Karis K.F. Cheng

Effects of pain, fatigue, insomnia, and mood disturbance on functional status and quality of life of elderly patients with cancer

BACKGROUNDnMost elderly patients with cancer suffer from a multitude of intense physical and psychological symptoms regardless of the stage of disease. The current paper describes the prevalence of pain, fatigue, insomnia, and mood disturbance, alone and in combination in elderly cancer patients, as well as the inter-correlations among these four symptoms, and the relationship of the symptom cluster to functional status and quality of life (QoL) during cancer therapy.nnnPATIENTS AND METHODSnThis cross-sectional study used secondary data from a convenience sample of 120 patients, 65 years of age and older, with colorectal, lung, head/neck, breast, gynecological, prostate or esophageal cancer receiving chemotherapy or radiotherapy. Measuring instruments included the Karnofsky Performance Scale (KPS), the respective items from the Chinese version of the Symptom Distress Scale (SDS-C), and the Functional Assessment of Cancer Therapy-General (FACT-G [C]). The influence of the symptom cluster on patients functional status and QoL was determined by hierarchical multiple regression.nnnRESULTSnTwenty percent and 29.2% of patients reported co-occurrence of any two and any three symptoms of pain, fatigue, insomnia, and mood disturbance, respectively. About one-third of patients (31.2%) reported co-occurrence of all of the four symptoms. The inter-correlations among pain, fatigue, insomnia, and mood disturbance were mild to moderate (r=0.29-0.43, p<0.01). In terms of functional status, the KPS showed a moderate negative correlation with the four symptoms (r=-0.29 to -0.55, p<0.01). Correlations between the FACT-G (C) subscale/total scores and symptom cluster showed moderate negative correlations (r=-0.23 to -0.55, p<0.01). About 8.7-52.9% of variance in functional status and QoL is explained by the symptom cluster of pain, fatigue, insomnia, and mood disturbance in elderly cancer patients receiving cancer therapy after adjustment for gender, age, co-morbidity, stage of disease, and treatment modality.nnnCONCLUSIONSnOur results suggest that pain, fatigue, insomnia, and mood disturbance are highly prevalent in elderly patients who undergone cancer therapy. These four symptoms may occur in a cluster and may negatively influence elderly patients functional status and QoL during cancer therapy.

Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients

PurposeThe aim of this project was to develop clinical practice guidelines on the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and management of oral mucositis (OM) in cancer patients.MethodsA systematic review of the available literature was conducted. The body of evidence for the use of each agent, in each setting, was assigned a level of evidence. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, or no guideline possible.ResultsA recommendation was developed in favor of patient-controlled analgesia with morphine in hematopoietic stem cell transplant (HSCT) patients. Suggestions were developed in favor of transdermal fentanyl in standard dose chemotherapy and HSCT patients and morphine mouth rinse and doxepin rinse in head and neck radiation therapy (H&N RT) patients. Recommendations were developed against the use of topical antimicrobial agents for the prevention of mucositis. These included recommendations against the use of iseganan for mucositis prevention in HSCT and H&N RT and against the use of antimicrobial lozenges (polymyxin–tobramycin–amphotericin B lozenges/paste and bacitracin–clotrimazole–gentamicin lozenges) for mucositis prevention in H&N RT. Recommendations were developed against the use of the mucosal coating agent sucralfate for the prevention or treatment of chemotherapy-induced or radiation-induced OM. No guidelines were possible for any other agent due to insufficient and/or conflicting evidence.ConclusionAdditional well-designed research is needed on prevention and management approaches for OM.

