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Long-term patient-reported distress in locally advanced cervical cancer patients treated with definitive chemoradiation.

ABSTRACT: Background and purpose:To evaluate longitudinal patient-reported distress in cervical cancer patients treated with definitive chemoradiation (CRT). Materials and methods:Between 2011 and 2016, consenting cervical cancer patients treated with definitive CRT who completed ? 2 revised Edmonton Symptom Assessment System (ESAS-r) questionnaires at clinical visits, including baseline, were included. A linear mixed model was used to assess the longitudinal trend in ESAS-r. A minimal clinically important difference (MCID) for total ESAS-r score was defined as a change of 3-points for improvement and 4-points for deterioration. The proportion of patients with an MCID over time was described using moving averages. To test for changes, mixed effects logistic models were fitted, each of which included patient-specific random intercepts and random slopes. Results:67 patients were eligible for analysis (736 ESAS-r assessments). Median (range) follow-up was 24 months (range: 15-45) and compliance at 12 months was 60% (40/67). There was a significant decrease in ESAS-r scores over time. Baseline ESAS-r was strongly predictive of ESAS-r at follow-up (p < 0.001). The proportion of patients with an MCID for improvement from baseline significantly increased over time (p < 0.001) and the proportion with an MCID for deterioration significantly decreased over time (p < 0.001). No predictors for distress were found. Conclusions:Long-term cervical cancer survivors experience distress that significantly improves over time to an extent expected to be clinically meaningful for patients. Implementing cervical cancer specific patient-reported outcome tools into practice could better inform patient needs.

SUBMITTER: Conway JL

PROVIDER: S-EPMC7186264 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Long-term patient-reported distress in locally advanced cervical cancer patients treated with definitive chemoradiation.

Conway Jessica L JL Felder Shira S Tang Jiayin J Lukovic Jelena J Han Kathy K Liu Zhihui Z Milosevic Michael M Fyles Anthony A Croke Jennifer J

Clinical and translational radiation oncology 20200416

<h4>Background and purpose</h4>To evaluate longitudinal patient-reported distress in cervical cancer patients treated with definitive chemoradiation (CRT).<h4>Materials and methods</h4>Between 2011 and 2016, consenting cervical cancer patients treated with definitive CRT who completed ≥ 2 revised Edmonton Symptom Assessment System (ESAS-r) questionnaires at clinical visits, including baseline, were included. A linear mixed model was used to assess the longitudinal trend in ESAS-r. A minimal clin ...[more]

PMID: 32368623

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Project description:PurposeIn patients with locally advanced, unresectable non-small cell lung cancer (NSCLC), the standard of care is concurrent chemoradiation (CRT) followed by consolidative immunotherapy with durvalumab. Pneumonitis is a known adverse event of both radiation therapy and immune checkpoint inhibitors such as durvalumab. We sought to characterize pneumonitis rates and dosimetric predictors of pneumonitis in a real-world population of patients with NSCLC treated with definitive CRT followed by consolidative durvalumab.Methods and materialsPatients with NSCLC from a single institution who were treated with definitive CRT followed by consolidative durvalumab were identified. Outcomes of interest included pneumonitis incidence, type of pneumonitis, progression-free survival, and overall survival.ResultsSixty-two patients were included in our data set treated from 2018 to 2021 with a median follow-up of 17 months. The rate of grade 2+ pneumonitis in our cohort was 32.3%, and the rate of grade 3+ pneumonitis was 9.7%. Lung dosimetry parameters including V20 ≥30% and mean lung dose (MLD) >18 Gy were found to be correlated with increased rates of grade 2+ and grade 3+ pneumonitis. Patients with a lung V20 ≥30% had a grade 2+ pneumonitis rate at 1 year of 49.8% compared with 17.8% in patients with a lung V20 <30% (P = .015). Similarly, patients with an MLD >18 Gy had a grade 2+ pneumonitis rate at 1 year of 52.4% compared with 25.8% in patients with an MLD ≤18 Gy (P = .01). Moreover, heart dosimetry parameters including mean heart dose ≥10 Gy were found to be correlated with increased rates of grade 2+ pneumonitis. The estimated 1-year overall survival and progression-free survival of our cohort were 86.8% and 64.1%, respectively.ConclusionsThe modern management of locally advanced, unresectable NSCLC involves definitive chemoradiation followed by consolidative durvalumab. Pneumonitis rates were higher than expected in this cohort, particularly for patients with a lung V20 ≥30%, MLD >18 Gy, and mean heart dose ≥10 Gy, suggesting that more stringent radiation planning dose constraints may be needed.

Dataset Information

Long-term patient-reported distress in locally advanced cervical cancer patients treated with definitive chemoradiation.

Publications

Long-term patient-reported distress in locally advanced cervical cancer patients treated with definitive chemoradiation.

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