Expanded validation of the EPIC bowel and urinary domains for use in women with gynecologic cancer undergoing postoperative radiotherapy

Gil, Karen M.; Pugh, Stephanie L.; Klopp, Ann H.; Yeung, Anamaria R.; Wenzel, Lari; Westin, Shannon N.; Gaffney, David K.; Small, William; Thompson, Spencer; Doncals, Desiree E.; Cantuaria, Guilherme; Yaremko, Brian; Chang, Amy; Kundapur, Vijayananda; Mohan, Dasarahally S.; Haas, Michael L.; Kim, Yong Bae; Ferguson, C.L.; Deshmukh, Snehal; Kachnic, Lisa A.; Bruner, Deborah Watkins

doi:10.1016/j.ygyno.2019.04.682

Cited by 13 publications

(15 citation statements)

References 21 publications

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“…Our findings need to be validated in studies with larger cohorts. Despite these limitations, these patients received current standard treatments with adequate follow-up, and their outcomes are comparable to previous studies [ 6 , 7 , 8 ].…”

Section: Discussionsupporting

confidence: 72%

“…However, we found that the PRO-CTCAE, PG-SGA, and body composition changes were not different between patients with chemotherapy and without chemotherapy. The possible explanation might be that patients in this study received intensity-modulated radiotherapy that can deliver focused radiation to the pelvic lymphatic regions while minimizing doses to the bowel and therefore lowering the GI toxicity [ 6 , 7 , 8 ]. However, it should be noted that the GI toxicity of pelvic radiotherapy is mainly abdominal pain and diarrhea, while nausea and vomiting are mainly related to chemotherapy [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pelvic radiotherapy is associated with gastrointestinal (GI) toxicities, including diarrhea, abdominal pain, food intolerance, and fecal incontinence [ 6 ]. GI toxicities are burdensome to patients, interfere with the quality of life, and can lead to nutritional status deterioration and muscle loss [ 7 , 8 , 9 , 10 , 11 , 12 ]. Muscle loss can, in turn, affect outcome and quality of life in women with gynecologic cancer [ 10 , 11 , 12 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Association of Patient-Reported Outcomes and Nutrition with Body Composition in Women with Gynecologic Cancer Undergoing Post-Operative Pelvic Radiotherapy: An Observational Study

et al. 2021

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Pelvic radiotherapy is associated with gastrointestinal toxicities and deterioration of nutritional status. This study aimed to investigate the association of patient-reported outcomes (PROs) and nutritional status with body composition changes in women who underwent hysterectomy and post-operative radiotherapy for gynecologic cancer. We analyzed data of 210 patients treated with post-operative pelvic radiotherapy for gynecologic cancer between 2013 and 2018. The PRO version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) was used for gastrointestinal toxicity assessment. The Patient-Generated Subjective Global Assessment (PG-SGA) was used for nutritional assessment. Skeletal muscle index was measured from computed tomography scans at the L3 vertebral level. A reduction in skeletal muscle index ≥ 5% was classified as muscle loss. Odds ratios were calculated through logistic regression models. The PG-SGA score increased from the beginning to the end of radiotherapy (1.4 vs. 3.7, p < 0.001). Patients with PRO-CTCAE scores ≥ 3 had significantly higher PG-SGA scores at the end of radiotherapy than those with PRO-CTCAE scores ≤ 2 (8.1 vs. 2.3, p < 0.001). On multivariable analysis, PRO-CTCAE scores ≥ 3 and PG-SGA scores ≥ 4 at the end of radiotherapy were independently associated with increased risk of muscle loss (odds ratio: 8.81, p < 0.001; odds ratio: 72.96, p < 0.001, respectively). PROs and PG-SGA may be considered as markers of muscle loss after post-operative pelvic radiotherapy for gynecologic cancer.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Patient-Reported Outcomes and Nutrition with Body Composition in Women with Gynecologic Cancer Undergoing Post-Operative Pelvic Radiotherapy: An Observational Study

et al. 2021

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“…EPIC was later validated for use in a female population. 134 There are also sexual, hormonal, and health-related quality of life domains of EPIC. The different domains can be used separately from each other.…”

Section: Patient-reported Symptomsmentioning

confidence: 99%

“…It can be used for both male and female subjects, and it covers both qualitative and quantitative symptoms. 134 EPIC only requires input from the patient and can hence be used for long-term evaluation without clinical assessment. Furthermore, EPIC is validated and has been used for over 20 years.…”

