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Quality of Life and Side Effects Management in Cancer Treatment (Volume II)

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: 30 April 2025 | Viewed by 11146

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Prof. Dr. António Araújo

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1. Centro Hospitalar Universitário de Santo António, Porto, Portugal
2. Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
Interests: clinical and translational research; mechanisms and control of adverse events; strategies to improve cancer patients’ quality of life
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Special Issue Information

Dear Colleagues,

This Special Issue is the Second Edition of a previous Special Issue, “Quality of Life and Side Effects Management in Cancer Treatment”. （link: https://www.mdpi.com/journal/cancers/special_issues/Quality_Effects_Cancer_Treatment）

Cancer treatment has evolved in recent years in an unimaginable way, giving our patients an increased rate of progression-free survival and/or overall survival. However, most importantly, these new drugs or new drug combinations are more patient friendly, increasing their quality of life. Nevertheless, we still have to learn how to control the adverse events that occur in target therapy, immunotherapy, and with the new drugs of hormonotherapy.

At present, we still struggle with these adverse events when combining different drugs for immunotherapy, immunotherapy with chemotherapy, or immunotherapy with target agents. Nausea and emesis induced by chemotherapy are still stressful events that we continually try to control; additionally, immune-mediated toxicity, rashes, and diarrhea induced by target therapy, and the numerous forms of pain that affect most of our cancer patients, are all still of significant concern and are the object of investigation.

We are, therefore, pleased to invite you to contribute to this Special Issue highlighting the current state of the art in the control of cancer treatments’ adverse events and in improving the quality of care of cancer patients, as well as featuring future prospects for improving therapies.

Prof. Dr. António Araújo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cancer treatment adverse events
quality of life in cancer patients
chemotherapy adverse events
target therapy adverse events
immunotherapy adverse events
hormonotherapy adverse events
chemotherapy-induced nausea and vomiting
cancer pain

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Published Papers (8 papers)

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Research

13 pages, 973 KiB

Open AccessCommunication

“From Drowning to Treading Water”: Adolescents and Young Adults Living with Incurable and Indolent Metastatic Soft Tissue Sarcoma for More than Two Years

by Paul R. D’Alessandro, Caitlin E. Homanick, Brittany D. Cooper, Katelyn Ferguson, Hillary Rutan and Joseph G. Pressey

Cancers 2025, 17(3), 442; https://doi.org/10.3390/cancers17030442 - 28 Jan 2025

Viewed by 502

Abstract

Introduction: Adolescent/young adult (AYA) patients with metastatic soft tissue sarcoma (STS) typically face a dismal prognosis. However, a subset of patients with incurable disease lives beyond two years. Due to the rarity of diagnoses and inherent heterogeneity within this population, a paucity of data exists regarding the experiences of AYAs with an indolent course (and how to best capture these experiences). With increasing biological insight and clinical experience, including the use of targeted or immune therapies, it is anticipated that more such patients will experience prolonged survival. Our pilot study aimed to describe the clinical characteristics and illness experiences of AYAs with incurable yet indolent metastatic STS who were living two years after their diagnoses. Our exploratory aim was to generate a conceptual framework that could subsequently be tested in a multi-center study with a larger cohort of patients. Materials and Methods: Patients with metastatic incurable STS, aged 15–39 years at diagnosis, and at least two years from diagnosis, were eligible. Patients were recruited over a two-year period at a quaternary children’s hospital with a comprehensive AYA oncology program. Participants completed a demographic form and PROMIS short form questionnaires for seven domains and answered an open-ended question. Responses to open-ended questions were coded independently by two authors and utilized to generate themes. Clinical variables were collected from medical records. Results: Five patients completed questionnaires. Mean age was 29.4 years (18.5–39.8 years) at diagnosis and 34 years (23.2–45.7 years) at study. Three patients were female; two were male; four were White; and one was Black/African American. Diagnoses included ASPSCR1::TFE3 alveolar soft part sarcoma; WWTR1::CAMTA1 epithelioid hemangioendothelioma; INI-1 deficient epithelioid sarcoma; EWSR1::NR4A3 extra-skeletal myxoid chondrosarcoma; and low-grade ARHGAP23::FER spindle cell malignancy, a novel fusion-driven sarcoma. Mean time since diagnosis was 4.5 years (2.6–6 years), and mean treatment duration was 4.2 years (1.5–6 years). On average, patients received 4.8 lines (range 2–8 lines) of antineoplastic therapy. All patients received at least one targeted therapy or immune checkpoint inhibitor. Patients reported increased fatigue and anxiety and decreased physical function compared to the standardized US reference population. Themes emerging from qualitative responses included managing physical symptoms, navigating feelings of guilt and inadequacy, self-reflection generating gratitude, and changing illness experiences over time. Conclusions: AYA patients living with incurable metastatic soft tissue sarcoma for more than two years were treated with multiple lines of antineoplastic therapy longitudinally. PROMIS data identified fatigue, anxiety, and decreased physical function within this population. Exploratory thematic analysis of qualitative responses generated concepts that could be further tested in an expanded cohort of patients. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment (Volume II))

