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Does Assessing Patients' Expectancies About Chemotherapy Side Effects Influence Their Occurrence?
Ben Colagiuri, Haryana Dhillon, Phyllis N. Butow, Jesse Jansen, Keith Cox, Jeralyn Jacquet
Journal of Pain and Symptom Management, Volume 46, Issue 2, August 2013, Pages 275-281
Editors’ comment: Dr Ricardo Caponero
Nowadays we see a lot of trials that consider patient reported outcomes (PROs), mainly in the area of symptoms control. Suggestion effects (and placebo effects) are well known by all of us. But … Will assessing patients’ expectancies about chemotherapy side effects influence their occurrence? This is the question asked by Ben Colagiuri and colleagues, and the findings suggest that patient expectancies might be a useful point of intervention for attempting to reduce the burden of chemotherapy-related side effects, as there do not appear to be any detrimental effects of asking patients to report their expectancies and their expectancies do appear related to the occurrence of post-treatment side effects.
To develop an evidence-based clinical practice guideline for the prevention of oral mucositis in children (0-18 years) receiving treatment for cancer or undergoing haematopoietic stem cell transplantation (HSCT).
The Mucositis Prevention Guideline Development Group was interdisciplinary and included internationally recognised experts in paediatric mucositis. For the evidence review, we included randomised controlled trials (RCTs) conducted in either children or adults evaluating the following interventions selected according to prespecified criteria: cryotherapy, low level light therapy (LLLT) and keratinocyte growth factor (KGF). We also examined RCTs of any intervention conducted in children. For all systematic reviews, we synthesised the occurrence of severe oral mucositis. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to describe quality of evidence and strength of recommendations.
We suggest cryotherapy or LLLT may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis. We also suggest KGF may be offered to children receiving HSCT conditioning with regimens associated with a high rate of severe mucositis. However, KGF use merits caution as there is a lack of efficacy and toxicity data in children, and a lack of long-term follow-up data in paediatric cancers. No other interventions were recommended for oral mucositis prevention in children.
All three specific interventions evaluated in this clinical practice guideline were associated with a weak recommendation for use. There may be important organisational and cost barriers to the adoption of LLLT and KGF. Considerations for implementation and key research gaps are highlighted.