High Symptom Burden in Patients Receiving Radiotherapy and Factors Associated with Being Offered an Intervention.

Patient report outcomes are commonly collected during oncology visits to elicit symptom burden and guide management. We aimed to determine the frequency of intervention for patients undergoing radiotherapy with high symptom complexity scores and identify which factors are associated with being offered an intervention. A retrospective chart audit was completed of adult patients with cancer who had at least one radiotherapy appointment and were assigned a high symptom complexity. A total of 200 patients were included; 150 (75.0%) patients were offered an intervention for the main symptom. The most offered intervention was medications. Multivariable logistic regression showed factors associated with being offered an intervention were the following: symptom score of 9 (OR = 9.56, 95% CI 1.64-62.8) and 10 (OR = 7.90, 95% CI 1.69-38.2); palliative intent radiation (OR 3.87, 96% CI 1.46-11.1); and last review appointment (OR 6.22, 95% CI 1.84-23.3). Symptoms associated with being offered an intervention included pain (OR 22.6, 95% CI 6.47-91.1), nausea (OR 15.7, 95% CI 1.51-412), shortness of breath (OR 7.97, 95% CI 1.20-63.7), and anxiety (OR 6.69, 95% CI 1.58-31.6). This knowledge will help guide clinical practice to understand symptom burden and how we can improve our management of patients' symptoms.

Feasibility and Acceptability of Implementing Site-Specific Patient-Reported Outcome Measure in Head and Neck Cancer Clinics: A Prospective Institutional Study.

Purpose: To assess the feasibility and acceptability of implementing the MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) module in cancer clinics and its effect on patient-reported experience. Methods: We conducted a prospective, longitudinal study at a tertiary cancer institution between September 2020 and August 2021. Patients with newly diagnosed head and neck (HN) cancer who were evaluated to receive radiation therapy with or without chemotherapy and could communicate in English were approached to participate. The primary outcome was feasibility and acceptability of the MDASI-HN implementation in the radiation oncology department assessed by patient and provider exit surveys. Secondary outcomes were patient-reported experience as recorded by a shortened Your Voice Matters survey (YVM) in 2 cohorts pre- and post-MDASI-HN implementation and symptom scores. Descriptive statistics were used for exit surveys and symptom scores. Mann-Whitney tests were used to assess differences in positive responses between pre- and postimplementation for each YVM question. Cochrane-Armitage tests were used to examine changes in patient-reported experience over time. Results: Fifty-one patients were enrolled in the postimplementation cohort and 29 (60%) responded to the exit survey. Eighty-nine percent of patients reported that MDASI-HN made it easier to remember symptoms, and 86% recommend its use in routine care. Four of the 5 radiation oncology HN providers (80%) responded to exit surveys; 75% felt the MDASI-HN provided clinically relevant information, improved communication with patients, and did not increase clinic time. The overall patient-reported experience was not affected by the implementation (P = .82). The probability of positive responses over time was significant (P = .025) in the clinic coordination domain for the postimplementation cohort. Conclusions: Implementation of MDASI-HN was feasible and acceptable by patients and providers. Although the overall patient-reported experience was not affected by implementation, some aspects improved as treatment progressed.

Comparing the M.D. Anderson Symptom and Dysphagia Inventories for Head and Neck Cancer Patients.

