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Khan JS, Gilron I, Devereaux PJ, Clarke H, Ayach N, Tomlinson G, Quan ML, Ladha KS, Choi S, Munro A, Brull R, Lim DW, Avramescu S, Richebé P, Hodgson N, Paul J, McIsaac DI, Derzi S, Zbitnew GL, Easson AM, Siddiqui NT, Miles SJ, Karkouti K. Prevention of persistent pain with lidocaine infusions in breast cancer surgery (PLAN): study protocol for a multicenter randomized controlled trial. Trials 2024; 25:337. [PMID: 38773653 PMCID: PMC11110187 DOI: 10.1186/s13063-024-08151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Persistent pain is a common yet debilitating complication after breast cancer surgery. Given the pervasive effects of this pain disorder on the patient and healthcare system, post-mastectomy pain syndrome (PMPS) is becoming a larger population health problem, especially as the prognosis and survivorship of breast cancer increases. Interventions that prevent persistent pain after breast surgery are needed to improve the quality of life of breast cancer survivors. An intraoperative intravenous lidocaine infusion has emerged as a potential intervention to decrease the incidence of PMPS. We aim to determine the definitive effects of this intervention in patients undergoing breast cancer surgery. METHODS PLAN will be a multicenter, parallel-group, blinded, 1:1 randomized, placebo-controlled trial of 1,602 patients undergoing breast cancer surgery. Adult patients scheduled for a lumpectomy or mastectomy will be randomized to receive an intravenous 2% lidocaine bolus of 1.5 mg/kg with induction of anesthesia, followed by a 2.0 mg/kg/h infusion until the end of surgery, or placebo solution (normal saline) at the same volume. The primary outcome will be the incidence of persistent pain at 3 months. Secondary outcomes include the incidence of pain and opioid consumption at 1 h, 1-3 days, and 12 months after surgery, as well as emotional, physical, and functional parameters, and cost-effectiveness. DISCUSSION This trial aims to provide definitive evidence on an intervention that could potentially prevent persistent pain after breast cancer surgery. If this trial is successful, lidocaine infusion would be integrated as standard of care in breast cancer management. This inexpensive, widely available, and easily administered intervention has the potential to reduce pain and suffering in an already afflicted patient population, decrease the substantial costs of chronic pain management, potentially decrease opioid use, and improve the quality of life in patients. TRIAL REGISTRATION This trial has been registered on clinicaltrials.gov (NCT04874038, Dr. James Khan. Date of registration: May 5, 2021).
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MESH Headings
- Humans
- Lidocaine/administration & dosage
- Lidocaine/adverse effects
- Breast Neoplasms/surgery
- Female
- Pain, Postoperative/prevention & control
- Pain, Postoperative/etiology
- Pain, Postoperative/diagnosis
- Mastectomy/adverse effects
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/adverse effects
- Infusions, Intravenous
- Multicenter Studies as Topic
- Randomized Controlled Trials as Topic
- Treatment Outcome
- Pain Measurement
- Quality of Life
- Chronic Pain/prevention & control
- Chronic Pain/etiology
- Mastectomy, Segmental/adverse effects
- Time Factors
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Analgesics, Opioid/adverse effects
- Cost-Benefit Analysis
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Affiliation(s)
- James S Khan
- Department of Anesthesiology & Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine, and Biomedical & Molecular Sciences, Centre for Neuroscience Studies, and School of Policy Studies, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - P J Devereaux
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Transitional Pain Service, Toronto General Hospital, Toronto, ON, Canada
| | - Nour Ayach
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - May Lynn Quan
- Department of Surgery/Oncology, University of Calgary, Calgary, AB, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia at St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen Choi
- Department of Anesthesiology and Pain Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Allana Munro
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Richard Brull
- Department of Anesthesiology and Pain Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - David W Lim
- Women's College Research Institute & Department Surgery, Women's College Hospital, Toronto, ON, Canada
| | - Sinziana Avramescu
- Department of Anesthesiology and Pain Medicine, Humber River Hospital, University of Toronto, Toronto, ON, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de L'Est de L'Ile de Montreal (CEMTL), University of Montreal, Montreal, QC, Canada
| | - Nicole Hodgson
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Daniel I McIsaac
- Departments of Anesthesiology & Pain Medicine and School of Epidemiology & Public Health, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Simone Derzi
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB, Canada
| | - Geoff L Zbitnew
- Department of Anesthesiology, Memorial University, St. John's, NF, Canada
| | - Alexandra M Easson
- Department of Surgery and Institute of Health, Policy, Management and Evaluation (HPME), Mount Sinai Hospital and Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Naveed T Siddiqui
- Department of Anesthesiology & Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Sarah J Miles
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network, Sinai Health System, and Women's College Hospital, Toronto, ON, Canada
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2
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Salati SA, Alsulaim L, Alharbi MH, Alharbi NH, Alsenaid TM, Alaodah SA, Alsuhaibani AS, Albaqami KA. Postmastectomy Pain Syndrome: A Narrative Review. Cureus 2023; 15:e47384. [PMID: 38021812 PMCID: PMC10657609 DOI: 10.7759/cureus.47384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Postmastectomy pain syndrome is a very common disorder in breast cancer survivors. The impact on the quality of patients' lives is significantly adverse. The precise pathophysiology has not been determined as yet though various risk factors have been identified that make the patient vulnerable. Required preoperative work includes the identification and possible elimination of risk factors. Treatment is multidisciplinary involving surgical and non-surgical modalities. There is a great scope of research in this field.
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Affiliation(s)
- Sajad Ahmad Salati
- General Surgery, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Lamees Alsulaim
- Surgery, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Mariyyah H Alharbi
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Norah H Alharbi
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Thana M Alsenaid
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Shoug A Alaodah
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Abdulsalam S Alsuhaibani
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
| | - Khalid A Albaqami
- College of Medicine, Unaizah College of Medicine & Medical Sciences, Qassim University, Qassim, SAU
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3
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Smith-Graziani DJ, Parker PA, Peterson SK, Bedrosian I, Shen Y, Black DM, DeSnyder SM, Hunt KK, Dong W, Brewster AM. Prospective Study of Pain Outcomes Associated With Breast Surgery in Women With Nonhereditary Breast Cancer. Ann Surg 2023; 277:e617-e623. [PMID: 33938495 PMCID: PMC10657557 DOI: 10.1097/sla.0000000000004925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess pain severity and interference with life in women after different types of breast cancer surgery and the demographic, treatment-related, and psychosocial variables associated with these pain outcomes. SUMMARY OF BACKGROUND DATA Data are conflicting regarding pain outcomes and quality of life (QOL) among women who undergo different types of breast surgery. METHODS Women with nonhereditary breast cancer completed the brief pain inventory before surgery and at 1, 6, 12, and 18 months postsurgery. We assessed associations between pain outcomes and CPM status and mastectomy status using multivariable repeated measures models. We assessed associations between pain outcome and QOL and decision satisfaction. RESULTS Of 288 women (mean age 56 years, 58% non-Hispanic White), 50 had CPM, 75 had unilateral mastectomy, and 163 had BCS. Mean pain severity scores were higher at one (2.78 vs 1.9, P = 0.016) and 6 months (2.79 vs 1.96, P = 0.031) postsurgery in women who had CPM versus those who did not, but there was no difference at 12 and 18 months. Comparing mastectomy versus BCS, pain severity was higher at 1 and 12 months. There was a significant interaction between pain severity and time point for CPM ( P = 0.006), but not mastectomy status ( P = 0.069). Regardless of surgery type, Black women had higher pain severity ( P = 0.004) than White women. Higher pain interference was associated with lower QOL ( P < 0.001) and lower decision satisfaction ( P = 0.034). CONCLUSIONS Providers should counsel women considering mastectomy about the potential for greater acute pain and its impact on overall well-being. Racial/ethnic disparities in pain exist and influence pain management in breast surgical patients.
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Affiliation(s)
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Y Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dalliah M Black
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wenli Dong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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4
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Fitzgerald Jones K, Fu MR, McTernan ML, Ko E, Yazicioglu S, Axelrod D, Guth AA, Miaskowski C, Conley YP, Wood LJ, Wang Y. Lymphatic Pain in Breast Cancer Survivors. Lymphat Res Biol 2022; 20:525-532. [PMID: 35089817 PMCID: PMC9603252 DOI: 10.1089/lrb.2021.0017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Breast cancer survivors who report chronic pain in the affected ipsilateral upper limb or body are nearly twice as likely to develop lymphedema. Little is known about lymphatic pain, defined as co-occurring pain and swelling in the affected ipsilateral upper limb or body. The study aimed to examine the predictors and effects of lymphatic pain on breast cancer survivors' activities of daily living (ADLs). Materials and Methods: A sample of 568 patients was recruited in a metropolitan cancer center in the United States. Demographic and clinical data were collected. Body mass index (BMI) and limb volume were measured using infra-red perometer. Lymphatic pain and ADLs were measured by the Lymphedema and Breast Cancer Symptom Experience Index. Parametric and nonparametric tests and generalized linear models were used to analyze data. Results: Lymphatic pain affected 33% of survivors. Significant predictors of lymphatic pain included younger age, higher BMI, financial hardship, and a diagnosis of lymphedema. Patients with a diagnosis of lymphedema had 9.68 odds (confidence interval [CI]: 5.78-16.63; p < 0.001) and those with financial hardship had 4.64 odds (CI: 1.99-11.32; p = 0.001) of experiencing lymphatic pain. Patients with lymphatic pain had more impairments in ADLs (p < 0.001) compared to patients with only pain, only swelling, and no symptoms. Significantly more patients with lymphatic pain had a limb volume difference of >5% and >10% compared to patients with only pain and no symptom. Conclusion: This study is the first to report that in a large sample of patients, 33.1% experienced lymphatic pain and that lymphatic pain was associated with significant impairments in ADLs. Findings suggest that lymphatic pain may be due to abnormal accumulation of lymph fluid. Research is needed to ascertain the physiological mechanisms that underlie lymphatic pain and determine whether strategies to prevent and treat lymphedema can decrease lymphatic pain.
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Affiliation(s)
| | - Mei Rosemary Fu
- School of Nursing–Camden, Rutgers University, Camden, New Jersey, USA
| | | | - Eunjung Ko
- The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Simay Yazicioglu
- New York University Tandon School of Engineering, Brooklyn, New York, USA
| | - Deborah Axelrod
- Department of Surgery, New York University School of Medicine, NYU Perlmutter Cancer Center, New York, New York, USA
| | - Amber A. Guth
- Department of Surgery, New York University School of Medicine, NYU Perlmutter Cancer Center, New York, New York, USA
| | - Christine Miaskowski
- Department of Physiological Nursing and Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | | | - Lisa J. Wood
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA
| | - Yao Wang
- Electrical and Computer Engineering and Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, New York, USA
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5
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Filipponi C, Masiero M, Pizzoli SFM, Grasso R, Ferrucci R, Pravettoni G. A Comprehensive Analysis of the Cancer Chronic Pain Experience: A Narrative Review. Cancer Manag Res 2022; 14:2173-2184. [PMID: 35855762 PMCID: PMC9288227 DOI: 10.2147/cmar.s355653] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/16/2022] [Indexed: 11/29/2022] Open
Abstract
Cancer-related chronic pain (CP) represents a critical clinical issue through the disease, severely compromising the quality of life (QoL) of patients and the family environment. The current review employed a narrative method to synthesize the main results about the impact of cancer-related CP on QoL, adopting a multidimensional and threefold vision: patients, caregivers, and patient–caregiver perspective. Evidence emphasizes the importance of considering a bidirectional perspective (patient–caregiver) to understand better the pain experience throughout the cancer continuum and its consequences on QoL of patients and caregivers. Moreover, a holistic and multidimensional approach to cancer-related CP and its impact on QoL of patients and caregivers is still needed, in which the interconnection between physical, psychological, and social factors should be analyzed. Theoretical and methodological issues for orienting future social and family research initiatives were discussed.
