Patient-Reported Toxicities During Chemotherapy Regimens in Current Clinical Practice for Early Breast Cancer

Nyrop, Kirsten A.; Deal, Allison M.; Shachar, Shlomit Strulov; Basch, Ethan; Reeve, Bryce B.; Choi, Seul Ki; Lee, Jordan T.; Wood, William A.; Anders, Carey K.; Carey, Lisa A.; Dees, Elizabeth Claire; Jolly, Trevor A.; Reeder‐Hayes, Katherine E.; Kimmick, Gretchen; Karuturi, Meghan Sri; Reinbolt, Raquel E.; Speca, Jo Ellen C.; Muss, Hyman B.

doi:10.1634/theoncologist.2018-0590

Cited by 66 publications

(72 citation statements)

References 56 publications

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“…In this study, we conducted an analysis among women with early‐stage breast cancer in which we compared clinician‐reported (CTCAE) and patient‐reported (PRO‐CTCAE) severity for 17 symptoms collected at multiple time points throughout chemotherapy. We have previously reported that patient‐assessed symptom severity for these 17 symptoms varies significantly among 4 chemotherapy regimens commonly used in current clinical practice, 17 and this confirms the importance of continuous symptom monitoring throughout treatment. We have also reported that there is minimal agreement between patient‐ and clinician‐reported severity scores for chemotherapy‐induced peripheral neuropathy associated with these chemotherapy regimens 18 .…”

Section: Introductionsupporting

confidence: 59%

Congruence of patient‐ and clinician‐reported toxicity in women receiving chemotherapy for early breast cancer

Nyrop

Deal

Reeve

et al. 2020

Cancer

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Background The National Cancer Institute's Patient‐Reported Outcomes Version of the Common Terminology Criteria for Adverse Events, collected alongside the clinician‐reported Common Terminology Criteria for Adverse Events, enables comparisons of patient and clinician reports on treatment toxicity. Methods In a multisite study of women receiving chemotherapy for early‐stage breast cancer, symptom reports were collected on the same day from patients and their clinicians for 17 symptoms; their data were not shared with each other. The proportions of moderate, severe, or very severe patient‐reported symptom severity were compared with the proportions of clinician‐rated grade 2, 3, or 4 toxicity. Patient‐clinician agreement was assessed via κ statistics. Chi‐square tests investigated whether patient characteristics were associated with patient‐clinician agreement. Results Among 267 women, the median age was 58 years (range, 24‐83 years), and 26% were nonwhite. There was moderate scoring agreement (κ = 0.413‐0.570) for 53% of symptoms, fair agreement for 41% (κ = 0.220‐0.378), and slight agreement for 6% (κ = 0.188). For example, patient‐reported and clinician‐rated percentages were 22% and 8% for severe or very severe fatigue, 41% and 46% for moderate fatigue, 32% and 39% for mild fatigue, and 6% and 7% for none. Clinician severity scores were lower for nonwhite patients in comparison with white patients for peripheral neuropathy, nausea, arthralgia, and dyspnea. Conclusions Although clinician reporting of symptoms is common practice in oncology, there is suboptimal agreement with the gold standard of patient self‐reporting. These data provide further evidence supporting the integration of patient‐reported outcomes into oncological clinical research and clinical practice to improve monitoring of symptoms as well as timely interventions for symptoms.

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Section: Introductionsupporting

confidence: 59%

Congruence of patient‐ and clinician‐reported toxicity in women receiving chemotherapy for early breast cancer

Nyrop

Deal

Reeve

et al. 2020

Cancer

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“…A large proportion of patients receive adjuvant chemotherapy as treatment in addition to surgery. During chemotherapy side-effects such as fatigue, myalgia, nausea, diarrhoea and peripheral neuropathy are common [2].…”

Section: Introductionmentioning

confidence: 99%

“…The aim of this study was to measure changes in energy, stress, nausea and pain immediately after a single session of aerobic or endurance training within the first week after chemotherapy. Additional aims were to study if potential changes were [1] related to type of training (aerobic or endurance) and [2] previous exercise habit, and if the [3] changes remained 3 hrs after training was completed.…”