Perceived symptoms and the supportive care needs of breast cancer survivors six months to five years post-treatment period

PURPOSEnThis study characterized the range and levels of perceived symptoms and unmet needs reported by breast cancer survivors in the half-year to five year post-treatment period, and determined whether the symptoms can be a predictor of unmet needs.nnnMETHODSnIn a cross-sectional study, 150 breast cancer survivors (mean age: 55.1 ± 8 years) at the half-year to five year post-treatment period were enrolled for analysis. The measuring scales used included the Memorial Symptom Assessment Scale (MSAS), and the Supportive Care Needs Survey Short Form (SCNS-SF34).nnnRESULTSn88% of the survivors reported having at least one symptom, while 51% reported at least one unmet need. Lack of energy was the most prevalent symptom (47%), followed by numbness/tingling in hands/feet (41%). Most of the survivors had unmet needs in the Health care system/Information domain (37% reported at least one unmet need for help), followed by Psychological needs (29%). The mean scores for the SCNS-SF34 domains, except for sexuality, were significantly higher in the high-symptom group (mean 17.6-32.2) compared with the low-symptom group (mean 3.5-22.3) (p < 0.01). Regression of the SCNS-SF34 domain scores against the MSAS scores revealed an increase in the explained variance of from 14% to 54%.nnnCONCLUSIONnOur results suggest that breast cancer survivors continue to experience a multitude of symptoms, and the burden of symptoms may be associated with unmet needs across a range of domains.

Severe oral mucositis associated with cancer therapy: impact on oral functional status and quality of life

Goals of workThis study determined the incidence of severe oral mucositis (OM), patients’ self-reported moderate and severe oral symptoms, and change of quality of life (QoL), as well as examined whether OM severity and pain scores predicted the impairment of oral function and QoL.Patients and methodsA multicenter approach was used and 137 patients treated with stomatotoxic chemotherapy (45%), high-dose myeloablative chemotherapy with or without concomitant total body irradiation (12%), head and neck irradiation with or without concomitant chemotherapy (44%) completed the OM-specific QoL measure (OMQoL) once or twice weekly over a 4- or 10-week period, along with concurrent measures of OM using WHO Mucositis Grading System and oral symptoms using 10xa0cm visual analog scale.Main resultsThe incidence of severe OM was 50% (nu2009=u200968). About 77–80% of patients with severe OM reported moderate or severe mouth or throat pain, and 66–78% reported moderate or severe oral functional problems. The oral symptoms peak and area-under-the-curve (AUC) scores of patients with severe OM (peak 5.6 to 6.8; AUC 3.8 to 5.2) were significantly higher than those without OM and those with mild OM (pu2009<u20090.01). The OMQoL subscales peak and AUC scores of patients with severe OM (peak 47.9 to 62.1; AUC −40.1 to −25.8) were significantly lower than those without OM and those with mild OM (pu2009<u20090.01). Of those with severe OM, 88–94% had a drop in the OMQoL subscale scores to at least 10 points from the baseline. Pain resulting from OM, in particular throat pain, is most predictive of oral functional impairment (standardized βu2009=u20090.53–0.83).ConclusionsSevere OM can cause profound pain and oral functional incapability and clinical significant impairment of QoL.

Measuring the Symptom Experience of Chinese Cancer Patients: A Validation of the Chinese Version of the Memorial Symptom Assessment Scale

The purpose of this study was to translate the Memorial Symptom Assessment Scale (MSAS) into Chinese and evaluate the psychometric properties of this version. The original MSAS is a 32-item, patient-rated measure that was developed to assess common cancer-related physical and psychological symptoms with respect to frequency, intensity, and distress. In this study, a two-phase design was used. Phase I involved iterative forward-backward translation, testing of content validity (CVI) and a pretest. Phase II established the psychometric properties of the Chinese version MSAS (MSAS-Ch). Results showed that the MSAS-Ch achieved content relevancy CVI of 0.94 and semantic equivalence CVI of 0.94. Pretesting was performed in 10 cancer patients, and the results revealed adequate content coverage and comprehensibility of the MSAS-Ch. A convenience sample of 370 patients undergoing cancer therapy or at the early post-treatment stage was recruited for psychometric evaluation. Confirmatory factor analysis confirmed the construct validity of the MSAS-Ch, with a good fit between the factor structure of the original version and our present sample data (goodness-of-fit indices all above 0.95). The internal consistency reliability of subscales and total MSAS-Ch was moderately high, with Cronbach alpha coefficients ranging from 0.79 to 0.87. The test-retest intraclass correlation results for the subscale and total MSAS-Ch ranged from 0.68 to 0.79. The subscale scores of MSAS-Ch were moderately correlated with the scores on various validation measurements that assessed psychological distress, pain, and health-related quality of life (r = 0.46-0.65, P < 0.01), confirming that they were measurements of similar constructs. The validity of the construct validity was also supported by comparing the MSAS-Ch scores for subpopulations that varied clinically. Inpatients and patients with poorer performance status scored higher on the MSAS-Ch subscale and total scores than outpatients and patients with higher performance status (P < 0.05). Our study shows that the MSAS-Ch has adequate psychometric properties of validity and reliability, and can be used to assess symptoms during cancer therapy and at the early post-treatment stage in Chinese-speaking patients.

