The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with complications following radiation and chemotherapy that affect the hypothalamic-pituitary-adrenal axis.
Subjective measures:
(1) activity level
(2) appetite
(3) skin color
Objective measures:
(1) strength
(2) cardiovascular
(3) metabolic
(4) skin color
Management measures:
(1) hypoadrenalism
Analytic studies: Assessment of adrenal responsiveness and the hypothalamic-pituitary-adrenal axis integrity
(1) corticotropin stimulation test
(2) corticotropin release hormone (CRH) stimulation test
If no toxicity is present, then the 0 points are assigned.
If a toxicity is present, then the grade indicates the number of points to assign.
|
|
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
activity level |
occasional fatigue |
intermittent fatigue and drowsiness |
drowsiness and weakness |
paralysis and/or coma |
|
appetite |
occasional anorexia |
anorexia and nausea |
persistent vomiting |
refractory vomiting |
|
skin color |
darkened scars |
darkened mucosa, palmar creases |
darkened skin |
NA |
|
strength |
NA |
NA |
muscle weakness |
paralysis |
|
cardiovascular |
NA |
blood pressure 20% below baseline |
blood pressure 20-50% below baseline |
blood pressure > 50% below baseline |
|
metabolic |
occasional salt craving and muscle cramping |
intermittent salt craving and muscle cramping; light headedness |
persistent salt craving and muscle cramping, dizziness or syncope |
refractory muscle cramping, coma |
|
skin color |
darkened scars |
darkened mucosa, palmar creases |
darkened skin |
NA |
|
hypo-adrenalism management |
hydrocortisone replacement therapy |
NA |
NA |
NA |
where:
• The subjective and objective findings for skin color are the same.
total score =
= SUM(points for all 8 items)
LENT score =
= (total score) / 8
Interpretation:
• maximum total score: 27
• minimum LENT score: 0
• maximum LENT score: 3.38
Specialty: Hematology Oncology, Endocrinology
