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Hooke MC, McCarthy K, Taylor O, Hockenberry MJ. Fatigue and carnitine levels over multiple cycles of chemotherapy in children and adolescents. Eur J Oncol Nurs 2014; 19:7-12. [PMID: 25260954 DOI: 10.1016/j.ejon.2014.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/18/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Fatigue in childhood cancer is a pervasive and distressing symptom described as a "lack of energy". Carnitine is a micronutrient used to transport long chain fatty acids into muscle mitochondria. Some chemotherapy drugs interfere with the carnitine network. Both carnitine and fatigue relate to physical energy and may be influenced by chemotherapy. Using a repeated measures design, change in carnitine levels and change in fatigue in childhood cancer patients receiving ifosfamide, cisplatin, or doxorubicin were examined over multiple chemotherapy cycles. The influence of carnitine levels on fatigue was evaluated. METHODS AND SAMPLE Fifty-eight patients, between ages 3 and 18 years, within two months from diagnosis and receiving cisplatin, doxorubicin, and/or ifosfamide chemotherapy drugs, participated. Measurements included carnitine plasma levels and self-reported fatigue using established child or adolescent fatigue scales and were collected during the 2nd cycle of chemotherapy, and repeated on alternating cycles up to cycle 8. The Parent Fatigue Scale was used for children under age 7. KEY RESULTS Total and free carnitine levels did not change significantly for the group. Fatigue decreased significantly in children age 7-12 (p = 0.04). Relationships between fatigue and carnitine were not significant. CONCLUSIONS Changes in carnitine plasma levels were not significant in this sample of patients. The carnitine levels remained within the reference values for children and were not associated with fatigue levels. School-age children may be more resilient to fatigue over the trajectory of treatment. Further research is needed into the biologic mechanisms of fatigue.
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Affiliation(s)
- Mary C Hooke
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455, USA; Children's Hospitals and Clinics of Minnesota Cancer and Blood Disorders Program, 2525 Chicago Ave. S., Minneapolis, MN, USA.
| | - Kathleen McCarthy
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital/Baylor College of Medicine, 1102 Bates St, Suite 1580, Houston, TX 77030, USA.
| | - Olga Taylor
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital/Baylor College of Medicine, 1102 Bates St, Suite 1580, Houston, TX 77030, USA.
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2013 Special Topics Conference: Peaks and pitfalls in longitudinal studies of symptom outcome data. Nurs Outlook 2014; 62:305-12. [DOI: 10.1016/j.outlook.2014.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/16/2014] [Accepted: 05/27/2014] [Indexed: 11/23/2022]
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Abstract
BACKGROUND Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults' symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes. OBJECTIVE We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients 65 years or older with a diagnosis of thoracic, digestive, gynecologic, and genitourinary cancers. METHODS This secondary analysis used combined subsets of data from 5 nurse-directed intervention clinical trials targeting patients after surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline and at 3 and 6 months. RESULTS A multivariable analysis, using generalized estimating equations, showed that symptom distress was significantly less at 3 and 6 months (3 months: P < .001, 6 months: P = .002) than at baseline while controlling for demographic, biologic, psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all P < .05). Participants 75 years or older reported increased symptom distress over time compared with those aged 65 to 69 years (P < .05). CONCLUSIONS Age, type of cancer, comorbidities, mental health, and function may influence older adults' symptom distress following cancer surgery. IMPLICATIONS FOR PRACTICE Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, those with worse mental health, those with decreased function, and those 75 years or older may prevent morbidity and improve outcomes of older adults following surgery.
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Coolbrandt A, Wildiers H, Aertgeerts B, Van der Elst E, Laenen A, Dierckx de Casterlé B, van Achterberg T, Milisen K. Characteristics and effectiveness of complex nursing interventions aimed at reducing symptom burden in adult patients treated with chemotherapy: A systematic review of randomized controlled trials. Int J Nurs Stud 2014; 51:495-510. [DOI: 10.1016/j.ijnurstu.2013.08.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 08/16/2013] [Accepted: 08/22/2013] [Indexed: 12/25/2022]
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Experiences of time: A qualitative inquiry into experiences of time as described by palliative care inpatients. Palliat Support Care 2013; 13:67-73. [DOI: 10.1017/s1478951513000886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:In palliative care, health professionals provide support and care for patients for the duration of the unknown time toward death. While the experiences of patients diagnosed with a life limiting illness in palliative care have received some scholarly attention, little research has explored these experiences as described by palliative inpatients themselves. The purpose of this article is to explore how patients describe their lived experiences of time while in a palliative inpatient facility.Methods:This study used a qualitative phenomenological method and nine inpatients were recruited. They were interviewed utilizing in-depth semi-structured interviews, which were audio taped and transcribed. These interview transcripts of their descriptions were the data sources for this inquiry. Their description is part of a broader phenomenological inquiry on the experience of living with a life limiting illness described by palliative inpatients. Data were analyzed to identify essential themes within and across cases.Results:Three essential themes were revealed: “brief time”; “waiting time,” and “transcendental horizon: future time.” These themes were not mutually exclusive and participant's experiences of time approaching death were described as a time of living toward death.Significance of results:The findings suggest that patients diagnosed with a life limiting illness have multi-dimensional experiences of time. Understanding the experiences of temporality for patients close to the gravity of death, from the patients' own words, can provide direction for patient informed interventions in clinical practice.
