Measuring Subjective Side Effects and Symptoms in Palliative Photodynamic Therapy

Teresa T. Goodell

ONF 2006, 33(3), 647-650. DOI: 10.1188/06.ONF.647-650

Purpose/Objectives: To evaluate the reliability and validity of the Photodynamic Therapy Side Effects and Symptoms Scale (PSES) and to begin to describe patient-reported outcomes of photodynamic therapy (PDT).

Design: Repeated-measures instrument validation. The PSES uses a 10-point numeric scale to evaluate side effects or symptom trouble or burden on 13 items.

Setting: A Pacific Northwest community hospital.

Sample: 14 patients with end-stage lung or esophageal cancer undergoing palliative PDT.

Methods: Participants completed five PSES surveys (i.e., at baseline and once a week for four weeks after PDT). Weekly phone calls were made to assess functional status, operationalized as Karnofsky Performance Status.

Main Research Variables: Symptoms and functional status.

Findings: The PSES possessed acceptable internal consistency reliability and concurrent validity. Functional status declined in the first week after PDT, concurrent with an increase in side-effect and symptom burden. Photosensitivity became more burdensome over time but was never extremely burdensome.

Conclusions: The feasibility of measuring a diverse set of side effects and symptoms in end-stage cancer with a single-page, large-type instrument essentially was supported. The study provided preliminary information about side effects and symptoms in patients undergoing palliative PDT.

Implications for Nursing: Nurses often are called on to provide information to patients considering various treatment options. This study offers the first data on patient-reported outcomes of palliative PDT that clinicians can use to help in answering inquiries. The design of the PSES may be replicated by researchers working with other populations with end-stage disease to reduce respondent burden and decrease attrition.

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    Axcan Pharma. (2004). Photofrin® [Product insert]. Birmingham, AL: Author.

    Bruce, S. (2001). Photodynamic therapy: Another option in cancer treatment. Clinical Journal of Oncology Nursing, 5, 95-99.

    Diaz-Jimenez, J.P., Martinez-Ballarin, J.E., Llunell, A., Farrero, E., Rodriguez, A., & Castro, M.J. (1999). Efficacy and safety of photodynamic therapy versus Nd-YAG laser resection in NSCLC with airway obstruction. European Respiratory Journal, 14, 800-805.

    Heier, S.K., Rothman, K.A., Heier, L.M., & Rosenthal, W.S. (1995). Photodynamic therapy for obstructing esophageal cancer: Light dosimetry and randomized comparison with Nd:YAG laser therapy. Gastroenterology, 109, 63-72.

    Karnofsky, D., & Burchenal, J. (1949). The clinical evaluation of chemotherapeutic agents in cancer. In C.M. Macleod (Ed.), Evaluation of chemotherapeutic agents (pp. 191-205). New York: Columbia University Press.

    Lightdale, C.J., Heier, S.K., Marcon, N.E., McCaughan, J.S., Jr., Gerdes, H., Overholt, B.F., et al. (1995). Photodynamic therapy with porfimer sodium versus thermal ablation therapy with Nd:YAG laser for palliation of esophageal cancer: A multicenter randomized trial. Gastrointestinal Endoscopy, 42, 507-512.

    McCaughan, J.S., Jr., Ellison, E.C., Guy, J.T., Hicks, W.J., Jones, J.J., Laufman, L.R., et al. (1996). Photodynamic therapy for esophageal malignancy: A prospective twelve-year study. Annals of Thoracic Surgery, 62, 1005-1010.

    Moghissi, K., Dixon, K., Hudson, E., Stringer, M., & Brown, S. (1997). Endoscopic laser therapy in malignant tracheobronchial obstruction using sequential Nd YAG laser and photodynamic therapy. Thorax, 52, 281-283.

    Moghissi, K., Dixon, K., Stringer, M., Freeman, T., Thorpe, A., & Brown, S. (1999). The place of bronchoscopic photodynamic therapy in advanced unresectable lung cancer: Experience of 100 cases. European Journal of Cardio-Thoracic Surgery, 15, 1-6.

    Nunnally, J.C., & Bernstein, I.H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill.

    Ware, J., Jr., Kosinski, M., & Keller, S.D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220-233.

    Webber, J., Herman, M., Kessel, D., & Fromm, D. (2000). Photodynamic treatment of neoplastic lesions of the gastrointestinal tract. Recent advances in techniques and results. Langenbeck's Archives of Surgery, 385, 299-304.