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Yang B, Zhang Z, Yang Z, Ruan J, Luo L, Long F, Tang D. Chanling Gao Attenuates Bone Cancer Pain in Rats by the IKKβ/NF-κB Signaling Pathway. Front Pharmacol 2020; 11:525. [PMID: 32431607 PMCID: PMC7214814 DOI: 10.3389/fphar.2020.00525] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/03/2020] [Indexed: 12/13/2022] Open
Abstract
Cancer pain is one of the most common and serious symptoms of cancer patients. At present, the agents used for the prevention or treatment of cancer pain do not act with optimal safety and efficacy. The nuclear factor kappa B (NF-κB) signaling pathway and its downstream inflammatory factors interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) play an important regulatory role in the developmental process of cancer pain. IKKβ is a key molecule of the IκB (IKK) kinase that propagates cellular responses to inflammation. Previous studies have shown that phosphorylation and degradation of the IκBα protein promotes the activation of NF-κB and the expression of TNF-α, IL-1β, and IL-6, participating in the formation and development of cancer pain. Chanling Gao (CLG) is a compound preparation of traditional Chinese medicine. It contains specific functions, namely nourishing Yin, activating blood circulation and relieving pain and dysfunction syndrome. It is used in the treatment of a variety of pain disorders including cancer-induced bone pain (CIBP), which has a certain relief effect. However, its mechanism of action still remains unclear. In the present study, a rat model of tibia CIBP was successfully established using the Walker 256 breast cancer cell line. The IKKβ/NF-κB signaling pathway and its related factors TNF-α, IL-1β, and IL-6 were used as the entry points to explore the effect of CLG on CIBP and their possible mechanisms of action. The results indicated that CLG improved the body mass of the CIBP rat model and increased the pain threshold in rats. CLG significantly inhibited the degradation of IκBα and the levels of p-IκBα, p-IKKβ, and p-p65 NF-κB proteins in the spinal cord of CIBP rats, inhibiting the contents of TNF-α, IL-1β, and IL-6. Therefore, we conclude that the analgesic effect of CLG in this rat model of CIBP may be related to the inhibition of the IKKβ/NF-κB signaling pathway and the reduction of synthesis and release of TNF-α, IL-1β, and IL-6.
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Affiliation(s)
- Bing Yang
- Department of Oncology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Zhen Zhang
- Oncology Team, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Zhu Yang
- Party Committee Office, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Jinghua Ruan
- Department of Oncology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Li Luo
- Department of Oncology, Guihang Guiyang Hospital, Guiyang, China
| | - Fengxi Long
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Dongxin Tang
- Department of Oncology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
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Storey S, Cohee A, Gathirua-Mwangi WG, Vachon E, Monahan P, Otte J, Stump TE, Cella D, Champion V. Impact of Diabetes on the Symptoms of Breast Cancer Survivors. Oncol Nurs Forum 2020; 46:473-484. [PMID: 31225841 DOI: 10.1188/19.onf.473-484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the impact of diabetes on the symptoms of women with breast cancer. SAMPLE & SETTING 121 women with breast cancer who self-identified as having a diabetes diagnosis and 1,006 women with breast cancer without diabetes from 97 sites across the United States. METHODS & VARIABLES Symptom scores for depression, anxiety, sexual function, peripheral neuropathy, physical function, attention function, sleep disturbance, and fatigue were compared between women with breast cancer and diabetes and women with breast cancer without diabetes, controlling for age, education, income, marital status, and body mass index (BMI). RESULTS Women with breast cancer and diabetes who were three to eight years postdiagnosis reported poorer physical and attention function, more sleep disturbance, and greater fatigue than women with breast cancer without diabetes. Age, education, income, and BMI were independent predictors of symptoms experienced by women with breast cancer. IMPLICATIONS FOR NURSING Oncology nurses can assess and monitor women with breast cancer and diabetes for increased post-treatment sequelae. If problematic symptoms are identified, implementing treatment plans can decrease symptom burden and increase quality of life for women with breast cancer and diabetes.
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Singh K, Paul SM, Kober KM, Conley YP, Wright F, Levine JD, Joseph PV, Miaskowski C. Neuropsychological Symptoms and Intrusive Thoughts Are Associated With Worse Trajectories of Chemotherapy-Induced Nausea. J Pain Symptom Manage 2020; 59:668-678. [PMID: 31689477 PMCID: PMC7024637 DOI: 10.1016/j.jpainsymman.2019.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT Although chemotherapy-induced vomiting is well controlled with evidence-based antiemetic regimens, chemotherapy-induced nausea (CIN) remains a significant clinical problem. OBJECTIVES Study purposes, in a sample of outpatients with breast, gastrointestinal, gynecological, or lung cancer who received two cycles of chemotherapy (CTX, n = 1251), were to evaluate for interindividual differences in the severity of CIN and to determine which demographic, clinical, symptom, and stress characteristics are associated with higher initial levels as well as with the trajectories of CIN. METHODS Patients were recruited during their first or second cycle of CTX. Patients completed self-report questionnaires a total of six times over two cycles of CTX. Hierarchical linear modeling was used to evaluate for interindividual differences in and characteristics associated with the severity of CIN. RESULTS Across the two cycles of CTX, higher levels of sleep disturbance, depression, and morning fatigue, as well as higher levels of intrusive thoughts, were associated with higher initial levels of CIN. In addition, lower functional status scores and shorter cycle lengths were associated with higher initial levels of CIN, and younger age and higher emetogenicity of the CTX regimen were associated with both higher initial levels as well as worse trajectories of CIN severity. CONCLUSION These findings suggest that common symptoms associated with cancer and its treatment are associated with increased severity of CIN. Targeted interventions for these symptoms may reduce the burden of unrelieved CIN.
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Affiliation(s)
- Komal Singh
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Paule V Joseph
- Sensory Science & Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, Bethesda, Maryland, USA
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Bjerkeset E, Röhrl K, Schou-Bredal I. Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics. Breast Cancer Res Treat 2020; 180:63-71. [PMID: 31938939 PMCID: PMC7031174 DOI: 10.1007/s10549-020-05522-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/04/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Breast cancer survivors may experience pain, fatigue, or psychological distress as a result of the treatment. These symptoms may co-occur and form a cluster. However little is known about symptom clusters (SCs) in long-term breast cancer survivors. This study aimed to identify subgroups of breast cancer survivors with the SC of pain, fatigue, and psychological distress, and to examine sociodemographic and clinical characteristics associated with this SC. METHODS Data were obtained from a nationwide survey of breast cancer survivors (N = 834). Exhaustive enumeration of possible combination of the three binary variables (pain, fatigue, psychological distress) was conducted. They were identified using the recommended threshold for the Hospital Anxiety and Depression Scale, the Fatigue Questionnaire, and a score of one or more on a numeric rating scale for pain. The SC was defined to include all the three variables, all other combinations were defined as no SC. Logistic regression analyses were conducted to examine the association between sociodemographic and clinical variables and the SC. RESULTS Of the 834 survivors, 13% had the SC. Younger age (OR 2.3, 95% CI 1.3-4.1, p = 0.003), lymphedema (OR 1.9, 95% CI 1.1-3.2, p = 0.02), working part-time (OR 2.9, 95% CI 1.6-5.3, p < 0.001), or being disabled (OR 4.1, 95% CI 2.2-7.8, p < 0.001) were all associated with the SC. CONCLUSION Thirteen percent of the survivors experienced the SC. It appears that premenstrual women are at greater risk, than postmenopausal women. Having this SC might have an impact on the survivors' ability to work.
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Affiliation(s)
- Ellen Bjerkeset
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Kari Röhrl
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Inger Schou-Bredal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
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Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics. Breast Cancer Res Treat 2020. [PMID: 31938939 DOI: 10.1007/s10549‐020‐05522‐8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE Breast cancer survivors may experience pain, fatigue, or psychological distress as a result of the treatment. These symptoms may co-occur and form a cluster. However little is known about symptom clusters (SCs) in long-term breast cancer survivors. This study aimed to identify subgroups of breast cancer survivors with the SC of pain, fatigue, and psychological distress, and to examine sociodemographic and clinical characteristics associated with this SC. METHODS Data were obtained from a nationwide survey of breast cancer survivors (N = 834). Exhaustive enumeration of possible combination of the three binary variables (pain, fatigue, psychological distress) was conducted. They were identified using the recommended threshold for the Hospital Anxiety and Depression Scale, the Fatigue Questionnaire, and a score of one or more on a numeric rating scale for pain. The SC was defined to include all the three variables, all other combinations were defined as no SC. Logistic regression analyses were conducted to examine the association between sociodemographic and clinical variables and the SC. RESULTS Of the 834 survivors, 13% had the SC. Younger age (OR 2.3, 95% CI 1.3-4.1, p = 0.003), lymphedema (OR 1.9, 95% CI 1.1-3.2, p = 0.02), working part-time (OR 2.9, 95% CI 1.6-5.3, p < 0.001), or being disabled (OR 4.1, 95% CI 2.2-7.8, p < 0.001) were all associated with the SC. CONCLUSION Thirteen percent of the survivors experienced the SC. It appears that premenstrual women are at greater risk, than postmenopausal women. Having this SC might have an impact on the survivors' ability to work.
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Li H, Marsland AL, Conley YP, Sereika SM, Bender CM. Genes Involved in the HPA Axis and the Symptom Cluster of Fatigue, Depressive Symptoms, and Anxiety in Women With Breast Cancer During 18 Months of Adjuvant Therapy. Biol Res Nurs 2020; 22:277-286. [PMID: 31908177 DOI: 10.1177/1099800419899727] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study aimed to (1) identify subgroups of women with breast cancer with the psychological symptom cluster (fatigue, depressive symptoms, and anxiety) during the first 18 months of adjuvant therapy and (2) explore associations between demographic and clinical characteristics and variations in genetic polymorphisms related to hypothalamic-pituitary-adrenal (HPA) axis function and predicted symptom trajectory subgroup membership. We obtained symptom data at 4 time points from baseline to 18 months of adjuvant therapy among 292 postmenopausal women with breast cancer. Genetic data were collected in a subgroup at baseline (N = 184). Group-based multitrajectory modeling was used to classify women into subgroups with similar psychological symptom cluster trajectories. Binary logistic regression was used to explore the associations between each genotypic and phenotypic predictor and predicted subgroup membership. Two distinct symptom subgroups (low and high) were identified based on the trajectories of the symptom cluster of fatigue, depressive symptoms, and anxiety over the first 18 months of adjuvant therapy. Women who were younger, less educated, and who received chemotherapy had greater likelihood of being in the high-symptom subgroup. Variation in genes regulating the HPA axis (FKBP5 rs9394309 [odds ratio (OR) = 3.98, p = .015], NR3C2 rs5525 [OR = 2.54, p = .036], and CRHR1 rs12944712 [OR = 3.99, p = .021]) was associated with membership in the high-symptom subgroup. These results may help to identify women with breast cancer who are at increased risk for psychological symptoms, facilitating the development of individualized and preemptive interventions to better manage these symptoms during adjuvant therapy.