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Affiliation(s)
- Chiara Filipponi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | | | - Roberto Grasso
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Roberta Ferrucci
- Department of Health Sciences, University of Milan, Milan, 20146, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
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6
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Yamada K, Adams H, Ellis T, Clark R, Sully C, Lariviere C, Sullivan MJ. The temporal relation between pain and fatigue in individuals receiving treatment for chronic musculoskeletal pain. BMC Musculoskelet Disord 2022; 23:219. [PMID: 35260111 PMCID: PMC8905765 DOI: 10.1186/s12891-022-05162-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Numerous investigations have revealed significant relations between pain and fatigue in individuals with persistent pain conditions. However, the direction of influence between pain and fatigue remains unclear. Shortcomings of design and analytic approaches used in previous research limit the nature of conclusions that can be drawn about possible causal or directional relations between pain and fatigue. The present study investigated the temporal relation between changes in pain and changes in fatigue in individuals with musculoskeletal pain enrolled in a 10-week behavioral activation intervention. On the basis of previous findings, it was hypothesized that analyses would support a bi-directional relation between pain and fatigue. Methods The study sample consisted of 104 individuals with chronic musculoskeletal pain participating in a 10-week standardized rehabilitation intervention. Measures of pain intensity and fatigue were completed pre-, mid-, and post-treatment. The three-wave data panel permitted examination of the direction of influence between pain and fatigue through the course of the intervention. A random-intercept cross-lagged panel model (RI-CLPM) was used to examine the temporal relation between pain and fatigue. Results Consistent with previous research, cross-sectional analyses of pre-treatment data revealed significant correlations between measures of pain and fatigue. Significant reductions in pain and fatigue were observed through the course of treatment (d = 0.33 and d = 0.66, p < .001, respectively). RI-CLPM revealed that pain severity predicted later fatigue (pre to mid-treatment standardized path coefficient (β) = 0.55, p = 0.02; mid to post-treatment β = 0.36, p = 0.001); however, fatigue did not predict later pain severity. Conclusions Discussion addresses the processes that might underlie the temporal relation between pain and fatigue. Clinical implications of the findings are also discussed.
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Affiliation(s)
- Keiko Yamada
- Department of Psychology, McGill University, 2001 McGill College, QC, H3A 1G1, Montreal, Canada.,Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Heather Adams
- University Centre for Research and Disability, Halifax, Nova Scotia, Canada
| | - Tamra Ellis
- Centre for Rehabilitation and Health, Toronto, ON, Canada
| | - Robyn Clark
- Kootenay Health Services, Nelson, BC, Canada
| | - Craig Sully
- Kootenay Health Services, Nelson, BC, Canada
| | - Christian Lariviere
- l'Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, QC, Canada
| | - Michael Jl Sullivan
- Department of Psychology, McGill University, 2001 McGill College, QC, H3A 1G1, Montreal, Canada.
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7
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Moorthy A, Lowry D, Edgley C, Casey MB, Buggy D. Effect of perioperative cognitive behavioural therapy on chronic post-surgical pain among breast cancer patients with high pain catastrophising characteristics: protocol for a double-blinded randomised controlled trial. Trials 2022; 23:66. [PMID: 35062997 PMCID: PMC8781049 DOI: 10.1186/s13063-022-06019-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/11/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Surgery is regarded as the primary treatment for breast cancer. Chronic post-surgical pain (CPSP) is a recognised complication after breast cancer surgery, and it is estimated to affect 20-30% of women. Pain catastrophizing has emerged as one of the most influential psychological variables associated with CPSP. METHODS This trial will be a single-centre, prospective, double-blinded, superiority, randomised controlled trial (RCT). Patients scheduled for elective breast cancer surgery (wide local excision or mastectomy with or without axillary lymph node dissection) will be screened preoperatively for high pain catastrophising. Patients with high pain catastrophising, defined as a score of ≥ 24 on the Pain Catastrophising Scale will be deemed eligible for inclusion in the study. Participants will be randomly assigned to receive either a cognitive behavioural therapy or an educational mindfulness based programme during their perioperative period. The primary outcome is the Brief Pain Inventory short form average pain severity score at 3 months postoperatively. Secondary outcomes include patient-reported quality of recovery at days 1-2 after surgery, levels of pain catastrophising, reported depressed mood and anxiety. DISCUSSION To the best of our knowledge, this protocol describes the first RCT which directly examines the effect of perioperative cognitive behavioural therapy on CPSP among breast cancer patients with high pain catastrophising characteristics. The outcomes of this trial may have significant implications for these patients because perioperative cognitive behavioural therapy has the potential to become an important perioperative intervention to complement patient management. TRIAL REGISTRATION ClinicalTrials.gov NCT04924010 . Registered on 11 June 2021. All item from the World Health Organisation Trial Registration Data set have been included.
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Affiliation(s)
- Aneurin Moorthy
- Division of Anaesthesiology & Perioperative Medicine, Mater University Hospital, Dublin, Ireland.
| | - Damien Lowry
- Depts of Psychology and Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Carla Edgley
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Donal Buggy
- Division of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland.,Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
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8
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Fu MR, Axelrod D, Guth AA, Scagliola J, Rampertaap K, El-Shammaa N, Qiu JM, McTernan ML, Frye L, Park CS, Yu G, Tilley C, Wang Y. A Web- and Mobile-Based Intervention for Women Treated for Breast Cancer to Manage Chronic Pain and Symptoms Related to Lymphedema: Results of a Randomized Clinical Trial. JMIR Cancer 2022; 8:e29485. [PMID: 35037883 PMCID: PMC8893593 DOI: 10.2196/29485] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/23/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The-Optimal-Lymph-Flow (TOLF) is a patient-centered, web- and mobile-based mHealth system that delivers safe, easy, and feasible digital therapy of lymphatic exercises and limb mobility exercises. OBJECTIVE The purpose of this randomized clinical trial (RCT) was to evaluate the effectiveness of the web- and mobile-based TOLF system for managing chronic pain and symptoms related to lymphedema. The primary outcome includes pain reduction, and the secondary outcomes focus on symptom relief, limb volume difference measured by infrared perometer, BMI, and quality of life (QOL) related to pain. We hypothesized that participants in the intervention group would have improved pain and symptom experiences, limb volume difference, BMI, and QOL. METHODS A parallel RCT with a control-experimental, pre- and posttest, and repeated-measures design were used. A total of 120 patients were recruited face-to-face at the point of care during clinical visits. Patients were randomized according to pain in a 1:1 ratio into either the arm precaution (AP) control group to improve limb mobility and arm protection or The-Optimal-Lymph flow (TOLF) intervention group to promote lymph flow and limb mobility. Trial outcomes were evaluated at baseline and at week 12 after the intervention. Descriptive statistics, Fisher exact tests, Wilcoxon rank-sum tests, t test, and generalized linear mixed effects models were performed for data analysis. RESULTS At the study endpoint of 12 weeks, significantly fewer patients in the TOLF intervention group compared with the AP control group reported chronic pain (45% [27/60] vs 70% [42/60]; odds ratio [OR] 0.39, 95% CI 0.17-0.90; P=.02). Patients who received the TOLF intervention were significantly more likely to achieve a complete reduction in pain (50% [23/46] vs 22% [11/51]; OR 3.56, 95% CI 1.39-9.76; P=.005) and soreness (43% [21/49] vs 22% [11/51]; OR 2.60, 95% CI 1.03-6.81; P=.03). Significantly lower median severity scores were found in the TOLF group for chronic pain (MedTOLF=0, IQR 0-1 vs MedAP=1, IQR 0-2; P=.02) and general bodily pain (MedTOLF=1, IQR=0-1.5 vs MedAP=1, IQR 1-3; P=.04). Compared with the AP control group, significantly fewer patients in the TOLF group reported arm/hand swelling (P=.04), heaviness (P=.03), redness (P=.03), and limited movement in shoulder (P=.02) and arm (P=.03). No significant differences between the TOLF and AP groups were found in complete reduction of aching (P=.12) and tenderness (P=.65), mean numbers of lymphedema symptom reported (P=.11), ≥5% limb volume differences (P=.48), and BMI (P=.12). CONCLUSIONS The TOLF intervention had significant benefits for breast cancer survivors to manage chronic pain, soreness, general bodily pain, arm/hand swelling, heaviness, and impaired limb mobility. The intervention resulted in a 13% reduction (from 40% [24/60] to 27% [16/60]) in proportions of patients who took pain medications compared with the AP control group, which had a 5% increase (from 40% [24/60] to 45% [27/60]). A 12% reduction (from 27% [16/60] to 15% [9/60]) in proportions of patients with ≥5% limb volume differences was found in the TOLF intervention, while a 5% increase in the AP control group (from 40% [24/60] to 45% [27/60]) was found. In conclusion, the TOLF intervention can be a better choice for breast cancer survivors to reduce chronic pain and limb volume. TRIAL REGISTRATION Clinicaltrials.gov NCT02462226; https://clinicaltrials.gov/ct2/show/NCT02462226. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.5104.
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Affiliation(s)
- Mei Rosemary Fu
- School of Nursing-Camden, Rutgers University, Camden, NJ, United States
| | - Deborah Axelrod
- Department of Surgery, School of Medicine, New York University, New York, NY, United States
| | - Amber A Guth
- Department of Surgery, School of Medicine, New York University, New York, NY, United States
| | - Joan Scagliola
- NYU Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, United States
| | - Kavita Rampertaap
- Mount Sinai Hospital, Mount Sinai Center for Nursing Research and Innovation, New York, NY, United States
| | | | - Jeanna M Qiu
- Harvard Medical School, Harvard University, Boston, MA, United States
| | | | - Laura Frye
- College of Global Public Health, New York University, New York, NY, United States
| | - Christopher S Park
- College of Global Public Health, New York University, New York, NY, United States
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Charles Tilley
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Yao Wang
- Department of Electrical and Computer Engineering and Biomedical Engineering, New York University Tandon School of Engineering, New York, NY, United States
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9
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Fu MR, McTernan ML, Qiu JM, Miaskowski C, Conley YP, Ko E, Axelrod D, Guth A, Somers TJ, Wood LJ, Wang Y. Co-occurring Fatigue and Lymphatic Pain Incrementally Aggravate Their Negative Effects on Activities of Daily Living, Emotional Distress, and Overall Health of Breast Cancer Patients. Integr Cancer Ther 2022; 21:15347354221089605. [PMID: 35446180 PMCID: PMC9047803 DOI: 10.1177/15347354221089605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/16/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Fatigue and lymphatic pain are the most common and debilitating long-term adverse effects of breast cancer treatment. Fatigue and pain independently have negative effects on quality of life, physical functions, and cancer recurrence-free survival. The interactions between fatigue and pain may aggravate their negative effects. OBJECTIVES Examine the effects of co-occurring fatigue and lymphatic pain on activities of daily living (ADLs), emotional distress, and overall health of breast cancer patients. METHODS A cross-sectional and observational design was used to enroll 354 breast cancer patients. Valid and reliable instruments were used to assess fatigue, lymphatic pain, ADLs, emotional distress, and overall health. Descriptive statistics and multivariable regression models were used for data analysis. RESULTS After controlling for demographic and clinical factors, patients with co-occurring fatigue and lymphatic pain had higher odds of having impaired ADLs (OR = 24.43, CI = [5.44-109.67], P < .001) and emotional distress (OR = 26.52, CI = [9.64-72.90], P < .001) compared to patients with only fatigue and only lymphatic pain. Patients with co-occurring fatigue and lymphatic pain had 179% increase in impaired ADL scores (B = 8.06, CI = [5.54-10.59]) and 211% increase in emotional distress scores (B = 9.17, CI = [5.52-12.83]) compared to those without co-occurring fatigue and lymphatic pain. Patients with co-occurring fatigue and lymphatic pain had a 34% decrease (B = -26.29, CI = [-31.90 to -20.69]) and patients with only fatigue had a 33% decrease in overall health scores (B = -25.74, 95% CI = [-34.14 to -17.33]), indicating poor overall health. CONCLUSIONS Fatigue and lymphatic pain affected 66.4% of breast cancer patients. Findings from this study suggest that co-occurring fatigue and lymphatic pain have negative effects on breast cancer patients' ADLs, emotional distress, and overall health. The synergistic interactions between fatigue and lymphatic pain incrementally aggravated their negative effects on ADLs and emotional distress. Findings of the study highlight the need to evaluate the underlying mechanisms for co-occurring fatigue and lymphatic pain and develop interventions that target both fatigue and lymphatic pain to improve breast cancer patients' the quality of life.
