Cancers

Research

16 pages, 1307 KiB

Open AccessArticle

Medication Risks and Their Association with Patient-Reported Outcomes in Inpatients with Cancer

by Maximilian Günther, Markus Schuler, Leopold Hentschel, Hanna Salm, Marie-Therese Schmitz and Ulrich Jaehde

Cancers 2024, 16(11), 2110; https://doi.org/10.3390/cancers16112110 - 31 May 2024

Viewed by 839

Abstract

Background: We aimed to assess medication risks and determine factors influencing the health-related quality of life (HRQOL) in cancer inpatients. Methods: A retrospective analysis was conducted to identify drug-related problems (DRPs) based on medication reviews, including patient-reported outcomes (PROs). Multiple linear regression analyses [...] Read more.

Background: We aimed to assess medication risks and determine factors influencing the health-related quality of life (HRQOL) in cancer inpatients. Methods: A retrospective analysis was conducted to identify drug-related problems (DRPs) based on medication reviews, including patient-reported outcomes (PROs). Multiple linear regression analyses were performed to identify sociodemographic, disease-related, and drug therapy-related factors influencing changes from hospital admission to discharge in the scales of the EORTC QLQ-C30 questionnaire. Results: A total of 162 inpatients with various hematological and solid cancer diseases was analyzed. Patients received a mean of 11.6 drugs and 92.6% of patients exhibited polymedication resulting in a mean of 4.0 DRPs per patient. Based on PRO data, 21.5% of DRPs were identified. Multiple linear regression models described the variance of the changes in global HRQOL and physical function in a weak-to-moderate way. While drug therapy-related factors had no influence, relapse status and duration of hospital stay were identified as significant covariates for global HRQOL and physical function, respectively. Conclusion: This analysis describes underlying DRPs in a German cancer inpatient population. PROs provided valuable information for performing medication reviews. The multiple linear regression models for global HRQOL and physical function provided explanations for changes during hospital stay. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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12 pages, 3124 KiB

Open AccessArticle

The Prevalence of Orthostatic Hypotension in Cancer Patients

by Mateusz A. Iwański, Aldona Sokołowska, Andrzej Sokołowski, Roman Wojdyła and Katarzyna Styczkiewicz

Cancers 2024, 16(8), 1541; https://doi.org/10.3390/cancers16081541 - 18 Apr 2024

Cited by 1 | Viewed by 3336

Abstract

Background: Orthostatic hypotension (OH) is associated with a higher risk of mortality in the general population; however, it has not been studied in the cancer population. This study aimed to assess the prevalence of OH in cancer patients compared to that in the [...] Read more.

Background: Orthostatic hypotension (OH) is associated with a higher risk of mortality in the general population; however, it has not been studied in the cancer population. This study aimed to assess the prevalence of OH in cancer patients compared to that in the noncancer population. Methods: A total of 411 patients (mean age 63.5 ± 10.6 years) were recruited: patients with active cancer (n = 223) and patients hospitalised for other reasons, but without a cancer diagnosis (n = 188). Medical histories were collected and an orthostatic challenge test was performed. OH was defined as a blood pressure (BP) decrease upon standing of ≥20 mmHg for the systolic or ≥10 mmHg for the diastolic BP after 1 or 3 min; or a systolic BP decrease <90 mmHg. Results: The prevalence of OH in the subjects with cancer was significantly higher than in the subjects without cancer (28.7% vs. 16.5%, respectively, p = 0.003). OH was the most common in the lung cancer patients (57.5%). In a single-variable analysis, the predictors of OH were cancer presence, age ≥ 65 years, and body mass index (BMI) ≥ 30 kg/m². In the multivariable model, the strongest independent predictor of OH was cancer status, which doubled the risk of OH, and BMI ≥ 30 kg/m² and diabetes. Conclusions: Cancer patients are characterised by a high prevalence of OH. In this population, the recommendation of routine orthostatic challenge tests should be considered. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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11 pages, 901 KiB

