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Psychological effects of cetuximab-induced cutaneous rash in advanced colorectal cancer patients

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Abstract

Goals of work

Advanced colorectal cancer (CRC) has recently been treated with monoclonal antibodies, such as cetuximab. Skin toxicity is a peculiar side effect of cetuximab that may induce patients to interrupt therapy if it becomes serious. This study investigates the psychological and social sequelae of skin rash.

Materials and methods

Patients affected by advanced CRC and treated with cetuximab-based therapy entered the trial. The following questionnaires were used: the Functional Assessment of Cancer Therapy—Colorectal (FACT-C) to measure quality of life (QoL) and the Psychological Distress Inventory (PDI). A single item regarding social avoidance was added with a three-point Likert scale. Toxicity was assessed using the National Cancer Institute Criteria (NCI-2).

Main results

Eighty patients were recruited; 41% presented psychological distress. As regards social avoidance, 53% of patients answered that they did not avoid going out at all. The rest of the sample answered that they “very much” (22%) or “somewhat” (25%) avoided going out. Psychological distress and social avoidance were not correlated to skin rash, but only to QoL.

Conclusion

Skin rash was not found to impact patients' psychological status or social life. Two likely explanations for this finding were that (a) patients with advanced cancer consider skin rash as a part of the complex suffering caused by cancer and (b) patients are encouraged by oncologists to continue treatment because skin rash is indicative of response to therapy. This expectation brings hope and helps patients bear the drug-related side effects.

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Acknowledgments

The authors thank Mr. Baldassarre Stea for his help in the statistical analyses.

Author information

Authors and Affiliations

  1. Experimental Unit of Psychological Oncology, Department of Critical Area and Surgery, National Cancer Institute “Giovanni Paolo II”, Via Hahnemann 10, 70100, Bari, Italy

    Francesca Romito & Vittorio Mattioli

  2. Department of Experimental and Medical Oncology, National Cancer Institute “Giovanni Paolo II”, Via Hahnemann 10, 70100, Bari, Italy

    Francesco Giuliani, Claudia Cormio & Giuseppe Colucci

  3. Department of Haematological Oncology, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy

    Cinzia Tulipani

Authors
  1. Francesca Romito
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  2. Francesco Giuliani
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  3. Claudia Cormio
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  4. Cinzia Tulipani
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  5. Vittorio Mattioli
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  6. Giuseppe Colucci
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Corresponding author

Correspondence to Francesca Romito.

Additional information

The authors declare that the procedures followed were in accordance with the ethical standards of the Helsinki Declaration (1964, amended in 1975, 1983, 1989, 1996, and 2000) of the World Medical Association.

Appendices

Appendix 1

The FACT-C (Version 4)

PHYSICAL WELL-BEING

I have a lack of energy.

I have nausea.

Because of my physical condition, I have trouble meeting the needs of my family.

I have pain.

I am bothered by side effects of treatment.

I feel ill.

I am forced to spend time in bed.

SOCIAL/FAMILY WELL-BEING

I feel close to my friends.

I get emotional support from my family.

I get support from my friends.

My family has accepted my illness.

I am satisfied with family communication about my illness.

I feel close to my partner (or the person who is my main support).

I am satisfied with my sex life.

EMOTIONAL WELL-BEING

I feel sad.

I am satisfied with how I am coping with my illness.

I am losing hope in the fight against my illness.

I feel nervous.

I worry about dying.

I worry that my condition will get worse.

FUNCTIONAL WELL-BEING

I am able to work (include work at home).

My work (include work at home) is fulfilling.

I am able to enjoy life.

I have accepted my illness.

I am sleeping well.

I am enjoying the things I usually do for fun.

I am content with the quality of my life right now.

ADDITIONAL CONCERNS

I have swelling or cramps in my stomach area.

I am losing weight.

I have control of my bowels.

I can digest my food well.

I have diarrhea.

I have a good appetite.

I like the appearance of my body.

Do you have an ostomy appliance?

If yes, please answer the next two items:

I am embarrassed by my ostomy appliance.

Caring for my ostomy appliance is difficult.

ANSWERS: (0) not at all; (1) a little bit; (2) somewhat; (3) quite a bit; (4) very much.

Appendix 2

The Psychological Distress Inventory (PDI)

In the last week:

  1. 1.

    Do you think your desire to speak with others has diminished?

  2. 2.

    Have you felt calm?

  3. 3.

    Have you experienced moments of anxiety or inner tension?

  4. 4.

    Have you felt tired or lacking in energy?

  5. 5.

    Have you felt more alone?

  6. 6.

    Have you felt better?

  7. 7.

    Have you experienced moments of dejection or depression?

  8. 8.

    Do you think that your illness might have created problems of self-image for you that did not exist before?

  9. 9.

    Have you felt worthless?

  10. 10.

    Have you felt a lack of willpower?

  11. 11.

    Has your interest in the world that surrounds you diminished?

  12. 12.

    Have you felt that your sexual desire has diminished?

  13. 13.

    Has your illness negatively influenced your relationship with others?

ANSWERS: (1) not at all; (2) a little; (3) quite a bit; (4) much; (5) very much.

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Romito, F., Giuliani, F., Cormio, C. et al. Psychological effects of cetuximab-induced cutaneous rash in advanced colorectal cancer patients. Support Care Cancer 18, 329–334 (2010). https://doi.org/10.1007/s00520-009-0656-9

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  • DOI: https://doi.org/10.1007/s00520-009-0656-9

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