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Affiliation(s)
| | | | | | | | | | - Eunjung Ko
- The Ohio State University, Columbus,
OH, USA
| | | | - Amber Guth
- New York University School of Medicine,
New York, NY, USA
| | | | | | - Yao Wang
- New York University Tandon School of
Engineering, Brooklyn, NY, USA
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10
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Predictive factors for patients who need treatment for chronic post-surgical pain (CPSP) after breast cancer surgery. Breast Cancer 2021; 28:1346-1357. [PMID: 34292500 DOI: 10.1007/s12282-021-01275-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although chronic postsurgical pain (CPSP) after breast cancer surgery is a common and prevalent postsurgical adverse event, the need for CPSP treatment has not been investigated. This study examined the proportion of patients who needed treatment for CPSP and associated predictors. METHODS We conducted a cross-sectional study with female patients who underwent breast cancer surgery at our institution. Participants were aged ≤ 65 years at the time of this study and were at least 1 year post surgery. The questionnaire examined the presence of and need for treatment for CPSP and included the Japanese version of the Concerns about Recurrence Scale (CARS-J). Multivariate analyses were used to identify independent predictors of needing treatment for CPSP. RESULTS In total, 305 patients completed the questionnaire. The mean time since surgery was 67.1 months; 156 (51%) patients developed CPSP after breast cancer surgery and 61 (39%) needed treatment for CPSP. Among patients that developed CPSP, the fear of breast cancer recurrence as assessed by the CARS-J (odds ratio [OR] 2.59, 95% confidence interval [CI] 1.14-6.28, P = 0.028) and ≥ 2 postsurgical pain regions (OR 2.52, 95% CI 1.16-5.57, P = 0.020) were independent predictors of needing treatment for CPSP. CONCLUSIONS This study is the first to identify the proportion and predictors of patients who need treatment for CPSP. Fear of breast cancer recurrence and ≥ 2 postsurgical pain regions may predict the need for CPSP treatment among patients following breast cancer surgery.
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11
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Leysen L, Cools W, Nijs J, Adriaenssens N, Pas R, van Wilgen CP, Bults R, Roose E, Lahousse A, Beckwée D. The mediating effect of pain catastrophizing and perceived injustice in the relationship of pain on health-related quality of life in breast cancer survivors. Support Care Cancer 2021; 29:5653-5661. [PMID: 33569674 DOI: 10.1007/s00520-021-06011-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/19/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND The importance of cognitive appraisals in the effectiveness of pain coping is well established. Two key variables in these appraisal processes are pain catastrophizing (PC) and perceived injustice (PI), which are known to increase the risk of long-term disability and aggravate the pain-related distress through maladaptive behavioral responses. However, to date, the mediating effects of these appraisals have not been examined concurrently in the breast cancer survivor (BCS) population, nor have they been related to health-related quality of life (HRQoL). METHODS Using cross-sectional data from 110 BCS, structural path analyses were used to examine the mediating effects of PC and PI in the relationship of pain on the HRQoL in BCS. RESULTS Results demonstrated a significant direct effect of pain and PI on HRQoL combined with a significant indirect effect through PI, but not through PC. An increase in pain is suggested to result in a decrease in quality of life. On the other hand, an increase in pain also is suggested to increase the PI. A similar relation with PC was not retained as significant. CONCLUSION The relative salience of PI as a mediator of HRQoL underscores the fact that PI is not only understudied but also underappreciated and undertreated in the BCS population. The results of our study warrant replication across longitudinal studies but continue to expand upon the evidence of the multifactorial nature of pain coping in BCS.
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Affiliation(s)
- Laurence Leysen
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium. .,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.
| | - Wilfried Cools
- Interfaculty Center Data Processing and Statistics, Brussels Health Campus, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Nele Adriaenssens
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.,Department of Oncology, University Hospital Brussels, Brussels, Belgium
| | - Roselien Pas
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium
| | - C Paul van Wilgen
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.,Transcare Pijn - Transdisciplinary Pain Center, Groningen, the Netherlands
| | - Rinske Bults
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Transcare Pijn - Transdisciplinary Pain Center, Groningen, the Netherlands.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - Eva Roose
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium
| | - Astrid Lahousse
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium
| | - David Beckwée
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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12
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Fu MR, McTernan ML, Qiu JM, Ko E, Yazicioglu S, Axelrod D, Guth A, Fan Z, Sang A, Miaskowski C, Wang Y. The Effects of Kinect-Enhanced Lymphatic Exercise Intervention on Lymphatic Pain, Swelling, and Lymph Fluid Level. Integr Cancer Ther 2021; 20:15347354211026757. [PMID: 34160294 PMCID: PMC8226364 DOI: 10.1177/15347354211026757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The-Optimal-Lymph-Flow (TOLF) intervention aims to promote lymph flow through therapeutic lymphatic exercises to relieve lymphatic pain, swelling, lymphedema symptoms, and to decrease lymph fluid levels among breast cancer survivors. To enhance the efficacy of the TOLF intervention, an innovative, intelligent, Kinect-enhanced lymphatic exercise intervention (Kinect-TOLF) was developed to teach patients to perform the lymphatic exercises correctly. OBJECTIVES This feasibility trial aimed to determine the feasibility, usability, and effects of the Kinect-TOLF on lymphatic pain, swelling, lymphedema symptoms, and lymph fluid levels. METHODS A single-arm feasibility trial with a pre- and post-test design was employed to recruit 30 breast cancer survivors with persistent lymphatic pain or swelling. Patients received a single training session to learn how to perform the lymphatic exercises using the Kinect-TOLF program. Descriptive statistics, Wilcoxon signed-rank tests, t-test, Spearman's rank correlation coefficients, linear regressions, and Cohen's d were performed for data analysis. Qualitative data were assessed for common themes. RESULTS The Kinect-TOLF was effective in training patients to perform the lymphatic exercises correctly with high user satisfaction. Significant reductions were found in scores of lymphatic pain (MedΔ = -1.00, CI = [-1.5, -0.1], P = .004), arm/hand swelling (MedΔ = -1.00, CI = [-1.5, -0.5], P = .004), total swelling (MedΔ = -1.5, CI = [-2.0, -1.0], P = .003), number of lymphedema symptoms (MΔ = -3.8, CI = [-5.5, -2.1], P < .001), and lymphedema symptom severity (MΔ = -5.3, CI = [-9.5, -1.1], P = .016). A significant reduction in lymph fluid levels was found in mean L-Dex scores (MΔ = -2.68, CI = [-4.67, -0.69], P = .010). Greater decrease in mean L-Dex scores were found in patients with abnormal lymph fluid levels (L-Dex ≥ 7.1) (MΔ = -5.19, CI = [-1.75, -8.63], P = .008). Patients' qualitative feedback supported the results of the study. CONCLUSIONS The Kinect-TOLF is safe, feasible, and effective in reducing lymphatic pain, swelling, lymphedema symptoms, and in decreasing lymph fluid levels. Future research should focus on a randomized clinical trial to confirm the unique or synergistic efficacy of the Kinect-TOLF in comparison with current lymphedema treatment and other forms of exercises or movement therapy. This study was registered in ClinicalTrials.gov with US ClinicalTrials.gov Identifier: NCT03999177.
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Affiliation(s)
- Mei R. Fu
- Boston College William F. Connell
School of Nursing, Chestnut Hill, MA, USA
| | | | | | - Eunjung Ko
- The Ohio State University College of
Nursing, Columbus, OH, USA
| | - Simay Yazicioglu
- New York University Tandon School of
Engineering, Brooklyn, NY, USA
| | | | - Amber Guth
- New York University School of Medicine,
New York, NY, USA
| | - Zhipeng Fan
- New York University Tandon School of
Engineering, Brooklyn, NY, USA
| | - Anna Sang
- New York University College of Arts and
Science, New York, NY, USA
| | | | - Yao Wang
- New York University Tandon School of
Engineering, Brooklyn, NY, USA
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13
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Glynn BA, Khoo EL, MacLeay HML, Duong A, Cantave R, Poulin PA. Exploring Cancer Patients' Experiences of an Online Mindfulness-Based Program: A Qualitative Investigation. Mindfulness (N Y) 2020; 11:1666-1677. [PMID: 32670431 PMCID: PMC7346987 DOI: 10.1007/s12671-020-01380-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective Chronic neuropathic pain (CNP) is a common condition cancer survivors experience. Mindfulness training may be one approach to address the psychosocial factors associated with CNP. The purpose of this study was to understand patients’ experiences in an 8-week online mindfulness-based program (MBP), including techniques and skills learned and applied, barriers to practice, and research experiences. Methods Nineteen participants who were part of a randomized controlled trial consented to participate in a telephone interview or submit written responses via email post-course. Interviews were transcribed and analyzed using the principles of Applied Thematic Analysis (ATA). Results Predominant themes identified in participant interviews included (1) common humanity, (2) convenience, (3) teacher resonance, (4) perceived relaxation and calm, (5) pain and stress management, (6) half-day session, and (7) mindful breathing. Participants also identified helpful strategies learned and implemented from the course, as well as barriers to practice, and key components of their experiences in a randomized controlled trial, including a sense of disconnection post-course and needing continued ongoing sessions, and the importance of the facilitators’ skills in creating a comfortable and supportive space. Conclusions An online group-based MBP may offer a more accessible resource and form of psychosocial intervention and support for cancer survivors living with CNP. Furthermore, the need and consideration for implementing ongoing group maintenance sessions to minimize participants’ feelings of disconnect and abandonment post-course and post-study are warranted in future MBP development.
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Affiliation(s)
- Brittany A Glynn
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Eve-Ling Khoo
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Hayley M L MacLeay
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - An Duong
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Rosemee Cantave
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Patricia A Poulin
- The Ottawa Hospital Research Institute, The Ottawa Hospital - General, Smyth Road, Ottawa, ON K1H 8L6 Canada
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14
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Klassen AF, Dominici L, Fuzesi S, Cano SJ, Atisha D, Locklear T, Gregorowitsch ML, Tsangaris E, Morrow M, King T, Pusic AL. Development and Validation of the BREAST-Q Breast-Conserving Therapy Module. Ann Surg Oncol 2020; 27:2238-2247. [PMID: 31965369 DOI: 10.1245/s10434-019-08195-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND In breast cancer surgery, patient-reported outcome measures are needed to measure outcomes best reported by patients (e.g., psychosocial well-being). This study aimed to develop and validate a new BREAST-Q module to address the unique concerns of patients undergoing breast-conserving therapy (BCT). METHODS Phase 1 involved qualitative and cognitive interviews with women who had BCT and clinical expert input to establish content for the BCT module. A field-test (phase 2) was performed, and Rasch measurement theory (RMT) analysis was used for item reduction and examination of reliability and validity. Validation of the item-reduced scales in a clinical sample (phase 3) was conducted for further assessment of their psychometric properties. RESULTS Qualitative interviews with 24 women resulted in the addition of 15 new items across multiple existing BREAST-Q scales and the development of two new scales (Adverse Effects of Radiation and Satisfaction With Information-Radiation Therapy). Feedback from 15 patients and 5 clinical experts were used to refine the instructions, response options, and item wording. An RMT analysis of data from 3497 women resulted in item reduction. The final set of scales showed evidence of ordered response option thresholds, good item fit, and good reliability, except for the Adverse Effects of the Radiation Scale. Validity and reliability were further supported by the phase 3 data from 3125 women. CONCLUSIONS The BREAST-Q BCT module can be used in research and clinical care to evaluate quality metrics and to compare surgical outcomes across all breast cancer surgery patients.
