Insight

Ishwaria Subbiah: If life’s in the journey and not the endpoint, then preparing our patients and caregivers for the EVP journey is the top priority!

Photo from Ishwaria Subbiah/Twitter

Oct 25, 2023, 17:23

Ishwaria Subbiah: If life’s in the journey and not the endpoint, then preparing our patients and caregivers for the EVP journey is the top priority!

Ishwaria Subbiah shared on Twitter:

“Wow! That OS w EVP! This wait for approval is the perfect time to put your symptom management teams on alert! Because these patients will need it. EVP’s low-grade AEs are exactly why PRO results MUST be reported out with the primary outcome and patients preparing pts and caregivers for the EVP journey is priority #1! Here’s why:

50% had ‘low grade’ peripheral sensory neuropathy. FYI Grade 2 is “moderate symptoms; limiting instrumental ADL (IADLs).”
40% had ‘low grade’ pruritus. FYI Grade 2 pruritus is “widespread & intermittent; skin changes from scratching (eg edema, papulation, excoriations, lichenification, oozing/crusts); oral intervention indicated; limiting IADL”
33% had ‘low grade’ alopecia. FYI Grade 2 alopecia is “Hair loss of >=50%…readily apparent to others; a wig or hair piece is necessary if desired; associated with psychosocial impact.” Gr 2 is the max — there’s no gr 3/4/5.
33% had ‘low grade’ maculopapular rash. FYI Grade 2 is “Macules/papules covering 10 – 30% BSA w or wo symptoms (e.g., pruritus, burning, tightness); limiting IADLs; rash covering > 30% BSA w or wo mild symptoms”
29% had ‘low grade’ fatigue. Grade 2 fatigue is ” Fatigue not relieved by rest; limiting IADLs.”
28% had ‘low grade’ diarrhea. Grade 2 diarrhea is “Increase of 4 – 6 stools per day over baseline; moderate increase in ostomy output compared to baseline; limiting IADLs”

FYI for the lay persons: Instrumental activities of daily living (IADLs) are things you do to take care of yourself and your home, such as:

Use the phone, answering and calling others.
Shop for groceries on your own.
Plan, heat, serve your own meals.
Manage your meds, refill them as needed, take them correctly.
Clean your home on your own.
Get around on your own by car, taxi, or public transportation.
Manage money and pay bills.

Practice-changing — yes! in that we ensure we prepare our patients and caregivers not just for the possibility of a longer life (!) but also for the management of side effects! Every disrupted IADL may have major consequences for a patient and family:

Significant rise in caregiver burden – imagine the IADLs falling solely on the working caregiver, with young kids, indefinitely);
Impact on independence and in turn, job security. i.e. trouble driving to work? needing to cut back work hours from that fatigue, diarrhea, neuropathy, etc.?;
Changes in everyday life from perceptible physical changes inc. hair loss, widespread rash, plus active symptoms of neuropathy, diarrhea, fatigue, etc. all impact social interactions and support.

One more time: If life’s in the journey and not the endpoint, then preparing our patients and caregivers for the EVP journey is the top priority! “

Source: Ishwaria Subbiah/Twitter

Ishwaria Subbiah is the Executive Director for Cancer Care Equity and Professional Wellness at Sarah Cannon Research Institute (SCRI). In this role, Dr. Subbiah focuses on reducing cancer outcomes disparities and diversifying clinical trial participation within SCRI’s combined research network of over more than 1,300 physicians at over 250 locations in 24 states across the US. Dr. Subbiah is a globally recognized expert in geriatric oncology, symptom management, palliative care, and healthcare professional well-being. She previously was an associate professor in the Division of Cancer Medicine at the University of Texas MD Anderson Cancer Center. She is the Chair for the ASCO Women in Oncology working group and the ASCO State of Cancer Care in America initiative.