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SYMPTOM TRAJECTORY FOLLOWING 12 WEEKS OF BIOTHERAPY. Constance Visovsky,
PhD, RN, ACNP, Case Western Reserve University, Cleveland, OH.
Significance: Patients treated for cancer with biotherapy experience
alterations in muscle strength, peripheral nerve function, and increases
in symptom distress. Studies of biotherapy-induced physiological changes
have been few, and patients are not systematically monitored for long-term
effects. Thus, the physiological changes accompanying biotherapy treatment
represents changes in function for which patients and families are ill
prepared. Limited data exist quantifying physiologic changes in muscle
and peripheral nerve function in individuals receiving biotherapy.
Purpose: The purpose of this prospective, exploratory pilot study was
to determine: 1) the change in muscle strength, peripheral nerve function,
and symptom distress during treatment with biotherapy; 2) the relationship
between the extent of these physiologic changes and symptom distress.
Theoretical framework: A physiological framework of neuronal degeneration
and skeletal muscle alterations was used.
Methods: A convenience sample of 11 subjects with malignant melanoma receiving
biotherapy had measures of peripheral nerve
and muscle function measured at baseline, 4, and 12 weeks of treatment.
A prospective, exploratory design was used. Data were analyzed using plots
and regression slopes to determine change over time in peripheral nerve
and muscle function and associated symptom distress. Independent variables
were age, gender, and cumulative drug dose. Outcome variables were sensation,
gait/balance, vision, hearing, vibratory sense, deep tendon reflexes,
blood pressure, and symptom distress.
Results: Declines in hearing, vibratory sensation, deep tendon reflexes,
and muscle strength were found. Changes in visual acuity and orthostatic
blood pressure were noted from baseline to 12 weeks, while gait/balance
remained stable. Alterations in peripheral nerve symptoms were associated
with increases in symptom distress. Symptom distress increased from baseline
to 4 weeks and began to decline by 12 weeks.
Implications for practice: The characterization of peripheral nerve and
muscle changes can assist in understanding the nature of the physiological
effects associated with high-dose biotherapy treatment and aid in preparing
patients for anticipated changes in function and subsequent life-style
adjustments. Study findings are essential to foster the development of
interventions aimed at preserving functional status and decreasing symptom
distress in patients receiving cancer treatment with biologic agents.
(This study was funded by the ONS Foundation.)
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