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Affiliation(s)
| | - Laura Dominici
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Fuzesi
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Madelijn L Gregorowitsch
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Tsangaris
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Monica Morrow
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Tari King
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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15
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Kanatas A, Velikova G, Roe B, Horgan K, Ghazali N, Shaw RJ, Rogers SN. Patient-Reported Outcomes in Breast Oncology: A Review of Validated Outcome Instruments. TUMORI JOURNAL 2018; 98:678-88. [DOI: 10.1177/030089161209800602] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Patient-reported outcomes (PROs) include areas of health-related quality of life but also broader concepts such as patient satisfaction with care. The aim of this review is to give an account of all instruments with potential use in patients with a history of treatment for breast cancer (including surgery, chemotherapy and/or radiotherapy) with evidence of validation in the breast cancer population. Methods All instruments included in this review were identified as PRO measures measuring breast-related quality of life and/or satisfaction that had undergone development and validation with breast oncology patients. We specifically looked for PRO measures examining patient satisfaction and/or quality of life after breast cancer treatment. Following an evaluation of 323 papers, we identified 15 instruments that were able to satisfy our inclusion criteria. Results These instruments are the EORTC QOL-C30 and QLQ-BR23 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Breast Cancer Module), the FACT-B (Functional Assessment of Cancer Therapy-Breast Cancer), the SLDS-BC (Satisfaction with Life Domains Scale for Breast Cancer), the BIBCQ (Body Image after Breast Cancer Questionnaire), the HIBS (Hopwood Body Image Scale), the PBIS (Polivy Body Image Scale), the MBROS (Michigan Breast Reconstruction Outcomes Study) Satisfaction and Body Image Questionnaires, the BREAST-Q, the BCTOS (Breast Cancer Treatment Outcome Scale), the BCQ, the FACT-ES (Functional Assessment of Cancer Therapy-Endocrine System), the MAS (Mastectomy Attitude Scale), and the Breast Cancer Prevention Trial Symptom Checklist (BCPT). Conclusions Suggestions for future directions include (1) to use and utilize validated instruments tailored to clinical practice; (2) to develop a comprehensive measurement of surgical outcome requiring the combination of objective and subjective measures; (3) to aim for a compromise between these two competing considerations in the form of a scale incorporating both generalizability in cancer-related QOL and specificity in breast cancer issues.
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Affiliation(s)
| | | | - Brenda Roe
- Edge Hill University, Ormskirk and University of Manchester, Manchester
| | - Kieran Horgan
- Breast Surgery Department, Leeds Teaching Hospitals, Leeds General Infirmary, Leeds
| | | | - Richard J Shaw
- Department of Molecular & Clinical Cancer Medicine, Liverpool CR-UK Centre, Liverpool
| | - Simon N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, Ormskirk, and Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
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16
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Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat 2017; 167:157-169. [DOI: 10.1007/s10549-017-4485-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
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17
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Oh J, Pagé MG, Zhong T, McCluskey S, Srinivas C, O'Neill AC, Kahn J, Katz J, Hofer SOP, Clarke H. Chronic Postsurgical Pain Outcomes in Breast Reconstruction Patients Receiving Perioperative Transversus Abdominis Plane Catheters at the Donor Site: A Prospective Cohort Follow-up Study. Pain Pract 2017; 17:999-1007. [PMID: 27996199 DOI: 10.1111/papr.12550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/18/2016] [Accepted: 10/26/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic postsurgical pain (CPSP) is a debilitating and costly condition. Risk factors for CPSP after autologous breast reconstruction have not been clearly established. Previously, we demonstrated that transversus abdominis plane (TAP) catheters delivering intermittent local anesthetic reduced postoperative morphine consumption. This prospective follow-up study aimed to (1) compare the incidence of CPSP after autologous breast reconstruction between patients who received postoperative intermittent TAP catheters with bupivacaine or saline boluses and (2) assess the factors that contribute to the development and maintenance of CPSP in this study cohort. METHODS Ninety-three patients who underwent deep inferior epigastric artery perforator or muscle-sparing transverse rectus abdominis breast reconstruction were randomized to receive TAP catheters with bupivacaine or saline postoperatively. Subsequently, patients were followed for a year to assess persistent pain, pain severity, quality of life scores, and functional disability at 6 and 12 months after surgery. RESULTS Twenty-four percent and 23% of patients reported CPSP at 6 and 12 months, respectively. There were no significant differences between groups (bupivacaine vs. placebo) on pain-related variables, including incidence of CPSP. Patients who reported greater variability in pain scores at rest over the first 48 hours postoperatively were more likely to have CPSP 6 months, but not 12 months, later. CONCLUSIONS Acute postoperative pain variability may contribute to the development of CPSP up to 6 months after autologous breast reconstruction surgery. Neither postoperative use of bupivacaine vs. saline in the TAP catheters nor acute pain severity influenced the 6- or 12-month incidence of CPSP.
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Affiliation(s)
- Justin Oh
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - M Gabrielle Pagé
- Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Toni Zhong
- Division of Plastic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Stuart McCluskey
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Coimbatore Srinivas
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Anne C O'Neill
- Division of Plastic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - James Kahn
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Joel Katz
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
| | - Stefan O P Hofer
- Division of Plastic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.,Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada
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18
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Abu Farha NH, Khatib MT, Salameh H, Zyoud SH. Cancer-related post-treatment pain and its impact on health-related quality of life in breast cancer patients: a cross sectional study in Palestine. ASIA PACIFIC FAMILY MEDICINE 2017; 16:7. [PMID: 29200943 PMCID: PMC5696967 DOI: 10.1186/s12930-017-0037-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Post-treatment pain has been suggested as an important indicator for health-related quality of life (HRQOL) in patients with breast cancer. Therefore, this study was performed to examine the association between pain and its impact on HRQOL among breast cancer patients in Palestine. Also, this study aimed to determine the QOL profile for breast cancer patients and stated the factors associated with QOL. METHODS A correlational cross-sectional study was conducted from May 2016 to November 2016 at Al-Watani Hospital and An-Najah National University Hospital in the Nablus district in Palestine. The five-level EuroQol five-dimensional instrument (EQ-5D-5L) was used to examine HRQOL. Pain severity and interference were assessed using the Brief Pain Inventory (BPI). Multiple linear regression analysis was performed to determine the most important variables related with HRQOL. RESULTS One hundred and seventy patients were involved in this study. Overall, all participants were female, with a mean ± SD for age of 51.71 ± 11.11 years. The reported HRQOL of this study was measured by using the median EQ-5D-5L index score, which was 0.67 (interquartile range: 0.51-0.84). There were moderate negative correlations between EQ-5D-5L index score and pain severity score (r = - 0.58, p value < 0.001), and pain interference score (r = - 0.604, p-value < 0.001). Furthermore, univariate analysis showed that age, marital status, employment status, income, current condition of cancer, and post-treatment pain were associated with quality of life (p-value < 0.05). Regression analysis revealed that patients with high income (p-value = 0.003), patients with lower pain severity score (p-value < 0.001), and lower pain interference score (p-value = 0.018) were independently associated with high QOL. CONCLUSIONS This is the first study to present important data regarding QOL by using the EQ-5D-5L instruments that may help healthcare providers to identify patients at risk of low QOL. Healthcare providers and health strategy makers should be alerted to low level HRQOL among breast cancer patients with low income level, patients with post-treatment pain, especially in the state of severe pain, and the state of pain interfering with daily life to improve their HRQOL.
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Affiliation(s)
- Nader H. Abu Farha
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Mohammed T. Khatib
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Husam Salameh
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- 0000 0004 0631 5695grid.11942.3fPoison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- 0000 0004 0631 5695grid.11942.3fDivision of Clinical and Community Pharmacy, Department of Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Moore E, Adams H, Ellis T, Thibault P, Sullivan MJL. Assessing catastrophic thinking associated with debilitating mental health conditions. Disabil Rehabil 2016; 40:317-322. [DOI: 10.1080/09638288.2016.1254283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Emily Moore
- Department of Psychology, McGill University, Montreal, Canada
| | - Heather Adams
- Recover Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Tamra Ellis
- Centre for Rehabilitation and Health, Toronto, Canada
| | - Pascal Thibault
- Department of Psychology, McGill University, Montreal, Canada
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Fu MR, Axelrod D, Guth A, Scagliola J, Rampertaap K, El-Shammaa N, Fletcher J, Zhang Y, Qiu JM, Schnabel F, Hiotis K, Wang Y, D'Eramo Melkus G. A Web- and Mobile-Based Intervention for Women Treated for Breast Cancer to Manage Chronic Pain and Symptoms Related to Lymphedema: Randomized Clinical Trial Rationale and Protocol. JMIR Res Protoc 2016; 5:e7. [PMID: 26795447 PMCID: PMC4742618 DOI: 10.2196/resprot.5104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/23/2015] [Indexed: 12/25/2022] Open
Abstract
Background Despite current advances in cancer treatment, many breast cancer survivors still face long-term post-operative challenges as a result of suffering from daily pain and other distressing symptoms related to lymphedema, ie, abnormal accumulation of lymph fluid in the ipsilateral upper limb or body. Grounded in research-driven behavioral strategies, The-Optimal-Lymph-Flow is a unique Web- and mobile-based system focusing on self-care strategies to empower, rather than inhibit, how breast cancer survivors manage daily pain and symptoms. It features a set of safe, feasible, and easily-integrated-into-daily-routine exercises to promote lymph flow and drainage, as well as guidance to maintain an optimal body mass index (BMI). Objective To conduct a randomized clinical trial (RCT) to evaluate the efficacy of the Web- and mobile-based The-Optimal-Lymph-Flow system for managing chronic pain and symptoms related to lymphedema. The primary outcome includes pain reduction, and the secondary outcomes focus on symptom relief, limb volume difference by infra-red perometer, BMI, and quality of life (QOL) related to pain. We hypothesize that participants in the intervention group will have improved pain and symptom experiences, limb volume difference, body mass index, and QOL. Methods A parallel RCT with a control-experimental, pre- and post-test, repeated-measures design is used in this study. A total of 120 patients will be randomized according to the occurrence of pain. Participants will be recruited face-to-face at the point of care during clinical visits. Participants in the intervention group will receive the Web- and mobile-based The-Optimal-Lymph-Flow intervention and will have access to and learn about the program during the first in-person research visit. Participants in the control group will receive the Web- and mobile-based Arm Precaution program and will have access to and learn about the program during the first in-person research visit. Participants will be encouraged to enhance their learning by accessing the program and following the daily exercises during the study period. Participants will have monthly online self-report of pain and symptoms at 4 and 8 weeks post-intervention. During the two in-person research visits prior to and 12 weeks post-intervention, participants will be measured for limb volume difference, BMI, and complete self-report of pain, symptoms, self-care behaviors, and QOL. Results This trial is currently open for recruitment. The anticipated completion date for the study is July 2017. The primary endpoint for the study is absence or reduction of pain reported by the participants at week 12 post-intervention. Conclusions The-Optimal-Lymph-Flow is a unique Web- and mobile-based self-care and patient-reported outcome system designed to effectively help women treated for breast cancer manage daily pain and symptoms related to lymphedema. Patients learn self-care strategies from a Web- and mobile-based program and track their symptoms. The RCT will directly benefit all women treated for breast cancer who suffer from or at risk for pain and symptoms related to lymph fluid accumulation. Trial Registration Clinicaltrials.gov NCT02462226; https://clinicaltrials.gov/ct2/show/NCT02462226 (Archived by WebCite at http://www.webcitation.org/6du4IupG5)
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Affiliation(s)
- Mei Rosemary Fu
- College of Nursing, New York University, New York, NY, United States.