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Affiliation(s)
- Hongjin Li
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, PA, USA
| | | | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, PA, USA
| | - Susan M Sereika
- Center for Research and Evaluation, University of Pittsburgh, PA, USA.,Department of Health and Community Systems, University of Pittsburgh, PA, USA
| | - Catherine M Bender
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, PA, USA
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Li H, Sereika SM, Marsland AL, Conley YP, Bender CM. Impact of chemotherapy on symptoms and symptom clusters in postmenopausal women with breast cancer prior to aromatase inhibitor therapy. J Clin Nurs 2019; 28:4560-4571. [PMID: 31469461 DOI: 10.1111/jocn.15047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/24/2019] [Accepted: 08/18/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine and compare the differences in symptoms and symptom clusters between postmenopausal women with early-stage breast cancer who did and did not receive chemotherapy prior to aromatase inhibitor (AI) therapy. BACKGROUND Women with breast cancer often experience multiple concurrent symptoms during AI therapy. The burden of symptoms prior to AI is associated with nonadherence to cancer treatment. To date, few studies have comprehensively explored the symptoms and symptom clusters occurring prior to AI therapy. DESIGN Secondary analysis of a prospective repeated-measures study. METHODS The sample comprised postmenopausal women (N = 339) with breast cancer who would receive AI therapy with or without chemotherapy. We collected information on 48 symptoms after surgery or chemotherapy but before AI therapy using different symptom assessment tools. Mann-Whitney U tests were used to compare the differences in the severity of symptoms between groups. Exploratory factor analysis (EFA) was conducted to determine symptom clusters. This study followed STROBE guidelines. RESULTS The most severe symptoms among women with breast cancer prior to AI therapy were breast sensitivity, unhappy with the appearance of my body, general aches and pain, joint pain and muscle stiffness. Women who received chemotherapy prior to AI therapy experienced significantly higher severity of 22 symptoms than women who did not receive chemotherapy. Through EFA seven distinct symptom clusters were revealed in both groups: cognitive, musculoskeletal, psychological, vasomotor, weight, sexual and urinary, with additional gastrointestinal symptom cluster been identified in women who received chemotherapy. CONCLUSIONS This study indicates the presence of symptoms among women with breast cancer prior to AI therapy, with higher severity of symptoms and greater number of symptom clusters for women who received chemotherapy. RELEVANCE TO CLINICAL PRACTICE Nurses should assess and be aware of symptoms and symptom clusters existed prior to AI therapy and manage them in advance.
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Affiliation(s)
- Hongjin Li
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan M Sereika
- Center for Research and Evaluation & Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anna L Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Catherine M Bender
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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Influence of Menopausal Status on the Symptom Experience of Women Before Breast Cancer Surgery. Cancer Nurs 2019; 41:265-278. [PMID: 28945634 DOI: 10.1097/ncc.0000000000000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Breast cancer treatments can change women's hormonal milieu and alter their symptom experience. Little is known about associations between menopausal status and menopausal symptoms in women with breast cancer before surgery. OBJECTIVE The purpose of this study was to evaluate for differences in occurrence, severity, and distress of symptoms between premenopausal and postmenopausal women before breast cancer surgery. METHODS A total of 312 women with breast cancer completed the Menopausal Symptoms Scale, a self-report measure that evaluated the occurrence, severity, and distress of 46 common symptoms associated with menopause. Regression analyses were used to evaluate for between-group differences in these symptoms. RESULTS Of the 312 patients enrolled, 37.4% (n = 116) were premenopausal, and 62.6% (n = 196) were postmenopausal. In the multivariate analysis that adjusted for 7 covariates, premenopausal patients reported higher occurrence rates for urinary frequency (P = .006) and reported lower occurrence rates for joint pain/stiffness (P = .011), difficulty falling asleep (P = .025), and vaginal dryness (P = .002). A significant interaction was found between age and menopausal status for hot flashes (P = .002), wake during the night (P = .025), and headache (P = .040). CONCLUSION Regardless of menopausal status, women reported high occurrence rates for several menopausal symptoms. Associations between some symptom occurrence rates and menopausal status depended on the patients' age. IMPLICATIONS FOR PRACTICE As part of a preoperative symptom assessment, clinicians need to consider a woman's menopausal status and salient demographic and clinical characteristics. The identification of women with a higher symptom burden will assist with more effective management.
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Roles of biological and psychosocial factors in experiencing a psychoneurological symptom cluster in cancer patients. Eur J Oncol Nurs 2019; 42:97-102. [PMID: 31479847 DOI: 10.1016/j.ejon.2019.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/31/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE (a) To identify subgroups with unique psychoneurological symptom-cluster experience (depression, cognitive impairment, fatigue, sleep disturbance, and pain) and (b) to examine whether the selected demographic, clinical, psychological, and biological factors determine a symptom-cluster experience in cancer patients. METHOD The sample included 203 patients with diverse cancer types recruited from a Korean university hospital. Latent profile analyses were conducted to identify subgroups. Influencing factors of subgroup membership (demographic/clinical variables, hemoglobin level, social support, and psychological stress) were included as covariates in latent profile analysis and analyzed by multinomial logistic regression. RESULTS Latent profile analyses classified patients into two subgroups with a unique symptom cluster experience: patients experiencing high intensity in all symptoms within the cluster (the all-high-symptom subgroup, 71%) and patients experiencing low intensity in all symptoms within the cluster (all-low-symptom subgroup, 29%). The validity of the two subgroups was confirmed by the group classification accuracy (97% of the all-low-symptom subgroup and 99% of the all-high-symptom subgroup) and by significant Wald's mean equality tests, showing each symptom (depression, cognitive impairment, fatigue, sleep disturbance, and pain) significantly differentiated the two subgroups (ps < .001). Psychological stress independently determined the subgroup membership. Patients with high levels of stress were more likely to be in the all-high-symptom group (OR = 4.69, p < .0001). Hemoglobin level, cancer diagnosis, social support, and previous chemotherapy experience did not influence group membership. CONCLUSIONS A large number of patients experience five psychoneurological symptoms simultaneously due to psychological stress. Interventions targeted to stress would be beneficial for those patients.
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Liu X, Moore C, Wanstall K, Armeson K, Kelechi T. Hematology and Depression Levels: Examining Correlated Factors Among Hospitalized Patients. Clin J Oncol Nurs 2019; 23:423-429. [PMID: 31322620 DOI: 10.1188/19.cjon.423-429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depression in patients with cancer negatively influences physical symptoms, treatment success, coping, and quality of life (QOL), and is associated with increased mortality. OBJECTIVES This study investigated the prevalence of depression and explored fatigue, QOL, and pain that is associated with depression in patients on first admission to a hematologic oncology unit. METHODS This descriptive study measured depression, QOL, and fatigue with the Patient Health Questionnaire-9, the Functional Assessment of Cancer Therapy (FACT)-General, and the FACT-Anemia scale, respectively. Pain levels were examined with a numeric rating scale. FINDINGS 58 patients participated; 17 reported moderate to severe depression, which highly correlated with fatigue, QOL, and pain. Among all factors, multivariate analysis showed that fatigue, particularly the physical domain of fatigue, has the strongest reverse correlation with depression.
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Affiliation(s)
- Xiang Liu
- Medical University of South Carolina
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Yoon HG, Park H. The effect of auricular acupressure on sleep in breast cancer patients undergoing chemotherapy: A single-blind, randomized controlled trial. Appl Nurs Res 2019; 48:45-51. [DOI: 10.1016/j.apnr.2019.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/28/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Park JY, Lengacher CA, Reich RR, Alinat CB, Ramesar S, Le A, Paterson CL, Pleasant ML, Park HY, Kiluk J, Han H, Ismail-Khan R, Kip KE. Translational genomic research: the role of genetic polymorphisms in MBSR program among breast cancer survivors (MBSR[BC]). Transl Behav Med 2019; 9:693-702. [PMID: 30137607 DOI: 10.1093/tbm/iby061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Genetic variations of breast cancer survivors (BCS) may contribute to level of residual symptoms, such as depression, stress, fatigue, and cognitive impairment. The objective of this study was to investigate whether particular single-nucleotide polymorphisms (SNPs) moderated symptom improvement resulting from the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program. An overarching goal of personalized medicine is to identify individuals as risk for disease and tailor interventions based on genetic profiles of patients with diseases including cancer. BCS were recruited from Moffitt Cancer Center and University of South Florida's Breast Health Program and were randomized to either the 6-week MBSR(BC) program (n = 92) or Usual Care (n = 93). Measures of symptoms, demographic, and clinical history data were attained at baseline, 6 weeks, and 12 weeks. A total of 10 SNPs from eight genes known to be related to these symptoms were studied using genomic DNA extracted from blood. Our results were examined for effect sizes, consistency, and statistical significance (p < .05). Three SNPs (rs4680 in COMT, rs6314 in HTR2A, and rs429358 in APOE) emerged as having the strongest (though relatively weak) and most consistent effects in moderating the impact of the MBSR program on symptom outcomes. Although effects were generally weak, with only one effect withstanding multiple comparisons correction for statistical significance, this translational behavioral research may help start the identification of genetic profiles that moderate the impact of MBSR(BC). The ultimate goal of this study is the development of personalized treatment programs tailored to the genetic profile of each patient.
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Affiliation(s)
- Jong Y Park
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Richard R Reich
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Sophia Ramesar
- University of South Florida College of Nursing, Tampa, FL, USA
| | - Alice Le
- University of South Florida College of Nursing, Tampa, FL, USA
| | - Carly L Paterson
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Hyun Y Park
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - John Kiluk
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hyo Han
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Roohi Ismail-Khan
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kevin E Kip
- Department of Epidemiology and Biostatistics, University of South Florida, College of Public Health, Tampa, FL, USA
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Busson R, van der Kaaij M, Mounier N, Aleman BMP, Thiéblemont C, Stamatoullas A, Ribrag V, Tilly H, Haioun C, Casasnovas RO, Kluin-Nelemans HC, Henry-Amar M. Fatigue level changes with time in long-term Hodgkin and non-Hodgkin lymphoma survivors: a joint EORTC-LYSA cross-sectional study. Health Qual Life Outcomes 2019; 17:115. [PMID: 31266501 PMCID: PMC6604328 DOI: 10.1186/s12955-019-1186-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/23/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Long-term lymphoma survivors often complain of persistent fatigue that remains unexplained. While largely reported in Hodgkin lymphoma (HL), long-term fatigue is poorly documented in non-Hodgkin lymphomas (NHL). Data collected in two cohort studies were used to illustrate the fatigue level changes with time in the two populations. METHODS Two cross-sectional studies were conducted in 2009-2010 (HL) and in 2015 (NHL) in survivors enrolled in European Organisation for Research and Treatment of Cancer (EORTC) Lymphoma Group and Lymphoma Study Association (LYSA) trials. The same protocol and questionnaires were used in both studies including the Multidimensional Fatigue Inventory (MFI) tool to assess fatigue and a checklist of health disorders. Multivariate linear regression models were used in the two populations separately to assess the influence of time since diagnosis and primary treatment, age, gender, education level, cohabitation status, obesity and health disorders on fatigue level changes. Fatigue level changes were compared to general population data. RESULTS Overall, data of 2023 HL and 1619 NHL survivors with fatigue assessment available (99 and 97% of cases, respectively) were analyzed. Crude levels of fatigue were similar in the two populations. Individuals who reported health disorders (61% of HL and 64% of NHL) displayed higher levels of fatigue than those who did not (P < 0.001). HL survivors showed increasing fatigue level with age while in NHL survivors mean fatigue level remained constant until age 70 and increased beyond. HL survivors showed fatigue changes with age higher than those of the general population with health disorders while NHL survivors were in between those of the general population with and without health disorders. CONCLUSIONS Among lymphoma survivors progressive increase of fatigue level with time since treatment completion is a distinctive feature of HL. Our data suggest that changes in fatigue level are unlikely to only depend on treatment complications and health disorders. Investigations should be undertaken to identify which factors including biologic mechanisms could explain why a substantial proportion of survivors develop high level of fatigue.