OBJECTIVES: Where patient-reported outcome measures (PROMs) may be administered at multiple patient visits, it is advantageous to capture these symptoms with as few questions as possible. In this study, the M.D. Anderson Head and Neck Symptom Inventory (MDASI-HN), and the M.D. Anderson Dysphagia Inventory (MDADI) is compared to determine if using the MDASI-HN alone would overlook symptoms identified with MDADI. METHODS: The MDASI-HN and the MDADI were completed by 156 patients, postradiotherapy for head and neck cancer (HNC). Associations between the two instruments were analyzed using correlation analysis, unsupervised machine learning, and sensitivity analysis. RESULTS: Little correlation was found between the two surveys; however, there was overlap between MDASI-HN dry mouth and many MDADI items, confirming that dry mouth is an important factor in difficulty swallowing, and patient QoL. Taking longer to eat (MDADI), was the most commonly reported item overall, with 85 (54%) patients rating it as moderate-severe. Dry mouth was the most endorsed MDASI-HN item (68, 44%). There were 51 patients missed by the MDASI-HN, reporting no moderate-severe symptoms, but reported one or more moderate-severe QoL impacts on MDADI. If patients who reported a score of 2 or higher on the MDASI-HN Dry Mouth item are flagged as requiring follow-up, the number of patients missed by MDASI-HN drops to 15. CONCLUSION: In an HNC clinic where MDASI-HN is routinely administered, assessment of symptoms and QoL might be enhanced by reducing the value at which MDASI Dry Mouth is considered moderate-severe to 2. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2388-2395, 2022.

Diagnostic timelines and self-reported symptoms of patients with lung and gastrointestinal cancers undergoing radiation therapy. Retrospective case control study.

BACKGROUND: Previous studies have found that patients with lung cancer report worse patient experience compared to other tumour groups. Reasons that may negatively impact patient experience include delays in diagnosis as well as inadequate symptom management. The purpose of this study was to compare the diagnostic timelines and symptom reports of patients with lung and gastrointestinal (GI) cancers. METHODS: This study included patients diagnosed with lung or GI cancers who attended a radiation oncology (RO) consultation and/or received radiation treatment between May and August 2019 at the Tom Baker Cancer Centre, Calgary, Alberta, Canada. Data collected included demographics, dates of diagnostic time points, and self-reported symptom scores across 3 time points. A descriptive analysis was completed, and the median number of days between time points was compared between tumour groups. RESULTS: Patients with lung cancer had longer diagnostic timelines compared to GI patients. The median number of days between the first investigative test and biopsy was 21 days longer for patients with lung cancer (p < 0.05). From RO consultation to the first treatment review appointment, 25% and 4% of lung and GI patients, respectively, reported worsening of symptoms. A greater proportion of lung patients reported worse symptom scores during treatment compared to GI patients. This varied by specific symptom. CONCLUSIONS: Patients with lung cancer experienced delays in receiving a diagnosis and worse symptom burden during radiation therapy in this study. We identified potential targets to improve patient experience.

Comparison of Patient-Reported Experience of Patients Receiving Radiotherapy Measured by Two Validated Surveys.

Patient-reported experience is associated with improved patient safety and clinical outcomes. Quality improvement programs rely on validated patient-reported experience measures (PREMs) to design projects. This descriptive study compares the experience of cancer patients treated with radiation as recorded through the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) or as recorded through Your Voice Matters (YVM) between February and August 2019. Six questions were compared ("overall experience with care", "discussion of worries", "involvement in decisions", "trusting providers with confidential information", "providing family with information", and "knowing who to contact"). Positive experience scores were calculated by cohort and by tumor groups. Multivariable logistic regression models evaluated factors associated with positive experience. Two cohorts (220 and 200 patients) met the eligibility criteria for the AOPSS and YVM, respectively. Positive experience was reported similarly between the two PREMs for "overall experience with care", "discussion of worries", and "trusting providers with confidential information" with a score difference of 1-4% at the cohort level. Positive experience score difference ranged from 5% to 44% across questions at the tumor group level. Different experience gaps were identified with the two measures, mainly at the tumor group level. Programs interested in using these PREMS might consider this when designing projects.

Facilitators and barriers to participation in lifestyle modification for men with prostate cancer: A scoping review.