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Sullivan MJL, Adams H, Yakobov E, Ellis T, Thibault P. Psychometric Properties of a Brief Instrument to Assess Perceptions of Injustice Associated with Debilitating Health and Mental Health Conditions. PSYCHOLOGICAL INJURY & LAW 2016. [DOI: 10.1007/s12207-015-9247-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ferreira VTK, Guirro ECDO, Dibai-Filho AV, Ferreira SMDA, de Almeida AM. Characterization of chronic pain in breast cancer survivors using the McGill Pain Questionnaire. J Bodyw Mov Ther 2015; 19:651-5. [PMID: 26592223 DOI: 10.1016/j.jbmt.2014.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 11/19/2022]
Abstract
The aim of the present study was to characterize pain in breast cancer survivors using the McGill Pain Questionnaire (MPQ). A descriptive, cross-sectional study was conducted with 30 women aged 30-80 years who had been submitted to treatment for breast cancer (surgery and complementary treatment) at least 12 months earlier with reports of pain related to the therapeutic procedures. Pain was characterized using the full-length version of the MPQ, which is made up of 78 descriptors divided into four categories: sensory (ten items), affective (five items), evaluative (one item) and miscellaneous (four items). Two indices were also used to measure pain through the use of the descriptors: the number of words chosen (NWC) and the pain rating index (PRI). The most frequent descriptive terms were "agonizing" (n = 16; 53.3%), "tugging" (n = 15; 50%), "sore" (n = 14; 46.7%), "wretched" (n = 14; 46.7%), "troublesome" (n = 13; 43.3%) and "spreading" (n = 11; 36.7%). The sensory category had the highest PRI value based on the descriptors chosen (mean: 0.41). Women with chronic pain following treatment for breast cancer employed the "agonizing", "tugging" and "sore" descriptors with greatest frequency and rated pain in the sensory category as having the greatest impact.
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Affiliation(s)
- Vânia Tie Koga Ferreira
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Elaine Caldeira de Oliveira Guirro
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Almir Vieira Dibai-Filho
- Postgraduate Program in Rehabilitation and Functional Performance, Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Simone Mara de Araújo Ferreira
- Postgraduate Program in Nursing in Public Health, Department of Maternal-Infant and Public Health Nursing, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ana Maria de Almeida
- Postgraduate Program in Nursing in Public Health, Department of Maternal-Infant and Public Health Nursing, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Giladi H, Scott W, Shir Y, Sullivan MJL. Rates and Correlates of Unemployment Across Four Common Chronic Pain Diagnostic Categories. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:648-657. [PMID: 25693781 DOI: 10.1007/s10926-015-9572-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To examine rates and correlates of unemployment across distinct common chronic pain diagnoses. METHODS Data were analyzed from a sample of 2,382 patients with chronic pain in the Quebec Pain Registry (QPR). Patients were grouped into the following diagnostic categories based on their primary pain diagnosis recorded in the QPR: musculoskeletal pain; myofascial pain; neuropathic pain, and visceral pain. Analyses were performed to examine the associations between pain diagnosis, patient demographics, pain intensity, depressive symptoms, and unemployment status. RESULTS Pain diagnosis, age, marital status, education, pain intensity, and depressive symptoms were each significant unique predictors of unemployment status in a hierarchical logistic regression analysis; the addition of depressive symptoms in this model contributed to the greatest increment of model fit. CONCLUSIONS Depressive symptoms are associated with unemployment across a number of common chronic pain conditions, even when controlling for other factors that are associated with unemployment in these patients. Depressive symptoms, as a modifiable factor, may thus be an important target of intervention for unemployed patients with chronic pain.
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Affiliation(s)
- Hili Giladi
- The Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC, Canada,
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Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Health Related Quality of Life. REHABILITATION ONCOLOGY 2015. [DOI: 10.1097/01893697-201533010-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Galvin R, Joyce D, Downey E, Boland F, Fahey T, Hill AK. Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study. BMC Cancer 2014; 14:743. [PMID: 25277332 PMCID: PMC4197234 DOI: 10.1186/1471-2407-14-743] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 09/26/2014] [Indexed: 12/25/2022] Open
Abstract
Background The number of primary care referrals of women with breast symptoms to symptomatic breast units (SBUs) has increased exponentially in the past decade in Ireland. The aim of this study is to develop and validate a clinical prediction rule (CPR) to identify women with breast cancer so that a more evidence based approach to referral from primary care to these SBUs can be developed. Methods We analysed routine data from a prospective cohort of consecutive women reviewed at a SBU with breast symptoms. The dataset was split into a derivation and validation cohort. Regression analysis was used to derive a CPR from the patient’s history and clinical findings. Validation of the CPR consisted of estimating the number of breast cancers predicted to occur compared with the actual number of observed breast cancers across deciles of risk. Results A total of 6,590 patients were included in the derivation study and 4.9% were diagnosed with breast cancer. Independent clinical predictors for breast cancer were: increasing age by year (adjusted odds ratio 1.08, 95% CI 1.07-1.09); presence of a lump (5.63, 95% CI 4.2-7.56); nipple change (2.77, 95% CI 1.68-4.58) and nipple discharge (2.09, 95% CI 1.1-3.97). Validation of the rule (n = 911) demonstrated that the probability of breast cancer was higher with an increasing number of these independent variables. The Hosmer-Lemeshow goodness of fit showed no overall significant difference between the expected and the observed numbers of breast cancer (χ2HL: 6.74, p-value: 0.56). Conclusions This study derived and validated a CPR for breast cancer in women attending an Irish national SBU. We found that increasing age, presence of a lump, nipple discharge and nipple change are all associated with increased risk of breast cancer. Further validation of the rule is necessary as well as an assessment of its impact on referral practice.
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Affiliation(s)
- Rose Galvin
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St, Stephen's Green, Dublin 2, Republic of Ireland.
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Taraballi F, Minardi S, Corradetti B, Yazdi IK, Balliano MA, Van Eps JL, Allegri M, Tasciotti E. Potential avoidance of adverse analgesic effects using a biologically "smart" hydrogel capable of controlled bupivacaine release. J Pharm Sci 2014; 103:3724-3732. [PMID: 25266282 DOI: 10.1002/jps.24190] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/08/2014] [Accepted: 08/29/2014] [Indexed: 11/11/2022]
Abstract
Acute pain remains a tremendous clinical and economic burden, as its prevalence and common narcotic-based treatments are associated with poorer outcomes and higher costs. Multimodal analgesia portends great therapeutic promise, but rarely allows opioid sparing, and new alternatives are necessary. Microparticles (MPs) composed of biodegradable polymers [e.g., poly(lactic-co-glycolic acid) or PLGA] have been applied for controlled drug release and acute pain treatment research. However, foreign particles' presence within inflamed tissue may affect the drug release or targeting, and/or cause a secondary inflammatory reaction. We examined how small alterations in the particulate nature of MPs affect both their uptake into and subsequent activation of macrophages. MPs composed of PLGA and chitosan (PLGA-Chi) loaded with bupivacaine (BP) were engineered at different sizes and their opsonization by J774 macrophages was assessed. Uptake of PLGA-Chi by macrophages was found to be size dependent, but they were not cytotoxic or proinflammatory in effect. Moreover, encapsulation of MPs in a thermoresponsive loading gel (pluronic F-127) effectively prevented opsonization. Finally, MPs displayed sustained, tunable release of BP up to 7 days. These results demonstrate our ability to develop a drug delivery system capable of controlled release of local anesthetics to treat acute/subacute pain while concurrently avoiding enhanced inflammation.
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Affiliation(s)
- Francesca Taraballi
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas 77030; Pain Therapy Service, University of Pavia-Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Minardi
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas 77030; Bioceramics and Bio-Hybrid Materials, National Research Council of Italy - ISTEC, Faenza, Ravenna 48018, Italy
| | - Bruna Corradetti
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas 77030; Department of Life and Environmental Sciences, Università Politecnica delle Marche, Ancona 60131, Italy
| | - Iman K Yazdi
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas 77030; Department of Biomedical Engineering, University of Houston, Houston, Texas
| | - Marta A Balliano
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas 77030
| | - Jeffrey L Van Eps
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas 77030; Department of Surgery, Houston Methodist Hospital, Houston, Texas 77030
| | - Massimo Allegri
- Pain Therapy Service, University of Pavia-Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinic Surgical Pediatric and Diagnostic Sciences, University of Pavia, Pavia, Italy
| | - Ennio Tasciotti
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, Texas 77030.
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Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther 2014; 12:1103-35. [PMID: 25077519 PMCID: PMC4196523 DOI: 10.1586/14787210.2014.940900] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions - the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1-13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.
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Affiliation(s)
- Daniel J Cameron
- International Lyme and Associated Diseases Society,PO Box 341461, Bethesda MD, 20827-1461,USA
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Chronic pain following abdominal free flap breast reconstruction: a prospective pilot analysis. Ann Plast Surg 2014; 71:278-82. [PMID: 23788145 DOI: 10.1097/sap.0b013e31828637ec] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic pain after breast reconstruction is an ill-defined process which can generate significant patient morbidity and disability. The purpose of this study was to examine chronic, persistent pain in a prospective study of free flap breast reconstruction patients, in an effort to identify possible points of intervention and counseling. METHODS We performed a prospective study evaluating function, quality of life, and satisfaction in patients undergoing abdominally based autologous reconstruction between 2006 and 2010. Using the short form 36, we examined the presence of chronic body pain (>4 months) as well as overall mental and physical health. Patients with debilitating pain were compared to those without in a post hoc analysis. RESULTS Overall, 399 women underwent reconstruction during the study period, with 149 enrolling and having long-term follow-up in this portion of the prospective study. Twenty-six (17%) of 149 patients experienced chronic body pain that was moderately debilitating after autologous reconstruction, making it one of the most common complications experienced in this cohort. No differences were noted in demographics, medical history, procedure type, history of axillary surgery, radiation treatment, surgical outcomes, or follow-up time between the cohorts. However, patients with chronic pain were found to have higher preoperative pain scores (P < 0.0001) and lower physical, mental, and overall health scores across time points. All scores significantly worsened with time in comparison to the cohort without pain, who, in contrast showed score improvement across all areas. Although pain issues trended toward being noted in postoperative visits more frequently in the chronic pain cohort (37% vs 19%, P = 0.051), only 1 (4.2%) patient was referred for pain service consultation. Additionally, satisfaction with reconstruction was significantly lower in patients who demonstrated chronic pain (P = 0.03). CONCLUSIONS Factors contributing to chronic pain continue to be elusive and understudied. Our data demonstrate the importance of screening for chronic pain, as we determined that preoperative pain is linked to increased, moderately debilitating postoperative chronic pain. Persistent chronic pain, in turn, is associated with significant morbidity, disability, and dissatisfaction. Such patients with pain issues may benefit from additional preoperative counseling and early involvement of the pain service.
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Jonsdottir T, Aspelund T, Jonsdottir H, Gunnarsdottir S. The relationship between chronic pain pattern, interference with life and health-related quality of life in a nationwide community sample. Pain Manag Nurs 2013; 15:641-51. [PMID: 24144571 DOI: 10.1016/j.pmn.2013.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 01/22/2023]
Abstract
To establish the scope of the problem of chronic pain in the population, we need to extend the focus on prevalence, the most frequently studied factor. Among other important factors is the complex relationship between the temporal characteristics of pain and their impact on peoples' lives. The purpose of the present study was to describe the characteristics of chronic pain, including pattern, severity, location, spread, and duration, in a population-based sample and to investigate the relationships between pain pattern and impact on the individual's life measured by interference with life and health-related quality of life (HRQoL). In this cross-sectional study, a postal questionnaire measuring pain characteristics, life interference (Brief Pain Inventory), and HRQoL (Short Form 36 Health Survey), was sent to a sample of 4,500 individuals, randomly drawn from the Icelandic National Register. The total response rate was 36.9% and was significantly higher among native Icelanders (40.6%) than individuals of non-Icelandic origin (8.6%).The prevalence of chronic pain (≥3 months) was 47.5% with mean duration of 9.3 years, and 31.9% reported constant pain. Participants with constant pain reported higher life interference scores and less HRQoL than participants with intermittent or periodic pain. Hierarchical stepwise regression analyses showed that pain pattern and severity accounted for 44.4% variance for life interference. The range of the variances for these variables for the five domains of HRQoL was from 7.3% (mental health) to 53.3% (bodily pain). Pain pattern and severity are the most significant predictors of the impact of chronic pain on individual's daily life.
