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Prevention and Management of Chemotherapy-Induced Side Effects in Survivors of Adult Cancers

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (15 July 2022) | Viewed by 17942

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Special Issue Editor

Prof. Dr. Doris Howell

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Guest Editor

Princess Margaret Cancer Research Institute, Toronto, ON M5G 2M9, Canada
Interests: self-management; patient activation; symptoms; distress; patient reported outcomes; health coaching
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Special Issue Information

Dear Colleagues,

Chemotherapy continues to be an important component of many cancer treatment regimens. Unfortunately, systemic and oral chemotherapy can result in side effects that are highly distressing such as fatigue, nausea/vomiting, myalgias/arthralgias, cognitive impairment, peripheral neuropathy, and depression that varies depending on the treatment regimen. Many of these acute treatment side effects occurring in early survivorship persist as long-term problems after treatment in adult cancer survivors with negative impacts on functioning in daily life and health-related quality of life (HRQOL). Late effects due to chemotherapy can occur months to years after treatment, including cardiovascular, pulmonary, neurological, endocrine, and other co-morbid conditions that challenge the survivors’ ability to live well with cancer as a chronic illness. Acute and long-term chemotherapy side effects often go unrecognized and undertreated in clinical care, leading to further disability and impairment of occupational and career goals, finances, and family relationships in cancer survivors, which exacerbates emotional distress and diminishing survival. While the discovery of therapeutic agents targeting underlying biological or genomic mechanisms is a priority for personalized prevention and management of chemotherapy side effects, greater attention must also focus on new models of proactive, personalized symptom management such as remote monitoring and ‘real-time’ adverse toxicity management with an earlier intensification of symptom management and activation of survivors in symptom and health self-management that can mitigate side effects. In this Special Issue, we focus on advancing knowledge for prevention and management of chemotherapy treatment side effects in adult cancer survivors, including targeting of biological or genomic mechanisms, psychoeducational/self-management, and/or health service interventions such as mobile health to reduce symptom burden and optimize quality of life.

Prof. Dr. Doris Howell
Guest Editor

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Keywords

chemotherapy
interventions
side effects
adult
cancer survivors
personalized
self-management

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Published Papers (6 papers)

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Research

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15 pages, 2021 KiB

Open AccessArticle

Patient-Reported Outcomes, Health-Related Quality of Life, and Clinical Outcomes for Urothelial Cancer Patients Receiving Chemo- or Immunotherapy: A Real-Life Experience

by Gry Assam Taarnhøj, Henriette Lindberg, Christoffer Johansen and Helle Pappot

J. Clin. Med. 2021, 10(9), 1852; https://doi.org/10.3390/jcm10091852 - 24 Apr 2021

Cited by 12 | Viewed by 2855

Abstract

Patients with urothelial cell carcinoma (UCC) often have comorbidities, which cause trouble for the completion of oncological treatment, and little is known about their quality of life (QoL). The aim of the present study was to obtain and describe patient-reported outcomes (PRO) and QoL data from UCC patients in the treatment for locally advanced muscle-invasive or metastatic UCC. A total of 79 patients with UCC completed four questionnaires (EORTC QLQ-C30, QLQ-BLM30, HADS, and select PRO-CTCAE™ questions) once weekly during their treatment. From those, 26 patients (33%) underwent neoadjuvant treatment for local disease while 53 patients (67%) were treated for metastatic disease. Of all patients, 54% did not complete the planned treatment due to progression, nephrotoxicity, death, or intolerable symptoms during treatment. The five most prevalent PRO-CTCAE grade ≥ 2 symptoms were frequent urination (37%), fatigue (35%), pain (31%), dry mouth (23%), and swelling of the arms or legs (23%). The baseline mean overall QoL was 61 (±SD 24) for all patients (neoadjuvant (73, ±SD 19) and metastatic (54, ±SD 24)) and remained stable over the course of treatment for both groups. A stable overall QoL was observed for the patients in this study. More than half of the patients did not, however, complete the planned treatment. Further supportive care is warranted for bladder cancer patients. Full article

(This article belongs to the Special Issue Prevention and Management of Chemotherapy-Induced Side Effects in Survivors of Adult Cancers)

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7 pages, 796 KiB

Open AccessArticle

Rationale, Design, and Feasibility of a Prospective Multicenter Registry Study of Anthracycline-Induced Cardiotoxicity (AIC Registry)

by Keiko Inoue, Noriko Iida, Kazuko Tajiri, Hiroko Bando, Shigeru Chiba, Nobutaka Tasaka, Kenji Nagashio, Rumi Sasamura, Hiroyuki Naito, Momoko Murata, Siqi Li, Tomoko Ishizu, Yoko Nakazawa, Ikuo Sekine and Masaki Ieda

