Symptom burden in patients with chronic myeloid leukemia

Preliminary analysis of a study to determine validity and reliability of the M.D. Anderson Symptom Inventory-Chronic Myeloid Leukemia (MDASI-CML) has found that patients with CML experience moderate levels of symptom burden over long periods of time.

Symptom management, a primary role for oncology nurses, is crucial for patients with CML, who can receive therapy for many years. Lack of symptom recognition may result in failure to address symptoms and to maximize patient functioning, Loretta A. Williams, PhD, RN, AOCN®, OCN®, and colleagues reported at the Oncology Nursing Society 36th Annual Congress. The Oncology Nursing Society Research Agenda identified development of an in-depth understanding of cancer-related symptoms as a priority for 2009-2013.

One challenge is that no measure for symptoms of CML currently exists, and there is little knowledge of symptom burden in CML and its treatment, added Williams, of the University of Texas M.D. Anderson Cancer Center, Houston, Texas. To remedy that situation, a study was conducted to develop a valid and reliable patient-reported measure of CML symptom burden and to describe this burden, which is defined as the combined impact of all symptoms on a person's ability to function as he or she did prior to onset of disease and therapy.

The three-part study included (1) an initial 35-subject cross-sectional qualitative data and exploratory analysis to define content domain for a measure of symptom burden in CML, (2) item reduction by a 15-member expert panel based on relevance of symptoms for patients with CML, and (3) a 1-year longitudinal descriptive study of 160 subjects with CML to determine validity and reliability of the MDASI-CML using standard psychometric techniques and to describe symptom patterns and risk factors using descriptive and modeling statistics.

Preliminary analysis of the third part of the study focused on 3-month data available for 101 patients. At study enrollment, average age was 51.7 years; 59% of patients were female; and 98% had chronic-phase CML. Four patients discontinued from the study due to its time requirements.

The reliability index (Cronbach alpha) of the MDASI-CML at baseline ranged from 0.73 to 0.95. The six most severe symptoms identified for patients receiving the kinase inhibitor imatinib, dasatinib, or nilotinib were fatigue, muscle soreness/cramping, disturbed sleep, drowsiness, swelling of face, abdomen, and extremeties, and difficulty remembering. There was a trend toward lower symptom burden in patients administered nilotinib.

The authors concluded that type of kinase inhibitor administered may influence the level of symptom burden; therefore, oncology nurses should be aware of these differences when caring for patients. Further investigation of the symptom burden of kinase inhibitor therapies and interventions to lessen the burden is warranted.
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