Experiencing neutropenia: Quality of life interviews with adult cancer patients

BACKGROUND: Neutropenia is a common toxicity in chemotherapy but detailed information about how neutropenia is associated with changes in patients' quality of life is not readily available. This prospective study interviewed patients with grade 4 neutropenia to provide qualitative information on patients' experience of developing and coping with grade 4 neutropenia during a cycle of chemotherapy. METHODS: A sample of 34 patients who developed grade 4 neutropenia during the first cycle of chemotherapy completed a total of 100 structured clinical interviews. Interviews were transcribed, and 2 raters inductively developed 5 broad categories comprising 80 specific complaint domains nominated by patients. Thirty-five patient-nominated problems were mentioned in 5% or more of the interviews. RESULTS: Fatigue was the most common physical symptom. Interference in daily routine, negative self-evaluation, negative emotion, and social isolation were other common complaints associated with neutropenia. CONCLUSION: Neutropenia is associated with a number of negative experiences among cancer patients undergoing chemotherapy, and these negative experiences have an adverse effect on the patient's quality of life. Oncology nurses can play a key role in helping patients manage adverse effects to maintain their quality of life

DSM-5 and Psychiatry's Second Revolution: Descriptive vs. Theoretical Approaches to Psychiatric Classification

A large part of the controversy surrounding the publication of DSM-5 stems from the possibility of replacing the purely descriptive approach to classification favored by the DSM since 1980. This paper examines the question of how mental disorders should be classified, focusing on the issue of whether the DSM should adopt a purely descriptive or theoretical approach. I argue that the DSM should replace its purely descriptive approach with a theoretical approach that integrates causal information into the DSM’s descriptive diagnostic categories. The paper proceeds in three sections. In the first section, I examine the goals (viz., guiding treatment, facilitating research, and improving communication) associated with the DSM’s purely descriptive approach. In the second section, I suggest that the DSM’s purely descriptive approach is best suited for improving communication among mental health professionals; however, theoretical approaches would be superior for purposes of treatment and research. In the third section, I outline steps required to move the DSM towards a hybrid system of classification that can accommodate the benefits of descriptive and theoretical approaches, and I discuss how the DSM’s descriptive categories could be revised to incorporate theoretical information regarding the causes of disorders. I argue that the DSM should reconceive of its goals more narrowly such that it functions primarily as an epistemic hub that mediates among various contexts of use in which definitions of mental disorders appear. My analysis emphasizes the importance of pluralism as a methodological means for avoiding theoretical dogmatism and ensuring that the DSM is a reflexive and self-correcting manual

Abstract P4-09-15: Real-world clinical outcomes in <i>BRCA</i>-positive metastatic breast cancer patients treated in the community oncology setting

Abstract Background: BRCA-mutated breast cancer remains a heterogeneous disease, with variations in histology, response to treatment, and survival outcomes. These cancers are more likely to be negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) or triple negative (TN). However, some are hormone receptor-positive (HR+) and amenable to hormone treatment. We compared treatment patterns and clinical outcomes in patients with BRCA-mutated metastatic breast cancer (MBC) who were either TN or HR+/HER2-negative using real-world data. Methods: This retrospective study examined progression-free survival (PFS) and overall survival (OS) in a US community oncology sample of adult patients with BRCA-mutated MBC for up to three lines of treatment. Medical records from the Vector Oncology Data Warehouse were used. Disease progression was determined from chart review. Overall survival was measured from start of first-line (L1) treatment; patients without evidence of death were censored at the last observed visit. Cox models of PFS and OS were adjusted for age, race, performance status, tumor grade, and bone metastasis. Results: The study included 57 TN patients and 57 HR+ patients with BRCA mutation. BRCA 1 and BRCA 2 mutations were more frequent in patients with TN disease and HR+ disease, respectively. In TN disease, the most common L1 treatments, n (%), were bevacizumab 10 (20.4%), capecitabine 10 (20.4%), carboplatin/gemcitabine 8 (16.3%), carboplatin plus other 7 (14.3%), and paclitaxel 5 (10.2%). In HR+ patients, L1 treatments included aromatase inhibitors 14 (24.6%), fulvestrant 10 (17.5%), tamoxifen 7 (12.3%), and capecitabine 5 (8.8%). The between-group difference in PFS following L1 was statistically significant favoring HR+ disease (see Table), but not following lines 2 or 3. Overall survival was also significantly longer for the HR+ group (see Table). Presence of bone metastasis was a significant predictor of higher risk for disease progression. Conclusions: In this real-world sample of patients with BRCA1- or BRCA2-mutated MBC, those with TN disease had significantly worse outcomes after L1 (PFS, OS) compared with similar patients with HR+ disease. Triple-negative disease was associated with poorer prognosis, demonstrating a need for new treatment options for patients with BRCA-mutated TN MBC. Baseline Characteristics and Outcomes TN N=57HR+ N=57Age, median yrs4651Performance Status Impaired, n (%)2 (3.5)4 (7.0)Any CCIa Comorbidity, n (%)18 (31.6)11 (19.3) BRCA1, n (%)  +40 (70.2)18 (31.6)b–17 (29.8)39 (68.4)bBRCA2, n (%)  +16 (28.1)39 (68.4)b–41 (71.9)18 (31.6)b PFS L1Median Months (95% CI)6.13 (4.2, 9.4)12.09 (7.1, 14.5)Adj PFS HR (95% CI) for TN vs HR+1.714 (1.082, 2.717)P=.022Bone Metastasis HR (95% CI) Present vs Absent1.631 (1.039, 2.561)P=.033OS from Start of L1Median Months (95% CI)23.43 (15.4, 26.4)38.41 (28.9, 67.4)Adj OS HR (95% CI) for TN vs HR+1.869 (1.072, 3.256)P=.027HR (95% CI) for Race Minority/Unknown vs White2.040 (1.118, 3.723)P=.020HR (95% CI) for Tumor G3 vs Other3.010 (1.299, 6.973)P=.010aCharlson Comorbidity IndexbP&amp;lt;.001 Citation Format: Houts AC, Olufade TO, Shenolikar R, Walker MS. Real-world clinical outcomes in BRCA-positive metastatic breast cancer patients treated in the community oncology setting [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-09-15.</jats:p