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Affiliation(s)
- Raphaël Busson
- École Doctorale MIIS, University of Caen-Normandie, 14032, Caen, France
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Plateforme de Recherche Clinique Ligue Contre le Cancer, Centre François Baclesse, 3 Avenue Général Harris, 14076, Caen, Cedex 5, France
| | - Marleen van der Kaaij
- Department of Internal Medicine, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands
| | - Nicolas Mounier
- Service d'Onco-hématologie, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 2, 151 Route Saint-Antoine de Ginestière, BP 3079, 06202, Nice, Cedex 3, France
| | - Berthe M P Aleman
- Department of Radiotherapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands
| | - Catherine Thiéblemont
- Service d'Hématologie, AP-HP CHU Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Aspasia Stamatoullas
- Service d'Hématologie, Centre Henri Becquerel, Rue d'Amiens, 76000, Rouen, France
| | - Vincent Ribrag
- Service d'Hématologie, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, Cedex, France
| | - Hervé Tilly
- Service d'Hématologie, Centre Henri Becquerel, Rue d'Amiens, 76000, Rouen, France
| | - Corinne Haioun
- Service d'Hématologie, AP-HP CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - René-Olivier Casasnovas
- Service d'Hématologie, CHRU de Dijon Bourgogne, Hôpital Le Bocage, 2 Boulevard Maréchal de Lattre of Tassigny, 21000, Dijon, France
| | - Hanneke C Kluin-Nelemans
- Department of Haematology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700, RB, Groningen, the Netherlands
| | - Michel Henry-Amar
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Plateforme de Recherche Clinique Ligue Contre le Cancer, Centre François Baclesse, 3 Avenue Général Harris, 14076, Caen, Cedex 5, France.
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LeVan TD, Xiao P, Kumar G, Kupzyk K, Qiu F, Klinkebiel D, Eudy J, Cowan K, Berger AM. Genetic Variants in Circadian Rhythm Genes and Self-Reported Sleep Quality in Women with Breast Cancer. J Circadian Rhythms 2019; 17:6. [PMID: 31303884 PMCID: PMC6611482 DOI: 10.5334/jcr.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Women diagnosed with breast cancer (BC) are at increased risk of sleep deficiency. Approximately 30-60% of these women report poor sleep during and following surgery, chemotherapy, radiation therapy, and anti-estrogen therapy. The purpose of this study was to examine the relationship between genetic variation in circadian rhythm genes and self-reported sleep quality in women with BC. METHODS This cross-sectional study recruited women with a first diagnosis of breast cancer at five sites in Nebraska and South Dakota. Sixty women were included in the study. Twenty-six circadian genes were selected for exome sequencing using the Nextera Rapid Capture Expanded Exome kit. 414 variants had a minor allele frequency of ≥5% and were included in the exploratory analysis. The association between Pittsburgh Sleep Quality Index (PSQI) score and genetic variants was determined by two-sample t-test or ANOVA. RESULTS Twenty-five variants were associated with the PSQI score at p < 0.10, of which 19 were significant at p<0.05, although the associations did not reach statistical significance after adjustment for multiple comparisons. Variants associated with PSQI were from genes CSNK1D & E, SKP1, BHLHE40 & 41, NPAS2, ARNTL, MYRIP, KLHL30, TIMELESS, FBXL3, CUL1, PER1&2, RORB. Two genetic variants were synonymous or missense variants in the BHLHE40 and TIMELESS genes, respectively. CONCLUSIONS These exploratory results demonstrate an association of genetic variants in circadian rhythm pathways with self-reported sleep in women with BC. Testing this association is warranted in a larger replication population.
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Affiliation(s)
| | - Peng Xiao
- University of Nebraska Medical Center, US
| | | | | | - Fang Qiu
- University of Nebraska Medical Center, US
| | | | - James Eudy
- University of Nebraska Medical Center, US
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Burnette CE, Roh S, Liddell J, Lee YS. American Indian women cancer survivors' coping with depressive symptoms. J Psychosoc Oncol 2019; 37:494-508. [PMID: 30590999 PMCID: PMC6529281 DOI: 10.1080/07347332.2018.1525467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Depressive symptoms have been identified as a primary predictor of quality of life among cancer patients. Depression and cancer are co-occurring and disproportionately elevated for American Indian and Alaska Native (AI/AN) women. The purpose of this article is to examine American Indian (AI) women cancer survivors' coping mechanisms for depressive symptoms. RESEARCH APPROACH The methodology included a qualitative descriptive approach with conventional content analysis to examine the coping strategies of AI women cancer survivors associated with depressive symptoms. The interview guide was semi-structured and developed in collaboration with a community advisory board (CAB). Data-derived qualitative analysis was used to generate codes inductively from the data. PARTICIPANTS A sample of 43 AI women cancer survivors (n = 14 cervical cancer, n = 14 breast cancer, and n = 15 other cancers) from the Northern Plains region, in the state of South Dakota were interviewed. Data were collected from June 2014 to February 2015. Methodological approach: Qualitative content analysis was used for data analysis, which allowed themes to emerge inductively from the data. Analysis revealed 430 preliminary codes. After de-briefing, validation, and discussion among coauthors, these were then sorted into 67 codes. Member checks with all available participants were conducted to minimize misinterpretation. FINDINGS A total of 26 participants (62%) indicated they had feelings of depression since their cancer diagnosis. Women coped with depressive feelings by (a) participating in faith traditions; (b) seeking creative and positive outlets; (c) martialing family and social support; and (d) keeping busy with other life activities. INTERPRETATION AI women experienced depressive symptoms following a cancer diagnosis and used a variety of positive coping mechanisms to create personal meaning. Implications for Psychosocial Providers or Policy: AI women may need unique support following a cancer diagnosis, and interventions should incorporate AI beliefs and traditions, such as storytelling and talking with family and community members.
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Affiliation(s)
- Catherine E. Burnette
- School of Social Work, Tulane University, 127 Elk Place, #8906, New Orleans, LA 70112, Phone: 504-862-3495,
| | - Soonhee Roh
- Department of Social Work, University of South Dakota, 365 Health Science Center, 1400 West 22 Street, Sioux Falls, SD 57105, Phone: 605-357-1593,
| | - Jessica Liddell
- City, Community, and Culture PhD Program, School of Social Work, Tulane University, 127 Elk Place, #8906, New Orleans, LA 70112, Phone: 504-862-3495,
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, Phone: 415-405-0944,
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Mirzaei S, Burke L, Rosenfeld AG, Dunn S, Dungan JR, Maki K, DeVon HA. Protein Cytokines, Cytokine Gene Polymorphisms, and Potential Acute Coronary Syndrome Symptoms. Biol Res Nurs 2019; 21:552-563. [PMID: 31238711 DOI: 10.1177/1099800419857819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The purpose of this study was to determine whether relationships exist among protein cytokines, cytokine gene polymorphisms, and symptoms of potential acute coronary syndrome (ACS). Participants included 438 patients presenting to the emergency department (ED) whose symptoms triggered a cardiac evaluation (206 ruled in and 232 ruled out for ACS). Presence or absence of 13 symptoms was recorded upon arrival. Levels of tumor necrosis factor α (TNF-α), interleukin (IL)-6, and IL-18 were measured for all patients. A pilot analysis of 85 patients (ACS = 49; non-ACS = 36) genotyped eight single-nucleotide polymorphisms (SNPs; four TNF and four IL6 SNPs). Logistic regression models were tested to determine whether cytokines or SNPs predicted symptoms. Increased levels of TNF-α and IL-6 were associated with a decreased likelihood of chest discomfort for all patients. Increased levels of IL-6 were associated with a lower likelihood of chest discomfort and chest pressure for ACS patients, and an increased likelihood of shoulder and upper back pain for non-ACS patients. Elevated IL-18 was associated with an increased likelihood of sweating in patients with ACS. Of the four TNF SNPs, three were associated with shortness of breath, lightheadedness, unusual fatigue, and arm pain. In all, protein cytokines and TNF polymorphisms were associated with 11 of 13 symptoms assessed. Future studies are needed to determine the predictive ability of cytokines and related SNPs for a diagnosis of ACS or to determine whether biomarkers can identify patients with specific symptom clusters.
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Affiliation(s)
- Sahereh Mirzaei
- 1 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Larisa Burke
- 1 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Susan Dunn
- 1 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Katherine Maki
- 1 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Holli A DeVon
- 1 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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The effect of a 12-week home-based walking program on reducing fatigue in women with breast cancer undergoing chemotherapy: A randomized controlled study. Int J Nurs Stud 2019; 99:103376. [PMID: 31442785 DOI: 10.1016/j.ijnurstu.2019.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/19/2019] [Accepted: 06/16/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue is the most common symptom experienced by cancer patients during treatment and can last long after completing treatment. Fatigue in cancer patients who have completed treatment is well known to be reduced by exercise, but the effect of exercise on reducing fatigue in patients under treatment has been inconsistent. OBJECTIVES The purposes of this study were to examine short-term and long-term effects of an individually tailored, home-based brisk walking program on reducing fatigue in breast cancer patients under chemotherapy. DESIGN, SETTING, PARTICIPANTS For this randomized controlled trial, women were recruited from a medical center in northern Taiwan if they were diagnosed with stages I-III breast cancer and experienced insomnia, fatigue, pain, or depressive symptoms after their first cycle of chemotherapy. Consenting participants (N = 159) were randomly assigned to either an exercise (12-week home-based walking program) group (n = 81) or an attention-control group (n = 78). METHODS The 12-week, home-based brisk walking program started on the first day of the third chemotherapy cycle. Fatigue was measured by the Brief Fatigue Inventory. Covariates, i.e., functional performance, sleep disturbance, anxiety, depression, and exercise-related variables, were also measured. Data were collected at baseline, two times during the exercise intervention, and five times after the exercise intervention (eight times in total). The effects of time-varying and time-invariant predictors on fatigue were analyzed by multilevel modeling. RESULTS Fatigue levels increased over time for both groups, even after completing treatment. At the end of the 12-week exercise program, the exercise group had less fatigue than the attention-control group, and this group difference was maintained for the whole study period. At the end of exercise program, women who had spent more time exercising before diagnosis had less fatigue than those who had exercised less often. In addition, patients' fatigue levels at various time points fluctuated along with their functional performance, sleep disturbance, and depression. CONCLUSIONS Our tailored, home-based brisk walking program effectively reduced fatigue in breast cancer patients under chemotherapy, and this effect lasted after completing treatment.
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Chemokine Signaling in Chemotherapy-Induced Neuropathic Pain. Int J Mol Sci 2019; 20:ijms20122904. [PMID: 31197114 PMCID: PMC6627296 DOI: 10.3390/ijms20122904] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 12/17/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a side effect of chemotherapics such as taxanes, vinca alkaloids, and platinum compounds. In recent years, several reports have indicated the involvement of different molecular mechanisms in CIPN. The pathways described so far are diverse and target various components of the peripheral Nervous System (PNS). Among the contributors to neuropathic pain, inflammation has been indicated as a powerful driver of CIPN. Several pieces of evidence have demonstrated a chemotherapy-induced increase in peripheral pro-inflammatory cytokines and a strong correlation with peripheral neuropathy. At present, there are not adequate strategies to prevent CIPN, although there are drugs for treating CIPN, such as duloxetine, that have displayed a moderate effect on CIPN. In this review, we focus on the players involved in CIPN with a particular emphasis on chemokine signaling.
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Fox RS, Ancoli-Israel S, Roesch SC, Merz EL, Mills SD, Wells KJ, Sadler GR, Malcarne VL. Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy. Support Care Cancer 2019; 28:845-855. [PMID: 31161437 DOI: 10.1007/s00520-019-04834-w] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/23/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Sleep disturbance and cancer-related fatigue (CRF) are among the most commonly reported symptoms associated with breast cancer and its treatment. This study identified symptom cluster groups of breast cancer patients based on multidimensional assessment of sleep disturbance and CRF prior to and during chemotherapy. METHODS Participants were 152 women with stage I-IIIA breast cancer. Data were collected before chemotherapy (T1) and during the final week of the fourth chemotherapy cycle (T2). Latent profile analysis was used to derive groups of patients at each timepoint who scored similarly on percent of the day/night asleep per actigraphy, the Pittsburgh Sleep Quality Index global score, and the five subscales of the Multidimensional Fatigue Symptom Inventory-Short Form. Bivariate logistic regression evaluated if sociodemographic/medical characteristics at T1 were associated with group membership at each timepoint. RESULTS Three groups (Fatigued with sleep complaints, Average, Minimal symptoms) were identified at T1, and five groups (Severely fatigued with poor sleep, Emotionally fatigued with average sleep, Physically fatigued with average sleep, Average, Minimal symptoms) at T2. The majority of individuals in a group characterized by more severe symptoms at T1 were also in a more severe symptom group at T2. Sociodemographic/medical variables at T1 were significantly associated with group membership at T1 and T2. CONCLUSIONS This study identified groups of breast cancer patients with differentially severe sleep disturbance and CRF symptom profiles prior to and during chemotherapy. Identifying groups with different symptom management needs and distinguishing groups by baseline sociodemographic/medical variables can identify patients at risk for greater symptom burden.
