Identifying symptom patterns can predict variations over time in oropharyngeal and laryngeal cancers

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NEW ORLEANS—Identifying individual symptom patterns (ISP) provides new information about symptom variations over the course of treatment in patients with oropharyngeal and laryngeal cancers, according to research presented at the Oncology Nursing Society (ONS) 37th Annual Congress.

Due to the anatomical location of the cancer, patients with oropharyngeal and laryngeal cancer experience difficulty swallowing, dry mouth, and pain. Although electronic medical records are used to collect patients' side effects during treatment, they are usually reported as a sum, statistical mean, or graph. Therefore, they are unable to track individual symptom patterns (ISP) and cannot identify variations in these patterns among patients.

 Identification of ISP during cancer treatment can provide vital information for the evaluation and delivery of tailored patient care. Because an estimated 40,000 men and 11,800 women will be diagnosed with a head and neck cancer in 2012, the problem has been growing.

At Johns Hopkins University School of Nursing, Baltimore, MD, Mary Ellen Haisfield-Wolfe, PhD, RN, OCN, attempted to identify the ISP of peak intensity and resolution for prevalent symptoms among oropharyngeal and laryngeal cancer patients receiving radiation. Visual graphical analysis (VGA), which is an exploratory technique that codes and graphs individual symptoms to identify symptom patterns or group profiles in secondary data analyses, was utilized.

For the study, VGA was applied to a sample of 21 outpatients at four time points during a 12-week period of radiation treatment: baseline, midtreatment, end of treatment, and at 1-month follow-up. ISP for difficulty swallowing, dry mouth, and pain were graphed over the time points, grouped by patterns, and then categorized. A panel of independent experts verified the correctness of each description and individual pattern of ISP using the reported symptoms and commented on the ISP to determine whether they should be combined or merged with other ISP or categories.

During VGA, an Excel file was created for each symptom from the data (eg, pain). Each patient received a separate graph file page for each symptom. Graphs were designed to be the same horizontally and vertically (eg, four time points and a scale of 0 to 4). Next, a graph was created of the symptom over the four established time points. Stringent eligibility criteria were established to prevent unnecessary or limited charts from being including in the VGA analysis.

Mean scores of difficulty swallowing, dry mouth, and pain severity over the four time points followed one pattern in which symptoms increased after baseline and resolved at 1-month follow-up. Using VGA, only a portion of ISP for difficulty swallowing (n=10, 48%), dry mouth (n=12, 57%), and pain (n=8, 38%), had a pattern similar to that of the means. In addition, three different ISP were identified for difficulty swallowing and dry mouth in which resolution did not occur 1 month after treatment. Three additional ISP categories were identified in which intense and elevated pain levels were present at baseline and resolution did not occur after treatment.

“Further research is needed to incorporate ISP techniques into large cancer center databases to evaluate symptoms and side effects related to treatment management and care,” the researchers concluded.

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