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Pruritus in patients with solid tumors: an overlooked supportive care need

  • Jaxon J. Vallely
  • Kathryn E. Hudson
  • Susan C. Locke
  • Steven P. Wolf
  • Gregory P. Samsa
  • Amy P. Abernethy
  • Thomas W. LeBlancEmail author
Original Article

Abstract

Purpose

Pruritus is a common symptom in cutaneous malignancies, but its impact on patients with solid tumors is unclear. We explored the impact and management of pruritus in patients with solid tumors, using patient-reported outcomes (PRO) data from a real-world registry.

Methods

From 2006 to 2011, patients seen in the Duke Cancer Institute reported their symptoms via the Patient Care Monitor v2.0, a validated PRO tool that includes a 0–10-point question about pruritus severity. From > 25,000 encounters, 203 patients reported severe pruritus (> 6/10) on at least one visit and 506 total visits were abstracted where patients reported either moderate or severe pruritus (> 3/10). From this cohort, we abstracted demographics, diagnosis, stage, cancer therapy, anti-pruritic therapy, and clinicians’ responses.

Results

Mean age was 59.8 (SD 13.3), 134 (66%) were female, 125 (62%) were Caucasian, and 65 (32%) were African American. Breast cancer was the most common tumor (36.5%), followed by lung cancer (23.2%). Mean pruritus severity score was 6.8 (SD 1.8) for patients on chemotherapy, 6.9 (SD 1.8) for patients on targeted therapy alone or in combination, and 7.1(SD 1.8) for patients off treatment. Overall, 67% of patients reported at least two episodes of moderate-severe pruritus (mean # of visits 4.2 (SD 2.7)). Despite frequent report of severe and persistent pruritus, this was mentioned in just 28% of clinician notes and an intervention was recommended/prescribed in only 7% of visits.

Conclusions

Pruritus is an under-addressed symptom in patients with solid tumors. Additional research is needed to understand the burden of pruritus in affected populations.

Keywords

Pruritus Patient-reported outcomes Patient experience research Supportive care Symptoms 

Notes

Compliance with ethical standards

This study was reviewed and approved by the Duke University School of Medicine’s institutional review board.

Conflict of interest

Tom LeBlanc has full control of all primary data and agrees to allow the journal to review these data if requested, provided this is done in accordance with Duke University policies regarding data. He reports consulting fees/honoraria in the last 12 months from Amgen, Abbvie, Agios, AstraZeneca, Celgene, Helsinn, Heron, Medtronic, Otsuka, Pfizer, Seattle Genetics, and Flatiron Health, as well as research grants to Duke University from the American Cancer Society, AstraZeneca, the Cambia Health Foundation, and Seattle Genetics. Amy Abernethy is a full-time employee of Flatiron Health, a member of the Roche Group; she advises SignalPath Research, The One Health Company and Robin Care; she is on the Board of Directors for Aetnahealth; and she has consulting fees from Bristol Meyers Squibb and Genentech. The remaining authors have no disclosures to report.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Campbell University School of Osteopathic MedicineBuies CreekUSA
  2. 2.Texas OncologyAustinUSA
  3. 3.Duke Cancer InstituteDurhamUSA
  4. 4.Biostatistics CoreDuke University School of MedicineDurhamUSA
  5. 5.Flatiron Health, Member of the Roche GroupNew YorkUSA
  6. 6.Division of Hematologic Malignancies and Cellular Therapy, Department of MedicineDuke University School of MedicineDurhamUSA

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