Trajectories of physical symptom burden and psychological distress during the last year of life in patients with a solid metastatic cancer

2021 ◽  
Author(s):  
Mahham Shafiq ◽  
Rahul Malhotra ◽  
Irene Teo ◽  
Semra Ozdemir ◽  
Ravindran Kanesvaran ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Metastatic Cancer ◽  
Symptom Burden ◽  
Physical Symptom

Prevalence and correlates of patient symptom burden at initiation of curative chemotherapy.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 176-176
Author(s):  
Caitlin McCarty ◽  
Lara Traeger ◽  
Joseph A. Greer ◽  
Jennifer S. Temel ◽  
Theresa Margaret McDonnell
Keyword(s):  
Psychological Distress ◽  
Early Stage ◽  
Metastatic Breast ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Physical Symptom ◽  
Physical Symptoms ◽  
Self Report ◽  
Services Research ◽  
Symptom Bother

176 Background: Side effects of curative chemotherapy regimens are highly prevalent and can lead to unplanned oncology clinic visits or hospital-level care. The current study aim was to examine physical symptoms among patients at their first chemotherapy visit, even prior to receiving their first infusion, in order to characterize symptom burden and unmet needs at this early stage of care. Methods: The current study utilized baseline data from a larger health services research trial for consecutive patients initiating chemotherapy for non-metastatic breast (48.0%), colorectal (28.0%), or lung (24.0%) cancer (n=75). Patients were invited to complete a self-report survey at their first chemotherapy visit, including demographics and measures of physical symptoms (Memorial Symptom Assessment Scale) and psychological distress (Patient Health Questionnaire-4; score ≥ 3 indicates positive anxiety or depression screen). Results: Among participants (M age=55.3 [SD=13.3]; female=70.7%), more than half (54.7%) endorsed at least one physical symptom -- primarily fatigue (34.7%) and constipation (29.3%). Additionally, one-fourth (25.3%) screened positive for anxiety (22.7%) and/or depression (9.3%). There were no differences in physical symptom bother or likelihood of fatigue or constipation, by factors including patient age, gender, marital status, work status, disease type, recent surgery, or concurrent radiotherapy. However, patients with positive anxiety and/or depression screens reported greater symptom bother and were more likely to endorse fatigue relative to those with negative screens (Mbother=4.5 vs. 1.3; fatigue=78.9% vs. 19.6%, p’s<.01). There was no difference in constipation between these groups. Conclusions: Symptom frequency was markedly high among patients initiating curative chemotherapy, with at least half reporting physical symptoms prior to their first infusion, and psychological distress clustered with general symptom bother and fatigue. Future work should explore 1) the extent to which physical and psychological symptoms at chemotherapy initiation may be associated with longitudinal symptom profiles, and 2) strategies for addressing symptom burden early on in outpatient care.

scholarly journals Symptom burden, psychological distress, and health-related quality of life in cancer survivors with pelvic late radiation tissue injuries

2021 ◽  
Author(s):  
Grete K. Velure ◽  
Bernd Müller ◽  
May Aa. Hauken
Keyword(s):  
Quality Of Life ◽  
Psychological Distress ◽  
Cancer Survivors ◽  
Symptom Burden ◽  
Life Questionnaire ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Tissue Injuries

Abstract Purpose Curative radiotherapy for cancer may lead to severe late radiation tissue injuries (LRTIs). However, limited knowledge exists about pelvic cancer survivors’ LRTI symptoms, distress, and health-related quality of life (HRQOL). We sought to assess the symptom burden, distress, and HRQOL in survivors with established pelvic LRTIs compared to norm populations and to investigate the relation between these factors. Methods Cancer survivors referred for treatment of established pelvic LRTIs were recruited nationwide. LTRIs were assessed with the Expanded Prostate Cancer Index Composite (EPIC), psychological distress was assessed with the General Health Questionnaire (GHQ-12), and HRQOL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORCT-QLQ-C30). Results A total of 107 participants (mean age 64, 53% men) were included. Compared to norms, participants reported more urinary (mean 68.7 vs. 89.5; p = 0.00; d = 1.4) and bowel symptoms (mean 62.5 vs. 92.4; p = 0.00; d = 2.7), increased psychological distress (mean 13.4 vs. 10.3; p = 0.00; d = 0.6), and overall poorer HRQOL (mean 54.9 vs. 71.2; p = 0.00; d = 0.7). Higher symptom burden and higher levels of psychological distress were associated with lower HRQOL (r2 = 46%), but psychological distress did not moderate the influence of symptoms on HRQOL. Conclusion Cancer survivors with established pelvic LRTIs are highly burdened compared to norms. The association of the LRTI-related symptom burden with HRQOL is independent of the level of psychological distress. Both coping and treatment interventions are crucial to promoting long-term health and HRQOL. Trial registration NCT03570229.

