Tools Track Lung Cancer Recovery
CancerWise - November 2007
By Sandi Stromberg
Physicians are using two new tools to help patients with stage II-III locally advanced inoperable non-small cell lung cancer (NSCLC) understand the potential side effects of chemotherapy and radiation, oncologists say.
The tools are an interactive voice response system (IVRS), a computer- and telephone-based assessment system, and the M. D. Anderson Symptom Inventory for lung cancer patients undergoing chemoradiation (MDASI-Lung).
Significance of results
The tools have significantly improved oncologists' understanding of patients’ symptom distress. Results of a study testing the IVRS and MDASI-Lung were published in the September 2006 Journal of Clinical Oncology.
“This study is very important in helping us educate patients,” says Zhongxing Liao, M.D., an associate professor in M. D. Anderson’s Department of Radiation Oncology.
“Before a patient starts, we can go over the symptoms associated with treatment, and patients appreciate that. Patients cope with the symptoms much better if they know what to expect. We used to get complaints, like ‘Nobody told me this was going to happen,’ or ‘I didn’t know this was going to be so bad.'"
The MDASI-Lung identifies 15 symptoms, caused either by the disease or treatment, and six symptoms that interfere with daily activities.
The 15 symptoms are:
- Disturbed sleep
- Shortness of breath
- Trouble remembering things
- Lack of appetite
- Dry mouth
- Numbness or tingling
- Sore throat
Patients may experience interference in:
- General activity
- Work (including work around the house)
- Enjoyment of life
For most patients with locally advanced inoperable NSCLC, standard care consists of concurrent chemotherapy and radiation, which have acute physical and non-specific symptoms that contribute to patients’ general distress.
To better understand these side effects, 64 patients being treated in the Department of Radiation Oncology were asked to use the IVRS and the MDASI-Lung questionnaire.
During the 12-week treatment regimen, all patients:
- Received a weekly phone call from the IVRS
- Used their telephone keypads to report symptom severity
Information was reported using a 0-10 scale — with 0 meaning not affected, 10 being as bad as you can imagine.
This study documented several clusters of symptoms that have impacted the daily functioning of this patient population.
Liao and the other researchers also found that their assumption that patients would feel better toward the end of treatment as the body started to heal was not true.
“We learned that symptoms last two to three weeks after treatment." Liao says. "In fact, they probably get worse during the first and second week after completion of chemoradiation.”
As a result, before patients go home, Liao tells them not to reduce their pain medication and not to remove their feeding tubes if their ability to swallow has not totally returned to normal due to the chemoradiation, because they need to maintain their hydration and pain control.
“This advice is based on these symptom studies, which will help us develop guidelines and treatment of the symptoms in the future,” she says.
The study's lead author is Xin Shelley Wang, M.D., an associate professor in the Department of Symptom Research. It is one of three clinical trials targeting a continuum of symptom management for patients with NSCLC from stage I to stage IV.
Liao’s team is preparing to begin two other studies to help define symptom burden in patients receiving different amounts and types of radiation therapy, such as intensity modulated radiation or proton beam radiation.