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. 2018 Mar;55(3):808-834.
doi: 10.1016/j.jpainsymman.2017.10.004. Epub 2017 Oct 17.

Changes in the Occurrence, Severity, and Distress of Symptoms in Patients With Gastrointestinal Cancers Receiving Chemotherapy

Ilufredo Y Tantoy  1 , Bruce A Cooper  1 , Anand Dhruva  2 , Janine Cataldo  1 , Steven M Paul  1 , Yvette P Conley  3 , Marilyn Hammer  4 , Fay Wright  5 , Laura B Dunn  6 , Jon D Levine  2 , Christine Miaskowski  7
Affiliations

Changes in the Occurrence, Severity, and Distress of Symptoms in Patients With Gastrointestinal Cancers Receiving Chemotherapy

Ilufredo Y Tantoy et al. J Pain Symptom Manage. 2018 Mar.

Abstract

Context: Studies on multiple dimensions of the symptom experience of patients with gastrointestinal cancers are extremely limited.

Objective: Purpose was to evaluate for changes over time in the occurrence, severity, and distress of seven common symptoms in these patients.

Methods: Patients completed Memorial Symptom Assessment Scale, six times over two cycles of chemotherapy (CTX). Changes over time in occurrence, severity, and distress of pain, lack of energy, nausea, feeling drowsy, difficulty sleeping, and change in the way food tastes were evaluated using multilevel regression analyses. In the conditional models, effects of treatment group (i.e., with or without targeted therapy), age, number of metastatic sites, time from cancer diagnosis, number of prior cancer treatments, cancer diagnosis, and CTX regimen on enrollment levels, as well as the trajectories of symptom occurrence, severity, and distress were evaluated.

Results: Although the occurrence rates for pain, lack of energy, feeling drowsy, difficulty sleeping, and change in the way food tastes declined over the two cycles of CTX, nausea and numbness/tingling in hands/feet had more complex patterns of occurrence. Severity and distress ratings for the seven symptoms varied across the two cycles of CTX.

Conclusions: Demographic and clinical characteristics associated with differences in enrollment levels as well as changes over time in occurrence, severity, and distress of these seven common symptoms were highly variable. These findings can be used to identify patients who are at higher risk for more severe and distressing symptoms during CTX and to enable the initiation of preemptive symptom management interventions.

Keywords: Gastrointestinal cancer; chemotherapy; distress; fatigue; feeling drowsy; pain; severity; sleep disturbance; targeted therapy; taste changes.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Observed (open circles) and predicted (filled circles) trajectories for the probability of occurrence of pain (a), lack of energy (c), and nausea (d) across the six assessments. Observed and predicted trajectories for the occurrence of pain across the six assessments for patients with colon, rectal, and anal cancers versus patients with all other gastrointestinal (GI) cancers (b).
Figure 2
Figure 2
Observed (open circles) and predicted (filled circles) trajectories for the probability of occurrence of feeling drowsy (a), numbness/tingling in hands/feet (b), difficulty sleeping (c), and change in the way food tastes (d) across the six assessments.
Figure 3
Figure 3
Observed and predicted trajectories for the probability of a reporting a higher versus a lower severity rating for pain across the six assessments for patients with colon, rectal, and anal cancers (a) versus patients with all other gastrointestinal (GI) cancers (b). Observed and predicted trajectories for the probability of a higher versus a lower severity rating for lack of energy (c) and nausea (d) across the six assessments. Severity ratings are plotted as observed (open circles) and predicted (filled symbols) values for slight versus moderate to very severe (1 versus 2 to 4), slight/moderate versus severe/very severe (1,2 versus 3 to 4), and slight to severe versus very severe (1 to 3 versus 4).
Figure 4
Figure 4
Observed and predicted trajectories for the probability of a higher versus a lower severity rating for numbness/tingling in the hands/feet (a) and change in the way food tastes (d) across the six assessments. Observed and predicted trajectories for the probability of a reporting a higher versus a lower severity rating for difficulty sleeping across the six assessments for patients who did not (b) and did (c) received targeted therapy (TT) with their chemotherapy. Severity ratings are plotted as observed (open circles) and predicted (filled symbols) values for slight versus moderate to very severe (1 versus 2 to 4), slight/moderate versus severe/very severe (1,2 versus 3 to 4), and slight to severe versus very severe (1 to 3 versus 4).
Figure 5
Figure 5
Observed and predicted trajectories for the probability of a higher versus a lower distress rating for pain (a), lack of energy (b), nausea (c), and feeling drowsy (d) across the six assessments. Distress ratings are plotted as observed (open circles) and predicted (filled symbols) values for not at all versus a little bit to very much (0 versus 1 to 4), not at all/a little bit versus somewhat to very much (0,1 versus 2 to 4), not at all to somewhat versus quite a bit/very much (0 to 2 versus 3,4), and not at all to quite a bit versus very much (0 to 3 versus 4).
Figure 6
Figure 6
Observed and predicted trajectories for the probability of a higher versus a lower distress rating for numbness/tingling in hands/feet (a), difficulty sleeping (b), and change in the way food tastes (c) across the six assessments. Distress ratings are plotted as observed (open circles) and predicted (filled symbols) values for not at all versus a little bit to very much (0 versus 1 to 4), not at all/a little bit versus somewhat to very much (0,1 versus 2 to 4), not at all to somewhat versus quite a bit/very much (0 to 2 versus 3,4), and not at all to quite a bit versus very much (0 to 3 versus 4).
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