Purpose Patients with cancer experience acute and chronic symptoms caused by their underlying disease or by the treatment. While numerous studies have examined the impact of various treatments on symptoms experienced by cancer patients, there are inconsistencies regarding the symptoms measured and reported in treatment trials. This article presents a systematic review of the research literature of the prevalence and severity of symptoms in patients undergoing cancer treatment. Methods A systematic search for studies of persons receiving active cancer treatment was performed with the search terms of “multiple symptoms” and “cancer” for studies involving patients over the age of 18 years and published in English during the years 2001 to 2011. Search outputs were reviewed independently by seven authors, resulting in the synthesis of 21 studies meeting criteria for generation of an Evidence Table reporting symptom prevalence and severity ratings. Results Data were extracted from 21 multi-national studies to develop a pooled sample of 4067 cancer patients in whom the prevalence and severity of individual symptoms was reported. In total, the pooled sample across the 21 studies was comprised of 62% female, with a mean age of 58 years (range: 18 to 97 years). A majority (62%) of these studies assessed symptoms in homogeneous samples with respect to tumor site (predominantly breast and lung cancer), while 38% of the included studies utilized samples with mixed diagnoses and treatment regimens. Eighteen instruments and structured interviews were including those measuring single symptoms, multi-symptom inventories, and single symptom items drawn from HRQOL or health status measures. The MD Anderson Symptom Inventory (MDASI) was the most commonly used instrument in the studies analyzed (n=9 studies; 43%), while the Functional Assessment of Cancer Therapy (FACT-G), Hospital Anxiety and Depression Subscale (HADS-D), Medical Outcomes Survey Short Form-36 (SF-36), and Symptom Distress Scale (SDS) were each employed in two studies. Forty-seven symptoms were identified across the 21 studies which were then categorized into 17 logical groupings. Symptom prevalence and severity were calculated across the entire cohort and also based upon sample sizes in which the symptoms were measured providing the ability to rank symptoms. Conclusions Symptoms are prevalent and severe among patients with cancer. Therefore, any clinical study seeking to evaluate the impact of treatment on patients should consider including measurement of symptoms. This study demonstrates that a discrete set of symptoms is common across cancer types. This set may serve as the basis for defining a “core” set of symptoms to be recommended for elicitation across cancer clinical trials, particularly among patients with advanced disease.

This core set will promote consistent assessment of common and clinically relevant disease- and treatment-related symptoms across cancer trials. As such, it provides a foundation to support data harmonization and continued efforts to enhance measurement of patient-centered outcomes in cancer clinical trials and observational studies.

Background Lowering dietary sodium and adhering to medication regimens are difficult for persons with heart failure (HF). Because these behaviors often occur within the family context, this study evaluated the effects of family education and partnership interventions on dietary sodium (NA) intake and medication adherence (MA). Methods HF patients and family member (FM) dyads (N = 117) were randomized to: usual care (UC), Patient-FM education (PFE), or a family partnership intervention (FPI). Dietary NA (3-day food record), Urine NA (24-hour urine) and MA (MEMS®) were measured at baseline (BL) prior to randomization, and at 4 and 8 months (M). Results FPI and PFE reduced Urine NA at 4 M, and FPI differed from UC at 8 M (p=.016). Dietary NA decreased from BL to 4M with both PFE (p=.04) and FPI (p=.018) lower than UC. The proportion of subjects adherent to NA intake (≤ 2500 mg/day) was higher at 8 M in PFE and FPI vs UC (χ2(2)=7.076, p=.029). MA did not differ among groups across time. Both FPI and PFE groups increased HF knowledge immediately after intervention. Conclusions Dietary NA intake, but not MA, was improved by the PFE and FPI interventions compared with UC. UC was less likely to be adherent with dietary NA. Greater efforts to study and incorporate family-focused education and support interventions into HF care are warranted.

The SARS-CoV-2 pandemic placed many locations under ‘stay at home” orders and adults simultaneously underwent a form of social isolation that is unprecedented in the modern world. Perceived social isolation can have a significant effect on health and well-being. Further, one can live with others and still experience perceived social isolation. However, there is limited research on psychological well-being during a pandemic. In addition, much of the research is limited to older adult samples. This study examined the effects of perceived social isolation in adults across the age span. Specifically, this study documented the prevalence of social isolation during the COVID-19 pandemic as well as the various factors that contribute to individuals of all ages feeling more or less isolated while they are required to maintain physical distancing for an extended period of time. Survey data was collected from 309 adults who ranged in age from 18 to 84. The measure consisted of a 42 item survey from the Revised UCLA Loneliness Scale, Measures of Social Isolation (Zavaleta et al., 2017), and items specifically about the pandemic and demographics. Items included both Likert scale items and open-ended questions. A “snowball” data collection process was used to build the sample. While the entire sample reported at least some perceived social isolation, young adults reported the highest levels of isolation, χ2(2) = 27.36, p < 0.001. Perceived social isolation was associated with poor life satisfaction across all domains, as well as work-related stress, and lower trust of institutions. Higher levels of substance use as a coping strategy was also related to higher perceived social isolation. Respondents reporting higher levels of subjective personal risk for COVID-19 also reported higher perceived social isolation. The experience of perceived social isolation has significant negative consequences related to psychological well-being.

Cardio-oncology has organically developed as a new discipline within cardiovascular medicine as a result of the cardiac and vascular adverse sequelae of the major advances in cancer treatment. Patients with cancer and cancer survivors are at increased risk of vascular disease for a number of reasons. First, many new cancer therapies, including several targeted therapies, are associated with vascular and metabolic complications. Second, cancer itself serves as a risk factor for vascular disease, especially by increasing the risk for thromboembolic events. Finally, recent data suggest that common modifiable and genetic risk factors predispose to both malignancies and cardiovascular disease. Vascular complications in patients with cancer represent a new challenge for the clinician and a new frontier for research and investigation. Indeed, vascular sequelae of novel targeted therapies may provide insights into vascular signaling in humans. Clinically, emerging challenges are best addressed by a multidisciplinary approach in which cardiovascular medicine specialists and vascular biologists work closely with oncologists in the care of patients with cancer and cancer survivors. This novel approach realizes the goal of providing superior care through the creation of cardio-oncology consultative services and the training of a new generation of cardiovascular specialists with a broad understanding of cancer treatments.