Patterns of Self-Reported Symptoms in Pancreatic Cancer Patients Receiving Chemoradiation

Abstract

Pancreatic cancer is a lethal disease characterized by multiple disease-related symptoms. Chemoradiation therapy is a standard of treatment for locally advanced pancreatic cancer. Although shown to prolong survival, there is little information about treatment-related symptoms or the palliative benefits of chemoradiation. We assessed symptoms of patients with locally advanced pancreatic cancer receiving chemoradiation to determine the prevalence, and co-occurrence, of symptoms and to identify the extent to which symptoms interfered with function. Forty-eight patients were treated with chemoradiation on a Phase I protocol. Patients received radiotherapy (50.4 Gy in 28 fractions), capecitabine (median dose 825 mg/m 2 twice daily), and bevacizumab (2.5-10 mg/kg). Symptom severity and its interference with function were prospectively assessed (at presentation, NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript during, and after chemoradiation) in 43 consenting patients using the M.D. Anderson Symptom Inventory. Results showed that 95% of patients reported at least one of the 13 symptoms assessed at presentation. The most commonly reported symptoms of moderate to severe (≥5 on a 0-10 scale) intensity at presentation were lack of appetite (24%), pain (19%), fatigue (19%), and sleep disturbance (10%). We observed an increase in patients reporting moderate to severe fatigue, nausea, and sleep disturbance during chemoradiation. McNemar tests for paired binary observations showed the proportion of patients reporting moderate to severe symptoms significantly (P < 0.001) decreased after chemoradiation at 94 days follow-up (lack of appetite = 7%, pain = 7%, fatigue = 13%, sleep disturbance = 7%). This study demonstrates the feasibility and usefulness of symptom assessment in chemoradiation protocols. Future studies with larger cohorts are needed to further characterize multiple symptoms associated with chemoradiation.

Patient and Clinical Variables Account for Changes in Health-related Quality of Life and Symptom Burden as Treatment Outcomes in Colorectal Cancer: A Longitudinal Study

“…This finding is consistent with a limited number of studies on physical symptoms (Reyes-Gibby et al, 2007;Brant et al, 2011). One possible explanation for the increase in severity of symptoms is the severe side effects that result from cancer treatments, including surgery, chemotherapy or CCRT.…”

A Progressive Postresection Walking Program Significantly Improves Fatigue and Health-Related Quality of Life in Pancreas and Periampullary Cancer Patients

“…These standardized questions included their current medical condition, adherence with the walking program, the amount and type of exercise performed, their current FVAS and PVAS rating, chemotherapy or radiation therapy being received, and the presence or absence of the following 10 symptoms: fatigue, pain, shortness of breath, weight loss, anorexia, diarrhea, constipation, weakness, insomnia, and depression. This 10 symptom profile survey was based on a literature review of the most commonly reported symptoms in patients with PPC (6,11,(12)(13)(14)(15)(24)(25)(26)(27), and was administered to the IG during monthly follow-up phone calls and upon final follow-up. The UCG received the followup 10 symptom profile survey only upon final follow-up.…”

“…For example, when 600 postings from pancreas cancer patients and their families in a monitored Internet pancreas cancer Frequently Asked Questions chat room were analyzedpain, fatigue, and anorexia were the most frequently reported symptoms by post-operative patients as well as those who did not have surgery (11). Other investigations have reported fatigue, pain, weight loss, nausea, anorexia, constipation, diarrhea, insomnia, depression, and anxiety as the most prevalent symptoms reported by PPC patients at all stages of disease (6,(12)(13)(14)(15).…”

“…Several studies have examined the occurrence of symptoms in patients following resection of the pancreas and have found that the most common issues are: foul bowel movements, thirst, frequent urination, poor blood glucose control, heartburn, nausea and vomiting, weight loss, abdominal pain, fatigue, and muscle weakness (6,15,(25)(26)(27). This study was conceptualized using the Levine Conservation of Energy Theory as the theoretical background (28).…”

Cancer and insomnia

“…Pankreas kanseri olan ve kemoradyoterapi ardın-dan kemoterapi alacak olan hastalara semptom değerlendirme ölçeği kullanılmıştır. [31] Uyku problemlerinin tanı anında %10 oranında orta dereceden şiddetli dereceye kadar olduğu saptandı bu oranın kemoradyoterapi boyunda biraz yükseldiği sonraki takip eden zamanda azaldığını göstermiş-lerdir. Yazarlar ayrıca tek soruluk anketlerin uyku problemlerinin değerlendirilmesinde yeterli olmadığını vurgulanmıştır.…”