Distress Scores in Elderly Cancer Patients During Radiotherapy.

BACKGROUND/AIM: When assigned to radiotherapy (RT), elderly patients may experience distress. We investigated distress during RT and potential risk factors in these patients. PATIENTS AND METHODS: Six-hundred-and-nineteen patients completed pre-RT and post-RT distress thermometers. Seven characteristics were investigated including age, sex, Karnofsky performance score (KPS), grouped KPS, tumor type, intent of RT, and previous RT. Additional analyses were performed in 358 patients with pre-RT scores ≤5. RESULTS: Mean change of distress was -0.5 (±2.7) points and associated with KPS (p=0.005) and grouped KPS (p<0.001). Male sex (p=0.035), KPS 90-100 (p=0.001), and curative intent (p=0.037) were associated with increased distress on univariable analyses, and KPS 90-100 (odds ratio=1.92, p=0.004) on multivariable analysis. In patients with baseline scores ≤5, mean change was +0.5 (±2.5) points and associated with KPS (p=0.040) and grouped KPS (p=0.025). CONCLUSION: Psychological assistance should be considered for all patients including those with baseline scores ≤5 and KPS 90-100. Patients with risk factors for increased distress would especially benefit.

Development of Distress During a Radiotherapy Course in Patients Irradiated for Breast Cancer.

BACKGROUND/AIM: Breast cancer patients receiving radiation therapy (RT) may experience considerable distress. We investigated the course of distress during an RT-course for breast cancer. PATIENTS AND METHODS: Three-hundred-and-thirty breast cancer patients completed Distress Thermometers before and directly after RT. Distress was evaluated in the entire cohort and different groups of age, sex, Karnofsky performance score (KPS), intent of RT, and previous RT. RESULTS: Mean change of distress scores was - 0.4 points, which was significantly associated with KPS. Decrease of distress was more pronounced in patients with KPS ≤80 or age <64 years. Deterioration (yes vs. no) was non-significantly associated with no previous RT. In patients with pre-RT distress scores ≤5 points, mean score increased by +0.5 points; no significant associations between characteristics and investigated endpoints were found. CONCLUSION: Psychological assistance should be offered to all patients irradiated for breast cancer, particularly to those with risk factors, regardless of the pre-RT distress score.

Distress Scores During Radiotherapy for Lung Cancer: Course and Prognostic Factors.

Background/Aim: Cancer treatment can lead to significant distress. We investigated the course of distress during radiotherapy (RT) for lung cancer. Patients and Methods: Data of 159 patients receiving RT for lung cancer were investigated for change of distress scores during RT. Five characteristics were analyzed including age, sex, Karnofsky performance score, intent of RT, and receipt of previous RT. Additional analyses were performed in patients with pre-RT scores ≤5 points. Results: Mean pre-RT and post-RT distress scores were 5.5 (±2.6) and 4.7 (±2.6), respectively. No characteristic was significantly associated with mean change or increase of distress. In patients with pre-RT scores ≤5 points, non-significantly higher rates of increased distress were found for age ≤64 years, female sex, and Karnofsky performance score 90-100. Conclusion: Distress is reduced during a course of RT for lung cancer. This may reflect a reduction in anticipatory distress after first-hand experience.

Final Results of a Study Evaluating the Course of Distress Scores During Radiotherapy for Malignant Diseases.

BACKGROUND/AIM: Patients who receive radiotherapy (RT) may experience significant distress. This study investigated distress scores during RT for a variety of malignancies. PATIENTS AND METHODS: Distress thermometers (scores of 0-10 points) were completed by 927 patients at baseline and end of RT. Six characteristics were evaluated for changes of distress scores including age, sex, Karnofsky performance score (KPS), tumor type, intent of treatment, and previous RT. RESULTS: Mean distress scores were 4.9 (±2.7) at baseline and 4.6 (±2.7) at the end of RT; mean change was -0.3 (±2.8) points. On univariable analysis, increased distress (≥2 points) was significantly associated with KPS 90-100 (p<0.001) and curative intent (p=0.040). Trends were found for age ≤64 years (p=0.062), head-and-neck cancer (p=0.076), and no prior RT (p=0.055). In patients with baseline scores ≤5 points, deterioration rates were 30-47%. CONCLUSION: Psychological support should be offered to all patients undergoing RT. This would benefit particularly patients with risk factors for increased distress.