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22 pages, 2251 KiB

Open AccessArticle

The Descriptive and Disproportionality Assessment of EudraVigilance Database Reports on Capecitabine Induced Cardiotoxicity

by Razvan Constantin Vonica, Anca Butuca, Andreea Loredana Vonica-Tincu, Claudiu Morgovan, Manuela Pumnea, Remus Calin Cipaian, Razvan Ovidiu Curca, Florina Batar, Vlad Vornicu, Adelaida Solomon, Adina Frum, Carmen Maximiliana Dobrea, Dan Damian Axente and Felicia Gabriela Gligor

Cancers 2024, 16(22), 3847; https://doi.org/10.3390/cancers16223847 - 16 Nov 2024

Viewed by 1067

Abstract

Capecitabine (CAP) is one of the most commonly prescribed fluoropyrimidines in oncology, especially in the treatment of colon cancer. Cardiac toxicity is a severe and potentially lethal adverse drug reaction (ADR) against fluoropyrimidines. Cardiac ADRs, such as myocardial infarction (MI), heart failure (HF), arrhythmias, and a number of cardiomyopathies, are reported for these molecules. To have a better understanding of the risk–benefit ratio of colon cancer therapy, a pharmacovigilance study of real-world evidence of the cardiac toxicity of antineoplastic agents is required. Aim: This post-marketing research on CAP aims to assess the risk of cardiac toxicity. Five other antitumor drugs used in colorectal cancer, i.e., 5-fluorouracil (5-FU), irinotecan (IRI), oxaliplatin (OX), bevacizumab (BEV) and panitumumab (PAN), were also studied to create a relative profile of observed cardiotoxicity. Methods: A retrospective study based on reports submitted in the EudraVigilance (EV) database until 28 July 2024 was conducted. Using the aggregated data from EV, a descriptive analysis and disproportionality analysis of cardiac ADRs induced by fluoropyrimidines were performed. To evaluate the disproportionality of the signals, Reporting Odds Ratio (ROR) and 95% confidence interval (95% CI) were calculated by comparison with other drugs used in colorectal cancer: 5-FU, IRI, OX, BEV, and PAN. Results: “Cardiac disorders” represent 3.4% of the total reports for CAP. The value is comparable to 5-FU, but higher than for other drugs. t was observed that there are no significant differences in the occurrence of cardiac ADRs in patients exposed to CAP and 5-FU treatments, and in particular MI and HF. Compared to 5-FU, which could produce cardiac arrythmias with a higher probability than all other drugs, CAP has a higher probability of reporting this ADR only in comparison with IRI (ROR: 1.2971; 95% CI: 1.0196-1.6502). Conclusions: CAP induces adverse cardiovascular reactions, especially MI, HF, and cardiomyopathies. Arrhythmias have been shown to be side effects more frequent associated with 5-FU than with CAP. The results emphasize the need for a rigorous cardiovascular monitoring of patients following treatment with CAP or 5-FU and especially for those with pre-existing cardiac pathology. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment (Volume II))

