz ◽

...

Keyword(s):

Young Adult ◽

Side Effects ◽

Patient Reported Outcomes ◽

Adult Survivors ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Care Providers ◽

Care Plans ◽

Adult Cancer Survivors ◽

Patient Reported

55 Background: Young adult survivors (YAS) are at risk for side effects of cancer therapy and poor post treatment self-management relative to older adult survivors (AS). Survivorship care plans (SCPs) have proved feasible to provide education on symptom management, but the characteristics of YAS who utilize SCPs and patient-reported outcomes (PROs) of YAS via SCPs remains unstudied. Methods: Patient-reported characteristics and outcomes of YAS, age 18 to 39 years, who used a free online SCP generator (OncoLife), between May 2010 and May 2012 are reported. PROs of YAS were compared to AS, age 40-70 years, via frequencies and chi-squared analyses. PROs were queried upon generation of SCP based on diagnosis and treatments received. Results: YAS (n = 1,445, Mage= 31.5 years) and AS (n = 6301, Mage= 56.3 years) were primarily female (69% vs. 78%), Caucasian (76% vs. 86%) and an average of 2.6 years (range 0-20years) vs. 3.2 years (range 0-46 years) since diagnosis and treatment. Most common diagnoses were breast cancer, testicular cancer, lymphoma, thyroid cancer, and sarcomas in YAS vs. breast, colon, lymphoma, prostate, and lung cancer in AS. Three-quarters (75%) of YAS and 70% of AS generated the SCP themselves with the remaining SCPs generated by health care providers. Less than a quarter (22%) of YAS or AS (18%) reported previously receiving a treatment summary. The most commonly endorsed PROs in YAS and AS were neurocognitive changes and fatigue. Fewer YAS than AS endorsed pulmonary concerns and male sexual side effects. The majority of PROs were reported at similar proportions by YAS and AS (see table). Conclusions: In patients who generated an OncoLife SCP, YAS reported similar rates of treatment-related side effects to those reported by AS demonstrating SCPs as a mechanism to capture and address off-therapy issues for all survivors. [Table: see text]

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Utilizing patient reported outcomes for patients recieving oral chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.190 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 190-190 ◽

Cited By ~ 1

Author(s):

Emily R. Mackler ◽

Kathleen W. Beekman ◽

Laura Bushey ◽

Anne Gentz ◽

Kathleen Davis ◽

...

Keyword(s):

Side Effects ◽

Side Effect ◽

Patient Reported Outcomes ◽

Symptom Burden ◽

Symptom Assessment ◽

Oral Chemotherapy ◽

Severe Side Effect ◽

Management Support ◽

Patient Reported ◽

Edmonton Symptom Assessment Scale

190 Background: Management of oral chemotherapy presents many challenges to oncology practitioners. The purpose of this study is to describe how incorporation of patient reported outcomes (PRO) for patients receiving oral chemotherapy can identify those patients who are experiencing moderate to severe symptom burden and nonadherence. Methods: As part of a statewide quality collaborative, we wished to improve our monitoring of patients receiving oral chemotherapy. The quality collaborative created a PRO assessment that includes a revised Edmonton Symptom Assessment Scale (ESAS), a single-item adherence question, reasons for nonadherence, the patient’s most bothersome symptom and questions related to patient confidence. Our medical assistants provide the assessment to the patient before each appointment. Results: Patients completing the PRO during the first 3 months (7/7/16 – 9/27/16) were evaluated. We had 32 assessments completed by 23 patients. The oral chemotherapy prescribed were capecitabine (48%), erlotinib (13%), temozolomide (13%), and not recorded (26%). Of the 29 completed ESAS assessments, 72% included at least 1 moderate side effect, and 48% included at least 1 severe side effect. 29% of patients reported low-moderate confidence to self-manage their symptoms. Less than excellent adherence (<80% adherence) was reported in 30% of patients with the most commonly reported reason being related to side effects or concerns about side effects. Conclusions: Use of PROs in our oral chemotherapy population identified a large proportion of patients experiencing moderate to severe side effects. Further assessment of how this compares to what patients report to their oncologist during their visits will be reviewed. In addition, we found that approximately 30% of our patients are nonadherent to their oral chemotherapy. This is consistent with recent publications. We plan to continue assessing patient outcomes and utilizing the data we collect to improve patient self-management support.

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Mapping PD-1 inhibitors’ side effects using patient-reported outcomes (PRO) generated by a digital patient-powered network (PPN).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.e15087 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. e15087-e15087

Author(s):

Daniel A. Vorobiof ◽

Irad Deutsch ◽

Eliran Malki ◽

Maytal Bivas-Benita

Keyword(s):

Side Effects ◽

Patient Reported Outcomes ◽

Patient Reported

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Implementing routine patient-reported outcome collection in a large, academic health system.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7053 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7053-7053

Author(s):

Nishant Shah ◽

Andrzej Wojcieszynski ◽

Erin Davis ◽

Jennifer Braun ◽

Meg Garrett ◽

...