Development of Distress During a Radiotherapy Course for Head-and-neck Cancer.

BACKGROUND/AIM: Radiotherapy (RT) is a standard treatment for head-and-neck cancer, which can be associated with patient distress. This study provides data investigating distress during head-and-neck RT. PATIENTS AND METHODS: Fifty-six patients completed the Distress Thermometer before and on the last day of their RT-course. Mean changes of distress scores and increase of distress were evaluated. Age, sex, Karnofsky performance score (KPS), tumor type, intent of RT, and previous RT were analyzed for associations with course of distress. RESULTS: Mean pre-RT and post-RT distress scores were 5.1 (±2.6) and 5.0 (±2.7) points, respectively (mean change: ±0.0 points). Mean change of distress scores was significantly associated with age (p=0.042) and KPS (p<0.001). On multivariable analysis, increased distress (by ≥2 points) was associated with KPS 90-100 (p=0.011) and palliative intent of RT (p=0.036). CONCLUSION: Mean pre-RT and post-RT distress scores were almost identical. Patients with risk factors for increased distress during their RT-course should be offered immediate psychological support.

Comparison of Distress Scores Before and After Radiotherapy for Prostate Cancer.

BACKGROUND/AIM: Prostate cancer patients undergoing radiotherapy (RT) may experience distress. This study evaluated the course of distress during RT. PATIENTS AND METHODS: Four distress characteristics were analyzed for change of distress in 136 patients irradiated for prostate cancer, including age, Karnofsky performance score, intent of RT, and previous RT. RESULTS: Mean distress scores were 4.3 (±2.9) at baseline and 4.2 (±2.7) at the end of RT. Associations with increased distress were found for KPS >80 (p<0.001) and curative intent RT (p=0.072). When evaluating increased distress as binary variable (yes vs. no), KPS >80 was significant on univariable (p<0.001) and multivariable (p=0.016) analyses. In patients with baseline scores ≤5 points, KPS >80 was associated with mean change of distress (p=0.009) and increased distress (p=0.029). CONCLUSION: Many patients receiving RT for prostate cancer do not experience increased distress during their treatment course. Patients at higher risk of increased distress may require early psychological assistance.

Comparison of Three Survival Scores in a Series of Patients ≥80 Years of Age Irradiated for Bone Metastases.

BACKGROUND/AIM: Very elderly patients irradiated for bone metastases likely benefit from individualized treatments. A specific survival score was created for this group and compared to existing instruments. PATIENTS AND METHODS: Ninety-six patients aged 80+ irradiated for bone metastases were retrospectively evaluated. Dose-fractionation regimen plus twelve characteristics were evaluated for survival. RESULTS: In the Cox regression model, performance status and tumor type were significant and used for the score, which included three groups (5-7, 8-12, and 14 points) with 6-month survival rates of 15%, 52%, and 90%. Positive predictive values (PPVs) regarding death ≤6 months were 85% (new score), 100% (previous 65+ score), and 84% (previous score for any age). The new instrument and the 65+ score were also very accurate regarding survival. Since PPV regarding death was calculated from only four patients for the 65+ score, this PPV may be less conclusive than that for the new instrument. CONCLUSION: The new score appears useful for patients aged 80+ irradiated for bone metastases.

A New Survival Score for Patients ≥65 Years Assigned to Radiotherapy of Bone Metastases.

Survival scores are important for personalized treatment of bone metastases. Elderly patients are considered a separate group. Therefore, a specific score was developed for these patients. Elderly patients (≥65 years) irradiated for bone metastases were randomly assigned to the test (n = 174) or validation (n = 174) cohorts. Thirteen factors were retrospectively analyzed for survival. Factors showing significance (p < 0.05) or a trend (p < 0.06) in the multivariate analysis were used for the score. Based on 6-month survival rates, prognostic groups were formed. The score was compared to an existing tool developed in patients of any age. In the multivariate analysis, performance score, tumor type, and visceral metastases showed significance and gender was a trend. Three groups were designed (17, 18−25 and 27−28 points) with 6-month survival rates of 0%, 51%, and 100%. In the validation cohort, these rates were 9%, 55%, and 86%. Comparisons of prognostic groups between both cohorts did not reveal significant differences. In the test cohort, positive predictive values regarding death ≤6 and survival ≥6 months were 100% with the new score vs. 80% and 88% with the existing tool. The new score was more accurate demonstrating the importance of specific scores for elderly patients.