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Affiliation(s)
- Rina S Fox
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sonia Ancoli-Israel
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
- University of California, San Diego, San Diego, CA, USA
| | - Scott C Roesch
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Erin L Merz
- California State University, Dominguez Hills, Carson, CA, USA
| | - Sarah D Mills
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen J Wells
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Georgia Robins Sadler
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
- University of California, San Diego, San Diego, CA, USA
| | - Vanessa L Malcarne
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA.
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA.
- University of California, San Diego, San Diego, CA, USA.
- San Diego State University, San Diego, CA, USA.
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Erasmus E, Steffens FE, van Reenen M, Vorster BC, Reinecke CJ. Biotransformation profiles from a cohort of chronic fatigue women in response to a hepatic detoxification challenge. PLoS One 2019; 14:e0216298. [PMID: 31075116 PMCID: PMC6510445 DOI: 10.1371/journal.pone.0216298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/17/2019] [Indexed: 02/02/2023] Open
Abstract
Chronic fatigue, in its various manifestations, frequently co-occur with pain, sleep disturbances and depression and is a non-communicable condition which is rapidly becoming endemic worldwide. However, it is handicapped by a lack of objective definitions and diagnostic measures. This has prompted the World Health Organization to develop an international instrument whose intended purpose is to improve quality of life (QOL), with energy and fatigue as one domain of focus. To complement this objective, the interface between detoxification, the exposome, and xenobiotic-sensing by nuclear receptors that mediate induction of biotransformation-linked genes, is stimulating renewed attention to a rational development of strategies to identify the metabolic profiles in complex multifactorial conditions like fatigue. Here we present results from a seven-year study of a cohort of 576 female patients suffering from low to high levels of chronic fatigue, in which phase I and phase II biotransformation was assessed. The biotransformation profiles used were based on hepatic detoxification challenge tests through oral caffeine, acetaminophen and acetylsalicylic acid ingestion coupled with oxidative stress analyses. The interventions indicated normal phase I but increased phase II glucuronidation and glycination conjugation. Complementarity was indicated between a fatigue scale, medical symptoms and associated energy-related parameters by application of Chi-square Automatic Interaction Detector (CHAID) analysis. The presented study provides a cluster of data from which we propose that multidisciplinary inputs from the combination of a fatigue scale, medical symptoms and biotransformation profiles provide the rationale for the development of a comprehensive laboratory instrument for improved diagnostics and personalized interventions in patients with chronic fatigue with a view to improving their QOL.
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Affiliation(s)
- Elardus Erasmus
- Human Metabolomics, North-West University (Potchefstroom Campus), South Africa
| | | | - Mari van Reenen
- Human Metabolomics, North-West University (Potchefstroom Campus), South Africa
| | - B. Chris Vorster
- Human Metabolomics, North-West University (Potchefstroom Campus), South Africa
| | - Carolus J. Reinecke
- Human Metabolomics, North-West University (Potchefstroom Campus), South Africa
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Mafu TS, September AV, Shamley D. KDR inferred haplotype is associated with upper limb dysfunction in breast cancer survivors of mixed ancestry. Cancer Manag Res 2019; 11:3829-3845. [PMID: 31118800 PMCID: PMC6502440 DOI: 10.2147/cmar.s191969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/29/2019] [Indexed: 01/27/2023] Open
Abstract
Introduction: Shoulder pain and disability are well-documented sequelae of breast cancer treatment. Angiogenesis signaling may have a role in the development of shoulder pain or shoulder disability in breast cancer survivors. The aim of this study was to determine if polymorphisms in angiogenesis-related genes are associated with shoulder pain or disability following breast cancer treatment. Participants and methods: A cross-sectional study was conducted on 220 South African breast cancer survivors. The study aimed to evaluate associations between shoulder pain/disability and seven single nucleotide polymorphisms (SNPs) within five angiogenesis-associated genes: KDR (rs2305948 C>T; rs7667298 C>T), NOS3 (rs1549758 C>T), MMP2 (rs708269 A>T), THBS2 (rs9766678 A>G) and TIMP3 (rs5754312 T>A; rs715572 G>A). In addition, associations between shoulder pain/disability and inferred haplotypes for KDR and TIMP3 SNPs were evaluated. Participants were grouped into no–low and moderate–high shoulder pain/disability based on total pain/disability scores: ≤30 and >30, respectively using the shoulder pain and disability index (SPADI). Results: No independent associations with shoulder pain/disability categories were found for all SNPs. However, 1 inferred haplotype (KDR “TT”) differed significantly (P=0.014) between the shoulder disability categories. After adjusting for participants’ age, the differences in KDR inferred haplotype frequencies between shoulder disability categories became non-significant (P=0.052). Conclusion: Our findings provide a preliminary suggestion of a possible association between polymorphisms in genes involved in angiogenesis and the presence of moderate–high shoulder disability among South African breast cancer survivors. A larger prospective cohort study is currently being conducted by our group.
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Affiliation(s)
- Trevor S Mafu
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alison V September
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Delva Shamley
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
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Ammitzbøll G, Kristina Kjær T, Johansen C, Lanng C, Wreford Andersen E, Kroman N, Zerahn B, Hyldegaard O, Envold Bidstrup P, Oksbjerg Dalton S. Effect of progressive resistance training on health-related quality of life in the first year after breast cancer surgery - results from a randomized controlled trial. Acta Oncol 2019; 58:665-672. [PMID: 30702006 DOI: 10.1080/0284186x.2018.1563718] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aims: To examine the effect of progressive resistance training (PRT) on health related quality of life and a predefined symptom cluster of pain-sleep-fatigue. Methods: This study was a planned secondary analysis of a randomized controlled trial examining the effect of PRT on prevention of arm lymphedema in a population of women between 18 and 75 years undergoing breast cancer surgery with axillary lymph node dissection. Participants were allocated by computer randomization to usual care control or a PRT intervention in a 1:1 ratio. The intervention, initiated in the third post-operative week, consisted of three times PRT per week, supervised in groups in the first 20 weeks, and self-administered in the following 30 weeks. Questionnaire assessments were made at baseline, 20 weeks and 12 months, with the European Organization for Research and Treatment in Cancer Core questionnaire (EORTC QLQ C30) and the Functional Assessment of Chronic Illness Therapy-(FACIT) fatigue questionnaire. The symptom cluster of pain-sleep-fatigue was measured with a constructed score adding EORTC C30 subscales of insomnia, pain, and fatigue. Data were treated as repeated measurements and analyzed with mixed models. Results: Among 158 recruited participants, we found a clinically relevant increased emotional functioning with nine points at both follow-ups (p = .02), and 16 and 11 points at 20 weeks and 12 months respectively (p = .04) in social functioning. Furthermore, in the subgroup of women with the symptom cluster pain-sleep-fatigue present at baseline, a significant effect was found for global health status (p = .01) and social functioning (p = .02). Conclusion: To our knowledge, this is the first study to report clinically relevant effects of PRT on social and emotional functioning in the first postoperative year after breast cancer surgery. Furthermore, a subgroup of women with the pain-sleep-fatigue symptom cluster had particular benefit from PRT on global health status and social functioning.
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Affiliation(s)
- Gunn Ammitzbøll
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Christoffer Johansen
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
- CASTLE Late Effects Unit, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Lanng
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | | | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Danish Cancer Society, Copenhagen, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Ole Hyldegaard
- Section for Hyperbaric Oxygen Treatment, Department for Anaesthetics and Operations, Center for Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Himbert C, Ose J, Lin T, Warby CA, Gigic B, Steindorf K, Schrotz-King P, Abbenhardt-Martin C, Zielske L, Boehm J, Ulrich CM. Inflammation- and angiogenesis-related biomarkers are correlated with cancer-related fatigue in colorectal cancer patients: Results from the ColoCare Study. Eur J Cancer Care (Engl) 2019; 28:e13055. [PMID: 31016796 DOI: 10.1111/ecc.13055] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 01/09/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Abstract
Cancer-related fatigue is one of the most common side effects of colorectal cancer treatment and is affected by biomedical factors. We investigated the association of inflammation- and angiogenesis-related biomarkers with cancer-related fatigue. Pre-surgery (baseline) serum samples were obtained from n = 236 newly diagnosed colorectal cancer patients. Meso Scale Discovery assays were performed to measure levels of biomarkers for inflammation and angiogenesis (CRP, SAA, IL-6, IL-8, MCP-1, sICAM-1, sVCAM-1, TNFα, VEGFA and VEGFD). Cancer-related fatigue was assessed with the EORTC QLQ-30 questionnaire at baseline and 6 and 12 months post-surgery. We tested associations using Spearman's partial correlations and logistic regression analyses, adjusting for age, sex and body mass index. sICAM-1 and VEGFD showed a significant positive correlation with cancer-related fatigue at baseline and 6-, and 12-month follow-up (sICAM-1: r = 0.19, p = 0.010; r = 0.24, p = 0.004; r = 0.25, p = 0.006; VEGFD: r = 0.20, p = 0.006; r = 0.15, p = 0.06; r = 0.23, p = 0.01 respectively). Biomarkers of inflammation and angiogenesis measured prior to surgery are associated with cancer-related fatigue in colorectal cancer patients throughout various time points. Our results suggest the involvement of overexpressed sICAM-1 and VEGFD in the development of fatigue.
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Affiliation(s)
- Caroline Himbert
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, Utah.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Jennifer Ose
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, Utah.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Tengda Lin
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, Utah.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Christy A Warby
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, Utah.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Biljana Gigic
- Department of Surgery, University Clinic of Heidelberg, Heidelberg, Germany
| | - Karen Steindorf
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany
| | | | | | - Lin Zielske
- Department of Surgery, University Clinic of Heidelberg, Heidelberg, Germany
| | - Juergen Boehm
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, Utah.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, Utah.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
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Charalambous A, Berger AM, Matthews E, Balachandran DD, Papastavrou E, Palesh O. Cancer-related fatigue and sleep deficiency in cancer care continuum: concepts, assessment, clusters, and management. Support Care Cancer 2019; 27:2747-2753. [DOI: 10.1007/s00520-019-04746-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/08/2019] [Indexed: 01/16/2023]
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Knoerl R, Chornoby Z, Smith EML. Estimating the Frequency, Severity, and Clustering of SPADE Symptoms in Chronic Painful Chemotherapy-Induced Peripheral Neuropathy. Pain Manag Nurs 2019; 19:354-365. [PMID: 29503217 DOI: 10.1016/j.pmn.2018.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/04/2018] [Accepted: 01/06/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients undergoing treatment for cancer commonly experience symptoms such as sleep disturbance, pain, anxiety, depression, and low energy/fatigue (SPADE), subsequently altering physical function and complicating effective symptom management. However, little is known about the frequency, severity, and clustering of SPADE symptoms in individuals with chronic painful chemotherapy-induced peripheral neuropathy (CIPN). Aims/Design: The purpose of this cross-sectional, secondary analysis was to describe the frequency, severity, and clustering of SPADE symptoms and their association with physical function in individuals with chronic painful CIPN. Participants/Subjects: Sixty individuals with chronic painful CIPN were recruited from five academic and community oncology outpatient center to participate in a randomized controlled pilot trial designed to test the efficacy of a cognitive behavioral therapy-based pain management program. METHODS Participants completed the 0-10 Average CIPN Pain Numerical Rating Scale and Patient-Reported Outcome Measurement Information System measures for sleep-related impairment, anxiety, depression, fatigue, and pain interference via tablet before being randomly assigned to a study arm. The frequency, severity, and clustering of SPADE symptoms were calculated via descriptive statistics and Partitioning Around Medoids cluster analysis. Spearman rank correlation was performed to determine the association between number of SPADE symptoms and pain interference severity. RESULTS AND CONCLUSIONS Participants (n = 59) experienced numerous SPADE symptoms. 66.1% of participants experienced at least two SPADE symptoms concurrently. The cluster analysis revealed high (n = 36) and low (n = 23) severity subgroups. There was a moderate correlation (r = 0.48) between the number of SPADE symptoms and pain interference severity. Determining the clustering of SPADE symptoms in individuals with chronic painful CIPN may lead to targeted multifaceted interventions to improve physical function.
