Uniform Baseline Measurements Are Crucial in Improving Standard of Supportive Care

Schapira, MD, FASCO

The combination of mental, physical, and emotional toxicities of cancer treatment result in a very large burden for patients, according to Lidia Schapira, MD, FASCO. Therefore, finding innovative strategies to improve supportive care and symptom management should be top of mind for all practicing oncology providers.

Schapira, who is a professor of medicine, and director of the Cancer Survivorship Program, at Stanford University, met with Oncology Nursing News® to discuss key takeaways from this year’s Symptoms and Survivors’ track at the 2022 ASCO Annual meeting. Schapira’s clinical research is focused on the psychosocial aspects of cancer care and issues that relate to patient experience and health equity, and she participated on the track as an invited speaker in a poster discussion session.

One key takeaway from the session is the value of uniform baseline measurements in clinical practice, she said.

“Having good baseline measurements in clinical practice, and of course, in research, is essential, especially in the field of symptom management,” she told Oncology Nursing News®, explaining that a great example of this was an ASCO presentation on vitamin D insufficiency-related peripheral neuropathy which compared the clinician assessment and patient reported assessment of neuropathy.

In this study, participants were evaluated at baseline for 25-OH-vitamin D (D2 + D3) via LC-MS assay. Investigators used logistic regression to identify the association between vitamin D insufficiency and grade 3 or greater sensory neurotoxicity. Vitamin D insufficiency was defined as 20 ng/mL with higher levels signifying vitamin D sufficient status.

Results were adjusted for paclitaxel regimen assignment, age, self-reported race, and body mass index and found that the rate of grade 3/4 chemotherapy-induced peripheral neuropathy (CIPN) was 21% (n = 397) among patients with sufficient status compared with 14% (n = 794) among those with vitamin D insufficiency (odds ratio [OR], 1.57; 95% CI, 1.14-1.15; P = .005). After adjusting for covariates, the odds ratio was 1.39 (95% CI, 0.98-1.97; P = .066).¹

“Neuropathy is one symptom that has—for decades—been very difficult for us to properly measure,” Schapira said. “The importance of this is that if we don’t quite understand just how much toxicity somebody is experiencing, we could overdose them and [induce] irreparable harm.”

According to Schapira, routine exams which standardize the measurements evaluated alongside neuropathy, as well as encouraging patients to be completely forthcoming about their experience and the symptoms they may be experiencing before it affects their function or ability to move, is critical in providing better support to patients.

“We need to be more rigorous with measurements and the definitions. It is very important to have [uniform] baseline measurements,” she said. “I was very impressed [with the SWOG investigators] and I certainly know that most of my colleagues do not do such detailed physical exams before they see a patient who is about to [receive a] taxane in their practice. [This was] well done.”

Another symptom which calls for more uniform measurement is fear of cancer recurrence, she added.

“So many cancer survivors endure some level of fear, and we do not typically assess it in a rigorous manner,” she said. “Even in research, there are different scales for measuring worry about recurrence and fear of cancer recurrence. But there are no rigid cut offs that determine what is sort of clinically very meaningful and not.”

With a growing population of cancer survivors, the prevalence of this symptoms is continuing to demand attention as well. Without clear guides and rigorous assessment, it may be unclear to a provider which patients could suffice from clinician reassurance and empathic communication and which patients require expert referrals because of disabling distress.

“This is very difficult to measure in the clinic but can really lead to somebody not being able to work [or] being very affected by these symptoms [in other ways],” she noted.

Of course, Schapira noted that these are just 2 examples where improvements are still needed, and that there are number of other potential symptoms which are hard to assess due, in part, to a lack of uniform measurements—such as hot flashes or cognitive decline, for example. Moving forward, she urges oncologists and oncology care teams to be diligent in their baseline measurements in order to improve clinical assessment capabilities.

References

Chen CS, McCann SE, Budd GT, et al. Vitamin D insufficiency as a peripheral neuropathy risk factor in White and Black patients in SWOG 0221. J Clin Oncol. 2022;40(suppl 16):12023. doi:10.1200/JCO.2022.40.16_suppl.12023