TY - JOUR
T1 - Prospective Study of Patient-Reported Symptom Burden in Patients with Non-Small-Cell Lung Cancer Undergoing Proton or Photon Chemoradiation Therapy
AU - Wang, Xin Shelley
AU - Shi, Qiuling
AU - Williams, Loretta A.
AU - Komaki, Ritsuko
AU - Gomez, Daniel R.
AU - Lin, Steven H.
AU - Chang, Joe Y.
AU - O'Reilly, Michael S.
AU - Bokhari, Raza H.
AU - Cox, James D.
AU - Mohan, Radhe
AU - Cleeland, Charles S.
AU - Liao, Zhongxing
N1 - Publisher Copyright:
© 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Context Intensity-modulated radiation therapy (IMRT), three-dimensional conformal radiation therapy (3DCRT), and proton-beam therapy (PBT) are chemoradiotherapy modalities for treating locally advanced non-small-cell lung cancer. Although therapy is carefully planned to maximize treatment benefit while minimizing risk for adverse side effects, most patients develop radiation-induced symptom burden. Objectives To demonstrate the MD Anderson Symptom Inventory's ability to detect fine differences in symptom development among these modalities. Methods This was a longitudinal observational study. Patients with unresectable primary or recurrent non-small-cell lung cancer (n = 82) underwent 3DCRT, IMRT, or PBT. Patients rated MD Anderson Symptom Inventory symptoms weekly for up to 12 weeks. We used mixed-effect modeling to estimate development of symptoms and functional interference. Results The PBT group received a significantly higher radiation target dose than did the IMRT and 3DCRT groups (P < 0.001). Fatigue was the most severe symptom over time for all groups. Controlling for patient and clinical factors (age, sex, race, cancer stage, performance status, body mass index, previous cancer therapy, total radiation dose), we found that pain, as a major esophagitis-related symptom, increased more during therapy (P = 0.019) and decreased more after (P = 0.013) therapy in the 3DCRT and IMRT groups than in the PBT group. Compared with the PBT group, the 3DCRT and IMRT groups reported greater decrease in systemic symptoms (fatigue, drowsiness, lack of appetite, disturbed sleep) after therapy (P = 0.016). Conclusion Patients receiving PBT reported significantly less severe symptoms than did patients receiving IMRT or 3DCRT. These results should be confirmed in a randomized study with comparable tumor burden among therapies.
AB - Context Intensity-modulated radiation therapy (IMRT), three-dimensional conformal radiation therapy (3DCRT), and proton-beam therapy (PBT) are chemoradiotherapy modalities for treating locally advanced non-small-cell lung cancer. Although therapy is carefully planned to maximize treatment benefit while minimizing risk for adverse side effects, most patients develop radiation-induced symptom burden. Objectives To demonstrate the MD Anderson Symptom Inventory's ability to detect fine differences in symptom development among these modalities. Methods This was a longitudinal observational study. Patients with unresectable primary or recurrent non-small-cell lung cancer (n = 82) underwent 3DCRT, IMRT, or PBT. Patients rated MD Anderson Symptom Inventory symptoms weekly for up to 12 weeks. We used mixed-effect modeling to estimate development of symptoms and functional interference. Results The PBT group received a significantly higher radiation target dose than did the IMRT and 3DCRT groups (P < 0.001). Fatigue was the most severe symptom over time for all groups. Controlling for patient and clinical factors (age, sex, race, cancer stage, performance status, body mass index, previous cancer therapy, total radiation dose), we found that pain, as a major esophagitis-related symptom, increased more during therapy (P = 0.019) and decreased more after (P = 0.013) therapy in the 3DCRT and IMRT groups than in the PBT group. Compared with the PBT group, the 3DCRT and IMRT groups reported greater decrease in systemic symptoms (fatigue, drowsiness, lack of appetite, disturbed sleep) after therapy (P = 0.016). Conclusion Patients receiving PBT reported significantly less severe symptoms than did patients receiving IMRT or 3DCRT. These results should be confirmed in a randomized study with comparable tumor burden among therapies.
KW - Key Words Symptom
KW - MDASI
KW - NSCLC
KW - patient-reported outcomes
KW - proton-beam therapy
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U2 - 10.1016/j.jpainsymman.2015.12.316
DO - 10.1016/j.jpainsymman.2015.12.316
M3 - Article
C2 - 26891607
AN - SCOPUS:84959420071
SN - 0885-3924
VL - 51
SP - 832
EP - 838
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 5
ER -