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Zach Chornoby
- University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Ellen M L Smith
- University of Michigan School of Nursing, Ann Arbor, Michigan
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Jhamb M, Abdel-Kader K, Yabes J, Wang Y, Weisbord SD, Unruh M, Steel JL. Comparison of Fatigue, Pain, and Depression in Patients With Advanced Kidney Disease and Cancer-Symptom Burden and Clusters. J Pain Symptom Manage 2019; 57:566-575.e3. [PMID: 30552961 PMCID: PMC6382584 DOI: 10.1016/j.jpainsymman.2018.12.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022]
Abstract
CONTEXT Although symptom clusters have been studied in the context of cancer, few data exist in chronic and end-stage kidney disease (CKD/ESKD) patients. OBJECTIVES The objectives of this study were to 1) characterize and compare symptom cluster phenotypes in patients with advanced CKD, ESKD, and cancer and 2) explore predictors of symptom clusters. METHODS We conducted secondary data analysis of three prospective studies in which pain, depression, and fatigue were assessed in patients with Stage 4-5 CKD, ESKD, and gastrointestinal cancer. Tetrachoric correlations between these symptoms were quantified, and partitioning around medoids algorithm was used for symptom cluster analysis. RESULTS In the 82 CKD, 149 ESKD, and 606 cancer patients, no differences in the average fatigue (P = 0.17) or pain levels (P = 0.21) were observed. Over 80% of patients in each group had at least one symptom. Moderate or severe depressive symptoms were more common in patients with cancer (31% vs. 19% in ESKD vs. 9% in CKD; P < 0.001). Mild-moderate correlations were observed between the three symptoms in ESKD and cancer patients. Three distinct clusters were observed in each group. In ESKD, the HIGH cluster (with high probability of pain, depression, and fatigue) had higher body mass index (P < 0.001) and antidepressant use (P = 0.01). In cancer patients, the HIGH cluster patients were more likely to be female (P = 0.04), use antidepressants (P = 0.04), and have lower serum albumin (P < 0.001) and hemoglobin (P = 0.03) compared to the other two clusters. CONCLUSION Although the burden of fatigue, pain, and depressive symptoms for CKD and ESKD patients is similar to patients with gastrointestinal cancer, symptom cluster phenotypes differed between the groups as did the predictors of symptom clusters.
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Affiliation(s)
- Manisha Jhamb
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | - Khaled Abdel-Kader
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Yabes
- Center for Research on Heath Care, Division of General Internal Medicine, Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yisi Wang
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven D Weisbord
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Mark Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Jennifer L Steel
- Department of Surgery, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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77
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Tometich DB, Small BJ, Carroll JE, Zhai W, Luta G, Zhou X, Kobayashi LC, Ahles T, Saykin AJ, Clapp JD, Jim HSL, Jacobsen PB, Hurria A, Graham D, McDonald BC, Denduluri N, Extermann M, Isaacs C, Dilawari A, Root J, Rini C, Mandelblatt JS. Pretreatment Psychoneurological Symptoms and Their Association With Longitudinal Cognitive Function and Quality of Life in Older Breast Cancer Survivors. J Pain Symptom Manage 2019; 57:596-606. [PMID: 30472317 PMCID: PMC6382533 DOI: 10.1016/j.jpainsymman.2018.11.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
CONTEXT Symptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied. OBJECTIVES The objectives of this study were to identify prototypical presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time. METHODS Women with newly diagnosed nonmetastatic breast cancer (n = 319) and matched noncancer controls (n = 347) aged 60+ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancer-specific QOL) by group, controlling for covariates. RESULTS Nearly one-fifth of older survivors were classified as having high pretherapy symptoms (n = 51; 16%); the remainder had low symptoms (n = 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancer-specific QOL at all time points (all P < 0.05). CONCLUSION Nearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention.
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Affiliation(s)
- Danielle B Tometich
- Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
| | - Brent J Small
- Moffitt Cancer Center, Tampa, Florida, USA; University of South Florida, Tampa, Florida, USA
| | - Judith E Carroll
- University of California Los Angeles and Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Wanting Zhai
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - George Luta
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Xingtao Zhou
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Lindsay C Kobayashi
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Tim Ahles
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Andrew J Saykin
- Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | - Jonathan D Clapp
- University of South Florida, Tampa, Florida, USA; Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | | | | | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Brenna C McDonald
- Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | | | | | - Claudine Isaacs
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Asma Dilawari
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - James Root
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Christine Rini
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA; John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Jeanne S Mandelblatt
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
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Flowers E, Flentje A, Levine J, Olshen A, Hammer M, Paul S, Conley Y, Miaskowski C, Kober KM. A Pilot Study Using a Multistaged Integrated Analysis of Gene Expression and Methylation to Evaluate Mechanisms for Evening Fatigue in Women Who Received Chemotherapy for Breast Cancer. Biol Res Nurs 2019; 21:142-156. [PMID: 30701989 PMCID: PMC6700896 DOI: 10.1177/1099800418823286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Fatigue is the most common symptom associated with cancer and its treatment. Investigation of molecular mechanisms associated with fatigue may identify new therapeutic targets. OBJECTIVE The objective of this pilot study was to evaluate the relationships between gene expression and methylation status and evening fatigue severity in women with breast cancer who received chemotherapy. METHODS Latent class analysis (LCA) was used to identify evening fatigue phenotypes. In this analysis, the lowest (i.e., moderate, n = 7) and highest (i.e., very high, n = 29) fatigue-severity classes identified using LCA were analyzed via two stages. First, a total of 32,609 transcripts from whole blood were evaluated for differences in expression levels between the classes. Next, 637 methylation sites located within the putative transcription factor binding sites for those genes demonstrating differential expression were evaluated for differential methylation state between the classes. RESULTS A total of 89 transcripts in 75 unique genes were differentially expressed between the moderate (the lowest fatigue-severity class identified) and very high evening fatigue classes. In addition, 23 differentially methylated probes and three differentially methylated regions were found between the moderate and very high evening fatigue classes. CONCLUSIONS Using a multistaged integrated analysis of gene expression and methylation, differential methylation was identified in the regulatory regions of genes associated with previously hypothesized mechanisms for fatigue, including inflammation, immune function, neurotransmission, circadian rhythm, skeletal muscle energy, carbohydrate metabolism, and renal function as well as core biological processes including gene transcription and the cell-cycle regulation.
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Affiliation(s)
- Elena Flowers
- 1 School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Annesa Flentje
- 1 School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Jon Levine
- 2 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Adam Olshen
- 2 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Marilyn Hammer
- 3 Department of Nursing, Mount Sinai Hospital, New York, NY, USA
| | - Steven Paul
- 1 School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Yvette Conley
- 4 School of Nursing, University of Pittsburg, Pittsburg, PA, USA
| | - Christine Miaskowski
- 1 School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Kord M Kober
- 1 School of Nursing, University of California, San Francisco, San Francisco, CA, USA
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79
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Bower JE, Asher A, Garet D, Petersen L, Ganz PA, Irwin MR, Cole SW, Hurvitz SA, Crespi CM. Testing a biobehavioral model of fatigue before adjuvant therapy in women with breast cancer. Cancer 2018; 125:633-641. [PMID: 30561795 DOI: 10.1002/cncr.31827] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/23/2018] [Accepted: 10/01/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fatigue is one of the most common and disabling side effects of cancer and its treatment. Although research typically has focused on fatigue that occurs during and after treatment, patients may experience fatigue even before treatment onset. The current study was designed to identify biobehavioral risk factors associated with fatigue before adjuvant therapy in women with early-stage breast cancer. METHODS Patients with stage 0 to stage IIIA breast cancer (270 women) were recruited before the onset of adjuvant or neoadjuvant therapy with radiotherapy, chemotherapy, and/or endocrine therapy. Host factors that may influence fatigue were identified from an empirically based, biobehavioral model and assessed using self-report questionnaires, medical record review, and blood collection (for genetic data). Fatigue was assessed by questionnaire. Linear regression analyses were used to evaluate the association between host factors and dimensions of fatigue, with general fatigue as the primary dimension of interest. RESULTS Fatigue was elevated at the pretreatment assessment compared with published controls. Bivariate analyses identified demographic, cancer-related, and biobehavioral correlates of fatigue. In the multivariable model, predictors of general fatigue included younger age, lower educational level, lower cancer stage, and history of childhood maltreatment (all P values <.05), with the full model accounting for approximately 18.4% of the variance in fatigue. Secondary analyses identified common and specific predictors of emotional, mental, and physical dimensions of fatigue. CONCLUSIONS Among women who have not yet initiated treatment of breast cancer, demographic and psychosocial factors are associated with elevated fatigue and could be used to identify at-risk patients for early intervention.
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Affiliation(s)
- Julienne E Bower
- Department of Psychology, University of California at Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California.,Norman Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
| | - Arash Asher
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Deborah Garet
- Norman Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California
| | - Laura Petersen
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California.,School of Medicine, University of California at Los Angeles, Los Angeles, California.,School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Michael R Irwin
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California.,Norman Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California
| | - Steve W Cole
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California.,Norman Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California.,Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Sara A Hurvitz
- Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Catherine M Crespi
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California.,Department of Biostatistics, University of California at Los Angeles, Los Angeles, California
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Knisely MR, Conley YP, Kober KM, Smoot B, Paul SM, Levine JD, Miaskowski C. Associations Between Catecholaminergic and Serotonergic Genes and Persistent Breast Pain Phenotypes After Breast Cancer Surgery. THE JOURNAL OF PAIN 2018; 19:1130-1146. [DOI: 10.1016/j.jpain.2018.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/04/2018] [Accepted: 04/12/2018] [Indexed: 12/20/2022]
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81
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Kühl T, Behrens S, Jung AY, Obi N, Thöne K, Schmidt ME, Becher H, Chang-Claude J. Validation of inflammatory genetic variants associated with long-term cancer related fatigue in a large breast cancer cohort. Brain Behav Immun 2018; 73:252-260. [PMID: 29763737 DOI: 10.1016/j.bbi.2018.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/02/2018] [Accepted: 05/09/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies to date have reported several associations between single nucleotide polymorphisms (SNPs) and cancer related fatigue (CRF), but have been limited by small sample sizes, missing adjustment for relevant covariates or multiple testing, as well as varying CRF definitions, i.e. time and method of assessment. This study aimed to validate previously reported associations using the largest independent breast cancer sample to date and to evaluate further functional cytokine variants in relation to total CRF and all relevant CRF subdomains (physical, cognitive, and affective CRF). METHOD 45 candidate SNPs in inflammatory pathway genes were selected based on previous reports (16 SNPs) or regulatory function (29 SNPs). Breast cancer patients recruited between 2002 and 2005 provided information on CRF at first follow-up (FU1) (N = 1389) and second follow-up (FU2) (N = 950), a median of 6.2 years and 11.7 years respectively after diagnosis. SNP associations were assessed using linear regression models on CRF scores separately for FU1 and FU2. Additionally, patients with persistent fatigue (fatigued at both time-points) were compared to those never fatigued using logistic regression models (N = 684). All analyses were adjusted for relevant covariates. Secondary analyses were conducted for CRF subdomains. RESULTS For total CRF none of the previously reported associations were confirmed after correction for multiple testing. The p-value distribution of all SNPs was not different than the one expected by chance. Analyses of CRF subdomains yielded a significant association between TNF-α rs3093662 and persistent physical CRF (Odds Ratio (OR) = 3.23, 95% Confidence Interval (CI) = 1.71-6.10, p = 0.0003). CONCLUSION We were unable to confirm previously reported findings, suggesting that individual SNPs are unlikely to be of clinical utility. Further investigations in well powered studies are warranted, which consider genetic heterogeneity according to subdomains of CRF.