Open AccessArticle

Disease Perception Is Correlated with Health-Related Quality of Life in Patients Suffering from Myelodysplastic Syndromes: Results of the Belgian Be-QUALMS Study

by Bert Heyrman, Stef Meers, Ann De Becker, Kristien Wouters, Achiel Van Hoof, Ann Van De Velde, Carlos Graux, Dominiek Mazure, Dominik Selleslag, Helena Maes, Jan Lemmens, Marielle Beckers, Dimitri Breems, Sélim Sid, Zwi Berneman and Sébastien Anguille

Cancers 2023, 15(13), 3296; https://doi.org/10.3390/cancers15133296 - 22 Jun 2023

Cited by 1 | Viewed by 1020

Abstract

Patients with myelodysplastic syndromes suffer from an impaired quality of life that is only partially explained by physical symptoms. In an observational study, we aimed to investigate the impact of current MDS treatments and the influence of disease perception on quality of life. [...] Read more.

Patients with myelodysplastic syndromes suffer from an impaired quality of life that is only partially explained by physical symptoms. In an observational study, we aimed to investigate the impact of current MDS treatments and the influence of disease perception on quality of life. Serial measurement of health-related quality of life was performed by ‘the QUALMS’, a validated MDS-specific patient reported outcome tool. Disease perception was evaluated by means of the Brief Illness Perception Questionnaire (B-IPQ). We prospectively collected data on 75 patients that started on a new treatment and could not demonstrate a significant change in QUALMS score or B-IPQ score during treatment. Six out of eight items evaluated in the B-IPQ correlated significantly with QUALMS score. In this small sample, no significant difference in QUALMS score was found between lower vs. higher risk MDS patients or other studied variables, e.g., targeted hemoglobin showed no correlation with QUALMS score. In daily practice attention must be paid to initial formation of disease perception as it correlates independently with health-related quality of life and does not change during treatment (clinicaltrials.gov identifier: NCT04053933). Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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8 pages, 384 KiB

Open AccessCommunication

Prophylactic High-Dose Gabapentin Reduces Opiate Use during Radiation Therapy for Head and Neck Squamous Cell Carcinoma

by Michelle L. Qiu, Austin J. Iovoli, Michael Khan, Mark K. Farrugia, Sung Jun Ma and Anurag K. Singh

Cancers 2023, 15(7), 2003; https://doi.org/10.3390/cancers15072003 - 28 Mar 2023

Cited by 1 | Viewed by 1420

Abstract

Background: The role of prophylactic high-dose gabapentin for the management of oral mucositis during radiation therapy for head and neck squamous cell carcinoma (HNSCC) remains controversial. Methods: A retrospective cohort analysis was performed on primary HNSCC patients treated at our institution. Kruskal–Wallis and [...] Read more.

Background: The role of prophylactic high-dose gabapentin for the management of oral mucositis during radiation therapy for head and neck squamous cell carcinoma (HNSCC) remains controversial. Methods: A retrospective cohort analysis was performed on primary HNSCC patients treated at our institution. Kruskal–Wallis and Fisher’s exact tests were used to compare the patients’ baseline characteristics. Multivariate competing risk and logistic regressions were performed to evaluate time to first opioid use and feeding tube placement. Results: In total, 480 consecutive HNSCC patients were included. Within this cohort, 186 patients received 3600 mg gabapentin, 182 received 300 to 3200 mg gabapentin, and 112 received no gabapentin. The time to first opioid use was greater in the 3600 mg group compared with the no gabapentin group (34.3 vs. 23.9 days, p < 0.001) and to the 300 to 3200 mg group (28.0 days, p < 0.001). The proportion of patients requiring opioids at any point during RT was lower in the 3600 mg gabapentin group compared with the no gabapentin group (31.8% vs. 60.1%, p < 0.001) and with the 300 to 3200 mg group (63.8%, p < 0.001). Conclusions: Prophylactic use of 3600 mg gabapentin was well tolerated, halved overall opioid use, and delayed the time to first opioid use during radiation therapy. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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17 pages, 1044 KiB

Open AccessArticle

Validation of “Self-Evaluation of Communication Experiences after Laryngectomy” (SECEL) Questionnaire for Spanish-Speaking Laryngectomized Patients

by Eva Villanueva, María Paula Fernández, Giovanna Arena, José L. Llorente, Juan P. Rodrigo, Fernando López and César Álvarez-Marcos