Keyword(s):

Side Effects ◽

Health System ◽

Patient Reported Outcomes ◽

Cancer Center ◽

Patient Portal ◽

Tablet Pc ◽

Specific Patient ◽

Gastrointestinal Malignancies ◽

Patient Reported ◽

Capture Rates

7053 Background: Patients' symptoms and side effects have traditionally been assessed by clinicians. There is increasing evidence that patient self-reported symptom severity often differs from clinician assessment, and that collecting patient-reported outcomes (PRO) can improve communication, symptom management, and even survival. However, the implementation of routine PRO collection across a large healthcare system poses operational and informatics challenges. Methods: Using native electronic health record (EHR) functionality, we implemented a standardized PRO questionnaire across a large academic cancer center and associated community-based practices. The questionnaire is based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) developed by the National Cancer Institute. It assesses eleven common side effects of cancer care and is available for completion from home via the EHR patient portal or in clinic via tablet PC. Implementation was stepwise, beginning with a disease-specific patient population in the main academic cancer center and expanding over two years to include all cancer types, three specialties (radiation oncology, hematology/oncology, gynecologic oncology), and multiple satellite practice locations. Results: PRO collection was initiated for patients with gastrointestinal malignancies in two clinic locations at the main cancer center in 12/2017. During the first 3 months of implementation (12/2017-2/2018), questionnaires were completed for 1838 (56.3%) of 3267 eligible patient visits. Work with practice managers and staff to refine operational workflows led to improvement to a 75.6% capture rate for the period 3/2018 – 5/2018. From 6/2018 through 6/2019, the program was expanded to all multidisciplinary clinics in the main cancer center, as well as eight satellite practices. Aggregate capture rates from 7/2018 through 12/2019 have shown sustained performance, with 101,082 (76.7%) of 131,720 eligible visits captured. Of twelve total clinics participating, eleven have sustained capture rates above 70%, and nine capture over 80% of eligible visits. Questionnaires were completed through the online patient portal 12.1% of the time, with the remainder completed in clinic via tablet PC. Conclusions: Routine PRO collection as standard-of-care is possible across a variety of practice environments in a large, complex health system, with sustained capture of approximately three-fourths of eligible visits. Most patients prefer to complete the questionnaire in clinic.

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Design of a randomized controlled trial to evaluate effectiveness of methotrexate versus prednisone as first-line treatment for pulmonary sarcoidosis: the PREDMETH study

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01290-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Vivienne Kahlmann ◽

◽

Montse Janssen Bonás ◽

Catharina C. Moor ◽

Coline H. M. van Moorsel ◽

...

Keyword(s):

Side Effects ◽

Patient Reported Outcomes ◽

Controlled Trial ◽

Pulmonary Sarcoidosis ◽

Response To Therapy ◽

Line Treatment ◽

First Line ◽

Patient Reported ◽

First Line Treatment

Abstract Background Treatment of pulmonary sarcoidosis is recommended in case of significant symptoms, impaired or deteriorating lung function. Evidence-based treatment recommendations are limited and largely based on expert opinion. Prednisone is currently the first-choice therapy and leads to short-term improvement of lung function. Unfortunately, prednisone often has side-effects and may be associated with impaired quality of life. Methotrexate is presently considered second-line therapy, and appears to have fewer side-effects. Objective The primary objective of this trial is to investigate the effectiveness and tolerability of methotrexate as first-line therapy in patients with pulmonary sarcoidosis compared with prednisone. The primary endpoint of this study will be the change in hospital-measured Forced Vital Capacity (FVC) between baseline and 24 weeks. Secondary objectives are to gain more insights in response to therapy in individual patients by home spirometry and patient-reported outcomes. Blood biomarkers will be examined to find predictors of response to therapy, disease progression and chronicity, and to improve our understanding of the underlying disease mechanism. Methods/design In this prospective, randomized, non-blinded, multi-center, non-inferiority trial, we plan to randomize 138 treatment-naïve patients with pulmonary sarcoidosis who are about to start treatment. Patients will be randomized in a 1:1 ratio to receive either prednisone or methotrexate in a predefined schedule for 24 weeks, after which they will be followed up in regular care for up to 2 years. Regular hospital visits will include pulmonary function assessment, completion of patient-reported outcomes, and blood withdrawal. Additionally, patients will be asked to perform weekly home spirometry, and record symptoms and side-effects via a home monitoring application for 24 weeks. Discussion This study will be the first randomized controlled trial comparing first-line treatment of prednisone and methotrexate and provide valuable data on efficacy, safety, quality of life and biomarkers. If this study confirms the hypothesis that methotrexate is as effective as prednisone as first-line treatment for sarcoidosis but with fewer side-effects, this will lead to improvement in care and initiate a change in practice. Furthermore, insights into the immunological mechanisms underlying sarcoidosis pathology might reveal new therapeutic targets. Trial registration The study was registered on the 19th of March 2020 in the International Clinical Trial Registry, www.clinicaltrials.gov; ID NCT04314193.