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Affiliation(s)
- T Kühl
- Cancer Epidemiology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Y Jung
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - N Obi
- Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Thöne
- Cancer Epidemiology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M E Schmidt
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H Becher
- Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Chang-Claude
- Cancer Epidemiology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Utne I, Løyland B, Grov EK, Rasmussen HL, Torstveit AH, Cooper BA, Mastick J, Mazor M, Wong M, Paul SM, Conley YP, Jahan T, Ritchie C, Levine JD, Miaskowski C. Distinct attentional function profiles in older adults receiving cancer chemotherapy. Eur J Oncol Nurs 2018; 36:32-39. [PMID: 30322507 DOI: 10.1016/j.ejon.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/25/2018] [Accepted: 08/17/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE While attentional function is an extremely important patient outcome for older adults, research on changes in function in this group is extremely limited. The purposes of this study were to: identify subgroups of older patients (i.e., latent growth classes) based on changes in their level of self-reported attentional function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality of life (QOL) outcomes. METHODS Older oncology outpatients (n = 365) who were assessed for changes in attention and working memory using the Attentional Function Index a total of six times over two cycles of chemotherapy (CTX). QOL was assessed using the Medical Outcomes Study-Short Form 12 and the QOL-Patient Version Scale. Latent profile analysis (LPA) was used to identify subgroups of older adults with distinct attentional function profiles. RESULTS Three distinct attentional functional profiles were identified (i.e., low, moderate, and high attentional function). Compared to the high class, older adults in the low and moderate attentional function classes had lower functional status scores, a worse comorbidity profile and were more likely to be diagnosed with depression. In addition, QOL scores followed an expected pattern (low class < moderate class < high attentional function class). CONCLUSIONS Three distinct attentional function profiles were identified among a relatively large sample of older adults undergoing CTX. The phenotypic characteristics associated with membership in the low and moderate latent classes can be used by clinicians to identify high risk patients.
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Affiliation(s)
- Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Hege Lund Rasmussen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ann Helen Torstveit
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Bruce A Cooper
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Judy Mastick
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Melissa Mazor
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Melisa Wong
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Steven M Paul
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thierry Jahan
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Christine Ritchie
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Jon D Levine
- Schools of Medicine, University of California, San Francisco, CA, USA
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Abrahams H, Gielissen M, Verhagen C, Knoop H. The relationship of fatigue in breast cancer survivors with quality of life and factors to address in psychological interventions: A systematic review. Clin Psychol Rev 2018; 63:1-11. [DOI: 10.1016/j.cpr.2018.05.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 12/24/2022]
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84
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Nguyen LT, Alexander K, Yates P. Psychoeducational Intervention for Symptom Management of Fatigue, Pain, and Sleep Disturbance Cluster Among Cancer Patients: A Pilot Quasi-Experimental Study. J Pain Symptom Manage 2018; 55:1459-1472. [PMID: 29505795 DOI: 10.1016/j.jpainsymman.2018.02.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To assess the feasibility of conducting a trial of a psychoeducational intervention involving the provision of tailored information and coaching to improve management of a cancer-related symptom cluster (fatigue, pain, and sleep disturbance) and reduce symptom cluster impacts on patient health outcomes in the Vietnamese context and to undertake a preliminary evaluation of the intervention. METHODS A parallel-group single-blind pilot quasi-experimental trial was conducted with 102 cancer patients in one Vietnamese hospital. The intervention group received one face-to-face session and two phone sessions delivered by a nurse one week apart, and the comparison group received usual care. Patient outcomes were measured at baseline before the chemotherapy cycle and immediately preceding the next chemotherapy cycle. Separate linear mixed models were used to evaluate the impact of the intervention on total symptom cluster severity, symptom scores, functional status, depressive symptoms, and health-related quality of life. RESULTS The study design was feasible with a recruitment rate of 22.6% and attrition rate of 9.8%. Compared to the control group, the intervention group showed a significant reduction in symptom cluster severity, fatigue severity, fatigue interference, sleep disturbance, depression, and anxiety. Significant differences were not observed for pain severity, pain interference, functional status, and health-related quality of life. The intervention was acceptable to the study population, with a high attendance rate of 78% and adherence rate of 95.7%. CONCLUSION On the basis of the present study findings, future randomized controlled trials are needed to test the effectiveness of a symptom cluster psychoeducational intervention in Vietnam.
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Affiliation(s)
- Ly Thuy Nguyen
- School of Nursing, Queensland University of Technology, Brisbane, Australia; Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam.
| | - Kimberly Alexander
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Brisbane, Australia
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85
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Kwekkeboom KL, Tostrud L, Costanzo E, Coe CL, Serlin RC, Ward SE, Zhang Y. The Role of Inflammation in the Pain, Fatigue, and Sleep Disturbance Symptom Cluster in Advanced Cancer. J Pain Symptom Manage 2018; 55:1286-1295. [PMID: 29360570 PMCID: PMC5899940 DOI: 10.1016/j.jpainsymman.2018.01.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/04/2018] [Accepted: 01/11/2018] [Indexed: 01/08/2023]
Abstract
CONTEXT Symptom researchers have proposed a model of inflammatory cytokine activity and dysregulation in cancer to explain co-occurring symptoms including pain, fatigue, and sleep disturbance. OBJECTIVES We tested the hypothesis that psychological stress accentuates inflammation and that stress and inflammation contribute to one's experience of the pain, fatigue, and sleep disturbance symptom cluster (symptom cluster severity, symptom cluster distress) and its impact (symptom cluster interference with daily life, quality of life). METHODS We used baseline data from a symptom cluster management trial. Adult participants (N = 158) receiving chemotherapy for advanced cancer reported pain, fatigue, and sleep disturbance on enrollment. Before intervention, participants completed measures of demographics, perceived stress, symptom cluster severity, symptom cluster distress, symptom cluster interference with daily life, and quality of life and provided a blood sample for four inflammatory biomarkers (interleukin-1β, interleukin-6, tumor necrosis factor-α, and C-reactive protein). RESULTS Stress was not directly related to any inflammatory biomarker. Stress and tumor necrosis factor-α were positively related to symptom cluster distress, although not symptom cluster severity. Tumor necrosis factor-α was indirectly related to symptom cluster interference with daily life, through its effect on symptom cluster distress. Stress was positively associated with symptom cluster interference with daily life and inversely with quality of life. Stress also had indirect effects on symptom cluster interference with daily life, through its effect on symptom cluster distress. CONCLUSION The proposed inflammatory model of symptoms was partially supported. Investigators should test interventions that target stress as a contributing factor in co-occurring pain, fatigue, and sleep disturbance and explore other factors that may influence inflammatory biomarker levels within the context of an advanced cancer diagnosis and treatment.
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Affiliation(s)
| | | | | | | | | | | | - Yingzi Zhang
- University of Wisconsin, Madison, Wisconsin, USA
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Nguyen LT, Yates P, Annoussamy LC, Truong TQ. The effectiveness of non-pharmacological interventions in the management of symptom clusters in adult cancer patients: a systematic review protocol. ACTA ACUST UNITED AC 2018; 14:49-59. [PMID: 27532309 DOI: 10.11124/jbisrir-2016-2476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
REVIEW QUESTION/OBJECTIVE To what extent are non-pharmacological interventions effective in reducing symptom clusters in terms of presence, frequency and severity, compared with standard care?More specifically, the objectives are to: CENTER CONDUCTING THE REVIEW:: The Hanoi Medical University Nursing Research Center for Evidence Based Health Care: a Collaborating Centre of the Joanna Briggs Institute; and Centre for Evidence-based Healthy Aging: an Affiliate Centre of the Joanna Briggs Institute, School of Nursing, Queensland University of Technology, Australia.
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Affiliation(s)
- Ly Thuy Nguyen
- 1Hanoi Medical University, Hanoi, Vietnam 2School of Nursing, Queensland University of Technology, Australia 3L'Hôpital Francais de Hanoi, Hanoi, Vietnam
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87
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Mazor M, Lee K, Dhruva A, Cataldo JK, Paul SM, Melisko M, Smoot BJ, Levine JD, Elboim C, Conley YP, Miaskowksi C. Menopausal-Related Symptoms in Women One Year After Breast Cancer Surgery. J Pain Symptom Manage 2018; 55:1138-1151.e1. [PMID: 29221848 PMCID: PMC5856592 DOI: 10.1016/j.jpainsymman.2017.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022]
Abstract
CONTEXT Approximately 60% to 100% of women with breast cancer experience at least one menopausal-related symptom. Little is known about associations between menopausal status and symptoms in women 12 months after breast cancer surgery. OBJECTIVES The purpose of this study was to evaluate for differences in occurrence, severity, and distress of symptoms between pre- and postmenopausal women 12 months after breast cancer surgery. METHODS Women with breast cancer (n = 327) completed the Menopausal Symptoms Scale, which evaluated the occurrence, severity, and distress of 46 common menopausal-related symptoms. Regression analyses were used to evaluate between-group differences in the seven symptoms that occurred in 30% and more of the sample (i.e., hot flashes, night sweats, depression, daytime sweats, joint pain or stiffness, wake during the night, and numbness or tingling). RESULTS Of the 327 patients with breast cancer, who completed the 12-month assessment, 35.2% were premenopausal and 64.8% were postmenopausal before surgery. In the conditional models, when significant interactions were found, the differences in symptom occurrence rates between pre- and postmenopausal patients depended on their age. CONCLUSION Regardless of menopausal status, women reported relatively high occurrence rates for several menopausal symptoms. Associations between symptom occurrence rates and menopausal status depended on the patient's age. During the development of a survivorship care plan, clinicians need to assess symptom burden within the context of a woman's menopausal status and salient demographic and clinical characteristics. This approach will assist with the prescription of more effective interventions.
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Affiliation(s)
- Melissa Mazor
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Kathryn Lee
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Anand Dhruva
- School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Janine K Cataldo
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Michelle Melisko
- School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Betty J Smoot
- School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Charles Elboim
- St. Joseph Health Medical Group, Santa Rosa, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christine Miaskowksi
- School of Nursing, University of California at San Francisco, San Francisco, California, USA.
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88
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Abstract
Preeclampsia is a complex genetic disorder with an incompletely understood pathogenesis. Its phenotype may be better elucidated by integrating symptoms. This study aimed to identify symptoms by gestational age and associations with novel preeclampsia candidate genes. Women with a history of preeclampsia recruited from The Preeclampsia Registry completed clinical/demographic, symptom surveys and provided medical records. DNA extracted from saliva was processed with multiplexed assays for eight single-nucleotide polymorphisms (SNPs) selected to tag candidate genes and/or located in symptom susceptibility regions. Groups with versus without symptoms were compared using χ2. Associations between SNPs and symptoms were analyzed as genotype categories and presence/absence of the variant allele. Logistic regression modeling was conducted with exploratory p = .05. In 114 participants, 113 reported at least 1 of the 18 symptoms. Symptoms varied by trimester. Nine symptoms were associated with seven SNPs. Visual disturbances were associated with three SNPs and nausea/vomiting with two SNPs. Modeling adjustment for maternal age and parity resulted in 15 associations between 9 symptoms and 8 SNPs. Medical records demonstrated 100% concordance with self-reported diagnosis and 48% concordance with reported severity. Findings indicated novel symptom-genotype associations in preeclampsia. The small sample was self-selected, but results support future studies including medical records review. When validated, these results may lead to holistic phenotyping of women to characterize subsets of preeclampsia. This approach may optimize health in pregnancy and later life for mothers and offspring through prediction, prevention, and precision nursing care.