J. Clin. Med. 2021, 10(7), 1370; https://doi.org/10.3390/jcm10071370 - 27 Mar 2021

Cited by 5 | Viewed by 2350

Abstract

As the number of cancer survivors increases, cardiac management in anthracycline-treated patients has become more important. We planned to conduct a prospective multicenter registry study for comprehensive echocardiographic and biomarker data collection and an evaluation of the current practice in terms of diagnosis and management of anthracycline-induced cardiotoxicity (AIC registry). To examine the feasibility of this registry study, we analyzed the 1-year follow-up data of 97 patients registered during the first year of this registry. The AIC registry was launched in July 2016. Data on echocardiographic parameters (e.g., two-and three-dimensional [(2- and 3-D) left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS)) and biomarkers (e.g., troponin T and brain natriuretic peptide) were collected before anthracycline treatment, every 3 months during the first year after starting anthracycline, and every 6 months during the second year. Eighty-three patients (86%) completed a 1-year follow-up. The measurable rates of 2D LVEF, 3D LVEF, and GLS on each visit were nearly optimal (100%, 86–93%, and 84–94%, respectively). During the 1-year follow-up, 5 patients (6.0%) developed cardiotoxicity (a reduction in LVEF ≥ 10 percentage points from baseline and <55%). The AIC registry study is feasible and will be the first study to collect sizable echocardiographic and biomarker data on cardiotoxicity in Japanese patients treated with anthracycline in a real-world setting. Full article

(This article belongs to the Special Issue Prevention and Management of Chemotherapy-Induced Side Effects in Survivors of Adult Cancers)

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Review

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11 pages, 266 KiB

Open AccessReview

Capecitabine—A “Permanent Mission” in Head and Neck Cancers “War Council”?

by Camil Ciprian Mireștean, Roxana Irina Iancu and Dragoș Petru Teodor Iancu

J. Clin. Med. 2022, 11(19), 5582; https://doi.org/10.3390/jcm11195582 - 23 Sep 2022

Cited by 2 | Viewed by 2154

Abstract

Capecitabine, an oral pro-drug that is metabolized to 5-FU, has been used in clinical practice for more than 20 years, being part of the therapeutic standard for digestive and breast cancers. The use of capecitabine has been evaluated in many trials including cases diagnosed in recurrent or metastatic settings. Induction regimens or a combination with radiation therapy were evaluated in head and neck cancers, but 5-FU still remained the fluoropyrimidine used as a part of the current therapeutic standard. Quantifications of levels or ratios for enzymes are involved in the capecitabine metabolism to 5-FU but are also involved in its conversion and elimination that may lead to discontinuation, dose reduction or escalation of treatment in order to obtain the best therapeutic ratio. These strategies based on biomarkers may be relevant in the context of the implementation of precision oncology. In particular for head and neck cancers, the identification of biomarkers to select possible cases of severe toxicity requiring discontinuation of treatment, including “multi-omics” approaches, evaluate not only serological biomarkers, but also miRNAs, imaging and radiomics which will ensure capecitabine a role in both induction and concomitant or even adjuvant and palliative settings. An approach including routine testing of dihydropyrimidine dehydrogenase (DPD) or even the thymidine phosphorylase (TP)/DPD ratio and the inclusion of miRNAs, imaging and radiomics parameters in multi-omics models will help implement “precision chemotherapy” in HNC, a concept supported by the importance of avoiding interruptions or treatment delays in this type of cancer. The chemosensitivity and prognostic features of HPV-OPC cancers open new horizons for the use of capecitabine in heavily pretreated metastatic cases. Vorinostat and lapatinib are agents that can be associated with capecitabine in future clinical trials to increase the therapeutic ratio. Full article

(This article belongs to the Special Issue Prevention and Management of Chemotherapy-Induced Side Effects in Survivors of Adult Cancers)

23 pages, 2131 KiB

Open AccessReview

Cardiotoxicity of Fluoropyrimidines: Epidemiology, Mechanisms, Diagnosis, and Management

by Michał Jurczyk, Magdalena Król, Aleksandra Midro, Magdalena Kurnik-Łucka, Adrian Poniatowski and Krzysztof Gil

