Friday, December 16, 2005
The current Journal of Pain and Symptom Management has the usual assortment of interesting articles. What struck me most, however, was a very modest article looking at changes in symptoms over time in patients undergoing radiotherapy. This was a large, single-center study in which ~1100 patients' symptoms were prospectively measured for 5 weeks while undergoing radiotherapy (they were able to gather a full 5 weeks' worth of data on ~400 people). This was an unselected group of people undergoing a variety of radiation therapies for a variety of different cancers. Much data is presented in the article, too much to discuss in detail here, but their findings were pretty consistent and depressing: troubling symptoms are common before radiotherapy and overall worsen throughout the 5 weeks. Fatigue, drowsiness, &--of course--skin problems worsened the most. Pain didn't decrease at all in the cohort, although they couldn't select out those receiving radiotherapy for painful bony mets. Not surpringly, those receiving head and neck radiation seemed to fare the worse.
These findings are congruent with another piece published in JPSM in August, surveying symptoms in a radiation oncology clinic. All of this magnifies the need for improved palliative care in the radiation oncology clinic, and improved symptom/palliative education & support for our rad onc colleagues.
(Somewhat along the same line, in this issue there's also an article on the symptom burden of those with HIV receiving palliative care.)