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Affiliation(s)
- Sandra A Founds
- 1 Magee-Womens Research Institute, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | | | - Dianxu Ren
- 3 University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - M Michael Barmada
- 4 University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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89
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Papachristou N, Barnaghi P, Cooper BA, Hu X, Maguire R, Apostolidis K, Armes J, Conley YP, Hammer M, Katsaragakis S, Kober KM, Levine JD, McCann L, Patiraki E, Paul SM, Ream E, Wright F, Miaskowski C. Congruence Between Latent Class and K-Modes Analyses in the Identification of Oncology Patients With Distinct Symptom Experiences. J Pain Symptom Manage 2018; 55:318-333.e4. [PMID: 28859882 PMCID: PMC5794511 DOI: 10.1016/j.jpainsymman.2017.08.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 12/20/2022]
Abstract
CONTEXT Risk profiling of oncology patients based on their symptom experience assists clinicians to provide more personalized symptom management interventions. Recent findings suggest that oncology patients with distinct symptom profiles can be identified using a variety of analytic methods. OBJECTIVES The objective of this study was to evaluate the concordance between the number and types of subgroups of patients with distinct symptom profiles using latent class analysis and K-modes analysis. METHODS Using data on the occurrence of 25 symptoms from the Memorial Symptom Assessment Scale, that 1329 patients completed prior to their next dose of chemotherapy (CTX), Cohen's kappa coefficient was used to evaluate for concordance between the two analytic methods. For both latent class analysis and K-modes, differences among the subgroups in demographic, clinical, and symptom characteristics, as well as quality of life outcomes were determined using parametric and nonparametric statistics. RESULTS Using both analytic methods, four subgroups of patients with distinct symptom profiles were identified (i.e., all low, moderate physical and lower psychological, moderate physical and higher Psychological, and all high). The percent agreement between the two methods was 75.32%, which suggests a moderate level of agreement. In both analyses, patients in the all high group were significantly younger and had a higher comorbidity profile, worse Memorial Symptom Assessment Scale subscale scores, and poorer QOL outcomes. CONCLUSION Both analytic methods can be used to identify subgroups of oncology patients with distinct symptom profiles. Additional research is needed to determine which analytic methods and which dimension of the symptom experience provide the most sensitive and specific risk profiles.
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Affiliation(s)
| | - Payam Barnaghi
- School of Health Sciences, University of Surrey, Guilford, UK
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Xiao Hu
- School of Nursing, University of California, San Francisco, California, USA
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | | | - Jo Armes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College, London, UK
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Stylianos Katsaragakis
- Faculty of Nursing, University of Peloponnese, Efstathiou & Stamatikis Valioti and Plateon, PC, Sparti, Greece
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Lisa McCann
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Elisabeth Patiraki
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guilford, UK
| | - Fay Wright
- School of Nursing, Yale University, New Haven, Connecticut, USA
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90
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Alexander K, Conley YP, Levine JD, Cooper BA, Paul SM, Mastick J, West C, Miaskowski C. Cytokine Gene Polymorphisms Associated With Various Domains of Quality of Life in Women With Breast Cancer. J Pain Symptom Manage 2018; 55:334-350.e3. [PMID: 28947144 PMCID: PMC5794537 DOI: 10.1016/j.jpainsymman.2017.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022]
Abstract
CONTEXT Little is known about the phenotypic and molecular characteristics associated with various domains of quality of life (QOL) in women after breast cancer surgery. OBJECTIVES In a sample of women with breast cancer (n = 398), purposes were as follows: to identify latent classes with distinct trajectories of QOL from before surgery through six months after surgery and to evaluate for differences in demographic and clinical characteristics, as well as for polymorphisms in cytokine genes, between these latent classes. METHODS Latent class analyses were done to identify subgroups of patients with distinct QOL outcomes. Candidate gene analyses were done to identify cytokine gene polymorphisms associated with various domains of QOL (i.e., physical, psychological, spiritual, social). RESULTS One latent class was identified for the psychological and spiritual domains. Two latent classes were identified for the social domain and overall QOL scores. Three latent classes were identified for the physical domain. For the physical and social domains, as well as for the overall QOL scores, distinct phenotypic characteristics (i.e., younger age, poorer functional status, higher body mass index, and receipt of adjuvant chemotherapy) and a number of cytokine gene polymorphisms (CXCL8, NFKB2, TNFSF, IL1B, IL13, and NFKB1) were associated with membership in the lower QOL classes. CONCLUSIONS Findings suggest that women experience distinctly different physical well-being, social well-being, and total QOL outcomes during and after breast cancer surgery. The genetic associations identified suggest that cytokine dysregulation influences QOL outcomes. However, specific QOL domains may be impacted by different cytokines.
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Affiliation(s)
| | | | - Jon D Levine
- University of California, San Francisco, California, USA
| | - Bruce A Cooper
- University of California, San Francisco, California, USA
| | - Steven M Paul
- University of California, San Francisco, California, USA
| | - Judy Mastick
- University of California, San Francisco, California, USA
| | - Claudia West
- University of California, San Francisco, California, USA
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91
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Mazor M, Cataldo JK, Lee K, Dhruva A, Cooper B, Paul SM, Topp K, Smoot BJ, Dunn LB, Levine JD, Conley YP, Miaskowski C. Differences in symptom clusters before and twelve months after breast cancer surgery. Eur J Oncol Nurs 2017; 32:63-72. [PMID: 29353634 DOI: 10.1016/j.ejon.2017.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/25/2017] [Accepted: 12/08/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Given the inter-relatedness among symptoms, research efforts are focused on an evaluation of symptom clusters. The purposes of this study were to evaluate for differences in the number and types of menopausal-related symptom clusters assessed prior to and at 12-months after surgery using ratings of occurrence and severity and to evaluate for changes in these symptom clusters over time. METHODS Prior to and at 12 months after surgery, 392 women with breast cancer completed the Menopausal Symptoms Scale. Exploratory factor analyses were used to identify the symptom clusters. RESULTS Of the 392 women evaluated, the mean number of symptoms (out of 46) was 13.2 (±8.5) at enrollment and 10.9 (±8.2) at 12 months after surgery. Using occurrence and severity, three symptom clusters were identified prior to surgery. Five symptom clusters were identified at 12 months following surgery. Two symptom clusters (i.e., pain/discomfort and hormonal) were relatively stable across both dimensions and time points. Two symptom clusters were relatively stable across both dimensions either prior to surgery (i.e., sleep/psychological/cognitive) or at 12 months after surgery (i.e., sleep). The other four clusters (i.e., irritability, psychological/cognitive, cognitive, psychological) were identified at one time point using a single dimension. CONCLUSIONS While some menopausal-related symptom clusters were consistent across time and dimensions, the majority of symptoms clustered together differently depending on whether they were evaluated prior to or at 12 months after breast cancer surgery. An increased understanding of how symptom clusters change over time may assist clinicians to focus their symptom assessments and management strategies.
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Affiliation(s)
- Melissa Mazor
- School of Nursing, University of California, San Francisco, CA, United States
| | - Janine K Cataldo
- School of Nursing, University of California, San Francisco, CA, United States
| | - Kathryn Lee
- School of Nursing, University of California, San Francisco, CA, United States
| | | | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, United States
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, United States
| | | | | | - Laura B Dunn
- School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
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92
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Clustering based on unsupervised binary trees to define subgroups of cancer patients according to symptom severity in cancer. Qual Life Res 2017; 27:555-565. [DOI: 10.1007/s11136-017-1760-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 10/24/2022]
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93
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Ji YB, Bo CL, Xue XJ, Weng EM, Gao GC, Dai BB, Ding KW, Xu CP. Association of Inflammatory Cytokines With the Symptom Cluster of Pain, Fatigue, Depression, and Sleep Disturbance in Chinese Patients With Cancer. J Pain Symptom Manage 2017; 54:843-852. [PMID: 28797869 DOI: 10.1016/j.jpainsymman.2017.05.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/30/2017] [Accepted: 05/25/2017] [Indexed: 02/01/2023]
Abstract
CONTEXT Pain, fatigue, depression, and sleep disturbance are common in patients with cancer and usually co-occur as a symptom cluster. However, the mechanism underlying this symptom cluster is unclear. OBJECTIVES This study aimed to identify subgroups of cluster symptoms, compare demographic and clinical characteristics between subgroups, and examine the associations between inflammatory cytokines and cluster symptoms. METHODS Participants were 170 Chinese inpatients with cancer from two tertiary hospitals. Inflammatory markers including interleukin-6 (IL-6), interleukin-1 receptor antagonist, and tumor necrosis factor alpha were measured. Intergroup differences and associations of inflammatory cytokines with the cluster symptoms were examined with one-way analyses of variance and logistic regression. RESULTS Based on cluster analysis, participants were categorized into Subgroup 1 (all low symptoms), Subgroup 2 (low pain and moderate fatigue), or Subgroup 3 (moderate-to-high on all symptoms). The three subgroups differed significantly in Eastern Cooperative Oncology Group (ECOG) performance status, sex, residence, current treatment, education, economic status, and inflammatory cytokines levels (all P < 0.05). Compared with Subgroup 1, Subgroup 3 had a significantly poorer ECOG physical performance status and higher IL-6 levels, were more often treated with combined chemoradiotherapy, and were more likely to be rural residents. IL-6 and ECOG physical performance status were significantly associated with 1.246-fold (95% CI 1.114-1.396) and 31.831-fold (95% CI 6.017-168.385) increased risk of Subgroup 3. CONCLUSION Our findings suggest that IL-6 levels are associated with cluster symptoms in cancer patients. Clinicians should identify patients at risk for more severe symptoms and formulate novel target interventions to improve symptom management.
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Affiliation(s)
- Yan-Bo Ji
- Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, China
| | - Chun-Lu Bo
- School of Nursing, Cheeloo Health Science Center, Shandong University, Jinan, Shandong Province, China
| | - Xiu-Juan Xue
- Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, China
| | - En-Ming Weng
- Yanggu No. 2 People's Hospital, Liaocheng, Shandong Province, China
| | - Guang-Chao Gao
- School of Nursing, Taishan Medical College, Tai'an, Shandong Province, China
| | - Bei-Bei Dai
- School of Nursing, Taishan Medical College, Tai'an, Shandong Province, China
| | - Kai-Wen Ding
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Cui-Ping Xu
- Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, China.
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94
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Ferranti EP, Grossmann R, Starkweather A, Heitkemper M. Biological determinants of health: Genes, microbes, and metabolism exemplars of nursing science. Nurs Outlook 2017; 65:506-514. [PMID: 28576296 PMCID: PMC5657318 DOI: 10.1016/j.outlook.2017.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/13/2017] [Accepted: 03/31/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increasingly, nurse scientists are incorporating "omics" measures (e.g., genomics, transcriptomics, proteomics, and metabolomics) in studies of biologic determinants of health and behavior. The role of omics in nursing science can be conceptualized in several ways: (a) as a portfolio of biological measures (biomarkers) to monitor individual risk, (b) as a set of combined data elements that can generate new knowledge based on large and complex patient data sets, (c) as baseline information that promotes health education and potentially personalized interventions, and (d) as a platform to understand how environmental parameters (e.g., diet) interact with the individual's physiology. PURPOSE In this article, we provide exemplars of nursing scientists who use omics to better understand specific health conditions. METHODS We highlight various ongoing nursing research investigations incorporating omics technologies to study chronic pain vulnerability, risk for a pain-related condition, cardiometabolic complications associated with pregnancy, and as biomarkers of response to a dietary intervention. DISCUSSION Omics technologies add an important dimension to nursing science across many foci of investigation. However, there are also challenges and opportunities for nurse scientists who consider using omics in their research. CONCLUSION The integration of omics holds promise for increasing the impact of nursing research and practice on population health outcomes.
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Affiliation(s)
- Erin P Ferranti
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Angela Starkweather
- Center for Advancement in Managing Pain and P20 Center for Accelerating Precision Pain Self-Management, University of Connecticut School of Nursing, Storrs, CT
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA.
