Symptom trajectories during chemotherapy in outpatients with lung cancer colorectal cancer, or lymphoma.
OBJECTIVE
Pain, depression, distress, fatigue, and sleep disturbance are common symptoms in oncology patients, but little data are available that examine the trajectories of these symptoms during chemotherapy (CTX). The purposes of this study were to examine the trajectories of these symptoms during the first six cycles of CTX and to determine whether individual characteristics predicted the trajectories of these symptoms.


METHODS
Oncology outpatients (n = 118) with newly diagnosed lung cancer, colorectal cancer, or lymphoma rated symptoms using an electronic patient care monitor system. Pain, fatigue, and sleep disturbance were rated on 0-10 numeric rating scales; depression and distress were evaluated using scales converted to normalized T scores. Latent growth curve analyses (LGCA) examined for intra- and inter-individual differences in the trajectories of these five symptoms during the six cycles of CTX.


RESULTS
Symptoms were present at the initiation of CTX (p < 0.0001) for all symptoms (p < 0.05). Distress (p = 0.03) and pain (p = 0.02) intensity decreased significantly over the six cycles of CTX. Advanced disease and a higher number of comorbidities predicted higher fatigue at baseline (p = 0.02 and 0.01 respectively). A diagnosis of lung cancer predicted an increasing intensity of fatigue during CTX (p = 0.04). Concurrent radiation therapy predicted more intense pain over time (p = 0.03).


CONCLUSIONS
While symptom trajectories were highly variable in patients undergoing initial CTX, the majority of the symptom intensity scores decreased over time. However, patients with lung cancer, those with a higher number of comorbidities, and those with advanced disease experienced more intense fatigue and sleep disturbance over time.
Billings Clinic Cancer Center, Billings, MT, USA. jbrant@billingsclinic.org
Jeannine M
JM
Brant
Susan L
SL
Beck
William N
WN
Dudley
Patrick
P
Cobb
Ginette
G
Pepper
Christine
C
Miaskowski
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D003863:Depression / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D008223:Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology* / Q000706:statistics & numerical data; D010146:Pain / Q000209:etiology; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology; D013315:Stress, Psychological / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents