Photo Credit: Pornpak Khunatorn
In a recent study of supportive care for advanced cancer management, targeted palliative care optimized patient care and enhanced clinical outcomes.
Managing symptoms in patients with advanced cancer often requires the use of multiple supportive care pharmacotherapies, leading to complex polypharmacy. This complexity can result in inefficacies or toxicities due to pharmacogenetic interactions.
Excessive polypharmacy is common in patients with cancer, especially older adults. According to a 2023 study published in Cancer, up to 80% of older patients take five or more medications, and up to 40% take 10 or more. Patients who receive numerous medications as part of supportive care may be at increased risk for potentially inappropriate medications and drug-drug interactions, which could impact their QOL. The study authors emphasized the importance of meaningful screening and interventional tools to optimize the use of medications for palliative care in these patients.
In a more recent study published in the Journal of Clinical Oncology, Giusti Raffaele, MD, and colleagues aimed to streamline pharmacotherapy by targeting the most impactful symptom.
“By prioritizing management of this ‘target symptom,’ our study seeks to optimize and improve overall symptom relief, reducing the need for extensive polypharmacotherapy,” Dr. Raffaele and colleagues wrote.
Choosing a Target Symptom
The researchers enrolled 72 patients with advanced cancer upon their initial palliative care evaluation. To identify and prioritize the most impactful symptoms, the researchers used the PERSONS score, a comprehensive tool assessing pain, eating/cachexia, rehabilitation/fatigue, sleeping disorder, O2/dyspnea, nausea/emesis, and suffering. Each symptom is rated on a scale from 0 to 10, with a total score ranging from 0 to 70.
After identifying a target symptom for each patient, the investigators implemented a personalized palliative care intervention. They assessed the efficacy of this strategy by monitoring changes in the PERSONS score approximately 10 days post-treatment. To evaluate the differences in symptom distributions between baseline and post-treatment scores, they employed non-parametric statistical tests: the Wilcoxon signed-rank test for comparisons between two groups and the Kruskal-Wallis test for comparisons across more than two groups.
Short Treatment Shows Benefits
At baseline, most study participants had intermediate Karnofsky Performance Status (KPS) scores, with 47% having scores that ranged from 30 to 40 and 33% ranging from 50 to 60. The majority (73%) of patients also were not yet receiving treatment for their symptoms. The median PERSONS score at baseline was 26 (range, 9 to 51).
Pain emerged as the most frequently identified target symptom (47%), followed by dyspnea (14%), fatigue (11%), suffering (11%), nausea/emesis (7%), and cachexia (7%). Suffering, when identified as a target symptom, demonstrated higher scores (range, 7 to 10; Kruskal-Wallis P=0.14). Patients whose target symptoms were fatigue, pain, and nausea-emesis had higher PERSONS scores for non-target symptoms.
After a median of 9.5 days (range, 6 to 138) of targeted treatment, PERSONS scores across non-target symptoms showed a significant reduction (P<0.001; median difference, -6; range, -24 to 10), as did the intensity of target symptoms (P<0.001).
The authors concluded that their study suggests focusing on a targeted symptom through a short treatment course alleviates that specific symptom and brings about clinically significant improvements in non-target symptoms. This strategy holds promise for improving the QOL for patients dealing with the multifaceted challenges of advanced cancer.
“This comprehensive approach, emphasizing the interconnectedness of symptoms, has the potential to optimize patient care and enhance clinical outcomes in the context of advanced cancer management,” Dr. Raffaele and colleagues concluded.