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95
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Miaskowski C, Conley YP, Mastick J, Paul SM, Cooper BA, Levine JD, Knisely M, Kober KM. Cytokine Gene Polymorphisms Associated With Symptom Clusters in Oncology Patients Undergoing Radiation Therapy. J Pain Symptom Manage 2017; 54:305-316.e3. [PMID: 28797847 PMCID: PMC5610097 DOI: 10.1016/j.jpainsymman.2017.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/07/2017] [Accepted: 05/09/2017] [Indexed: 01/08/2023]
Abstract
CONTEXT Most of the reviews on the biological basis for symptom clusters suggest that inflammatory processes are involved in the development and maintenance of the symptom clusters. However, no studies have evaluated for associations between genetic polymorphisms and common symptom clusters (e.g., mood disturbance, sickness behavior). OBJECTIVES Examine the associations between cytokine gene polymorphisms and the severity of three distinct symptom clusters (i.e., mood-cognitive, sickness-behavior, treatment-related) in a sample of patients with breast and prostate cancer (n = 157) at the completion of radiation therapy. METHODS Symptom severity was assessed using the Memorial Symptom Assessment Scale. Symptom clusters were created using exploratory factor analysis. The associations between cytokine gene polymorphisms and the symptom cluster severity scores were evaluated using regression analyses. RESULTS Polymorphisms in C-X-C motif chemokine ligand 8 (CXCL8), interleukin (IL13), and nuclear factor kappa beta 2 (NFKB2) were associated with severity scores for the mood-cognitive symptom cluster. In addition to interferon gamma (IFNG1), the same polymorphism in NFKB2 (i.e., rs1056890) that was associated with the mood-cognitive symptom cluster score was associated with the sickness-behavior symptom cluster. Polymorphisms in interleukin 1 receptor 1 (IL1R1), IL6, and NFKB1 were associated with severity factor scores for the treatment-related symptom cluster. CONCLUSION Our findings support the hypotheses that symptoms that cluster together have a common underlying mechanism and the most common symptom clusters in oncology patients are associated polymorphisms in genes involved in a variety of inflammatory processes.
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Affiliation(s)
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Mitchell Knisely
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
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Xiao C, Miller AH, Felger J, Mister D, Liu T, Torres MA. Depressive symptoms and inflammation are independent risk factors of fatigue in breast cancer survivors. Psychol Med 2017; 47:1733-1743. [PMID: 28193310 DOI: 10.1017/s0033291717000150] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Psychosocial and inflammatory factors have been associated with fatigue in breast cancer survivors. Nevertheless, the relative contribution and/or interaction of these factors with cancer-related fatigue have not been well documented. METHOD This cross-sectional study enrolled 111 stage 0-III breast cancer patients treated with breast surgery followed by whole breast radiotherapy. Fatigue was measured by the total score of the Multidimensional Fatigue Inventory-20. Potential risk factors included inflammatory markers (plasma cytokines and their receptors and C-reactive protein; CRP), depressive symptoms (as assessed by the Inventory of Depressive Symptomatology-Self Reported), sleep (as assessed by the Pittsburgh Sleep Quality Index) and perceived stress (as assessed by the Perceived Stress Scale) as well as age, race, marital status, smoking history, menopause status, endocrine treatment, chemotherapy and cancer stage. Linear regression modeling was employed to examine risk factors of fatigue. Only risk factors with a significance level <0.10 were included in the initial regression model. A post-hoc mediation model using PROCESS SPSS was conducted to examine the association among depressive symptoms, sleep problems, stress, inflammation and fatigue. RESULTS At 1 year post-radiotherapy, depressive symptoms (p<0.0001) and inflammatory markers (CRP: p = 0.015; interleukin-1 receptor antagonist: p = 0.014; soluble tumor necrosis factor receptor-2: p = 0.009 in separate models) were independent risk factors of fatigue. Mediation analysis showed that depressive symptoms also mediated the associations of fatigue with sleep and stress. CONCLUSIONS Depressive symptoms and inflammation were independent risk factors for cancer-related fatigue at 1 year post-radiotherapy, and thus represent independent treatment targets for this debilitating symptom.
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Affiliation(s)
- C Xiao
- Emory University School of Nursing,Atlanta, GA,USA
| | - A H Miller
- Emory University Department of Psychiatry and Behavioral Sciences,Atlanta, GA,USA
| | - J Felger
- Emory University Department of Psychiatry and Behavioral Sciences,Atlanta, GA,USA
| | - D Mister
- Department of Radiation Oncology,Emory University, Winship Cancer Institute,Atlanta, GA,USA
| | - T Liu
- Department of Radiation Oncology,Emory University, Winship Cancer Institute,Atlanta, GA,USA
| | - M A Torres
- Department of Radiation Oncology,Emory University, Winship Cancer Institute,Atlanta, GA,USA
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97
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Mansano-Schlosser TC, Ceolim MF. Association between poor clinical prognosis and sleep duration among breast cancer patients. Rev Lat Am Enfermagem 2017; 25:e2899. [PMID: 28591304 PMCID: PMC5479377 DOI: 10.1590/1518-8345.1826.2899] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/21/2017] [Indexed: 01/19/2023] Open
Abstract
Objective: to investigate the association between clinical progression and the quality and duration of sleep in women with breast cancer. Method: longitudinal study, with 114 participants, conducted in a hospital in Brazil. The instruments used were: questionnaire for sociodemographic and clinical characterization, Pittsburgh Sleep Quality Index; Beck Depression Inventory and Herth Hope Scale. Data were analyzed through descriptive statistics and survival analyses (outcome: poor clinical progression), using the Kaplan-Meier curve, Log-rank test and Cox proportional model. Results: a higher probability of poor clinical progression was verified in women with sleep durations of less than six hours or nine hours and over (p=.0173). Conclusion: the results suggest the importance of further studies that seek to verify whether the quantitative management of sleep disorders would have an impact on the progression of breast cancer. Women should be encouraged to report sleep problems to nurses.
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Affiliation(s)
| | - Maria Filomena Ceolim
- PhD, Associate Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil
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98
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Lacourt TE, Heijnen CJ. Mechanisms of Neurotoxic Symptoms as a Result of Breast Cancer and Its Treatment: Considerations on the Contribution of Stress, Inflammation, and Cellular Bioenergetics. CURRENT BREAST CANCER REPORTS 2017; 9:70-81. [PMID: 28616125 PMCID: PMC5445149 DOI: 10.1007/s12609-017-0245-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Breast cancer and its treatment are associated with a range of neurotoxic symptoms, such as fatigue, cognitive impairment, and pain. Although these symptoms generally subside after treatment completion, they become chronic in a significant subset of patients. We here summarize recent findings on neuroinflammation, stress, and mitochondrial dysfunction as mechanistic pathways leading to neurotoxic symptom experience in breast cancer patients and survivors. RECENT FINDINGS Neuroinflammation related to stress or cancer treatment and stress resulting from diagnosis, treatment, or (cancer-related) worrying are important predictors of a neurotoxic symptom experience, both during and after treatment for breast cancer. Both inflammation and stress hormones, as well as cancer treatment, can induce mitochondrial dysfunction resulting in reduced cellular energy. SUMMARY We propose reduced cellular energy (mitochondrial dysfunction) induced by inflammation, oxygen radical production, and stress as a result of cancer and/or cancer treatment as a final mechanism underlying neurotoxic symptoms.
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Affiliation(s)
- Tamara E. Lacourt
- Department of Symptom Research, Neuroimmunology Laboratory, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 384, Houston, TX 77030 USA
| | - Cobi J. Heijnen
- Department of Symptom Research, Neuroimmunology Laboratory, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 384, Houston, TX 77030 USA
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Miaskowski C, Barsevick A, Berger A, Casagrande R, Grady PA, Jacobsen P, Kutner J, Patrick D, Zimmerman L, Xiao C, Matocha M, Marden S. Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations. J Natl Cancer Inst 2017; 109:2581261. [PMID: 28119347 PMCID: PMC5939621 DOI: 10.1093/jnci/djw253] [Citation(s) in RCA: 286] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/25/2016] [Accepted: 09/28/2016] [Indexed: 12/17/2022] Open
Abstract
An overview of proceedings, findings, and recommendations from the workshop on "Advancing Symptom Science Through Symptom Cluster Research" sponsored by the National Institute of Nursing Research (NINR) and the Office of Rare Diseases Research, National Center for Advancing Translational Sciences, is presented. This workshop engaged an expert panel in an evidenced-based discussion regarding the state of the science of symptom clusters in chronic conditions including cancer and other rare diseases. An interdisciplinary working group from the extramural research community representing nursing, medicine, oncology, psychology, and bioinformatics was convened at the National Institutes of Health. Based on expertise, members were divided into teams to address key areas: defining characteristics of symptom clusters, priority symptom clusters and underlying mechanisms, measurement issues, targeted interventions, and new analytic strategies. For each area, the evidence was synthesized, limitations and gaps identified, and recommendations for future research delineated. The majority of findings in each area were from studies of oncology patients. However, increasing evidence suggests that symptom clusters occur in patients with other chronic conditions (eg, pulmonary, cardiac, and end-stage renal disease). Nonetheless, symptom cluster research is extremely limited and scientists are just beginning to understand how to investigate symptom clusters by developing frameworks and new methods and approaches. With a focus on personalized care, an understanding of individual susceptibility to symptoms and whether a "driving" symptom exists that triggers other symptoms in the cluster is needed. Also, research aimed at identifying the mechanisms that underlie symptom clusters is essential to developing targeted interventions.
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Affiliation(s)
- Christine Miaskowski
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Andrea Barsevick
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Ann Berger
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Rocco Casagrande
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Patricia A. Grady
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Paul Jacobsen
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Jean Kutner
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Donald Patrick
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Lani Zimmerman
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Canhua Xiao
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Martha Matocha
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Sue Marden
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
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Astrup GL, Hofsø K, Bjordal K, Guren MG, Vistad I, Cooper B, Miaskowski C, Rustøen T. Patient factors and quality of life outcomes differ among four subgroups of oncology patients based on symptom occurrence. Acta Oncol 2017; 56:462-470. [PMID: 28077018 DOI: 10.1080/0284186x.2016.1273546] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONTEXT Reviews of the literature on symptoms in oncology patients undergoing curative treatment, as well as patients receiving palliative care, suggest that they experience multiple, co-occurring symptoms and side effects. OBJECTIVES The purposes of this study were to determine if subgroups of oncology patients could be identified based on symptom occurrence rates and if these subgroups differed on a number of demographic and clinical characteristics, as well as on quality of life (QoL) outcomes. METHODS Latent class analysis (LCA) was used to identify subgroups (i.e. latent classes) of patients with distinct symptom experiences based on the occurrence rates for the 13 most common symptoms from the Memorial Symptom Assessment Scale. RESULTS In total, 534 patients with breast, head and neck, colorectal, or ovarian cancer participated. Four latent classes of patients were identified based on probability of symptom occurrence: all low class [i.e. low probability for all symptoms (n = 152)], all high class (n = 149), high psychological class (n = 121), and low psychological class (n = 112). Patients in the all high class were significantly younger compared with patients in the all low class. Furthermore, compared to the other three classes, patients in the all high class had lower functional status and higher comorbidity scores, and reported poorer QoL scores. Patients in the high and low psychological classes had a moderate probability of reporting physical symptoms. Patients in the low psychological class reported a higher number of symptoms, a lower functional status, and poorer physical and total QoL scores. CONCLUSION Distinct subgroups of oncology patients can be identified based on symptom occurrence rates. Patient characteristics that are associated with these subgroups can be used to identify patients who are at greater risk for multiple co-occurring symptoms and diminished QoL, so that these patients can be offered appropriate symptom management interventions.
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Affiliation(s)
- Guro Lindviksmoen Astrup
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Kristin Bjordal
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Marianne Grønlie Guren
- Department of Oncology and K.G. Jebsen Colorectal Cancer Research Centre, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingvild Vistad
- Department of Obstetrics and Gynecology, Division of Surgery, Sørlandet Hospital HF, Kristiansand, Norway
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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