Cancers 2022, 14(14), 3347; https://doi.org/10.3390/cancers14143347 - 9 Jul 2022

Cited by 3 | Viewed by 2458

Abstract

Background: Laryngectomized patients have communicative limitations when they lose their phonatory function after surgery. The scale “Self-Evaluation of Communication Experiences after Laryngectomy” (SECEL) assesses the impact of total laryngectomy on quality of life related to communication. The aim of this study was to [...] Read more.

Background: Laryngectomized patients have communicative limitations when they lose their phonatory function after surgery. The scale “Self-Evaluation of Communication Experiences after Laryngectomy” (SECEL) assesses the impact of total laryngectomy on quality of life related to communication. The aim of this study was to translate and adapt the SECEL from English to Spanish and to apply this first version to a group of patients to check its reliability and validity. Materials and Methods: One-hundred-and-one laryngectomized patients completed the SECEL scale adjusted to Spanish, the Voice Handicap Index (VHI-30), the Hospital Anxiety and Depression Scale (HADS) and the EORTC QLQ-H&N35 questionnaire. Results: The Spanish version of the SECEL questionnaire has the same format and conceptual, semantic and idiomatic meaning as the original. The resulting model is composed of 21 items dimensioned in two highly correlated factors that are clear, meaningful, and replicable leading to measures that are reliable enough to be used in clinical evaluation. Conclusion: The Spanish translation and validation of the SECEL questionnaire were performed. It can be considered an appropriate tool to assess communication skills from laryngectomized people. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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15 pages, 826 KiB

Open AccessArticle

Validating an Instrument for Direct Patient Reporting of Distress and Chemotherapy-Related Toxicity among South African Cancer Patients

by Charmaine L. Blanchard, Keletso Mmoledi, Michael H. Antoni, Georgia Demetriou, Maureen Joffe, Gilberto Lopes, Paul Ruff and Daniel S. O’Neil

Cancers 2022, 14(1), 95; https://doi.org/10.3390/cancers14010095 - 24 Dec 2021

Viewed by 2733

Abstract

Patient-reported outcome measures (PROM) for monitoring treatment toxicity improve quality of life (QoL) and clinical outcomes. However, no such PROMs exist for sub-Saharan African cancer patients. We aimed to validate the Patient Reported Symptoms-South Africa (PRS-SA) survey, a novel PROM for measuring distress [...] Read more.

Patient-reported outcome measures (PROM) for monitoring treatment toxicity improve quality of life (QoL) and clinical outcomes. However, no such PROMs exist for sub-Saharan African cancer patients. We aimed to validate the Patient Reported Symptoms-South Africa (PRS-SA) survey, a novel PROM for measuring distress and chemotherapy-related symptoms in South African cancer patients. We enrolled patients at the oncology clinic at Charlotte Maxeke Hospital, Johannesburg. At three separate visits, participants simultaneously completed the PRS-SA survey and several previously validated questionnaires. We constructed a receiver operator characteristics curve for distress levels predicting a Hospital Anxiety and Depression Scale (HADS) score ≥15. We evaluated construct validity for symptom items by comparing severity to the EORTC Core Quality of Life Questionnaire (QLQ-C30) summary score (Pearson correlation tests) and ECOG performance status (Mann–Whitney U tests). We assessed symptom item responsiveness by comparing change in severity to change in QLQ-C30 summary score and comparing standardized mean scores with negative, no, or positive change on the Global Impression of Change (GIC) questionnaire (Jockheere–Terpstra trend test). Overall, 196 participants with solid tumors completed instruments. A distress score of 4 had 82% sensitivity and 55% specificity for clinical depression/anxiety. All symptom items showed construct validity by association with either QLQ-C30 score or performance status (highest p = 0.03). All but cough showed responsiveness to change in QLQ-C30 score (highest p = 0.045). In South African cancer patients, the PRS-SA’s stress scale behaves similarly to the distress thermometer in other populations, and the symptom items demonstrated construct validity and responsiveness. Of note, 46% and 74% of participants who completed the PRS-SA in English or isiZulu, respectively, required assistance reading half or more of the instrument. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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16 pages, 3528 KiB