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Affiliation(s)
- Thorbjorg Jonsdottir
- Faculty of Nursing, University of Iceland, Reykjavik; Faculty of Nursing, School of Health Sciences, University of Akureyri, Akureyri, Iceland.
| | - Thor Aspelund
- Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Sigridur Gunnarsdottir
- Faculty of Nursing, University of Iceland, Reykjavik; Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
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Jain G, Bansal P, Ahmad B, Singh DK, Yadav G. Effect of the perioperative infusion of dexmedetomidine on chronic pain after breast surgery. Indian J Palliat Care 2013; 18:45-51. [PMID: 22837611 PMCID: PMC3401734 DOI: 10.4103/0973-1075.97354] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This prospective double-blind trial was undertaken to analyze the role of perioperatively administered dexmedetomidine on the occurrence of chronic pain in cases undergoing surgery for breast cancer. Subjects and Methods: Eighty-six cases were randomly assigned to two groups to receive either dexmedetomidine (2 μg/ml) in group D or saline in group C, in a loading dose of 0.5 ml/kg, intravenous (IV), 30 min prior to induction, followed by a continuous infusion of 0.25 ml/kg/h IV till the completion of surgery, and then the dose tapered to 0.1 ml/kg/h for up to 24 h. The standardized questionnaires that measured chronic pain (Brief Pain Inventory, BPI; Short Form McGill Pain Questionnaire, SF-MPQ2) and quality of life (Quality of Life Scale, QOLS) were gathered after 3 months of surgery as a primary outcome. Pain (verbal numerical score, VNS), sedation scores (Ramsay scoring), and analgesic requirements were also assessed for 72 h postoperatively. Results: In total, 84 cases (n=42) were analyzed for acute pain and 69 (34 in group D and 35 in group C) for chronic pain. The consumption of isoflurane/fentanyl intra-operatively and paracetamol postoperatively was significantly lower in Group D. The sedation scores were non-significant between the groups. The VNS at rest and after movement was significantly lower in group D at corresponding times (except at 60 min) throughout the assessment period. The BPI and SF-MPQ2 scores were significantly lower in group D in most of the factors. The QOLS score was significantly better in group D in all items except for relationships, friends, and learning. Conclusion: The perioperative infusion of dexmedetomidine has a pivotal role in attenuating the incidence and severity of chronic pain and improving the quality of life in cases undergoing breast cancer surgery.
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Affiliation(s)
- Gaurav Jain
- Department of Anaesthesia, Teerthankar Mahaveer Medical College, Moradabad, Uttar Pradesh, India
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Cooney MA, Culleton-Quinn E, Stokes E. Current Knowledge of Pain After Breast Cancer Treatment: A Systematic Review. Pain Manag Nurs 2013; 14:110-23. [DOI: 10.1016/j.pmn.2010.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 09/02/2010] [Accepted: 09/02/2010] [Indexed: 10/18/2022]
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Martinez V, Baudic S, Fletcher D. Douleurs chroniques postchirurgicales. ACTA ACUST UNITED AC 2013; 32:422-35. [DOI: 10.1016/j.annfar.2013.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
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Peretti-Watel P, Bendiane MK, Spica L, Rey D. Pain narratives in breast cancer survivors. PAIN RESEARCH AND TREATMENT 2012; 2012:153060. [PMID: 23150819 PMCID: PMC3488421 DOI: 10.1155/2012/153060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 07/30/2012] [Indexed: 11/17/2022]
Abstract
In-depth interviews were conducted with French breast cancer survivors 24 month after cancer diagnosis (N = 21 women). We documented their experience of chronic pain, compared their pain narratives with their answers to the WHOQOL-BREF questionnaire, and studied both the meaning they gave to their pain and how they dealt with it in their daily lives. Half of participants reported are suffering from iatrogenic chronic pain. Most of the time, this pain was not captured by the WHOQOL questionnaire and was not medically treated. Patients "normalized" their pain in various ways: they considered it either as a necessary step on the road to recovery, as the proof of treatment efficacy, or as a permanent condition one must learn to live with. They learned to deal with pain by taking precautions, giving up certain activities, and changing the way they performed others. Participants were also prone to compare themselves with other patients suffering worse pain. Breast cancer survivors should be better informed about chronic pain and how to alleviate it. Physicians should contribute to fighting pain-related beliefs which lead patients to conceal their pain. Techniques used by patients to cope with chronic pain in their daily lives should also be promoted.
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Affiliation(s)
- Patrick Peretti-Watel
- INSERM, UMR912 (SESSTIM), 13006 Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006 Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006 Marseille, France
| | - Marc-Karim Bendiane
- INSERM, UMR912 (SESSTIM), 13006 Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006 Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006 Marseille, France
| | - Laura Spica
- INSERM, UMR912 (SESSTIM), 13006 Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006 Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006 Marseille, France
| | - Dominique Rey
- INSERM, UMR912 (SESSTIM), 13006 Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006 Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006 Marseille, France
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Sheridan D, Foo I, O'Shea H, Gillanders D, Williams L, Fallon M, Colvin L. Long-term follow-up of pain and emotional characteristics of women after surgery for breast cancer. J Pain Symptom Manage 2012; 44:608-14. [PMID: 22743155 DOI: 10.1016/j.jpainsymman.2011.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 10/11/2011] [Accepted: 10/19/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Persistent pain after treatment for breast cancer (PPBCT) is a common side effect of breast cancer treatment, with prevalence as high as 50%. It is predominantly a neuropathic condition. OBJECTIVES The aim of this cross-sectional, questionnaire-based study was to examine the emotional characteristics of patients with PPBCT in long-term breast cancer patients. A secondary objective was to characterize the risk factors and severity of that pain. METHODS From March 1, 2010 to April 9, 2010, long-term follow-up patients were invited to complete a questionnaire. This recorded their surgical and demographic data and ascertained whether they had PPBCT. If the patient had pain, she completed a range of validated self-report questionnaires and questions about the nature of the pain, including a visual analogue scale. RESULTS One hundred eleven patients completed the questionnaire; 33 (29.7%) patients reported chronic pain at a median time of 64 months postoperatively (interquartile range 54.25). Patients with persistent pain were not significantly more anxious (t(105)=-0.369, P=0.713) or depressed (t(105)=0.713, P=0.507) than patients without pain. Patients with constant pain compared with intermittent pain were significantly more anxious (t(25)=-3.460, P=0.002). Preoperative pain conferred a fivefold increased risk of PPBCT (odds ratio [OR]=5.17, 95% confidence interval [CI]=1.79-14.97, P=0.002); chemotherapy conferred a threefold increased risk (OR=3.004, 95% CI=1.22-7.40, P=0.017). CONCLUSION We have shown significant numbers of patients suffer from PPBCT. At a median time of 64.5 months, women with pain are not significantly more anxious or depressed than women without pain. Preoperative pain and chemotherapy have been highlighted as risk factors.
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Affiliation(s)
- David Sheridan
- School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, United Kingdom.
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Cooney M, Galvin R, Connolly E, Stokes E. The International Classification of Functioning (ICF) Core Set for breast cancer from the perspective of women with the condition. Disabil Rehabil 2012; 35:740-8. [DOI: 10.3109/09638288.2012.707742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Thomas ML, Elliott JE, Rao SM, Fahey KF, Paul SM, Miaskowski C. A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management. Oncol Nurs Forum 2012; 39:39-49. [PMID: 22201654 DOI: 10.1188/12.onf.39-49] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To test the effectiveness of two interventions compared to usual care in decreasing attitudinal barriers to cancer pain management, decreasing pain intensity, and improving functional status and quality of life (QOL). DESIGN Randomized clinical trial. SETTING Six outpatient oncology clinics (three Veterans Affairs [VA] facilities, one county hospital, and one community-based practice in California, and one VA clinic in New Jersey)Sample: 318 adults with various types of cancer-related pain. METHODS Patients were randomly assigned to one of three groups: control, standardized education, or coaching. Patients in the education and coaching groups viewed a video and received a pamphlet on managing cancer pain. In addition, patients in the coaching group participated in four telephone sessions with an advanced practice nurse interventionist using motivational interviewing techniques to decrease attitudinal barriers to cancer pain management. Questionnaires were completed at baseline and six weeks after the final telephone calls. Analysis of covariance was used to evaluate for differences in study outcomes among the three groups. MAIN RESEARCH VARIABLES Pain intensity, pain relief, pain interference, attitudinal barriers, functional status, and QOL. FINDINGS Attitudinal barrier scores did not change over time among groups. Patients randomized to the coaching group reported significant improvement in their ratings of pain-related interference with function, as well as general health, vitality, and mental health. CONCLUSIONS Although additional evaluation is needed, coaching may be a useful strategy to help patients decrease attitudinal barriers toward cancer pain management and to better manage their cancer pain. IMPLICATIONS FOR NURSING By using motivational interviewing techniques, advanced practice oncology nurses can help patients develop an appropriate plan of care to decrease pain and other symptoms.
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Akkaya N, Atalay NS, Selcuk ST, Alkan H, Catalbas N, Sahin F. Frequency of fibromyalgia syndrome in breast cancer patients. Int J Clin Oncol 2012; 18:285-92. [PMID: 22322540 DOI: 10.1007/s10147-012-0377-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/05/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to determine the frequency of fibromyalgia syndrome (FM) in operated breast cancer patients and to research the relationship between FM and the severity of fatigue and quality of life in these breast cancer patients. METHODS The demographic data of 101 operated breast cancer patients were recorded. The patients who had pain were then classified as having regional pain (RP), widespread pain without FM (WP), and widespread pain with FM (WFM). The FM diagnosis was based on the American College of Rheumatology (ACR) criteria. The severity of fatigue was evaluated with the Brief Fatigue Inventory, the disease impact was evaluated with the Fibromyalgia Impact Questionnaire (FIQ), and the quality of life was evaluated with the European Organization for Research on Treatment of Cancer questionnaire Quality of Life-C30 (EORTC-QoL-C30). RESULTS There was no pain in 38 (37.6%) patients, whereas there was pain in 63 (62.4%) patients (N = 42, 41.6% had RP, N = 21, 20.8% had WP). Ten (9.9%) of the entire patient cohort were diagnosed as having FM according to the ACR criteria. There were no differences among the 3 groups in respect to demographic characteristics when patients were classified as RP (N = 42), WP (N = 11), and WFM (N = 10) groups. While there were negative correlations between the FIQ and EORTC-QoL-C30-function score (r = -0.727) and EORTC-QoL-C30-global score (r = -0.488), there was a positive correlation between the FIQ and EORTC-QoL-C30-symptom score (r = 0.726). CONCLUSION We note that the frequency of FM in the operated breast cancer patients in this study was higher than that reported in normal populations in the literature. Also, we found that the presence of FM had negative effects on the quality of life of the breast cancer patients. Accordingly, in the evaluation of widespread pain and complaints of fatigue in long-surviving breast cancer patients, after metastatic disease is excluded, the probability of FM should be kept in mind, so that appropriate treatment can be initiated to improve their functional status and quality of life.
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Affiliation(s)
- Nuray Akkaya
- Department of Physical Medicine and Rehabilitation, Medicine Faculty, University of Pamukkale, 20070, Kinikli-Denizli, Turkey.