J. Clin. Med. 2021, 10(19), 4426; https://doi.org/10.3390/jcm10194426 - 27 Sep 2021

Cited by 17 | Viewed by 3938

Abstract

Cancer is a growing public health problem; it is responsible annually for millions of deaths worldwide. Fluoropyrimidines are highly effective and commonly prescribed anti-neoplastic drugs used in a wide range of chemotherapy regimens against several types of malignancies. 5-fluorouracil and its prodrugs affect neoplastic cells in multiple ways by impairing their proliferation, principally through the inhibition of thymidylate synthase. Fluoropyrimidine-induced cardiotoxicity was described more than 50 years ago, but many details such as incidence, mechanisms, and treatment are unclear and remain disputed. Severe cardiotoxicity is not only life-threatening, but also leads to withdrawal from an optimal chemotherapy regimen and decreases survival rate. Differences in the frequency of cardiotoxicity are explained by different chemotherapy schedules, doses, criteria, and populations. Proposed pathophysiological mechanisms include coronary vasospasm, endothelial damage, oxidative stress, Krebs cycle disturbances, and toxic metabolites. Such varied pathophysiology of the cardiotoxicity phenomenon makes prevention and treatment more difficult. Cardiovascular disturbances, including chest pain, arrhythmias, and myocardial infarction, are among the most common side effects of this class of anti-neoplastic medication. This study aims to summarize the available data on fluoropyrimidine cardiotoxicity with respect to symptoms, incidence, metabolism, pathophysiological mechanism, diagnosis, management, and resistance. Full article

(This article belongs to the Special Issue Prevention and Management of Chemotherapy-Induced Side Effects in Survivors of Adult Cancers)

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32 pages, 991 KiB

Open AccessReview

Identifying Patient-Reported Outcome Measures (PROMs) for Routine Surveillance of Physical and Emotional Symptoms in Head and Neck Cancer Populations: A Systematic Review

by Sheilla de Oliveira Faria, Gillian Hurwitz, Jaemin Kim, Jacqueline Liberty, Kimberly Orchard, Geoffrey Liu, Lisa Barbera and Doris Howell

J. Clin. Med. 2021, 10(18), 4162; https://doi.org/10.3390/jcm10184162 - 15 Sep 2021

Cited by 7 | Viewed by 3180

Abstract

The aims of this review were to identify symptoms experienced by head and neck cancer (HNC) patients and their prevalence, as well as to compare symptom coverage identified in HNC specific patient-reported outcome measures (PROMs). Searches of Ovid Medline, Embase, PsychInfo, and CINAHL were conducted to identify studies. The search revealed 4569 unique articles and identified 115 eligible studies. The prevalence of reported symptoms was highly variable among included studies. Variability in sample size, timing of the assessments, and the use of different measures was noted across studies. Content mapping of commonly used PROMs showed variability and poor capture of prevalent symptoms, even though validation studies confirmed satisfactory reliability and validity. This suggests limitations of some of the tools in providing an accurate and comprehensive picture of the patient’s symptoms and problems. Full article

(This article belongs to the Special Issue Prevention and Management of Chemotherapy-Induced Side Effects in Survivors of Adult Cancers)

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Other

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7 pages, 1819 KiB

Open AccessCase Report

Successful Treatment of Acute Uric Acid Nephropathy with Rasburicase in a Primary Central Nervous System Lymphoma Patient Showing a Dramatic Response to Methotrexate—Case Report

by Yoshihiro Mouri, Manabu Natsumeda, Noritaka Okubo, Taro Sato, Taiki Saito, Kohei Shibuya, Shiori Yamada, Jotaro On, Yoshihiro Tsukamoto, Masayasu Okada, Makoto Oishi, Takeyoshi Eda, Junko Murai, Hiroshi Shimizu, Akiyoshi Kakita and Yukihiko Fujii

J. Clin. Med. 2022, 11(19), 5548; https://doi.org/10.3390/jcm11195548 - 22 Sep 2022

Cited by 1 | Viewed by 1929

Abstract

Background: Primary central nervous system lymphomas (PCNSLs) are sensitive to chemotherapy. The standard treatment is high-dose methotrexate (MTX)-based chemotherapy. There are no reports of successful treatment of acute uric acid nephropathy with rasburicase after MTX administration in PCNSLs. Case presentation: A 54-year-old man with a history of gout presented with a change in character and cognitive dysfunction. MRI showed a large enhancing mass spanning the bilateral frontal lobes and the right temporal lobe. After endoscopic biopsy, an MTX, procarbazine, and vincristine (MPV) regimen was initiated for the treatment of the PCNSL. After the initiation of chemotherapy, the patient experienced a gout attack, and blood examination revealed acute renal failure (ARF) and hyperuricemia. The considered causes of ARF included MTX toxicity and acute uric acid nephropathy. As the dramatic effect of MTX was observed, treatment was continued despite ARF, most probably due to acute hyperuricemia due to tumor lysis, which was treated in parallel. After an improvement in renal function, MTX was resumed, and rasburicase was initiated to control hyperuricemia. A complete response was obtained after induction chemotherapy. Hyperuricemia was controlled with rasburicase, and renal function was preserved. Conclusions: Acute uric acid nephropathy should be considered when ARF occurs after the initiation of MTX in PCNSLs, especially in newly diagnosed PCNSL patients with large tumors or hyperuricemia. Full article

(This article belongs to the Special Issue Prevention and Management of Chemotherapy-Induced Side Effects in Survivors of Adult Cancers)

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