Section: Does Hbot Help At All? -Paper Imentioning

confidence: 99%

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Oscarsson

Müller

Rosén

et al. 2019

The Lancet Oncology

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Introduction Cancer is affecting a growing number of persons. Still, the treatment and survival of cancer is improving. Radiation therapy is used in the treatment of cancer. Late radiation-induced injuries afflict 5-15% of irradiated patients. The urinary bladder and bowel may be affected after irradiation of cancer in the pelvic region. Symptoms can be severe, with impaired health related quality of life (HRQoL). Hyperbaric oxygen therapy (HBOT) involves breathing oxygen at high ambient pressure. HBOT can reverse radiation-induced injuries, alleviate patient-perceived symptoms, and improve HRQoL. We aimed to clarify the effects of HBOT on late radiation-induced injuries in the urinary bladder and bowel, and to clarify some of the underlying mechanisms through which HBOT exerts its effects. Methods A prospective cohort study assessed effects of HBOT on patient-perceived symptoms (Paper I). A rat study assessed reversal of radiation-induced stress with HBOT (Paper II). A methodological experiment assessed reversal of HBOT on cellular death induced by radiation (Paper III). A multi-center, randomized, controlled trial assessed patient-perceived symptoms, HRQoL, and objective clinical outcomes (Paper IV). Result HBOT can alleviate patient-perceived symptoms, reduce objective findings, and improve HRQoL in patients affected by late radiation-induced injuries (Paper I, IV). Oxidative stress and downstream effects, induced by the irradiation, can be reversed by HBOT (Paper II). Paper III outlines a method for studies on urothelial cells exposed to radiation and HBOT. Conclusion HBOT can reduce radiation-induced oxidative stress and inflammatory response. HBOT can reverse injuries induced by radiation therapy to the pelvic region, alleviate patient-perceived symptoms and lead to improved HRQoL.

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Symptom burden, psychological distress, and health-related quality of life in cancer survivors with pelvic late radiation tissue injuries

Velure

Müller

Hauken

2021

Support Care Cancer

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Purpose Curative radiotherapy for cancer may lead to severe late radiation tissue injuries (LRTIs). However, limited knowledge exists about pelvic cancer survivors’ LRTI symptoms, distress, and health-related quality of life (HRQOL). We sought to assess the symptom burden, distress, and HRQOL in survivors with established pelvic LRTIs compared to norm populations and to investigate the relation between these factors. Methods Cancer survivors referred for treatment of established pelvic LRTIs were recruited nationwide. LTRIs were assessed with the Expanded Prostate Cancer Index Composite (EPIC), psychological distress was assessed with the General Health Questionnaire (GHQ-12), and HRQOL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORCT-QLQ-C30). Results A total of 107 participants (mean age 64, 53% men) were included. Compared to norms, participants reported more urinary (mean 68.7 vs. 89.5; p = 0.00; d = 1.4) and bowel symptoms (mean 62.5 vs. 92.4; p = 0.00; d = 2.7), increased psychological distress (mean 13.4 vs. 10.3; p = 0.00; d = 0.6), and overall poorer HRQOL (mean 54.9 vs. 71.2; p = 0.00; d = 0.7). Higher symptom burden and higher levels of psychological distress were associated with lower HRQOL (r2 = 46%), but psychological distress did not moderate the influence of symptoms on HRQOL. Conclusion Cancer survivors with established pelvic LRTIs are highly burdened compared to norms. The association of the LRTI-related symptom burden with HRQOL is independent of the level of psychological distress. Both coping and treatment interventions are crucial to promoting long-term health and HRQOL. Trial registration NCT03570229.

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Expanded validation of the EPIC bowel and urinary domains for use in women with gynecologic cancer undergoing postoperative radiotherapy

Cited by 13 publications

References 21 publications

Association of Patient-Reported Outcomes and Nutrition with Body Composition in Women with Gynecologic Cancer Undergoing Post-Operative Pelvic Radiotherapy: An Observational Study

Association of Patient-Reported Outcomes and Nutrition with Body Composition in Women with Gynecologic Cancer Undergoing Post-Operative Pelvic Radiotherapy: An Observational Study

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2–3 trial

Symptom burden, psychological distress, and health-related quality of life in cancer survivors with pelvic late radiation tissue injuries

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