Clinical psychology in palliative care

2015 ◽  
Author(s):  
Anja Mehnert
Keyword(s):  
Advanced Disease ◽  
Symptom Burden ◽  
Adjustment Disorder ◽  
Physical Symptom ◽  
Emotional States ◽  
Loss Of Control ◽  
Medical Needs ◽  
Hastened Death ◽  
Major Factors ◽  
Depressive Episodes

The psychosocial implications of disease progression result in a range of challenges for both the patient and the caregiver. The consequences of advanced disease can comprise emotional states such as anxiety, distress and depressive episodes, fear of being a burden to others, loss of control, anger, loss of sense of dignity, uncertainty, and changes in close relationships and social roles. Adjustment disorder, anxiety disorder, depressive disorder, and the demoralization syndrome represent common disorders and phenomena among patients with advanced cancer. Moreover, uncontrollable pain and high unrelieved physical symptom burden, depression, feelings of helplessness and hopelessness, delirium, and low family support are major factors in the desire for thoughts of suicide and the desire for hastened death. Caregivers play an important and challenging role, providing emotional and social support for the patient, helping with medical needs, and meeting increasingly complex instrumental needs such as running the household and work.

scholarly journals Quality of life in a real-world study of patients with metastatic colorectal cancer treated with trifluridine/tipiracil

2020 ◽  
Vol 27 (5) ◽  
Author(s):  
W.Y. Cheung ◽  
P. Kavan ◽  
A. Dolley
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Real World ◽  
Symptom Burden ◽  
Physical Symptom ◽  
Activity Impairment ◽  
Cross Sectional ◽  
Patient Reported

Background Quality of life (qol) is important for oncology patients, especially for those with late-stage disease. The present study was initiated to address the lack of published prospective data about the qol benefits of trifluri­dine/tipiracil (tfd/tpi) compared with best supportive care (bsc) in patients with refractory metastatic colorectal cancer (mcrc). Methods This prospective, cross-sectional, non-interventional study used multidimensional validated scales to evaluate patient-reported qol in two study cohorts of patients and also to measure differences in mcrc-related symptoms and pain in a real-world clinical setting. Results Our findings demonstrate that patients with refractory mcrc report better overall qol when treated with tfd/ tpi than with bsc alone. In that population, statistically significant differences in mean qol measures favoured tfd/tpi over bsc for physical symptom distress, psychological distress, activity impairment, overall valuation of life, and symptomatology. The overall better qol for patients receiving tfd/tpi implies that treatment was well tolerated and was associated with a lower symptom burden. No significant differences for pain were observed between the groups. Conclusions This study suggests that tfd/tpi is a well-tolerated option for the treatment of patients with refractory mcrc, showcasing the value of capturing real-world qol data in routine clinical practice.

The association between physical functioning, symptom burden, and coping strategies with quality of life (QOL) in patients with chronic graft-versus-host disease (cGVHD).

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 178-178
Author(s):  
Robert Sommer ◽  
Jamie M. Jacobs ◽  
Lauren Waldman ◽  
Lara Traeger ◽  
Joseph Greer ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Coping Strategies ◽  
Physical Functioning ◽  
Depression Scale ◽  
Symptom Burden ◽  
Cell Transplant ◽  
Symptom Scale ◽  
Patient Reported ◽  
And Coping ◽  
Over Time