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Relationships between life attitude profile and symptoms experienced with treatment decision evaluation in patients with cancer. Holist Nurs Pract 2013; 27:98-105. [PMID: 23399709 DOI: 10.1097/hnp.0b013e318280f7d6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite many researches that have examined life attitude profile, treatment decision evaluation, and symptoms experienced in cancer populations, the relationships between life attitude profile and symptoms experienced with treatment decision evaluation are still not well understood. A thorough understanding of these relationships is critical for health care professionals to provide appropriate management to patients. The aim of this study was to determine relationships among life attitude profile, the treatment decision evaluation, and symptoms experienced in Turkish patients with cancer. A convenience sample of 199 patients with cancer at a Turkish university hospital completed a structured questionnaire including demographic characteristics and the Life Attitude Profile-Revised Scale for patients with cancer in 2007. The researchers visited the oncology clinic 5 work days every week and conducted interviews with the patients. The life attitude profile was not correlated with the treatment decision evaluation and symptoms experienced (r = 0.082, r = -026). The treatment decision evaluation showed that the patients were uncertain about their satisfaction with the treatment decision. Significant correlations were found between the treatment decision evaluation and symptoms experienced (r = 0.206; P <.01). Holistic nursing interventions can be implemented as they promote healing of the whole person processes as facilitating self-awareness, living meaningfully, and promotion connection with others and with nature and a higher power.
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Chaudhry SI, Murphy TE, Gahbauer E, Sussman LS, Allore HG, Gill TM. Restricting symptoms in the last year of life: a prospective cohort study. JAMA Intern Med 2013; 173:1534-40. [PMID: 23836056 PMCID: PMC4041035 DOI: 10.1001/jamainternmed.2013.8732] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
IMPORTANCE Freedom from symptoms is an important determinant of a good death, but little is known about symptom occurrence during the last year of life. OBJECTIVE To evaluate the monthly occurrence of physical and psychological symptoms leading to restrictions in daily activities (ie, restricting symptoms) among older persons during the last year of life and to determine the associations of demographic and clinical factors with symptom occurrence. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study. Comprehensive assessments were completed every 18 months, and monthly interviews were conducted to assess the presence of restricting symptoms. Of 1002 nondisabled community-dwelling individuals 70 years or older in greater New Haven, Connecticut, eligible to participate, 754 agreed and were enrolled between 1998 and 1999. MAIN OUTCOMES AND MEASURES The primary outcome was the monthly occurrence of restricting symptoms as a dichotomous outcome. The monthly mean count of restricting symptoms was a secondary outcome. RESULTS Among the 491 participants who died after their first interview and before June 30, 2011, mean age at death was 85.8 years, 61.9% were women, and 9.0% were nonwhite. The mean number of comorbid conditions was 2.4, and 73.1% had multimorbidity. The monthly occurrence of restricting symptoms was fairly constant from 12 months before death (20.4%) until 5 months before death (27.4%), when it began to increase rapidly, reaching 57.2% in the month before death. In multivariable analysis, age younger than 85 years (odds ratio [OR], 1.30 [95% CI, 1.07-1.57]), multimorbidity (OR, 1.38 [95% CI, 1.09-1.75]), and proximity to time of death (OR, 1.14 per month [95% CI, 1.11-1.16]) were significantly associated with the monthly occurrence of restricting symptoms. Participants who died of cancer had higher monthly symptom occurrence (OR, 1.80 [95% CI, 1.03-3.14]) than participants who died of sudden death, although this difference was only marginally significant (P = .04). Symptom burden did not otherwise differ substantially according to condition leading to death. CONCLUSIONS AND RELEVANCE Restricting symptoms are common during the last year of life, increasing substantially approximately 5 months before death. Our results highlight the importance of assessing and managing symptoms in older patients, particularly those with multimorbidity.
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Affiliation(s)
- Sarwat I Chaudhry
- Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Abstract
PURPOSE OF REVIEW Researchers have focused on identifying and describing symptom experiences among children with various diseases but symptoms can have a synergistic and/or an antecedent effect that must be evaluated. This review reports the current knowledge of symptoms among various pediatric diseases and highlights symptom cluster research. RECENT FINDINGS Symptoms of depression and anxiety are the most prevalent variables studied across pediatric disease studies followed by pain, fatigue, and quality of life. Although previous pediatric symptom research provides a foundation for understanding the complexities of these symptoms, there is limited evidence on symptom cluster research in pediatrics. Pain and fatigue are the most common symptoms analyzed for correlations, and relationships among symptoms that have been evaluated in children with juvenile idiopathic arthritis, HIV, cancer, cardiac disease requiring an implantable cardioverter defibrillator, and at end of life. Pain and fatigue have been associated with sleep disturbances, anxiety, depression, anorexia, and nausea/vomiting. SUMMARY Pediatric oncology researchers are leading the way with symptom cluster studies; however, this work remains in the early stages. There is great potential to advance the state of the science with cluster analysis. Future research work should focus on evaluating symptoms and their interactions.