Open AccessArticle

A Retrospective Cohort Study of Myosteatosis and Quality of Life in Head and Neck Cancer Patients

by Amy L. Shaver, Katia Noyes, Heather M. Ochs-Balcom, Gregory Wilding, Andrew D. Ray, Sung Jun Ma, Mark Farrugia, Anurag K. Singh and Mary E. Platek

Cancers 2021, 13(17), 4283; https://doi.org/10.3390/cancers13174283 - 25 Aug 2021

Cited by 3 | Viewed by 2253

Abstract

Head and neck cancer (HNC) treatment-related morbidity can be detrimental to quality of life (QOL). Myosteatosis is associated with poor QOL in multiple cancers. If predictive of poor QOL trajectories, myosteatosis would be a tool for clinicians to determine which patients may require [...] Read more.

Head and neck cancer (HNC) treatment-related morbidity can be detrimental to quality of life (QOL). Myosteatosis is associated with poor QOL in multiple cancers. If predictive of poor QOL trajectories, myosteatosis would be a tool for clinicians to determine which patients may require additional support during treatment. The purpose of this study was to determine if pretreatment myosteatosis is associated with a poor QOL trajectory following treatment completion. Methods: In a retrospective cohort design, myosteatosis was determined from pretreatment CT scans. Both physical and global QOL score was assessed through patient interview on follow-up appointment. Demographic, cancer-specific, and social covariates were collected, reported, and considered as potential confounders. Results: The population of 163 patients was mostly male (82.2%) and white (91.4%) with oropharyngeal cancer (55.8%). Males with myosteatosis had a physical QOL score 46.84 points lower at one-year following treatment completion (p = 0.01) than those with normal muscle density (p = 0.01). Males with myosteatosis averaged 57.57 points lower at one-year post-treatment (p = 0.01) in global QOL scores. Conclusions: Over one year following completion of treatment, patients with myosteatosis reported worse physical and global QOL scores than patients with normal muscle density. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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9 pages, 244 KiB

Open AccessArticle

Financial Counseling Is Associated with Reduced Financial Difficulty Scores in Head and Neck Cancer Patients Treated with Radiation Therapy

by Mark Farrugia, Han Yu, Sung Jun Ma, Austin J. Iovoli, Kayleigh Erickson, Elizabeth Wendel, Kristopher Attwood, Kimberly E. Wooten, Vishal Gupta, Ryan P. McSpadden, Moni A. Kuriakose, Michael R. Markiewicz, Jon M. Chan, Wesley L. Hicks, Jr., Mary E. Platek, Andrew D. Ray, Elizabeth A. Repasky and Anurag K. Singh

Cancers 2021, 13(11), 2516; https://doi.org/10.3390/cancers13112516 - 21 May 2021

Cited by 14 | Viewed by 2182

Abstract

Background: Financial toxicity (FT) can be devastating to cancer patients, and solutions are urgently needed. We investigated the impact of financial counseling (FC) on FT in head and neck cancer (HNC) patients. Methods: Via a single-institution database, we reviewed the charts of HNC [...] Read more.

Background: Financial toxicity (FT) can be devastating to cancer patients, and solutions are urgently needed. We investigated the impact of financial counseling (FC) on FT in head and neck cancer (HNC) patients. Methods: Via a single-institution database, we reviewed the charts of HNC patients who underwent definitive or post-operative radiotherapy, from October 2013 to December 2020. Of these patients, 387 had provided baseline and post-treatment information regarding financial difficulty. In July 2018, a dedicated financial counselor was provided for radiation therapy patients and we subsequently examined the impact of FC on financial difficulty scores. Results: Following the hiring of a dedicated financial counselor, there was a significant increase in the proportion of patients receiving FC (5.3% vs. 62.7%, p < 0.0001). Compared with baseline scores, patients who did not undergo FC had a significant increase in reported financial difficulty at the end of treatment (p = 0.002). On the other hand, there was no difference in pre- and post-treatment scores in patients who had received FC (p = 0.588). After adjusting for gender and nodal status with a multiple linear regression model, FC was significantly associated with change in financial difficulty (β = −0.204 ± 0.096, p = 0.035). On average, patients who received FC had a 0.2 units lower change in financial difficulty score as compared with those with the same gender and nodal stage but without FC. Conclusions: Providing a dedicated financial counselor significantly increased the proportion of HNC receiving FC, resulting in the stabilization of financial difficulty scores post-treatment. Based on a multiple linear regression model, FC was independently associated with reduced financial difficulty. The employment of a financial counselor may be a viable, hospital-based approach to begin to address FT in HNC. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

