title: Differences in symptom occurrence, severity, and distress ratings between patients with gastrointestinal cancers who received chemotherapy alone or chemotherapy with targeted therapy.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Ilufredo Y
authors.initials: IY
authors.lastname: Tantoy
authors.affiliation: Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Dhruva
authors.affiliation: Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Janine
authors.initials: J
authors.lastname: Cataldo
authors.affiliation: Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Venook
authors.affiliation: Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cooper
authors.affiliation: Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.affiliation: Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Levine
authors.affiliation: Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Yvette P
authors.initials: YP
authors.lastname: Conley
authors.affiliation: Department of Nursing, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Frances
authors.initials: F
authors.lastname: Cartwright
authors.affiliation: Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Nursing and Acute Care/Health Systems, School of Nursing, Yale University, New Haven, CT, USA.
authors.forename: Fay
authors.initials: F
authors.lastname: Wright
authors.affiliation: Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
keywords: Gastrointestinal cancer; chemotherapy (CTX); symptoms; targeted therapy (TT)