Social support and quality of life among Chinese breast cancer survivors: Findings from a mixed methods study

BACKGROUNDnSocial support has been identified as a significant factor positively influencing quality of life (QOL) in breast cancer survivors. However, less is known about whether and how social support remains important among cancer survivors over the course of the survivorship trajectory.nnnAIMnTo explore social support and its relationship with QOL in breast cancer survivors in China.nnnMETHODSnThis was a sequential mixed methods study. In Phase I, 100 breast cancer survivors were surveyed using standardized questionnaires. A multivariate regression analysis was performed to examine the relationship between social support and QOL after controlling for annual household income and length of survivorship. In Phase II, individual in-depth interviews were conducted to understand social support experience from 29 survivors selected from Phase I. Interview data were transcribed and analyzed using qualitative content analysis.nnnRESULTSnSurvivors reported a median support network size of 2.2 persons (interquartile range = 1.2-3.8) and a median support satisfaction score of 5.5 (interquartile range = 5-6). While support satisfaction was found to be associated with QOL, no association was found between support network size and QOL. Interview findings revealed that close family members and peer survivors constituted the major source of breast cancer survivors support, especially in emotional and informational support aspects. Cultural factors played a role in the perception and utilization of support of the breast cancer survivors.nnnCONCLUSIONSnThis study has indicated that support satisfaction is more critical than support network size in influencing various aspects of survivors QOL through the underlying different types of situation-specific support.

Risk factors for oral mucositis in children undergoing chemotherapy : A matched case-control study

Oral mucositis (OM) is the most frequent and severe complication of chemotherapy for children with cancer, yet little is known about its risk factors. The aim of this study was to determine the risk factors associated with chemotherapy-induced OM in children. A matched case-control design was used. The matching criteria were age, type of cancer and chemotherapy regimen. Patient-and treatment-related data were collected via chart review. Conditional logistic regression analyses were performed to estimate odds ratios (OR) and adjusted odds ratios (AOR) for the development of OM. Fifty-one cases and 51 controls were identified. The mean+/-SD age of the children was 7.6+/-5.2 years, with 65 (63.73%) boys. Eighty-two percent of the children had been diagnosed with haematological malignancies (n=84). The most common chemotherapy regimen was a combination of plant alkaloids and antitumor antibiotics (n=42, 41.18%). In the multivariable model, lower body weight (AOR=0.91; 95% CI=0.84-0.98; p=0.013), lower value of log nadir neutrophil count (AOR=0.33; 95% CI=0.16-0.68; p=0.0025), and higher value of peak creatinine (AOR=1.06; 95% CI=1.01-1.12; p=0.025) were significantly associated with a greater risk of OM. Our findings suggest that children who are neutropenic, those with serum creatinine elevation, and those with a low body weight prior to chemotherapy are at greater risk of developing OM.

Incidence and risk factors of oral mucositis in paediatric and adolescent patients undergoing chemotherapy

There is a dearth of studies with respect to oral mucositis (OM) in the paediatric and adolescent populations. The purpose of this prospective cohort study was to examine the incidence and risk factors associated with OM in paediatric and adolescent patients receiving chemotherapy. OM assessments were made daily until 14days after chemotherapy using the self-report Mouth and Throat Soreness-Related Questions of the Oral Mucositis Daily Questionnaire (OMDQ MTS). Potential risk factors included age, gender, prior OM, anxiety level, cancer diagnosis, nausea/vomiting, use of growth factor, neutrophil count, liver enzymes, and creatinine value. Multiple logistic, Cox proportional hazards, and ordinal regression analyses were used to determine risk factors for the incidence and time to onset of MTS scores of ⩾2, and MTS scores across 14days by AUC categories, respectively, after adjusting for chemotherapy. A total of 140 patients who were 6-18years of age were evaluated. Forty-one percent (95% CI, 32.6-48.8%) developed OM; of these, 23% and 18% reported a maximum MTS score of 2 and 3-4 as the worst OM, respectively. The mean time to onset of OM was 4.7±2.7days with a mean duration of 6.3±4days. Prior OM (RR 1.90-3.94), a higher level of anxiety (RR 1.27-1.46), WHO grade 1-2 (RR 1.86-4.59) and 3-4 (RR 3.08-9.19) neutropenia were significantly associated with a higher probability of the incidence, earlier onset, and greater severity of OM, after controlling for chemotherapy (p<0.01). OM was associated with indirect cytotoxicity, prior OM, and anxiety level after controlling for chemotherapy where neutropenia was found to be the most important factor.

Colorectal cancer screening behaviour and associated factors among Chinese aged 50 and above in Hong Kong – A population-based survey

PURPOSEnThis study reports the uptake rate of colorectal cancer screening among Chinese people aged 50 or above and the identified factors associated with the likelihood of undergoing such screening.nnnMETHODSnA cross-sectional population-based telephone survey was conducted in Hong Kong during the period 2 to 28 May 2007. The survey covered demographics, perceived health status and susceptibility to cancer, utilisation of complementary medicine, family history of cancer and cancer screening behaviour.nnnRESULTSnThe survey was completed by 2004 Hong Kong Chinese residents aged 50 or older (response rate = 66.6%). The uptake rate of a fecal occult blood test and a colonoscopy was 12% and 19% respectively. Factors associated with colorectal cancer screening behaviour included: male participants, ex-smokers, with cancer or other serious disease, a family history of cancer, perceived health status fair or poor, regular visits to a doctor to look after health, and utilisation of complementary medicine.nnnCONCLUSIONSnThe uptake rate of this study population was low though an increasing trend did appear. Heath education and promotion programmes may focus on these identified factors to facilitate colorectal cancer screening in a Chinese population.

A pilot study of chlorhexidine and benzydamine oral rinses for the prevention and treatment of irradiation mucositis in patients with head and neck cancer.

This pilot study was designed to compare the efficacy of 0.2% wt/vol chlorhexidine gluconate and 0.15% wt/vol benzydamine hydrochloride oral rinses in alleviating irradiation oropharyngeal mucositis for patients with head and neck cancer. This was a prospective, randomized, and double-blinded study. Fourteen subjects were stratified based on nasopharyngeal cancer and non-nasopharyngeal head and neck cancer, and were randomly assigned to receive oral care protocol either containing with chlorhexidine (n = 7) or benzydamine (n = 7) from the first day to 2 weeks after the completion of radiotherapy. Subjects were evaluated twice weekly through days 1 to 64 using the World Health Organization mucositis scale and the 10 cm visual analogue scale for mouth pain and dysphagia. In the chlorhexidine arm, 4 subjects (57%) had grade 2, and 3 subjects (43%) had grade 3 mucositis. In the benzydamine arm, 5 subjects (71%) had grade 2, and 2 subjects (29%) had grade 3 mucositis (P > .05). The mean area-under-the-curve values of mucositis were 26.5 +/- 13.6 (median 26) and 24.1 +/- 6.1 (median 22) in the chlorhexidine group and benzydamine group, respectively (P > .05). The mean area-under-the-curve values of pain and dysphagia were 70.8 +/- 33 (median 88.5) and 71.5 +/- 39 (median 101), and 62.1 +/- 17.2 (median 72) and 66 +/- 22.3 (median 57.5) in the chlorhexidine and benzydamine groups, respectively (P > .05). A trend has emerged of a lessening of severity of mucositis, pain, and dysphagia for patients with head and neck cancer receiving benzydamine oral rinse. The beneficial effects, however, need to be confirmed in a larger trial.