15 pages, 1145 KiB

Open AccessArticle

Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy

by Mark Farrugia, Kayleigh Erickson, Elizabeth Wendel, Mary E. Platek, Wenyan Ji, Kristopher Attwood, Sung Jun Ma, Fangyi Gu, Anurag K. Singh and Andrew D. Ray

Cancers 2021, 13(7), 1638; https://doi.org/10.3390/cancers13071638 - 1 Apr 2021

Cited by 12 | Viewed by 2458

Abstract

Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in [...] Read more.

Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in HNC and was the focus of this investigation. Methods: Patients who underwent radiation therapy for HNC from 2018 to 2020 were evaluated as a prospective observational cohort. Functional decline, QoL, and the frailty phenotype were measured via the Short Physical Performance Battery (SPPB), European Organization for Research and Treatment of Cancer (EORTC) qlq-C30, and Fried Frailty index, respectively. Results: A total of 106 HNC patients were included, 75 of which received concurrent chemoradiation therapy (CCRT) and 31 received radiation alone, both with and without surgery. There was a decrease in SPPB overall (p < 0.001) from the beginning to the end of treatment in the CCRT group but not the radiation group (p = 0.43). Change in overall SPPB points following treatment correlated with the decline in physical QoL for both groups (p < 0.05) as well as transition frail status in the CCRT group (p < 0.001) with a trend in the radiation group (p = 0.08). Conclusions: Change in SPPB correlates with QoL and transition to frailty status in patients undergoing definitive CCRT for HNC with similar trends in those receiving radiation alone. Decline in SPPB could potentially be useful in identification of those who may benefit from rehabilitation in future studies. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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10 pages, 6058 KiB

Open AccessArticle

Longitudinal Changes of Quality of Life and Hearing Following Radiosurgery for Vestibular Schwannoma

by Paul Windisch, Jörg-Christian Tonn, Christoph Fürweger, Felix Ehret, Berndt Wowra, Markus Kufeld, Christian Schichor and Alexander Muacevic

Cancers 2021, 13(6), 1315; https://doi.org/10.3390/cancers13061315 - 15 Mar 2021

Cited by 6 | Viewed by 2855

Abstract

Background: Most existing publications on quality of life (QoL) following stereotactic radiosurgery (SRS) for vestibular schwannomas (VS) gather information retrospectively by conducting surveys several years after treatment. The purpose of this study is therefore to provide longitudinal QoL data and assess how changes [...] Read more.

Background: Most existing publications on quality of life (QoL) following stereotactic radiosurgery (SRS) for vestibular schwannomas (VS) gather information retrospectively by conducting surveys several years after treatment. The purpose of this study is therefore to provide longitudinal QoL data and assess how changes in hearing impact QoL. Methods: Patients completed the 12-item short-form (SF-12) health survey prior to treatment and at every follow-up visit. One hundred and seventy-five patients who had complete forms prior to treatment as well as at an early and at a late follow-up were included in the analysis. For 51 of these patients, longitudinal audiometry data were available. Results: Median follow-up was 7.2 years. Patients experienced a significant reduction in the physical composite score (PCS, p = 0.011) compared to before treatment. The mental composite score (MCS) increased significantly (p = 0.032). A decrease in PCS was not significantly correlated with an increased hearing threshold on the affected but rather on the unaffected ear (r(49) = −0.32, p = 0.023). Conclusions: It is unclear whether the decline in the PCS is due to treatment-related toxicity or the normal decline of PCS with age. Ensuring proper hearing on the untreated ear might be crucial to ensure good QoL for patients treated with SRS for VS, though this association should be confirmed in additional studies. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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14 pages, 899 KiB

