Prevalence and prognostic implications of psychological distress in patients with gastric cancer

BACKGROUND: The aim of this study was to investigate the prevalence and prognostic significance of psychological distress in gastric cancer patients. METHODS: The study population included 229 gastric cancer patients visiting Yonsei Cancer Center between November 2009 and March 2011. The distress was measured by available tools including the Modified Distress Thermometer (MDT), Hospital Anxiety and Depression Scale (HADS), and Center for Epidemiologic Studies-Depression Scale (CES-D). Patients with psychological distress were defined as those who scored above the cut-off values in both the MDT and either one of the HADS or CES-D. RESULTS: The median age of patients was 56 (range, 20 to 86) and 97 (42.4%) patients were with stage IV disease status at enrollment. The overall prevalence of psychological distress was 33.6% (95% CI: 27.5-39.8%) in 229 gastric cancer patients. In multiple logistic regression analysis, lower education level (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.11-5.17, P = 0.026) and higher disease stage (OR 2.72; 95% CI 1.47-5.03, P = 0.001) were associated with psychological distress. In stage I-III disease, patients with psychological distress had worse disease-free survival (DFS) (5-year DFS rate: 60% vs 76%, P = 0.49) compared with those without psychological distress. In stage IV disease (n = 97), patients with psychological distress showed poorer overall survival than those without psychological distress (median OS (Overall Survival): 12.2 vs. 13.8 months, P = 0.019). CONCLUSION: Psychological distress is common in patients with all stages of gastric cancer and is associated with worse outcomes.ope

Controlling chemotherapy-induced nausea requires further improvement: symptom experience and risk factors among Korean patients

PURPOSE: The purpose of the present study is to describe the incidence and intensity of chemotherapy-induced nausea and vomiting (CINV) and patterns of symptom change after chemotherapy among Korean cancer patients for whom antiemetic guidelines were widely utilized and guideline-consistent antiemetics were available. The study also aimed to determine the contribution of known risk factors for CINV to the incidence and intensity of CINV, as well as patterns of symptom change. METHODS: A prospective observational descriptive study was conducted. A total of 332 adult cancer patients starting their first adjuvant chemotherapy participated in this study. Items of the Multinational Association of Supportive Care in Cancer Antiemesis Tool were utilized to generate a symptom diary. Descriptive statistics, logistic regression analyses, repeated measures ANOVA, and hierarchical generalized linear models were applied to analyze the data. RESULTS: Vomiting occurred, on average, less than once in the acute and delayed phases, and its frequency remained similar throughout 5 days after chemotherapy infusion in the first and second cycles. A quadratic pattern of nausea change was found. Nausea intensity increased to a peak on the third day after chemotherapy infusion (first-cycle incidence rate ratio (IRR) = 1.40 and second-cycle IRR = 1.27, both p < .001) and then changed gradually (first-cycle IRR = 0.69 and second-cycle and IRR = 0.76, both p < .001). Nausea experience in the previous cycle contributed to the subsequent nausea intensity (IRR = 2.78, p < .001). Younger age, consuming less alcohol, and expecting nausea were identified as risk factors for chemotherapy-induced nausea that needed to be considered from the start of the chemotherapy. CONCLUSIONS: Nausea control, especially in the delayed phase, has room for improvement. As the first chemotherapy-induced nausea experience contributes to subsequent symptom experience, intense control from the start of chemotherapy is necessary while considering patient-related risk factors. Future studies should evaluate the contribution of risk factors when antiemetic prophylaxis is fully provided in multiple settings.restrictio

Gaps exist between patients' experience and clinicians' awareness of symptoms after chemotherapy: CINV and accompanying symptoms

INTRODUCTION: Correlating patients' chemotherapy-induced nausea and vomiting (CINV) experience with clinicians' understanding of the symptom severity and the patients' and clinicians' symptom management goals would aid in advancing symptom management. Identifying rankings of symptom severity after chemotherapy would help prioritizing symptom management. OBJECTIVE: The purpose of this study was to investigate and compare patients' CINV experience and clinicians' awareness of symptoms and symptom management goals. The study also aimed to identify and compare rankings of the severity of symptoms after chemotherapy by patients and clinicians. METHODS: A prospective observational study was conducted. Cancer patients starting the first adjuvant highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) (n = 313), and oncology clinicians at two university hospitals (n = 73) in Korea participated in the study. The Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) items and 20-symptom list were used to generate a symptom diary and survey questions. Descriptive statistics with a 95 % confidence interval and the Mann-Whitney U test were used to analyze the data. RESULTS: In general, clinicians overestimated the patients' CINV experience. Patients' symptom experiences and clinicians' estimates only corresponded for delayed nausea after the second cycle MEC. For symptom management goals, patients aimed for absolute vomiting control and avoiding significant nausea. Patients' symptom management goals exceeded the clinicians' goals for CINV control except for the goal for delayed nausea control. Clinicians rated chemotherapy-induced nausea as the most problematic symptom followed by vomiting; however, fatigue and loss of appetite were the top rated symptoms by patients. CONCLUSIONS: Gaps exist between patients' symptom experience and clinicians' symptom awareness. Clinicians overestimated the patients' CINV experience and set less stringent symptom control goals. Enhancing clinicians' understanding of patients' symptom experience and retargeting the CINV management goals are the next steps for advancing symptom management. Symptoms other than CINV require more attention to set symptom management priorities reflecting patient experience and clinical significance.restrictio

Assessment of Adrenal Function and Health-Related Quality of Life in Advanced Gastric Cancer Patients Who Received First-Line Chemotherapy.

OBJECTIVE: We performed this prospective study to identify both the incidence of adrenal insufficiency (AI) and health-related quality of life (HRQOL) in advanced gastric cancer (AGC) patients who were treated with the S-1 plus cisplatin (SP) regimen as a first-line palliative chemotherapy. METHODS: We assessed adverse events (AEs) observed in 52 patients who received the SP regimen for AGC between January 2009 and June 2010 using the Common Toxicity Criteria Adverse Events (CTCAE) version 3.0. Adrenal function was assessed at baseline and 12 weeks after chemotherapy using the low-dose adrenocorticotropic hormone stimulation test. HRQOL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC-QLQ C30). RESULTS: The incidence of AI was 30.8% (n = 16) and of AE observed 55% (n = 29) among 52 patients after 12 weeks of chemotherapy. Of 29 patients with AE, 34.4% (n = 10) were diagnosed with AI, and of 23 patients without AE, 26.1% (n = 6) were diagnosed with AI. CONCLUSION: The incidence of secondary AI in AGC patients was not rare and was not correlated with the presence of nonspecific AEs. Although patients diagnosed with AI did not show any related symptoms, they are at risk of potentially life-threatening consequences. Thus, the evaluation of AI could be suggested for patients who received chemotherapy.restrictio