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16 pages, 1344 KiB

Open AccessArticle

Smell and Taste Alterations in Patients Receiving Curative or Palliative Chemotherapy—The CONKO 021—ChemTox Trial

by Tobias Bleumer, Janine Abel, Wolfgang Böhmerle, Sebastian Schröder, Soo Ann Yap, Nigel Dross Engelbert Schaeper, Thomas Hummel, Sebastian Stintzing, Lars Uwe Stephan and Uwe Pelzer

Cancers 2024, 16(14), 2495; https://doi.org/10.3390/cancers16142495 - 9 Jul 2024

Cited by 1 | Viewed by 1272

Abstract

Previous data regarding chemotherapy-induced olfactory and gustatory dysfunction (CIOGD) are heterogeneous due to inconsistent study designs and small numbers of patients. To provide consistent, reliable data, we conducted a cohort study using standardized testing. Patients diagnosed with lymphoma, leukemia, or gastrointestinal malignancies were examined up to five times (T1 to T5), beginning prior to chemotherapy. We examined patients receiving temporary treatment up to 12 months post-therapy. Clinical assessment included extensive questionnaires, psychophysical tests of olfactory and gustatory function, and measurement of peripheral neuropathy. Statistical analysis included non-parametric tests to evaluate the longitudinal development of CIOGD. Our data (n = 108) showed a significant decline in olfactory and gustatory testing during chemotherapy (p-values < 0.001). CIOGD appeared stronger among patients above 60 years, while sex did not matter significantly. However, we identified distinct associations between CIOGD and reported anorexia as well as with higher neuropathy scores. Self-assessment appeared less sensitive to chemosensory dysfunction than psychophysical testing. Post-therapy, olfactory and gustatory function regenerated, though baseline levels were not attained within 6 to 12 months. In conclusion, our data highlight the wide prevalence and slow recovery of CIOGD. Understanding CIOGD as a potential neurotoxic effect may disclose new therapeutic prospects. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment (Volume II))

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14 pages, 740 KiB

Open AccessArticle

Reasonability of Frequent Laboratory Analyses during Therapy with Nivolumab and Nivolumab+Ipilimumab in Patients with Advanced or Metastatic Renal Cell Carcinoma during the Phase 2 Clinical Trial TITAN-RCC

by Klara Franke, Susan Foller, Michele Estephania Rosero Moreno, Nalyan Ali, Lutz Leistritz, Katharina Leucht and Marc-Oliver Grimm

Cancers 2024, 16(12), 2287; https://doi.org/10.3390/cancers16122287 - 20 Jun 2024

Viewed by 1040

Abstract

In clinical trials, laboratory values are assessed with high frequency. This can be stressful for patients, resource intensive, and difficult to implement, for example in office-based settings. In the prospective, multicentre phase 2 TITAN-RCC trial (NCT02917772), we investigated how many relevant changes in laboratory values would have been missed if laboratory values had been assessed less frequently. Patients with metastatic renal cell carcinoma (n = 207) received a response-based approach with nivolumab and nivolumab+ipilimumab boosts for non-response. We simulated that laboratory values were obtained before every second dose instead of every dose of the study drug(s). We assessed elevated leukocyte counts, alanine aminotransferase, aspartate aminotransferase, bilirubin, creatinine, amylase, lipase, and thyroid-stimulating hormone. Dose delay and discontinuation criteria were defined according to the study protocol. With the reduced frequency of laboratory analyses, dose delay criteria were rarely missed: in a maximum of <0.1% (3/4382) of assessments (1% [2/207] of patients) during nivolumab monotherapy and in a maximum of 0.2% (1/465) of assessments (1% [1/132] of patients) during nivolumab+ipilimumab boosts. An exception was lipase-related dose delay which would have been missed in 0.6% (25/4204) of assessments (7% [15/207] of patients) during nivolumab monotherapy and in 0.8% (4/480) of assessments (3% [4/134] of patients) during nivolumab+ipilimumab boosts, but would have required the presence of symptoms. Discontinuation criteria would have only been missed for amylase (<0.1% [1/3965] of assessments [0.5% (1/207) of patients] during nivolumab monotherapy, none during nivolumab+ipilimumab boosts) and lipase (0.1% [5/4204] of assessments [2% (4/207) of patients] during nivolumab monotherapy; 0.2% [1/480] of assessments [0.7% (1/134) of patients] during nivolumab+ipilimumab boosts). However, only symptomatic patients would have had to discontinue treatment due to amylase or lipase laboratory values. In conclusion, a reduced frequency of laboratory testing appears to be acceptable in asymptomatic patients with metastatic renal cell carcinoma treated with nivolumab or nivolumab+ipilimumab. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment (Volume II))