Open AccessArticle

A Principal Component of Quality of Life Measures Is Associated with Survival for Head and Neck Cancer Patients Treated with Radiation Therapy

by Mark Farrugia, Han Yu, Sung Jun Ma, Austin J. Iovoli, Kristopher Attwood, Kimberly E. Wooten, Hassan Arshad, Vishal Gupta, Ryan P. McSpadden, Moni A. Kuriakose, Michael R. Markiewicz, Jon M. Chan, Wesley L. Hicks, Jr., Mary E. Platek, Andrew D. Ray, Elizabeth A. Repasky and Anurag K. Singh

Cancers 2021, 13(5), 1155; https://doi.org/10.3390/cancers13051155 - 8 Mar 2021

Cited by 5 | Viewed by 2113

Abstract

Background: Health-related quality of life (HRQOL) metrics can be associated with survival in head and neck cancer (HNC); however, the impact of HRQOL recovery and the relevant HRQOL domains regarding outcome are unclear. Methods: Using a single-institution database, we retrospectively reviewed HNC patients [...] Read more.

Background: Health-related quality of life (HRQOL) metrics can be associated with survival in head and neck cancer (HNC); however, the impact of HRQOL recovery and the relevant HRQOL domains regarding outcome are unclear. Methods: Using a single-institution database, we retrospectively reviewed HNC patients treated with definitive or postoperative radiation therapy between 2013 and 2018. The recovery of individual HRQOL domains were determined by the ratio of the post-treatment to baseline scores. Univariate and Multivariate Cox regression were used to analyze survival outcomes. Principal component analysis was used to adjust for multicollinearity of HRQOL domains. Results: In 218 HNC patients who received radiation therapy, median follow-up was 24.8 months (interquartile range (IQR) 14.5–32.0). Principal component analysis evaluating the recovery of HRQOL domains revealed two independent principal components (PC), PC1 and PC2. PC1, which received contributions from the functional domains; physical (PF), role (RF), emotional (EF), cognitive (CF), and global health status (GQOL) was significantly associated with disease-free (HR = 0.77, 95% CI 0.61–0.98, p = 0.034) and overall survival (HR = 0.76, 95% CI 0.65–0.91, p = 0.004) on multivariate analysis and PC2, had no correlation with outcome and was mainly represented by social functioning. Unplanned hospitalization was significantly associated with lower PC1 scores (β = −0.997, Std. Error = 0.244, p < 0.001). Conclusion: Our study provides evidence that post-treatment recovery of HRQOL domains were associated with overall survival (OS) in HNC. PC1 is an attractive clinical tool to assess the recovery across multiple different HRQOL and the relationship with survival. Future prospective studies may identify patients who could benefit from additional rehabilitation based on PC1 score. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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Review

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13 pages, 426 KiB

Open AccessReview

The Gut Microbiome and Gastrointestinal Toxicities in Pelvic Radiation Therapy: A Clinical Review

by Byeongsang Oh, Thomas Eade, Gillian Lamoury, Susan Carroll, Marita Morgia, Andrew Kneebone, George Hruby, Mark Stevens, Frances Boyle, Stephen Clarke, Brian Corless, Mark Molloy, David Rosenthal and Michael Back

Cancers 2021, 13(10), 2353; https://doi.org/10.3390/cancers13102353 - 13 May 2021

Cited by 15 | Viewed by 3126

Abstract

Background: Gastrointestinal (GI) toxicities are common adverse effects of pelvic radiotherapy (RT). Several recent studies revealed that toxicity of RT is associated with dysbiosis of the gut microbiome. Method: A literature search was conducted in electronic databases Medline, PubMed, and ScienceDirect, with search [...] Read more.