PURPOSE: Diet and physical activity changes have been shown to improve quality of life and health outcomes for prostate cancer (PC) survivors; however, few survivors make lifestyle changes. We aimed to identify PC-specific facilitators and barriers to dietary and physical activity changes and participation in survivorship-based lifestyle management programmes. METHODS: A scoping review investigating facilitators and barriers of PC survivor's participation in lifestyle management programmes was conducted in June 2018. A total of 454 studies were identified, 45 studies were assessed in full, and 16 were included in the scoping review. RESULTS: Barriers to lifestyle change included perceived lack of evidence for lifestyle guidelines, treatment side effects, perception of change as unnecessary, time pressure and age. Facilitators for lifestyle change included advice from health professionals, support systems (family and peer), diagnosis as a time for change, lifestyle as a coping strategy to manage side effects and improve well-being. CONCLUSIONS: Health professionals, peers and family have a significant role in lifestyle management for PC survivors to facilitate engagement. Specific and clear messaging of the benefits of lifestyle management is warranted. Treatment-related side effects, time pressure, current health perception and age should be considered when developing lifestyle management programmes for PC survivors.

The association between recreational physical activity, sedentary time, and colorectal polyps in a population screened for colorectal cancer.

PURPOSE: Regular recreational moderate to vigorous physical activity (rMVPA) has been previously associated with a reduced risk of colorectal cancer (CRC), however, few studies have examined the association of rMVPA with colorectal polyps, the pre-malignant precursor lesions. The objective of this study was to examine the associations between physical activity and sitting time and polyps at the time of screening. METHODS: We conducted a cross-sectional study of 2496 individuals undergoing screening-related colonoscopy in Calgary, Alberta, Canada. Physical activity and sitting time were characterized using hours of rMVPA, meeting physical activity recommendations and hours of sitting time using self-reported data obtained from the International Physical Activity Questionnaire. Logistic regression models were used to estimate the crude and adjusted odds ratios (OR) for presence of polyps associated with rMVPA and sitting time. RESULTS: Meeting physical activity guidelines of ≥150 min/week was non-significantly associated with a modest decrease in odds of having ≥1 polyp at screening (ORadj = 0.95, 95% CI: 0.80-1.14). In males, threshold effects for sitting time were observed for up to 20 h/week (ORadj per hour sitting = 1.07, 95% CI: 1.01-1.13). In stratified analysis, larger inverse associations were observed between physical activity and the presence of polyps in females, obese individuals, and ever smokers, compared to pooled findings. CONCLUSIONS: In this large CRC screening population, there was a suggestive association between increased rMVPA and reduced prevalence of polyps at screening, particularly among females. Even low amounts of regular sitting time (0-20 h/day) were associated with the presence of polyps, particularly among males. Further research on rMVPA and sitting time is necessary to better inform strategies to reduce the frequency of pre-malignant colorectal lesions.

Leisure-time physical activity and lung cancer risk: A systematic review and meta-analysis.

OBJECTIVES: We conducted a systematic review and meta-analysis of the association between recreational physical activity and lung cancer risk to update previous analyses and to examine population subgroups of interest defined by smoking status and histology. MATERIALS AND METHODS: We searched the PubMed database for studies up to May 2015. Individual study characteristics were abstracted including study design, number of cases, assessment of recreational physical activity and type and level of adjustment for confounding factors. Combined effect estimates were calculated for the overall associations and across subgroups of interest. RESULTS: We identified 28 studies that were eligible for inclusion in the meta-analysis. The overall analysis indicated an inverse association between recreational physical activity and lung cancer risk (Relative Risk (RR), 0.76; 95% Confidence Interval (CI), 0.69-0.85, p-value: <0.001). Similar inverse associations with risk were also noted for all evaluated histological subtypes, including adenocarcinoma (RR, 0.80; 95% CI, 0.72-0.88), squamous (RR, 0.80; 95% CI, 0.71-0.90) and small cell (RR, 0.79; 95% CI, 0.66-0.94). When we examined effects by smoking status, inverse associations between recreational physical activity and lung cancer risk were observed among former (RR, 0.77; 95% CI, 0.69-0.85) and current smokers (RR, 0.77; 95% CI, 0.72-0.83), but not among never smokers (RR, 0.96; 95% CI, 0.79-1.18). CONCLUSION: Results from this meta-analysis suggest that regular recreational physical activity may be associated with reduced risk of lung cancer. Only four studies examining never smokers were identified, suggesting the need for additional research in this population.