A Review of the Literature on Multiple Co-occurring Symptoms in Patients With Colorectal Cancer Who Received Chemotherapy Alone or Chemotherapy With Targeted Therapies.
Ilufredo Y Tantoy, Janine K Cataldo, Bradley E Aouizerat and 2 others
PMID 26895413WHAT IT FOUND
Colorectal cancer patients receiving chemotherapy alone or with targeted therapy often have many symptoms at once, including numbness/tingling, low energy, drowsiness, nausea, poor sleep, and worry.
Severity varied across studies; differences with targeted therapy were not clear.
Key findings
01In the only study that reported symptom occurrence, patients reported an average of 10.3 symptoms out of 32; numbness/tingling (64%), lack of energy (62%), drowsiness (49%), nausea (45%), shortness of breath (43%), and dry mouth (42%) were common, along with difficulty sleeping (46%) and worrying (44%).
02Symptom severity was inconsistent: one study reported 51% had at least one moderate or severe symptom; another reported 67% had moderate to severe fatigue; another found patients rated symptom frequency higher than severity or distress.
03In the study that reported severity ranges, patients receiving chemotherapy alone had a higher rate of moderate to severe nausea than patients receiving chemotherapy plus targeted therapy, and patients receiving bevacizumab had lower rash scores than patients receiving chemotherapy only.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only five studies were identified, and most were cross-sectional with retrospective data, so they describe symptoms at points in time rather than how symptoms change. The studies used different symptom instruments and assessed different numbers of symptoms, so results cannot be combined into one reliable symptom profile. One included study had only 55.5% colorectal cancer patients, so its findings do not apply only to colorectal cancer. Only two studies reported symptom data for patients with and without targeted therapies, so the review cannot show whether targeted therapies reduce symptoms. Sample sizes varied widely, and three studies had fewer than 250 patients. Symptom severity findings were inconsistent across studies. Associations with age, sex, income, education, stage, and other factors were reported, but these studies cannot prove those factors cause more symptoms.
Declared interests
The supplied publication types indicate NIH extramural research support. The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that targeted therapies reduce symptom burden. Only one included study reported severity ranges, and it found higher moderate to severe nausea with chemotherapy alone; this does not establish a treatment effect.