Tantoy Ilufredo Y, Dhruva Anand, Cataldo Janine, Venook Alan, Cooper Bruce A, Paul Steven M, Levine Jon D, Conley Yvette P, Cartwright Frances, Lee Kathryn, Wright Fay, Miaskowski Christine
Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA.
Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA.
J Gastrointest Oncol. 2017 Feb;8(1):109-126. doi: 10.21037/jgo.2017.01.09.
Approximately 28% of patients with gastrointestinal (GI) cancers will receive targeted therapy (TT) because of the associated increases in survival. Only four studies have examined the symptom experience of these patients. To date, no studies have evaluated for differences in symptom occurrence, severity, and distress between patients who received chemotherapy (CTX) alone (n=304) or CTX with TT (n=93).
Patients completed self-report questionnaires, approximately one week after they received CTX. A modified version of the Memorial Symptom Assessment Scale (MSAS) was used to obtain data on symptom occurrence, severity, and distress. Binary logistic regression analyses were used to test for differences in symptom occurrence rates between the two treatment groups. Ordinal logistic regression analyses were used to test for differences in severity and distress ratings between the two treatment groups.
Patients who received CTX with TT were significantly younger (P=0.009); were diagnosed with cancer longer (P=0.004); had a higher number of prior treatments (P=0.024); had metastatic disease, specifically to the liver (P<0.001); had a diagnosis of anal, colon, rectum, or colorectal cancer (CRC) (P<0.001); and were positive for detection of B-Raf proto-oncogene, serine/threonine kinase (BRAF) and Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations (both P<0.001). In addition, CTX treatment regimens were significantly different between the two groups (P<0.001). After controlling for significant covariates, patients who received TT reported lower occurrence rates for lack of energy, cough, feeling drowsy, and difficulty sleeping (all, P<0.05). Patients who received TT reported lower severity scores for dry mouth (P=0.034) and change in the way food tastes (P=0.035). However, they reported higher severity scores for "I don't look like myself" (P=0.026). No differences in symptom distress scores were found between the two treatment groups.
This study is the first to evaluate for differences in the symptom experience of GI cancer patients who received CTX alone or CTX with TT using a multidimensional symptom assessment scale. While between group differences in patients' symptom experiences were identified, both treatment groups warrant ongoing assessments to optimally manage their symptoms.
约28%的胃肠道（GI）癌症患者因生存期延长而接受靶向治疗（TT）。仅有四项研究考察了这些患者的症状体验。迄今为止，尚无研究评估单纯接受化疗（CTX）的患者（n = 304）与接受CTX联合TT的患者（n = 93）在症状发生、严重程度及困扰方面的差异。
患者在接受CTX约一周后完成自我报告问卷。采用改良版纪念症状评估量表（MSAS）获取症状发生、严重程度及困扰的数据。二元逻辑回归分析用于检验两个治疗组之间症状发生率的差异。有序逻辑回归分析用于检验两个治疗组之间严重程度及困扰评分的差异。
接受CTX联合TT的患者显著更年轻（P = 0.009）；癌症诊断时间更长（P = 0.004）；既往治疗次数更多（P = 0.024）；有转移性疾病，尤其是肝转移（P < 0.001）；诊断为肛门、结肠直肠或结直肠癌（CRC）（P < 0.001）；B-Raf原癌基因、丝氨酸/苏氨酸激酶（BRAF）和Kirsten大鼠肉瘤病毒癌基因同源物（KRAS）检测呈阳性（P均< 0.001）。此外，两组之间的CTX治疗方案显著不同（P < 0.001）。在控制了显著的协变量后，接受TT的患者报告缺乏精力、咳嗽、嗜睡和睡眠困难的发生率较低（均P < 0.05）。接受TT的患者报告口干（P = 0.034）和食物味道改变（P = 0.035）的严重程度评分较低。然而，他们报告“我看起来不像自己”的严重程度评分较高（P = 0.026）。两个治疗组之间在症状困扰评分上未发现差异。
本研究首次使用多维症状评估量表评估单纯接受CTX或接受CTX联合TT的GI癌症患者在症状体验方面的差异。虽然确定了两组患者症状体验的差异，但两个治疗组都需要持续评估以优化症状管理。
