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Prediction of side effects from anticancer treatment with the purpose of increasing quality of life
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cancer and its treatments can cause a variety of symptoms. Some of these symptoms are related to the disease and others are seen as a consequence of the treatment. Since patients experience side effects to different degrees despite undergoing the same treatment, it is hypothesized that there is a genetic factor. The individual variation that exists between different patients regarding nausea triggered by chemotherapy, radiotherapy induced skin reactions as well as sleep disorders associated with cancer could partly be explained by genetic differences. We have in these studies confirmed these individual differences. Previous nursing research has mainly focused on the symptoms themselves. The focus in this thesis are the following three main symptoms; nausea and vomiting related to chemotherapy, acute skin inflammation following radiotherapy and sleep problems associated with cancer diagnosis and -treatment.

The aim of this thesis was to find biological markers that can identify the risk of and/or protective factors for nausea and/or vomiting (CINV) as well as understand its heterogeneity (Study 1 and 2). It also aimed to understand the individual factors behind acute radiation skin reactions (ARSR) (Study 3) and sleeping disturbances in patients treated for cancer (Study 4), permitting a more individualized care and optimized health-related quality of life (HRQoL).

In Study 1 and 2 the patients themselves had to document in a diary their experience of nausea and vomiting and well-being. Well-being was considered as synonymous with quality of life. We found a variability and heterogeneity of those symptoms (Study 1). Three genetic markers, FAS/CD95, RB1/LPAR6 and CCL2 that could explain the individual differences and assess the risk of chemotherapy-induced nausea were found in Study 2.

Acute radiation skin reactions (ARSR) along with itching and burning sensation associated with radiotherapy (RT) was assessed by the patients themselves (Study 3) with help of the VAS- and RTOG scales, scoring for visible redness. We found two possible genetic markers, XRCC2 and IFNG. Also, individual differences in symptoms behavior were found.

Sleep disturbances were common and were reported with obvious individual differences [1]. For data collection were used a sleep questionnaire, the Medical Outcomes Study Sleep Scale (MOS), open ended questions and EORTC QLQ- C30 questionnaire of quality of life. Sleep, which is important for all primary body functions, is often affected in connection with cancer diagnosis and -treatment.

Through collaboration between nursing staff and specialists in basic science, we have found that biological markers can help in creating individualized care. Knowledge of individual variations in the severity of chemo- or radiotherapy-induced side effects is important in order to better personalize the treatment and care, improve the treatment results and alleviate or prevent the side effects of oncological treatments. By linking symptoms to biological markers, it will hopefully be able to increase the patients’ total health-related quality of life, this being the main goal of this thesis.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. , p. 93
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1716
National Category
Cancer and Oncology Nursing Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:liu:diva-162101DOI: 10.3383/diss.diva-162101ISBN: 9789179299569 (print)OAI: oai:DiVA.org:liu-162101DiVA, id: diva2:1371186
Public defence
2019-12-12, Originalet, Qulturum, Länssjukhuset Ryhov, Jönköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-11-19 Created: 2019-11-19 Last updated: 2019-11-20Bibliographically approved
List of papers
1. Variations in Self-Reported Nausea, Vomiting, and Well-Being During the First 10 Days Postchemotherapy in Women With Breast Cancer
Open this publication in new window or tab >>Variations in Self-Reported Nausea, Vomiting, and Well-Being During the First 10 Days Postchemotherapy in Women With Breast Cancer
2014 (English)In: Clinical Journal of Oncology Nursing, ISSN 1092-1095, E-ISSN 1538-067X, Vol. 18, no 2, p. E32-E36Article in journal (Refereed) Published
Abstract [en]

Women with breast cancer undergoing chemotherapy experience nausea and vomiting, both common symptoms affecting quality of life. The aim of the current study was to describe how nausea, vomiting, and well-being vary during the first 10 days after chemotherapy in women with breast cancer. A pilot study with a repeated-measurements design was conducted at a Swedish county hospital where 39 women with breast cancer treated with adjuvant chemotherapy were observed. A structured 10-day diary was used for data collection. Of the 39 women in the study, 33 experienced nausea and 6 also experienced vomiting after chemotherapy. Changes in well-being as a result of nausea or vomiting during any part of the day, as well as distress for other reasons, were reported. Well-being also varied among the individuals. The pattern of change in experienced levels of well-being was not homogeneous, nor did it move in any certain direction. The results of this study show that an individualized treatment approach is required to better meet individual women's needs.