178 Background: Allogeneic stem cell transplant survivors with cGVHD experience substantial psychological distress and impairments in QOL. However, the relationship between patients’ physical functioning, symptom burden, coping strategies, and QOL over time is unknown. Methods: We conducted a longitudinal study of patients with moderate-severe cGVHD. We assessed patient-reported psychological distress (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy-General), physical functioning (Human Activity Profile), cGVHD symptom burden (Lee Symptom Scale), and coping (Coping Inventory for Stressful Situations) at baseline, 3 months, and 6 months. Using mixed linear effects models, we examined the longitudinal relationship between QOL and physical functioning, cGVHD symptoms, and coping strategies. Results: We enrolled 53 patients with moderate (71.7%, 38/53) or severe (28.3%, 15/53) cGVHD. The rate of clinically significant depression and anxiety symptoms at baseline was 32.1% (17/53) and 30.2% (16/33), respectively, and did not change over time. Patients reported low QOL at baseline [M = 70.33, SD = 18.96], which did not change significantly over time [β = -0.66, SE = 1.11, P = 0.550]. Over time, higher physical functioning was associated with better QOL [β = 0.17, SE = 0.05, P = 0.001], while greater symptom burden was associated with worse QOL [β = -0.38, SE = 0.06, P < 0.001]. While the use of emotion-oriented coping was associated with lower QOL over time [β = -0.70, SE = 0.14, P < 0.001], the use of avoidance-oriented coping was associated with higher QOL over time [β = 0.38, SE = 0.10, P < 0.001]. Task-oriented coping was not associated with psychological distress or QOL. Conclusions: Patients with moderate-severe cGVHD report substantial psychological distress and persistently impaired QOL over time. Higher physical function and lower symptom burden are associated with improved QOL. The use of certain coping strategies was associated with changes in QOL. These data underscore the need for supportive care interventions to promote effective coping and enhance physical functioning in patients with cGVHD.

Impact of baseline symptom burden as assessed by patient-reported outcomes (PROs) on overall survival (OS) of patients with metastatic cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12020-12020
Author(s):  
Atul Batra ◽  
Colleen Ann Cuthbert ◽  
Andrew Harper ◽  
Lin Yang ◽  
Devon J. Boyne ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metastatic Cancer ◽  
Metastatic Breast ◽  
Symptom Burden ◽  
Assessment System ◽  
Clinical Practices ◽  
Cox Regression Analysis ◽  
Symptom Intensity ◽  
Patient Reported ◽  
Symptom Scores

12020 Background: Patients with metastatic cancer experience variable symptom burden, but serial symptom assessments using PROs may be challenging to implement in routine clinical practices. We aimed to determine if a single measurement of symptom burden at the time of metastatic diagnosis is associated with survival. Methods: We examined prospectively collected baseline PROs of patients newly diagnosed with metastatic breast, lung, colorectal, or prostate cancer using the revised Edmonton Symptom Assessment System (ESASr) questionnaire from a large province (Alberta, Canada) between 2016 and 2019. The ESASr was categorized into physical (PH), psychosocial (PS), and total symptom (TS) domains whereby scores were classified as mild (0-3), moderate (4-6), or severe (7-10). Multivariable Cox proportional hazards models were constructed to evaluate the effect of baseline symptom scores on OS. Results: We identified 1,315 patients, of whom 57% were men and median age was 66 (IQR, 27-93) years. There were 180, 601, 240, and 294 patients with breast, lung, colorectal, and prostate cancer, respectively. Approximately one-quarter of all patients reported moderate to severe PH, PS, and TS scores, with lung cancer patients experiencing the highest symptom intensity across all domains ( P<0.0001). While age did not affect symptom scores, women were more likely to report severe PH, PS, and TS scores as compared to men ( P=0.02, 0.002, and 0.007, respectively). On multivariable Cox regression analysis, older age (HR 1.02, 95% CI, 1.02-1.03, P<0.0001) and female sex (HR 1.67, 95% CI, 1.39-1.99, P<0.0001) were predictive of worse OS as were severe baseline PH and TS scores (see Table) . However, baseline PS scores were not related to OS. Conclusions: A single assessment of baseline symptom burden using the ESASr in patients with metastatic cancer has significant prognostic value. This may represent a feasible first step toward routine collection of PROs in real-world settings where serial symptom measurements can be challenging to implement. [Table: see text]

Individual differences in physical symptom burden and psychological responses in individuals with chronic lymphocytic leukemia

2016 ◽  
Vol 95 (12) ◽  
pp. 1989-1997 ◽  
Author(s):  
Eleshia J. Morrison ◽  
Joseph M. Flynn ◽  
Jeffrey Jones ◽  
John C. Byrd ◽  
Barbara L. Andersen
Keyword(s):  
Individual Differences ◽  
Chronic Lymphocytic Leukemia ◽  
Symptom Burden ◽  
Physical Symptom ◽  
Lymphocytic Leukemia ◽  
Psychological Responses
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