Section: Introductionmentioning

confidence: 99%

A single exercise session improves side-effects of chemotherapy in women with breast cancer: an observational study

et al. 2019

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BackgroundTo measure changes in four common chemotherapy related side-effects (low energy, stress, nausea and pain) immediately after a single exercise session within the first week after treatment.MethodsThirty-eight patients with chemotherapy-treated breast cancer, participating in a multi-centre randomised controlled study, the Physical Training and Cancer study (Phys-Can) were included in this sub-study. The Phys-Can intervention included endurance and resistance training. Before and after a single training session (endurance or resistance) within the first week of chemotherapy, energy and stress were measured with the Stress-Energy Questionnaire during Leisure Time, and nausea and pain were assessed using a Visual Analog Scale 0–10. Paired t-tests were performed to analyse the changes, and linear regression was used to analyse associations with potential predictors.ResultsThirty-eight participants performed 26 endurance training sessions and 31 resistance training sessions in the first week after chemotherapy. Energy and nausea improved significantly after endurance training, and energy, stress and nausea improved significantly after resistance training. Energy increased (p = 0.03 and 0.001) and nausea decreased (p = 0.006 and 0.034) immediately after a single session of endurance or resistance training, and stress decreased (p = 0.014) after resistance exercise.ConclusionsBoth endurance and resistance training were followed by an immediate improvement of common chemotherapy-related side-effects in patients with breast cancer. Patients should be encouraged to exercise even if they suffer from fatigue or nausea during chemotherapy.Trial registrationNCT02473003, June 16, 2015.

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“…1 Common cancer treatments, such as chemotherapy, lead to side effects during treatment such as nausea, peripheral neuropathy and cancer-related fatigue. 2 Survivors also live with treatment-related side effects, including fatigue, pain, loss of strength and anxiety, for years after their treatments have ended. 1 3 4…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a novel strategy to implement exercise evidence into clinical practice in breast cancer care: protocol for the NEXT-BRCA randomised controlled trial

Smith-Turchyn

Mukherjee

Richardson

et al. 2020

BMJ Open Sport Exerc Med

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IntroductionThe burden of breast cancer in Canada is steadily growing. More women are surviving breast cancer, yet, survivors live with side effects for years after treatments have ended. The benefits of exercise for women with breast cancer are well established and include improvement in treatment-related physical and emotional side effects. Despite these benefits, few survivors meet exercise guidelines. Exercise programmes are needed within the cancer institution in Canada to bridge the current knowledge to practice gap. The purpose of this study is to test the effects of a novel implementation strategy that includes institution-based exercise plus self-management (SM) or SM alone versus usual care in improving exercise level, quality of life, aerobic capacity, muscle strength and use of healthcare services over 12 months for women with breast cancer receiving chemotherapy.Methods and analysisParticipants: Women with stages I–III breast cancer undergoing chemotherapy. Intervention: Group 1: institution-based exercise and SM (8 exercise sessions plus 8 SM modules); Group 2: SM alone; Group 3: usual care. Outcomes: The primary effectiveness outcome is minutes per week of moderate to vigorous physical activity. Secondary outcomes include quality of life, aerobic capacity, muscle strength, and use of healthcare services. Randomisation: Participants will be randomised (1:1:1) to one of the three groups by a blinded statistician and will be stratified based on age of participant (<40, 40–60, and >60 years). Statistical analysis: Outcomes will be measured at baseline, post-intervention, 6-month and 12-month follow-up using an analysis of covariance to test changes between groups over time adjusted for age.Ethics and DisseminationThis study addresses a long-standing need to help women with breast cancer undergoing chemotherapy become and stay more active by implementing novel rehabilitation strategies into real-world practice. This is vital in order for this population to minimise the lingering side effects of treatment, improve function and quality of life and prevent cancer recurrence.Trial registration numberThe study protocol (v1: July 2020) has been registered on ClinicalTrials.gov (NCT04109274).

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Patient-Reported Toxicities During Chemotherapy Regimens in Current Clinical Practice for Early Breast Cancer

Cited by 66 publications

References 56 publications

Congruence of patient‐ and clinician‐reported toxicity in women receiving chemotherapy for early breast cancer

Congruence of patient‐ and clinician‐reported toxicity in women receiving chemotherapy for early breast cancer

A single exercise session improves side-effects of chemotherapy in women with breast cancer: an observational study

Evaluation of a novel strategy to implement exercise evidence into clinical practice in breast cancer care: protocol for the NEXT-BRCA randomised controlled trial

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