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Expanding patient-reported outcomes to oral health complications from systemic cancer therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.60 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 60-60

Author(s):

Rebecca A. Miksad ◽

Rohit Goyal ◽

G. Scott Gazelle ◽

J. Shannon Swan

Keyword(s):

Oral Health ◽

Side Effects ◽

Cancer Therapy ◽

Performance Measurement ◽

Cancer Patients ◽

Patient Reported Outcomes ◽

Full Range ◽

Cross Sectional ◽

Patient Reported ◽

Health Complications

60 Background: Cross-disciplinary patient reported outcomes (PROs) assess the full range of side effects from systemic cancer therapy. For oral health complications, however, the validity of oral-health specific and generic health-related quality-of-life (QoL) instruments is unknown for cancer patients. This study evaluates the performance, measurement, and prediction characteristics of the Oral Health Impact Profile (OHIP–14) and EQ–5D in cancer patients with bisphosphonate-associated Osteonecrosis of the Jaw (ONJ). Methods: 34 cancer patients assessed the QoL of their own ONJ with the OHIP–14 and evaluated the QoL of 4 standardized ONJ Health States with the EQ–5D, as previously published. For each instrument, the standard response mean (SRM), effect size (ES), and ability to distinguish minimally important differences (MID) were evaluated for ONJ compared to baseline (longitudinal responsiveness). Instrument MIDs (cross-sectional responsiveness) were also calculated. Performance of a published general dentistry algorithm to predict EQ–5D values from OHIP–14 results was tested. Results: The OHIP–14 and EQ-5D instruments demonstrated moderate to large longitudinal and cross-sectional responsiveness. Pain was one of the most responsive domains for both instruments. Ceiling/floor effects were most prominent for OHIP–14. A general dentistry algorithm did not adequately predict EQ–5D values for cancer patients. Conclusions: This study provides the first empirical evidence for the performance, measurement, and prediction characteristics of oral-health specific and generic QoL instruments for the oral health side effects of systemic cancer treatment. Instrument validity is supported for oral health complications in cancer patients. These results provide benchmarks for PROs at the intersection of oral medicine and surgery, dentistry, and oncology. [Table: see text]

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A Factor Analysis Approach for Clustering Patient Reported Outcomes

Methods of Information in Medicine ◽

10.3414/me16-01-0035 ◽

2016 ◽

Vol 55 (05) ◽

pp. 431-439 ◽

Cited By ~ 6

Author(s):

Maria Thor ◽

Caroline Olsson ◽

Viktor Skokic ◽

Rebecka Jörnsten ◽

David Alsadius ◽

...

Keyword(s):

Factor Analysis ◽

Quantitative Analysis ◽

Side Effects ◽

Radiation Dose ◽

Cancer Patients ◽

Patient Reported Outcomes ◽

Dose Volume ◽

Patient Reported ◽

Symptom Group ◽

The Relationship

SummaryBackground: In the field of radiation oncology, the use of extensive patient reported outcomes is increasingly common to meas -ure adverse side effects after radiotherapy in cancer patients. Factor analysis has the potential to identify an optimal number of latent factors (i.e., symptom groups). However, the ultimate goal of treatment response modeling is to understand the relationship between treatment variables such as radiation dose and symptom groups resulting from FA. Hence, it is crucial to identify clinically more relevant symptom groups and improved response variables from those symptom groups for a quantitative analysis. Objectives: The goal of this study is to design a computational method for finding clinically relevant symptom groups from PROs and to test associations between symptom groups and radiation dose. Methods: We propose a novel approach where exploratory factor analysis is followed by confirmatory factor analysis to determine the relevant number of symptom groups. We also propose to use a combination of symptoms in a symptom group identified as a new response variable in linear regression analysis to investigate the relationship between the symptom group and dose-volume variables. Results: We analyzed patient-reported gastrointestinal symptom profiles from 3 datasets in prostate cancer patients treated with radiotherapy. The final structural model of each dataset was validated using the other two datasets and compared to four other existing FA methods. Our systematic EFA-CFA approach provided clinically more relevant solutions than other methods, resulting in new clinically relevant outcome variables that enabled a quantitative analysis. As a result, statistically significant correlations were found between some dose- volume variables to relevant anatomic structures and symptom groups identified by FA. Conclusions: Our proposed method can aid in the process of understanding PROs and provide a basis for improving our understanding of radiation-induced side effects.

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