Cancer-related fatigue is defined as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. It is one of the most common side effects in patients with cancer. Fatigue has been shown to be a consequence of active treatment, but it may also persist into posttreatment periods. Furthermore, difficulties in end-of-life care can be compounded by fatigue. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cancer-Related Fatigue provide guidance on screening for fatigue and recommendations for interventions based on the stage of treatment. Interventions may include education and counseling, general strategies for the management of fatigue, and specific nonpharmacologic and pharmacologic interventions. Fatigue is a frequently underreported complication in patients with cancer and, when reported, is responsible for reduced quality of life. Therefore, routine screening to identify fatigue is an important component in improving the quality of life for patients living with cancer.
Technology‐aided remote interventions for poorly controlled symptoms may improve cancer symptom outcomes. In a randomized controlled trial, the efficacy of an automated symptom management system was tested to determine if it reduced chemotherapy‐related symptoms. Prospectively, 358 patients beginning chemotherapy were randomized to the Symptom Care at Home (SCH) intervention (n = 180) or enhanced usual care (UC) (n = 178). Participants called the automated monitoring system daily reporting severity of 11 symptoms. SCH participants received automated self‐management coaching and nurse practitioner (NP) telephone follow‐up for poorly controlled symptoms. NPs used a guideline‐based decision support system. Primary endpoints were symptom severity across all symptoms, and the number of severe, moderate, mild, and no symptom days. A secondary endpoint was individual symptom severity. Mixed effects linear modeling and negative binominal regressions were used to compare SCH with UC. SCH participants had significantly less symptom severity across all symptoms (P < 0.001). On average, the relative symptom burden reduction for SCH participants was 3.59 severity points (P < 0.001), roughly 43% of UC. With a very rapid treatment benefit, SCH participants had significant reductions in severe (67% less) and moderate (39% less) symptom days compared with UC (both P < 0.001). All individual symptoms, except diarrhea, were significantly lower for SCH participants (P < 0.05). Symptom Care at Home dramatically improved symptom outcomes. These results demonstrate that symptoms can be improved through automated home monitoring and follow‐up to intensify care for poorly controlled symptoms.
Importance Chemotherapy induced peripheral neuropathy is a common side effect of neurotoxic chemotherapy resulting in pain, sensory loss and decreased quality of life. Few studies have prospectively examined the relationship between sensory neuropathy symptoms, falls and fall related injuries in those receiving neurotoxic chemotherapy. Objective Determine the association between the symptoms of chemotherapy induced peripheral neuropathy (CIPN) and fall risk in those receiving neurotoxic chemotherapy. Design Patients starting neurotoxic chemotherapy with a taxane or platinum called a novel automated phone system daily for one full course of chemotherapy. The phone system, “Symptom Care @ Home” utilized a series of relevant CIPN questions to track symptoms on a 0–10 ordinal scale and contained a questionnaire about falls. Those reporting a numbness and tingling severity of 3 or greater for at least 10 days were considered to have significant CIPN symptoms and were compared to those who did not. Setting Ambulatory participants at an academic cancer center. Participants A consecutive sample of breast, ovarian and lung cancer patients beginning neurotoxic chemotherapy was recruited from oncology clinics. The study population was largely female (94%) and Caucasian (96%). Exposures Chemotherapy with a neurotoxic taxane or platinum agent. Main Outcome Measure Patient reported fall events (falls or near falls) and fall related injuries. The hypothesis was generated after data collection but prior to data analysis. Results 32/116 patients met the predetermined criteria for CIPN symptoms. The mean duration of follow up was 62 days with 51 calls completed per participant. 74 fall events were reported. Those with CIPN symptoms were nearly 3 times more likely to have a fall event than those without (HR 2.67, CI 1.62–4.41, p<0.001). The CIPN group was more likely to obtain medical care for falls (25.0% vs. 7.1%, p=0.013). Conclusions and Relevance These findings suggest the sensory symptoms of CIPN are an indicator of increased fall risk and health care utilization. This study demonstrates the utility of a novel phone based system to track neuropathy symptoms. Careful monitoring and coaching of patients receiving neurotoxic chemotherapy for new sensory symptoms may facilitate more effective fall prevention strategies.
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period. This portion of the guidelines describes recommendations regarding the management of anthracycline-induced cardiotoxicity and lymphedema. In addition, recommendations regarding immunizations and the prevention of infections in cancer survivors are included.
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