Place, publisher, year, edition, pages
Pittsburgh: Oncology Nursing Society, 2014
National Category
Nursing Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-162105 (URN)10.1188/14.CJON.E32-E36 (DOI)
Available from: 2019-11-19 Created: 2019-11-19 Last updated: 2019-11-20Bibliographically approved
2. Single nucleotide polymorphisms might influence chemotherapy induced nausea in women with breast cancer
Open this publication in new window or tab >>Single nucleotide polymorphisms might influence chemotherapy induced nausea in women with breast cancer
Show others...
2017 (English)In: Clinical and Translational Radiation Oncology, ISSN 2405-6308, Vol. 2, p. 1-6Article in journal (Refereed) Published
Abstract [en]

Background Women receiving FEC (5 fluorouracil, epirubicin and cyclophosphamide) chemotherapy (CT) for breast cancer (BC) often experience side effects such as nausea and vomiting. Individual variations of side effects occur in patients despite similar cancer therapy. The purpose of this study was to investigate a possible genetic background as a predictor for individual variations in nausea induced by CT. Methods 114 women were included in the study. All women received adjuvant CT for BC. Self-reported nausea and vomiting was recorded in a structured diary over ten days following treatment. Blood samples were collected before the treatment and used for the detection of 48 single nucleotide polymorphisms (SNPs) in 43 genes. SNPs from each individual woman were analyzed for their relation to the patient-reported frequency and intensity of nausea and vomiting. Results Eighty-four percent (n=96) of the women reported acute or delayed nausea or combined nausea and vomiting during the ten days following CT. Three out of the forty-eight SNPs in the following genes: FAS/CD95, RB1/LPAR6 and CCL2 were found to be associated with a risk of nausea. Conclusion SNPs in the FAS/CD95, RB1/LPAR6 and CCL2 genes were found to be associated with nausea among women treated with adjuvant FEC for BC. SNPs analysis is fast and cost effective and can be done prior to any cancer therapy. The association between individual SNPs and severe side effects from FEC may contribute to a more personalized care of patients with BC.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Single nucleotide polymorphisms, Chemotherapy, Nausea, Breast cancer
National Category
Nursing Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-162106 (URN)10.1016/j.ctro.2016.12.001 (DOI)
Available from: 2019-11-19 Created: 2019-11-19 Last updated: 2019-11-20Bibliographically approved
3. Individual Genetic Variation Might Predict Acute Skin Reactions in Women Undergoing Adjuvant Breast Cancer Radiotherapy
Open this publication in new window or tab >>Individual Genetic Variation Might Predict Acute Skin Reactions in Women Undergoing Adjuvant Breast Cancer Radiotherapy
Show others...
2018 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 38, no 12, p. 6763-6770Article in journal (Refereed) Published
Abstract [en]

Adverse skin reactions during radiotherapy (RT) are common. The aim of this study was to explore whether genetic variation might be linked to acute radiation skin reactions (ARSR). Materials and Methods: One hundred and nineteen women undergoing adjuvant RT for breast cancer were included. The symptoms of itching, burning and irritation were self-reported twice using the visual analogue scale. Assessments used the Radiation Therapy Oncology Group scoring system for acute RT skin reaction (RTOG scale). Blood-based single nucleotide polymorphism (SNP) analysis was performed. Thirty SNPs of well-defined functional genes were investigated. Results: All women were assessed with ARSR. After RT, the women self-reported itching (n=97), burning (n=64) and irritation (n=96). Two SNPs in X-Ray Repair Cross Complementing 2 gene (XRCC2) rs2040639 and interferon gamma (IFNG) rs2069705 genes were found to be associated with ARSR. Conclusion: An association between two SNPs and ARSR was found. The possibility of using these SNPs as prognostic biomarkers for ARSR as tools to improve the care of patients needs further investigation.

Place, publisher, year, edition, pages
The International Institute of Anticancer Research, 2018
Keywords
Radiotherapy; breast cancer; skin reactions; single nucleotide polymorphism
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-153515 (URN)10.21873/anticanres.13047 (DOI)000451742800022 ()30504388 (PubMedID)
Note

Funding Agencies|Uppsala University; Knut & Alice Wallenberg Foundation of Uppsala, Sweden; Foundation for Clinical Cancer Research in Jonkoping; Futurum Academy for Health and Care, Region Jonkoping County, Sweden; FORSS-Medical Research Council of Southeast Sweden

Available from: 2019-01-02 Created: 2019-01-02 Last updated: 2019-11-20Bibliographically approved

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