A Symptom Profile Analysis of Patients with Lung Cancer, Head & Neck Cancer, and Malignant Pleural Mesothelioma

Oluwatosin Bamidele, The University of Texas School of Public Health

Abstract

Abstract I: Background: Reduction of disease-related symptom burden is a major treatment goal in oncology. Treatment also produces symptoms. There is paucity of data on symptom reports of head and neck cancer (HNC) patients prior to initial treatment, receiving therapy or patients before re-treatment after a disease-free interval. We aim to investigate and compare treatment effects/delayed treatment effects of several common cancer-related symptoms with pre-treatment patient reported symptom ratings in a large cohort of HNC patients at a large tertiary multi-disciplinary HNC center. Methods: Retrospective chart review and analysis on routine measurement of baseline HNC patient reported symptoms and interference using the MD Anderson Symptom Inventory (MDASI) from 2010 to 2011. Patients were categorized into treatment statuses using their MDASI data entry and last (or No) treatment date. Precancer and benign cancer patients were excluded at analysis. Mean symptom score and frequency percentages for moderate-severe symptoms were generated for each category. A two-factor ANOVA was used to examine interaction and group differences by treatment status and covariates. Using a TwoStep Cluster analysis and logistic regression, we examined the effect of treatment groups on high symptom burden, controlling for tumor site, stage and gender. Results: A total of 1365 HNC patients were categorized into persistent cancer (PC = 302), recurrent cancer (RC = 315) and treatment naïve (TN = 748) groups. Majority were non-Hispanic whites (81%) and male (69%), with a median age of 60. Distinct symptom patterns were observed in the 3 treatments cohorts but differed by tumor site. All symptom items mean scores were highest in the mucosal group except difficulty in remembering (Skull base). General activity, work, and enjoyment of life had highest interference mean scores in the mucosal group while mood, relations with other people and walking were highest in skull base group. None was reported highest in the non-mucosal group. Dry mouth was the highest overall with a mean score of 4.72 in patients with recurrent mucosal HNC, while Pain and Fatigue come after with a similar mean score of 4.04 in the same group of patients. Drowsiness, disturbed sleep, nausea/vomiting, loss of appetite, distress, numbness and tingling had highest mean scores in the persistent mucosal HNC patients. Patients in the high symptom burden group were 1.5 times more likely to be persistent cancer (95% CI = 1.0 – 2.4, P<.04) or recurrent cancer (95% CI = 1.0 – 2.2, P<.05) compared to treatment naïve. The symptom difference between PC and RC groups was insignificant. Conclusion: Both persistent and recurrent HNC tend to have treatment and delayed treatment effects respectively and have higher symptom burden than patients who never received cancer treatment. The high moderate to severe symptoms observed in the treatment groups are impacted by the location of various head and neck tumors. Abstract II: Introduction: Patients with newly diagnosed lung cancer who have not yet begun treatment may already be experiencing major symptoms produced by their disease. Understanding the symptomatic effects of cancer treatment requires knowledge of pretreatment symptoms (both severity and interference with daily activities). We assessed pretreatment symptom severity, interference, and quality of life (QOL) in treatment-naive patients with lung cancer and report factors that correlated with symptom severity. Methods: This was a retrospective analysis of data collected at initial intake. Symptoms/interference was rated on the MD Anderson Symptom Inventory (MDASI) between 30 days pre-diagnosis and 45 days post-diagnosis. We examined symptom severity by disease stage and differences in severity by histology. Linear regression analyses identified significant predictors of severe pain and dyspnea. Results: Of 460 eligible patients, 256 (62%) had adenocarcinoma, 30 (7%) had small cell carcinoma, and 100 (24%) had squamous cell carcinoma; >30% reported moderate-to-severe (rated .5, 0.10 scale) pretreatment symptoms. The most-severe were fatigue, disturbed sleep, distress, pain, dyspnea, sadness, and drowsiness. Symptoms affected work, enjoyment of life, and general activity (interference) and physical well-being (QOL) the most. Patients with advanced disease (n=289, 63%) had more-severe symptoms. Cancer stage was associated with pain severity. Histology and stage were associated with severe dyspnea. Conclusions: A third of lung cancer patients were symptomatic at initial presentation. Quantification of pretreatment symptom burden can inform patient-specific palliative therapy and differentiate disease-related symptoms from treatment-related toxicities. Poorly controlled symptoms could negatively affect treatment adherence and therapeutic outcomes. (Abstract shortened by ProQuest.)

Subject Area

Oncology

Recommended Citation

Bamidele, Oluwatosin, "A Symptom Profile Analysis of Patients with Lung Cancer, Head & Neck Cancer, and Malignant Pleural Mesothelioma" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10790621.
https://digitalcommons.library.tmc.edu/dissertations/AAI10790621

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