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11 pages, 236 KiB

Open AccessArticle

Past Happiness and Broken Future Horizon of Oncological Patients during Chemotherapy—A Quantitative Exploration of a Phenomenological Hypothesis

by Magdalena Fryze, Patrycja Wisniewska, Jadwiga Wiertlewska-Bielarz and Marcin Moskalewicz

Cancers 2024, 16(11), 2124; https://doi.org/10.3390/cancers16112124 - 2 Jun 2024

Viewed by 1257

Abstract

Understanding the impact of cancer on the experience of time is crucial in the context of hope and recovery. This study, a follow-up to a previous qualitative study of ovarian cancer patients – explored two types of such experiences—the memory of past happiness and the limited future planning. A sociodemographic questionnaire with nine questions about the experience of time was used on a convenience sample of 202 patients with various cancers, predominantly women with breast, ovarian, and cervical cancer. It was found that the respondents experienced increased focus on the present, decreased focus on the future, and a sense of unpredictability, with a relatively short temporal horizon measured in weeks and months, not years. Almost half of the respondents (46%) measured time during treatment by the rhythm of chemotherapy and check-ups, which thus appeared as the most meaningful events. The increase in the frequency with which patients underwent chemotherapy mildly affected their focus on the present (R = 0.25, p < 0.05), likely because of the discomfort of the side effects. The correlations between age and time in treatment, on the one hand, and the experience of time, on the other, were negligible. Changed temporal experience during chemotherapy is a factor that can have an impact on patients’ well-being and ability to cope with the disease. It thus should be taken into account when planning oncology care. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment (Volume II))

14 pages, 464 KiB

Open AccessArticle

The Sarcoma Assessment Measure (SAM): Preliminary Psychometric Validation of a Novel Patient-Reported Outcome Measure

by Lee Hulbert-Williams, Nicholas J. Hulbert-Williams, Ana Martins, Lesley Storey, Jennie Bradley, Hatty O’Sullivan, Lorna A. Fern, Maria Lawal, Rachael Windsor, Craig Gerrand, Jeremy S. Whelan, Lindsey Bennister, Mary Wells and Rachel M. Taylor

Cancers 2024, 16(6), 1096; https://doi.org/10.3390/cancers16061096 - 8 Mar 2024

Viewed by 1347

Abstract

The Sarcoma Assessment Measure (SAM) was developed as a sarcoma-specific patient-reported outcome measure to be used in clinical practice. We have reported in detail how SAM has been developed in collaboration with patients and healthcare professionals. The aim of this paper is to report the preliminary validation of SAM. The 22-item SAM was administered alongside a validated quality of life questionnaire and measure of activities of daily living. Linear modelling was used to build a measure, which had predictive validity in comparison to more established outcome measures. Of the 762 patients who participated in the study, 44.1% identified as male, and participant age ranged from 13 to 82 years. Clinically, participants presented with a range of soft tissue (82.2%) and bone (21.8%) sarcomas. Our preliminary analysis indicates that SAM accounts for 35% of the global quality of life scale and 18% of the Toronto Extremity Salvage Scale (TESS); so psychometrically, it overlaps with quality of life and activities of daily living, but also measures distinct concerns. This demonstrates that this measure picks up issues that are important to patients with sarcoma that are not reflected in other measures. We have established the preliminary validity of SAM and believe it has utility as a patient-reported outcome measure both as a research tool and for assessing the impact of symptoms and dysfunction related to sarcoma as part of clinical care. Further validation using a larger and more clinically diverse sample is now needed. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment (Volume II))

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13 pages, 636 KiB

Open AccessArticle

Immunotherapy in Elderly Patients—Single-Center Experience

by Maria João Ramos, Ana Sofia Mendes, Raquel Romão, Joana Febra and António Araújo

Cancers 2024, 16(1), 145; https://doi.org/10.3390/cancers16010145 - 27 Dec 2023

Cited by 1 | Viewed by 1867

Abstract

Cancer management faces a substantial challenge posed by the aging demographic. Aging is marked by accumulated DNA damage, and this phenomenon is implicated in the process of tumorigenesis. The concept of immunosenescence, postulated to manifest in elderly individuals, is defined by an age-related decline in T cells and a simultaneous elevation in proinflammatory status, leading to a diminished efficacy in response to immunotherapy. Notably, despite the rising prevalence of cancer in the elderly population, their underrepresentation in clinical trials persists. This underscores the unmet need to evaluate the safety and efficacy of cancer treatment in the elderly. This retrospective, single-center cohort study aimed to assess and evaluate the effectiveness and safety of immunotherapy in patients compared to younger individuals with metastatic solid tumors receiving ICI. A total of 220 patients were included, mostly males, with a median age of 64. The proportion of patients ≥ 65 years old was 56.5%. The use of ICI showed no significant differences concerning overall survival (OS) and progression-free survival (PFS) among age groups across different cancer types (melanoma, non-small-cell lung cancer (NSCLC), renal, and bladder cancer; p = 0.388). Concerning the response to treatment in renal cancer patients, a significant difference was observed (p = 0.041), suggesting a potential negative impact of age on the treatment response. In patients that presented immune-related adverse events (irAEs), oral corticosteroid therapy was marginally associated (p = 0.059) with the elderly population. When evaluating the NSCLC population alone (n = 131, 59.5%), our study revealed a strong association between the development of irAEs, patients’ PFS and OS, and the duration of ICI treatment, but not directly correlated with age. The NSCLC elderly population presented a marginally greater number of irAEs, although without statistical significance (p = 0.86). ICI maintained efficacy and safety in elderly patients, challenging the notion that age alone should determine treatment decisions. The findings emphasize the necessity of a comprehensive geriatric assessment rather than relying solely on chronological age for personalized cancer treatment in the elderly population. Further prospective studies are needed to better understand immune responses in older adults and derive predictive biomarkers for cancer treatment. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment (Volume II))

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12 pages, 586 KiB

Open AccessArticle

Factors Associated with Poor Quality of Life in Breast Cancer Survivors: A 3-Year Follow-Up Study

by Soo-Hyun Kim and Ha-Yeon Jo

Cancers 2023, 15(24), 5809; https://doi.org/10.3390/cancers15245809 - 12 Dec 2023

Cited by 3 | Viewed by 1752

Abstract

The purpose of this study was to identify subgroups of quality of life (QOL) changes in breast cancer survivors (BCSs), and to determine factors associated with subgroups of consistently low or deteriorated QOL. We enrolled 101 women recently diagnosed with breast cancer in South Korea and asked them to complete a questionnaire at baseline (within 1 month of diagnosis), 1 year later (Year 1), 2 years later (Year 2), and 3 years later (Year 3). We assessed QOL using the global QOL subscale from the EORTC QLQ-C30. We defined low QOL as a global QOL score 10 points below the mean score of the general population. Based on low QOL as defined in this study, we identified subgroups of QOL changes over 3 years. We identified four subgroups of QOL changes: improved (47.4%), stable (30%), continuously low (8.8%), and deteriorated (13.8%), and considered the last two categories (22.6%) poor QOL. Logistic regression analyses demonstrated that significant determinants of poor QOL were insomnia at Year 1, fatigue and anxiety at Year 2, and fatigue, depression, and comorbidity at Year 3. In conclusion, persistent symptoms of insomnia, fatigue, anxiety, depression, and comorbidity are potential risk factors for poor QOL in BCSs. Full article

(This article belongs to the Special Issue Quality of Life and Side Effects Management in Cancer Treatment (Volume II))

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