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Chopra I, Kamal KM. A systematic review of quality of life instruments in long-term breast cancer survivors. Health Qual Life Outcomes 2012; 10:14. [PMID: 22289425 PMCID: PMC3280928 DOI: 10.1186/1477-7525-10-14] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 01/31/2012] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in women, representing 16% of all female cancers. According to the American Cancer Society, long-term cancer survival is defined as more than five years of survivorship since diagnosis, with approximately 2.5 million breast cancer survivors (BCS) in 2006. The long-term effects from breast cancer and its treatment have been shown to have positive and negative effects on both recovery and survivors' quality of life (QoL). The purpose of the study was to identify QoL instruments that have been validated in long-term BCS and to review the studies that have used the QoL instruments in this population. METHODS A systematic literature search was conducted from January 1990 to October 2010 using electronic databases. Instruments validated and used in BCS were included in the review. In addition, QoL studies in long-term BCS using the validated instruments were reviewed. The search was limited to studies in English language. Studies of BCS of less than five years after initial diagnosis, any clinical or review studies were excluded. RESULTS The review identified a total of 12 instruments (10 disease-specific, 2 condition-specific) validated in long-term BCS. According to the QoL framework proposed by Ferrell and colleagues, three instruments (Quality of Life-Cancer Survivors, Quality of Life in Adult Cancer Survivors Scale, and Quality of Life Index-Cancer Version) evaluated all four domains (physical, psychological, social, and spiritual) of QoL. A review of the psychometric evaluation showed that Quality of Life in Adult Cancer Survivors Scale has acceptable reliability, validity, and responsiveness in long-term BCS compared to other disease-specific instruments. The review also yielded 19 studies that used these QoL instruments. The study results indicated that age-group, ethnicity, and type of treatment influenced different aspects of QoL. CONCLUSIONS There is a significant impact of breast cancer on QoL in long-term BCS. The review can help researchers and clinicians select the most appropriate instruments to assess the changes in QoL in BCS.
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Affiliation(s)
- Ishveen Chopra
- Division of Clinical, Social and Administrative Sciences, Mylan School of Pharmacy, 418F Mellon Hall, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282, USA
| | - Khalid M Kamal
- Division of Clinical, Social and Administrative Sciences, Mylan School of Pharmacy, 418B Mellon Hall, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282, USA
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Offenbächer M, Sauer S, Kohls N, Waltz M, Schoeps P. Quality of life in patients with fibromyalgia: validation and psychometric properties of the German Quality of Life Scale (QOLS-G). Rheumatol Int 2011; 32:3243-52. [PMID: 22038277 DOI: 10.1007/s00296-011-2184-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
Abstract
Our objectives were to translate the Quality of Life Scale (QOLS) into German and to evaluate its reliability and validity for the use in patients with fibromyalgia (FMS). Together with German versions of the Fibromyalgia Impact Questionnaire (FIQ), the SF-36, a tender point count (TPC) and other questionnaires, we administered the QOLS to 146 patients with FMS. Patients were asked about the severity of pain today (VAS) and the duration of symptoms. Test-retest reliability was assessed using Spearman's correlations. Internal consistency was evaluated with Cronbach's alpha. Construct validity of the QOLS was evaluated by correlating the QOLS with the FIQ, the SF-36, the Beck Depression Inventory (BDI), and the Symptom Checklist (SCL-90-R) as well as with the pain variables. An exploratory factor analysis (EFA) was also conducted. Mean age was 53.1 years. Means were for pain today 6.8 and for duration of symptoms 11.8 years. Test-retest reliability for the total QOLS was rho = .91. Internal consistency was α = .90. Low-to-moderate correlations were obtained between the QOLS and the total FIQ (rho = -.42), the SF-36 (e.g. physical functioning rho = .37; mental health rho = .56) as well as the pain variables (VAS rho = -.11 ns; TPC rho = -.20). Psychological variables were moderately to substantially correlated with the QOLS (e.g. BDI rho = -.61). An EFA suggested a three-factor solution. The QOLS-G is a reliable and valid instrument for measuring quality of life in German patients with FMS.
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Affiliation(s)
- Martin Offenbächer
- GRP, Generation Research Program, Human Science Center, Ludwig-Maximilians-Universität München, Prof.-Max-Lange-Platz 11, 83646 Bad Tölz, Germany.
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Chen CM, Cano SJ, Klassen AF, King T, McCarthy C, Cordeiro PG, Morrow M, Pusic AL. Measuring quality of life in oncologic breast surgery: a systematic review of patient-reported outcome measures. Breast J 2011; 16:587-97. [PMID: 21070435 DOI: 10.1111/j.1524-4741.2010.00983.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multiple randomized trials demonstrate equivalent survival between BCT and mastectomy, but clinical outcomes research must also evaluate patient satisfaction and quality of life. This review analyzes existing patient-reported outcome (PRO) measures in oncologic breast surgery to assess utility and make recommendations for future research. We performed a systematic literature review to identify PRO measures used in oncologic breast surgery patients. After applying inclusion and exclusion criteria, qualifying instruments were assessed for adherence to international guidelines for health outcomes instrument development and validation. Ten measures underwent development and psychometric evaluation in an oncologic breast surgery population. Five of ten measures (EORTC QLQ BR-23, FACT-B, HBIS, BIBCQ, and BREAST-Q) reported an adequate development and validation process. Three of these 5 measures (EORTC QLQ BR-23, FACT-B, HBIS) focused on non-surgical treatment issues. A fourth instrument (BIBCQ) did not address aesthetic concerns after breast reconstruction. The fifth instrument (BREAST-Q) was developed for use in patients undergoing mastectomy ± reconstruction, but did not address breast-conserving therapy. Overall, two key limitations were noted: 1) surgery-specific issues of breast-conserving surgery patients were not well represented and 2) measures were largely developed without the aid of newer psychometric methods that may improve their clinical utility. Reliable and valid PRO measures in breast cancer patients exist, but even the best instruments do not address all important surgery-specific and psychometric issues of oncologic breast surgery patients. Newer psychometric methods would facilitate development of scales for use in individual patient care as well as group level comparisons.
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Montgomery GH, Schnur JB, Erblich J, Diefenbach MA, Bovbjerg DH. Presurgery psychological factors predict pain, nausea, and fatigue one week after breast cancer surgery. J Pain Symptom Manage 2010; 39:1043-52. [PMID: 20538186 PMCID: PMC2918882 DOI: 10.1016/j.jpainsymman.2009.11.318] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 11/10/2009] [Accepted: 11/10/2009] [Indexed: 11/27/2022]
Abstract
Before scheduled surgery, breast cancer surgical patients frequently experience high levels of distress and expect a variety of postsurgery symptoms. Previous literature has supported the view that presurgery distress and response expectancies are predictive of postsurgery outcomes. However, the contributions of distress and response expectancies to postsurgical side effect outcomes have rarely been examined together within the same study. Furthermore, studies on the effects of response expectancies in the surgical setting have typically focused on the immediate postsurgical setting rather than the longer-term setting. The purpose of the present study was to test the contribution of presurgery distress and response expectancies to common postsurgery side effects (pain, nausea, and fatigue). Female patients (n=101) undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery pain severity (P<0.05) and fatigue (P<0.003) one week after surgery. Response expectancies uniquely contributed to pain severity (P<0.001), nausea (P<0.012), and fatigue (P<0.010) one week after surgery. Sobel tests indicated that response expectancies partially mediated the effects of distress on pain severity (P<0.03) and fatigue (P<0.03). Response expectancies also mediated the effects of age on pain severity, nausea, and fatigue. Results highlight the contribution of presurgery psychological factors to postsurgery side effects, the importance of including both emotional and cognitive factors within studies as predictors of postsurgery side effects, and suggest presurgical clinical targets for improving patients' postoperative experiences of side effects.
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Affiliation(s)
- Guy H Montgomery
- Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
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Ablin JN, Beilinson N, Aloush V, Elkayam O, Finkelstein A. Association between fibromyalgia and coronary heart disease and coronary catheterization. Clin Cardiol 2010; 32:E7-11. [PMID: 18727109 DOI: 10.1002/clc.20308] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibromyalgia (FM) has been associated with physical and emotional trauma including invasive medical procedures. Both FM and ischemic heart disease have been linked with depression. The purpose of this study was to retrospectively investigate the frequency of FM symptoms and physical findings among patients undergoing coronary catheterization. METHODS Consecutive patients who underwent coronary angiography during the previous 6 mo were recruited. Patients with major depression, bi-polar disorder, schizophrenia, or malignancy were excluded. Patients underwent dolorimetry for tender-point assessment and completed the fibromyalgia impact questionnaire (FIQ). Group A included patients with significant coronary pathology (n = 43), group B included patients with normal coronary arteries (n = 50), and group C included patients with normal controls (n = 51). A cardiological score incorporated the number of coronary arteries with significant pathology and left ventricular function. Chi-square or Fisher's exact test was used for categorical data and a one-way analysis of variance for continuous variables; a multivariate linear regression was performed to compare groups. RESULTS Significantly increased levels of tenderness were discovered among patients with coronary pathology compared with healthy controls. Significantly increased levels of depression were also found, as well as higher scores on the FIQ scale. On multivariate analysis, a positive correlation was demonstrated between tenderness/FIQ scores and a composite cardiological score. CONCLUSION Coronary angiography is associated with a significantly increased frequency of pain, tenderness, and depression after 6 mo, apparent in both patients undergoing coronary procedures and patients with normal coronaries. This association may impact the outcome of patients with significant coronary disease.
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Affiliation(s)
- Jacob N Ablin
- Department of Internal Medicine 6, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Eyigor S, Karapolat H, Korkmaz OK, Eyigor C, Durmaz B, Uslu R, Uyar M. The frequency of fibromyalgia syndrome and quality of life in hospitalized cancer patients. Eur J Cancer Care (Engl) 2009; 18:195-201. [PMID: 19267737 DOI: 10.1111/j.1365-2354.2008.00997.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To explore the frequency of fibromyalgia syndrome (FMS) among hospitalized cancer patients and address the relationships between pain, fatigue and quality of life with regard to the extent of pain, a cross-sectional and descriptive study was carried out in the Oncology Supportive Care Unit on 122 hospitalized cancer patients. Pain, sleep, disease impact (Fibromyalgia Impact Questionnaire), fatigue (Brief Fatigue Inventory), quality of life (Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30) were gathered using standardized measures. Thirteen of the hospitalized cancer patients (10.7%) included in the study were diagnosed with FMS. There were no statistically significant differences among three pain groups with respect to demographic characteristics (P > 0.05). There were significant differences among groups with regard to the presence of metastasis, fatigue, sleep disorder, pain, Brief Fatigue Inventory, Fibromyalgia Impact Questionnaire, most of subscores of Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30 scores (P < 0.05). In the present study, we have calculated the frequency of FMS among patients admitted to the oncology hospital in addition to establishing the relationships between pain, fatigue and quality of life with regard to the extent of pain. We believe that the descriptive data presented in this study would be helpful in future studies and therapeutic approaches.
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Affiliation(s)
- S Eyigor
- Ege University Faculty of Medicine Physical Therapy and Rehabilitation Department, Tulay Aktas Oncology Hospital, Supportive Care Unit, Izmir, Turkey.
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Couceiro TCDM, Menezes TCD, Valênça MM. Post-mastectomy pain syndrome: the magnitude of the problem. Rev Bras Anestesiol 2009; 59:358-65. [PMID: 19488550 DOI: 10.1590/s0034-70942009000300012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 01/20/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Breast cancer is the most frequent neoplastic tumor in women, and surgical treatment is indicated in most patients. Complications related to this treatment, such as post-mastectomy pain syndrome (PMPS), a persistent pain that develops after surgery, have been reported. Although the genesis of the pain is multifactorial, sectioning of the intercostobrachial nerve is the nerve lesion diagnosed more often. The objective of this study was to review the etiopathogeny, diagnosis, presentation, aggravating or attenuating factors, and risk factors related with the post-mastectomy pain syndrome. CONTENTS Provides the definition of the post-mastectomy pain syndrome and the knowledge to facilitate its diagnosis and prevention. CONCLUSIONS The approach to patients undergoing surgery for breast cancer requires pre- and postoperative follow-up by a multidisciplinary team. This approach can provide a rational choice of surgical technique, identify patients with risk factors, minimize or eliminate risk factors whenever possible, diagnose beforehand the post-mastectomy pain syndrome, and provide adequate treatment to improve the quality of life for this specific patient population.
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Affiliation(s)
- Tania Cursino de Menezes Couceiro
- Responsável pela Residência Médica em Anestesiologia do Instituto de Medicina Integral Professor Fernando Figueira; Mestre em Neuropsiquiatria e Ciência do Comportamento, pela Universidade Federal de Pernambuco.