Background: Gastrointestinal (GI) toxicities are common adverse effects of pelvic radiotherapy (RT). Several recent studies revealed that toxicity of RT is associated with dysbiosis of the gut microbiome. Method: A literature search was conducted in electronic databases Medline, PubMed, and ScienceDirect, with search terms “microbiome and/or microbiota” and “radiotherapy (RT) and/or chemoradiation therapy (CRT)” and “cancer”, and the relevant literature were selected for use in this article. Results: Eight prospective cohort studies were selected for review with a total of 311 participants with a range of 15–134 participants within these studies. The selected studies were conducted in patients with gynaecological (n = 3), rectal (n = 2), or prostate cancers (n = 1), or patients with various types of malignancies (n = 2). Three studies reported that cancer patients had significantly lower alpha diversity compared with healthy controls. Seven studies found that lower alpha diversity and modulated gut microbiome were associated with GI toxicities during and after pelvic RT (n = 5) and CRT (n = 2), whereas one study found that beta diversity was related to a complete response following CRT. Two further studies reported that fatigue was associated with dysbiosis of the gut microbiome and low alpha diversity during and after RT, and with dysbiosis of the gut microbiome and diarrhoea, respectively. Conclusion: Gut microbiome profiles are associated with GI toxicities and have the potential to predict RT/CRT-induced toxicities and quality of life (QoL) in patients undergoing those treatments. Further robust randomized controlled trials (RCTs) are required to elucidate the effect of gut microbiome profiles on RT-related adverse effects and responses to RT. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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Other

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21 pages, 2862 KiB

Open AccessSystematic Review

Systemic Oncological Treatments versus Supportive Care for Patients with Advanced Hepatobiliary Cancers: An Overview of Systematic Reviews

by Javier Bracchiglione, Gerardo Rodríguez-Grijalva, Carolina Requeijo, Marilina Santero, Josefina Salazar, Karla Salas-Gama, Adriana-Gabriela Meade, Alba Antequera, Ariadna Auladell-Rispau, María Jesús Quintana, Ivan Solà, Gerard Urrútia, Roberto Acosta-Dighero and Xavier Bonfill Cosp

Cancers 2023, 15(3), 766; https://doi.org/10.3390/cancers15030766 - 26 Jan 2023

Cited by 3 | Viewed by 2274

Abstract

Background: The trade-off between systemic oncological treatments (SOTs) and UPSC in patients with primary advanced hepatobiliary cancers (HBCs) is not clear in terms of patient-centred outcomes beyond survival. This overview aims to assess the effectiveness of SOTs (chemotherapy, immunotherapy and targeted/biological therapies) versus [...] Read more.

Background: The trade-off between systemic oncological treatments (SOTs) and UPSC in patients with primary advanced hepatobiliary cancers (HBCs) is not clear in terms of patient-centred outcomes beyond survival. This overview aims to assess the effectiveness of SOTs (chemotherapy, immunotherapy and targeted/biological therapies) versus UPSC in advanced HBCs. Methods: We searched for systematic reviews (SRs) in PubMed, EMBASE, the Cochrane Library, Epistemonikos and PROSPERO. Two authors assessed eligibility independently and performed data extraction. We estimated the quality of SRs and the overlap of primary studies, performed de novo meta-analyses and assessed the certainty of evidence for each outcome. Results: We included 18 SRs, most of which were of low quality and highly overlapped. For advanced hepatocellular carcinoma, SOTs showed better overall survival (HR = 0.62, 95% CI 0.55–0.77, high certainty for first-line therapy; HR = 0.85, 95% CI 0.79–0.92, moderate certainty for second-line therapy) with higher toxicity (RR = 1.18, 95% CI 0.87–1.60, very low certainty for first-line therapy; RR = 1.58, 95% CI 1.28–1.96, low certainty for second-line therapy). Survival was also better for SOTs in advanced gallbladder cancer. No outcomes beyond survival and toxicity could be meta-analysed. Conclusion: SOTs in advanced HBCs tend to improve survival at the expense of greater toxicity. Future research should inform other patient-important outcomes to guide clinical decision making. Full article

(This article belongs to the Special Issue Correlating Patient-Reported Quality of Life before, during, and after Therapy with Objective Measures and Outcomes)

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