Abstract P5-12-04: Symptom Burden Declines When Breast Cancer Patients Treated with Adjuvant Trastuzumab/Combination Chemotherapy Regimens Enter Trastuzumab Monotherapy Follow-Up

Abstract Background: Trastuzumab (T) is indicated for the adjuvant treatment of HER2-overexpressing breast cancer (BC). We report the results of a retrospective study of patient-reported outcomes (PROs) for patients who received T plus chemotherapy followed by T monotherapy or T as a single-agent. Methods: Included in this analysis were 210 patients with early HER2+ BC treated in community oncology practices affiliated with ACORN Research, who completed a 38-item symptom assessment scale, the Patient Care Monitor (PCM). Treatment regimens were classified as: combination chemotherapy followed by T monotherapy: doxorubicin, cyclophosphamide, paclitaxel [n=74] or docetaxel [n=18] and T (AC→TH/ACTH) (n=92); docetaxel, carboplatin, and T (TCH) (n = 38); or “Other” chemotherapy/T (n=47); or T only (n=33). Medical records were abstracted and symptom burden was measured by PCM index scores for: Physical Symptoms, Treatment Side Effects, Distress, Despair, Impaired Ambulation, and Impaired Performance. Linear mixed models were used to examine change in PCM index scores over time, controlling for first line chemotherapy group and relevant covariates. Results: Patients were 66% Caucasian and 28% African American. The mean age of, this cohort was 56.0 years (range=31-85 years). Demographic and disease characteristic s did not differ among the four treatment regimens except patients treated with AC→TH/ACTH tended to have higher stage of disease at time of diagnosis. Among patients on combination chemotherapy, median time on active chemotherapy was 3.5 months. Patients were observed for a median of 12.5 months. Impaired Ambulation, Impaired Performance, and General Physical Symptoms worsened over the course of active chemotherapy (p &amp;lt; .05), whereas Treatment Side Effects were worse from the start and remained stable during active chemotherapy. When chemotherapy stopped and patients entered T monotherapy, General Physical Symptoms and Treatment Side Effects improved significantly, but showed less improvement for TCH than for the other 2 groups (p &amp;lt; .05). Symptom burden improved during T monotherapy for TCH, AC→TH/ACTH and “Other”, generally converging with scores for patients who had T only, which tended to be lower and more stable. With the exception of younger patients showing more Distress, patient level characteristics (age, race, BMI, stage) were not significantly predictive of symptom burden trajectory and change. Discussion: Functioning and physical symptom burden tended to worsen during active chemotherapy and to improve when active chemotherapy stopped. TCH was associated with more gradual improvement in symptom burden than AC→TH/ACTH and the “Other” combination group. Most patients treated with combination chemotherapy showed symptom burden similar to those treated with T only once they transitioned to T monotherapy as follow-up treatment. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-12-04.</jats:p