Trajectories and Predictors of Symptom Occurrence, Severity, and Distress in Prostate Cancer Patients Undergoing Radiation Therapy

Abstract

Context Radiation therapy (RT) is a common treatment for prostate cancer. Despite available research, prostate cancer patients report that information about side effects is their most important unmet need. Additional research is needed that focuses on specific dimensions of the patient’s symptom experience. Objectives The study’s purposes were to evaluate the trajectories of occurrence, severity, and distress of the six most prevalent symptoms reported by patients undergoing RT for prostate cancer and to evaluate the effects of selected demographic and clinical characteristics on these trajectories. Methods Patients completed the Memorial Symptom Assessment Scale eleven times before, during, and after RT. For problems with urination, pain, lack of energy, feeling drowsy, difficulty sleeping, and diarrhea, the trajectories of occurrence, severity, and distress were evaluated using multilevel generalized linear models. Results Across all three dimensions, pain, lack of energy, feeling drowsy, and difficulty sleeping followed a decreasing linear trend. Problems with urination and diarrhea demonstrated more complex patterns of change over time. Conclusion Although longitudinal data on pain, lack of energy, feeling drowsy, and difficulty sleeping are limited, they are highly prevalent symptoms in these patients. In addition, diarrhea becomes a significant problem for these patients over the course of RT. A number of demographic and clinical characteristics affects the trajectories of these common symptoms differentially.

Symptoms and self-care strategies during and six months after radiotherapy for prostate cancer – Scoping the perspectives of patients, professionals and literature

“…The occurrence and frequencies of urinary symptoms varied in the literature as well. Most studies reported an increase of urinary symptoms over time (Cameron et al, 2012;Chen et al, 2012;Knapp et al, 2012;McCaughan et al, 2013;Faithfull, 1995;Steginga et al, 2004;Wahlgren et al, 2005), and some reported constant levels of problems during the treatment (Galbraith et al, 2001). Anderson Table 1 Symptoms reported by patients (n ¼ 8), health care professionals (n ¼ 10), and the literature (n ¼ 26).…”

“…In the literature, the most frequently reported symptoms 6 months after the start of radiotherapy were chronic mild to moderate diarrhea and slight to excessive rectal discharge or bleeding (Tsui et al, 2005). Overall, the bowel symptoms increased in severity during the treatment (Chen et al, 2012;Cameron et al, 2012;Knapp et al, 2012;McCaughan et al, 2013) and could remain for quite a long time after cessation of radiotherapy (Galbraith et al, 2001;Steginga et al, 2004;Wahlgren et al, 2005).…”

“…And I was perhaps a little silly thinking I could continue to play tennis … thought I was going to die, had pain everywhere. I thought I had cancer throughout my body, it was the worst experience …" Pain in general during treatment was identified by three studies (Knapp et al, 2012;McCaughan et al, 2013;Maliski et al, 2008) and increased during the treatment in the study by Knapp et al (2012) in contrast to the study by McCaughan et al (2013) that showed that pain levels did not change over time. Pain was not mentioned as a major concern by any of the health care professionals except that they mentioned skeletal pain due to the radiotherapy as it could cause worries that the cancer had spread.…”

“…Fatigue was described as a common problem in the literature (Saligan et al, 2013;Bryant-Lukosius et al, 2010;Maliski et al, 2008), increasing after one week of radiotherapy and peaking significantly at the end of treatment (Saligan et al, 2013;Knapp et al, 2012;McCaughan et al, 2013;Poirier, 2006). However, one month after external radiotherapy no significant difference between patients with non-metastatic prostate cancer undergoing radiotherapy and healthy men was shown (Saligan et al, 2013).…”

Symptom burden among people with chronic disease

“…Symptom research has so far mostly been performed in a context of the most advanced stages of single diseases (Blinderman et al 2008, Blinderman et al 2009), or in people with an ongoing treatment for a severe disease (Knapp et al 2012, Hofsø et al 2013. Early recognition of and timely response to a chronic disease might lead to a more successful diagnosis and treatment (Vestbo et al 2013, McMurray et al 2012).…”