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Couceiro TCDM, Valença MM, Lima LC, de Menezes TC, Raposo MCF. Prevalence and influence of gender, age, and type of surgery on postoperative pain. Rev Bras Anestesiol 2009; 59:314-20. [PMID: 19488544 DOI: 10.1590/s0034-70942009000300006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Accepted: 02/28/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postoperative pain is frequent despite of the therapeutic armamentarium available. Its development is related with factors inherent to the surgery and patient. The objective of this study was to evaluate the prevalence of postoperative pain in hospitalized patients and its association with gender and type of surgery. METHODS This is a transversal study in which interviews were done with 187 patients undergoing surgeries. The incidence of pain in the first 24 hours and its severity according to a numeric rating scale: mild (1 to 3), moderate (4 to 6), and severe (7 to 10), were evaluated. RESULTS Three of 190 patients interviewed were excluded due to difficulties understanding the method used to evaluate the level of pain. In the study population, 66.8% (n = 125) were females; mean age 45.83 +/- 16.17 years, but 25.1% (n = 47) were 60 years old or more. In the first 24 hours, 46% (n = 85) of the patients reported pain. Among male patients, 48.4% (n = 30) complained of pain, while 66.8% (n = 55) of the females did so. The prevalence of pain showed no differences regarding gender (p = 0.536) and age (p = 0.465). As for pain severity, 29.4% of the patients referred mild pain, it was moderate in 43.5%, and severe in 27.1%. A significant association between the incidence of postoperative pain and type of surgery was observed (p = 0.003). CONCLUSIONS This study demonstrated that an elevated number of patients experience pain in the first 24 hours after the surgery. The incidence of pain was higher in patients undergoing general surgery.
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The complexity of the relationship between chronic pain and quality of life: a study of the general Norwegian population. Qual Life Res 2009; 18:971-80. [PMID: 19688608 PMCID: PMC2744798 DOI: 10.1007/s11136-009-9515-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 07/11/2009] [Indexed: 11/30/2022]
Abstract
Purpose The aims of this paper were to evaluate the relationship between chronic pain and global quality of life (GQOL) and to explore the effect of possible confounders, mediators, and moderators such as selected demographic variables, chronic illnesses, stress-related symptoms, fatigue, and subjective health of the relationship between chronic pain and GQOL. Methods We used a cross-sectional design, including 1,893 respondents from a population of 4,000 of Norwegian citizens, aged 19–81 years, who were randomly drawn from the National Register by Statistics Norway in November 2000 (48.5%). Pain duration of more than 3 months was categorized as having chronic pain. The Quality of Life Scale, the Fatigue Severity Scale, and the Posttraumatic Stress Scale were used as our main dependent and independent variables, respectively. A series of multiple regression analyses (GLM in SPSS) were applied using GQOL as the dependent variable, entering subsets of independent variables in a theoretically predefined sequence. Results In the total model, there was no significant relationship between chronic pain and GQOL. The model explained 39% of the variance in GQOL. For direct effect sizes, stress-related symptoms were related most strongly to GQOL, followed by subjective health, fatigue, chronic illnesses, and selected demographic variables. Conclusion These findings support the assumption of a complex and indirect relationship between chronic pain and GQOL.
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Paskett E, Herndon J, Donohue K, Naughton M, Grubbs S, Pavy M, Hensley M, Stark N, Kornblith A, Bittoni M. Health-related quality of life in long-term breast cancer survivors: differences by adjuvant chemotherapy dose in Cancer and Leukemia Group B study 8541. Cancer 2009; 115:1109-20. [PMID: 19170232 DOI: 10.1002/cncr.24140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Survivor's Health and Reaction (SHARE) study examined health-related quality of life (HRQL) in breast cancer patients who had participated in Cancer and Leukemia Group B Trial 8541 from 1985 to 1991. METHODS In total, 245 survivors (78% of eligible patients) who were 9.4 to 16.5 years postdiagnosis (mean, 12.5 years postdiagnosis) completed HRQL surveys relating to 5 domains. Analyses examined HRQL domains according to 3 different chemotherapy dose levels that were administered in the original treatment trial: low-dose cyclophosphamide, doxorubicin, and fluorouracil (CAF) at 300 mg/m(2), 30 mg/m(2), and 300 x 2 mg/m(2), respectively, over 4 cycles; standard-dose CAF at 400 mg/m(2), 40 mg/m(2), and 400 x 2 mg/m(2), respectively, over 6 cycles; and high-dose CAF at 600 mg/m(2), 60 mg/m(2) and 600 x 2 mg/m(2), respectively, over 4 cycles. RESULTS In univariate analyses, a statistically significant difference was observed on the Medical Outcomes Study 36-item short form Physical Role Functioning subscale by treatment group, with lower mean scores in the standard treatment arm (mean, 65.05) compared with mean scores in the low-dose arm (mean, 74.66) and the high-dose arm (mean, 84.94; P.0001). However, multivariate analysis revealed that treatment arm no longer was statistically significant, whereas the following factors were associated with decreased physical role functioning: age >or=60 years (odds ratio [OR], 3.55; P = .006), increased comorbidity interference total score (OR, 1.64; P = .005), lower vitality (OR, 1.05; P = .0002), and increased menopausal symptoms (OR, 1.04 P = .02). CONCLUSIONS At 9.4-16.5 years after their original diagnosis, differences in physical role functioning among breast cancer survivors who had received 3 different dose levels of chemotherapy were explained by clinical and demographic variables, such as age, fatigue, menopausal symptoms, and comorbidities. Prospective studies are needed to further assess the role of these factors in explaining HRQL and physical role functioning among long-term survivors.
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Affiliation(s)
- Electra Paskett
- College of Public Health and Comprehensive Cancer Center, The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall A356, Columbus, OH 43210-1240, USA.
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Torrance N, Smith BH, Lee AJ, Aucott L, Cardy A, Bennett MI. Analysing the SF-36 in population-based research. A comparison of methods of statistical approaches using chronic pain as an example. J Eval Clin Pract 2009; 15:328-34. [PMID: 19335493 DOI: 10.1111/j.1365-2753.2008.01006.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Medical Outcomes Study 36 Item Short-Form (SF-36) questionnaire is one of the most widely used measures of health related quality of life in medical research, including studies on pain-related conditions. Although scores in each of its eight domains rarely conform to a normal distribution, it is most widely analysed using simple parametric statistical techniques. Some have suggested a need for more complex or non-parametric analytical approaches, and this quandary faces researchers recurrently when using the SF-36. In this study of chronic pain, we compared results arising from the SF-36 between three study sub-samples, using conventional parametric, non-parametric, bootstrapping and log transforming methods. METHODS Respondents to a postal survey conducted in Aberdeen, Leeds and London (n = 3002, response rate 52%) were categorized in three groups according to previously validated questionnaires: those with chronic pain of predominantly neuropathic origin (POPNO, n = 241), those with chronic pain (non-POPNO, n = 1179), and those with no chronic pain (n = 1537). SF-36 scores were compared between these groups, using: ANOVA and t-tests; Kruskall-Wallis and Mann-Whitney U-tests; bootstrapping methods; and log transformation with ANOVA. RESULTS There were highly significant differences between the three groups, with lower scores in all SF-36 domains found those with chronic pain (P < 0.001). Those with chronic POPNO had lower scores in all domains than those with chronic pain (non-POPNO) (P < 0.001). These results were the same after applying each statistical method. CONCLUSIONS In this study, the choice of statistical approach had no influence on the results. We conclude that the conventional approach, using straightforward parametric tests, is both simplest and the best for allowing comparison with other studies. We are likely to adopt this in future studies.
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Affiliation(s)
- Nicola Torrance
- Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Center, Westburn Road, Aberdeen, UK
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Kuroi K, Shimozuma K, Ohashi Y, Hisamatsu K, Masuda N, Takeuchi A, Aranishi T, Morita S, Ohsumi S, Hausheer FH. Prospective assessment of chemotherapy-induced peripheral neuropathy due to weekly paclitaxel in patients with advanced or metastatic breast cancer (CSP-HOR 02 study). Support Care Cancer 2008; 17:1071-80. [PMID: 19089463 DOI: 10.1007/s00520-008-0550-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 11/19/2008] [Indexed: 11/25/2022]
Abstract
GOALS OF WORK The aim of this study was to prospectively evaluate chemotherapy-induced peripheral neuropathy (CIPN) using a patient-based instrument, the Patient Neurotoxicity Questionnaire (PNQ) and a physician-based instrument, the National Cancer Institute-Common Toxicity Criteria (NCI-CTC) in patients with advanced or metastatic breast cancer who were treated with weekly paclitaxel. MATERIALS AND METHODS CIPN symptoms were prospectively assessed in 35 patients using the PNQ, NCI-CTC, and the Functional Assessment of Cancer Therapy (FACT)-Taxane including neurotoxicity component (Ntx) at the baseline, and 8 and 16 weeks after starting chemotherapy. RESULTS For sensory neuropathy symptoms, the reported incidence of CIPN was significantly increased during active treatment in terms of both the PNQ and NCI-CTC assessments. In contrast, there was a notable increase of patient motor neuropathy symptoms that were elucidated only by the PNQ. The PNQ grades of CIPN were widely distributed in the patient population as compared with the NCI-CTC grades for both sensory and motor neuropathy. The sensory PNQ grade was correlated with sensory NCI-CTC grade (r = 0.58) and Ntx (r = 0.51), and the motor PNQ grade was correlated with Ntx (r = 0.57). CONCLUSIONS The PNQ appears to be more sensitive and responsive than the NCI-CTC for CIPN; the PNQ appears to have diagnostic validity for evaluating CIPN in patients who are receiving neurotoxic chemotherapy.
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Affiliation(s)
- Katsumasa Kuroi
- Department of Surgery, Division of Clinical Trials and Research, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
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Cameron DJ. Clinical trials validate the severity of persistent Lyme disease symptoms. Med Hypotheses 2008; 72:153-6. [PMID: 19013025 DOI: 10.1016/j.mehy.2008.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 08/25/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Persistent Lyme Disease Symptoms (PLDS) have included fatigue, headaches, poor concentration and memory, lightheadedness, joint pain, and mood disturbances. Evidence-based guidelines committees disagree over the severity of PLDS. The 2004 International Lyme and Associated Diseases Society (ILADS) concluded that PLDS are severe. The 2006 Infectious Disease Society of America (IDSA) guidelines committee concluded that PLDS are nothing more than the "aches and pains of daily living" and an ad hoc International Lyme group concluded that PLDS are "symptoms common in persons who have never had Lyme disease." HYPOTHESIS Clinical trials validate the severity of persistent Lyme disease symptoms. EVALUATION OF THE HYPOTHESIS There are 22 standardized instruments used to measure the severity of PLDS among the four published National Institutes of Health (NIH) sponsored double-blind randomized placebo-controlled trials (RCTs). VALIDATING THE HYPOTHESIS: All four NIH sponsored RCTs validate the severity of PLDS. PLDS are as severe as symptoms seen in other serious chronic illnesses, and result in a quality of life lower than for the general population as determined by 22 standardized measures of QOL, including fatigue, pain, role function, psychopathology, and cognition. None of the four RCTs support the IDSA hypothesis that PLDS are nothing more than "the aches and pains of daily living" nor the ad hoc International Lyme group conclusion that PLDS are "symptoms common in persons who have never had Lyme disease." IMPLICATIONS OF THE HYPOTHESIS If the QOL of life for these patients is as poor as for patients with other serious chronic diseases, their symptoms need to be addressed by their doctors. Studies differ as to the precise cause of PLDS, the most effective treatments, and whether a cure is possible. But the fact that there is disagreement is not a license for physicians to ignore or turn away patients complaining of PLDS, or to dismiss their symptoms as purely psychosomatic. For physicians, the goal or purpose of treating PLDS should be the same as their purpose in treating other chronic illnesses that result in a poor QOL: vigorous pursuit of a cure, and where a cure proves impossible, amelioration of patients' symptoms and suffering. Even if this hypothesis fails to be apply to more than a fraction of the total Lyme disease population, this still represents a significant number of patients, and these findings could address a neglected aspect of caring for patients with Lyme disease.
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