Cancer-Related Pain and Immunotherapy Side Effects: Research from the 2018 Palliative and Supportive Care in Oncology Symposium

Palliative and Supportive Care in Oncology Symposium: Patient-Centered Care Across the Cancer Continuum
November 13, 2018
Greg Guthrie, ASCO Staff

Palliative care, also called supportive care, is an important part of cancer care. For someone with cancer, the goals of palliative care include treating symptoms, managing emotional and social needs, and addressing spiritual and practical concerns. Anyone, regardless of age or type and stage of cancer, may receive palliative care before, during, and after treatment.share on twitter

The 2018 Palliative and Supportive Care in Oncology Symposium, held November 16 and 17 in San Diego, brings together experts to share strategies and methods for integrating palliative care into every point in the patient’s cancer care. You can read more research news from this symposium by following the #PallOnc18 hashtag on Twitter.

Here are summaries of 2 studies that will be highlighted at this meeting.

  • Smartphone app uses artificial intelligence to reduce cancer-related pain

  • Certain immunotherapies may cause more side effects than previously thought

Smartphone app uses artificial intelligence to reduce cancer-related pain

Cancer-related pain affects many people with cancer, leading to significant discomfort and a lower quality of life. In this study, researchers investigated whether using an artificial intelligence (AI)-based smartphone app could lower the severity of cancer-related pain and pain-related hospital admissions. After 8 weeks, people who used the app reported a 20% reduction in the severity of their pain and had a 69% lower chance of having to be admitted to the hospital because of pain than people who did not use the app.

Of the 112 people in the study, 56 were given the app and the other 56 were assigned to receive usual care. All had metastatic cancer. The app would send alerts with daily pain management tips and prompted users to submit their pain rating levels 3 days a week. People measured their pain on a scale of 0 to 10, where 10 is the worst pain imaginable. A drop of 1 point in self-reported pain was considered a significant reduction. If the pain level was severe, the app alerted a nurse who responded within an hour. If the pain was moderate, the app asked the user about their pain and then electronically gave them educational support, such as information on how to better manage side effects of a medication. The app’s AI was able to distinguish between the levels of pain and to respond appropriately.

All people in the study were given questionnaires at the beginning, middle, and end of the 8-week study to evaluate their perspectives about their own overall treatment and their general anxiety.

Everyone in the study had similar pain scores at the start of the study, with an average pain level of 4. This did not change for the people who received usual care. Those who were assigned to use the app had an average pain score of 2.99 at the end of the study, a 20% reduction in pain levels. In addition, app users had 4 pain-related hospital admissions, while those receiving usual care had 20 hospital admissions. Anxiety scores, however, increased for those who used the app and decreased slightly for those in the usual-care group. The researchers think that the reason for this may be that simply asking about pain may create anxiety in some people. However, the study also found that people who reported pain through the app more than twice a week did not experience an increase in anxiety.

What does this mean? There is growing awareness of the power of using technology to help improve quality of life for people with cancer,share on twitter such as reducing symptoms in people with head and neck cancer and helping survivors of childhood cancer stay physically active. This study shows how an AI-based app can help reduce pain, a common cancer-related side effect, without the direct intervention of the health care team or visits to the hospital. When people with cancer can report their symptoms quickly, they are able to get the care they need in a timely manner, which helps improve their quality of life. Even if people with cancer do not have access to an experimental app like the one in this study or others, they should still know that they are encouraged to report any symptoms that are affecting their quality of life through other methods.

“It’s significant that patients who used the app had significantly fewer hospital admissions without an associated increase in outpatient clinical burden. These findings suggest that integrating innovations like mobile technology and AI could have a real impact on patient well-being, resource utilization, and cost of care.”

—   senior study investigator Kamal Jethwani, MD
Partners HealthCare Pivot Labs
Boston, Massachusetts

Certain immunotherapies may cause more side effects than previously thought

An analysis of health insurance claims data for nearly 2,800 people found that immune checkpoint inhibitors may cause more side effects than previously thought. Specifically, this study looked at people with non-small cell lung cancer treated with nivolumab (Opdivo), pembrolizumab (Keytruda), or atezolizumab (Tecentriq) from 2015 to 2017. The researchers then looked at what treatment-related side effects occurred the most frequently.

The researchers found that the most common side effects were hypothyroidism (a little over 9% of patients), anemia (nearly 6% of patients), and kidney problems (nearly 3% of patients). Hypothyroidism is when the thyroid gland does not produce enough thyroid hormone and can cause fatigue and weight gain. Anemia is an abnormally low level of red blood cells.

The analysis also showed that immunotherapy-related side effects may happen more often than shown in earlier clinical trials of these treatments. This analysis showed that 2.4% of patients developed hypophysitis. Hypophysitis is inflammation of the pituitary gland, and it is a rare condition. An earlier study of pembrolizumab showed that hypophysitis affected less than 1% of patients.  

What does this mean? As more immunotherapy treatments are approved to treat cancer, patients and oncologists need to stay aware that this is still a relatively new treatment method.share on twitter  This means that the medical community is still learning which side effects may be caused by a specific drug and how severe those side effects may be. People receiving immunotherapy to treat cancer should let their health care team know about side effects they are experiencing.

“Immunotherapy continues to be well tolerated, and severe side effects are less frequent than those seen with conventional chemotherapy. Still, immunotherapy can, in rare occasions, cause other serious medical problems. It’s important to understand the full extent of cancer treatments’ side effects, and patients and providers should be aware that it can take a while to fully assess them for newer therapies.”

—   senior study author Elizabeth Jane Cathcart-Rake, MD
Mayo Clinic
Rochester, Minnesota

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