Distress Scores During a Course of Radiotherapy: A Pilot Study.

BACKGROUND/AIM: Many cancer patients receive radiotherapy, which may cause distress. This pilot study evaluated distress levels before and after radiotherapy to contribute to the design of a prospective trial. PATIENTS AND METHODS: Two-hundred patients completed distress thermometers before and after radiotherapy. Distress levels ranged from 0 (no distress) to 10 (maximum distress). Five characteristics were retrospectively analyzed regarding changes of distress including age, sex, performance score, tumor type, previous radiotherapy, and treatment intention. Additional analyses were performed for elderly (>65 years) and non-elderly (≤65 years) patients. RESULTS: In all patients and both age groups, median pre-radiotherapy and post-radiotherapy distress levels were 5 (0-10) vs. 4 (0-10) points. Mean changes of distress levels were -0.5 (±2.6) points in all, -0.4 (±2.5) in elderly, and -0.7 (±2.8) in non-elderly patients. Changes were significantly associated with tumor type in all (p=0.049) and elderly (p=0.025) patients. CONCLUSION: Future studies investigating distress levels in patients receiving radiotherapy should consider age and tumor type.

A Survival Score for Very Elderly Patients With Brain Metastases Assigned to Stereotactic Radiosurgery or Fractionated Stereotactic Radiotherapy.

BACKGROUND/AIM: Very elderly patients may benefit from individualized treatment. A survival score was created for patients aged 80+ receiving radiosurgery or fractionated stereotactic radiotherapy for 1-2 brain metastases. PATIENTS AND METHODS: Thirteen patients were retrospectively evaluated. Characteristics showing significant associations with survival or trends were used for analysis. Prognostic groups were calculated from scoring points of these characteristics (0=worse, 1=better survival) added for each patient. RESULTS: Survival was significantly associated with performance score (p=0.010). Trends were found for histology (p=0.066) and diameter of lesions (p=0.071). Three groups were created (0, 1-2, 3 points) with 6-month survival rates of 0%, 56%, and 100% (p=0.025). Positive predictive values (PPVs) to predict death ≤6 months were 100% with the new score vs. not available and 50% with previous scores; PPVs regarding survival ≥6 were 100% vs. 75% and 67%. CONCLUSION: Given its limitations, the score was more precise than previous tools and can serve for orientation in patients aged 80+.

The First Survival Score for Patients Aged ≥80 Years Irradiated for Brain Metastases.

Survival scores facilitate personalized cancer treatment. Due to demographic changes, very elderly patients are more prevalent than in the past. A score was developed in 94 patients aged ≥ 80 years undergoing whole-brain radiotherapy for brain metastases. Dose fractionation, treatment period, age, sex, performance score (ECOG-PS), tumor type, count of lesions, metastases outside the brain, and interval tumor diagnosis to radiotherapy were retrospectively evaluated. Independent predictors of survival were used for the score. Based on individual scoring points obtained from 3-month survival rates, prognostic groups were designed. Additionally, the score was compared to an existing tool developed in patients ≥ 65 years. ECOG-PS, count of lesions, and extra-cranial metastases were independent prognostic factors. Three groups were created (7, 10, and 13−16 points) with 3-month survival of 6%, 25%, and 67% (p < 0.001), respectively. Positive predictive values (PPVs) regarding death ≤ 3 and survival ≥ 3 months were 94% and 67% (new score) vs. 96% and 48% (existing tool), respectively. PPVs for survival ≥1 and ≥2 months were 88% and 79% vs. 63% and 58%, respectively. Both tools were accurate in predicting death ≤2, ≤3, and ≤6 months. The new score was more precise regarding death ≤1 month and survival (all time periods) and appeared preferable. However, it still needs to be validated.