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Houghton-Rahrig LD, Schutte DL, von Eye A, Fenton JI, Given BA, Hord NG. Exploration of a symptoms experience in people with obesity-related nonalcoholic fatty liver disease. Nurs Outlook 2013; 61:242-251.e2. [PMID: 23849554 DOI: 10.1016/j.outlook.2013.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/29/2013] [Accepted: 05/07/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent condition strongly associated with obesity that can result in premature death. Little is known about the symptoms experience in this progressive disease, preventing health care providers from intervening in the early stages. PURPOSE This study explicated symptoms in persons with NAFLD at higher risk of disease progression defined as the presence of one or two copies of the PNPLA3 (rs738409)-G allele. METHOD Guided by the Symptoms Experience Model, 42 persons older than 21 years of age with diagnosed NAFLD were recruited from Western Michigan specialty offices in this cross-sectional descriptive study design. The Memorial Symptom Assessment Scale was used to measure the symptoms experience. DISCUSSION Participants (97%) experienced 1 or more symptoms (average number of symptoms 12.02, standard deviation = 8.817). There was no statistically significant relationship between symptoms and the PNPLA3 (rs738409) variants. Significant predictors of mean frequency, severity, and distress of symptoms (the Total Memorial Symptom Scale) (F[15, 25] = 2.609, p = .016) were identified. CONCLUSION People with NAFLD experience an average of 12 symptoms.
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Almutary H, Bonner A, Douglas C. Symptom burden in chronic kidney disease: a review of recent literature. J Ren Care 2013; 39:140-50. [PMID: 23826803 DOI: 10.1111/j.1755-6686.2013.12022.x] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND People living with chronic kidney disease (CKD) experience multiple symptoms due to both the disease and its treatment. However, these symptoms are often underrecognised. In addition, the majority of studies have focused on an individual symptom; however, these symptoms rarely occur in isolation and may instead occur in clusters. AIM OF REVIEW To investigate the total symptom burden in advanced CKD (Stages 4 and 5) and to identify the key instruments that are used to assess multiple symptoms. METHODS A literature search from 2006 to 2012 was undertaken and a total of 19 articles were included. RESULTS The most common CKD symptoms were fatigue or lack of energy, feeling drowsy, pain and pruritus. However, symptom assessment instruments varied between studies, often with inconsistent or inadequate symptom dimensions. CONCLUSION People with CKD experience a high symptom burden, although little is known about the burden for people with CKD Stage 4 and for those with CKD Stage 5 receiving peritoneal dialysis. This review recommends that a full range of symptoms be assessed for those at different stages of CKD. Improved understanding of the burden of symptoms can be used as the basis for treatment choices and for identifying priorities which are likely to contribute to a better quality of life and improve the quality of care.
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Affiliation(s)
- Hayfa Almutary
- School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia.
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Brunton L, Booker J, Molassiotis A. Making sense of symptoms in men with prostate cancer: a longitudinal qualitative exploration. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2012. [DOI: 10.1111/j.1749-771x.2012.01150.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim HJ, Barsevick AM, Beck SL, Dudley W. Clinical subgroups of a psychoneurologic symptom cluster in women receiving treatment for breast cancer: a secondary analysis. Oncol Nurs Forum 2012; 39:E20-30. [PMID: 22201665 DOI: 10.1188/12.onf.e20-e30] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To investigate clinical subgroups using an empirically identified psychoneurologic symptom cluster (depressed mood, cognitive disturbance, fatigue, insomnia, and pain) and to examine the differences among subgroups in the selected demographic and clinical variables, as well as in patient outcome (i.e., functional performance). DESIGN Secondary analysis. SETTING A university health science center in Salt Lake City, UT, and a National Cancer Institute-designated comprehensive cancer center in Philadelphia, PA. SAMPLE 282 patients with breast cancer undergoing chemotherapy or radiotherapy. METHODS Cluster analyses were conducted to identify subgroups. Multinomial logistic regression and one-way analyses of variance were used to examine the differences among subgroups. MAIN RESEARCH VARIABLES Depressed mood, cognitive disturbance, fatigue, insomnia, pain, and functional performance. FINDINGS Patients were classified into four distinct subgroups based on their symptom cluster experience: all low symptom, high fatigue and low pain, high pain, and all high symptom. Such patient classification patterns were consistent across the treatment trajectory, although group memberships were inconsistent. After initiating treatment, two additional subgroups emerged: high depressed mood and cognitive disturbance, and high fatigue and insomnia. Subgroups differed in physical performance status at baseline, symptom burden, and treatment modality in a relatively consistent pattern across time points. Patients in the all-high-symptom subgroup experienced the most serious limitations in activities across all time points. CONCLUSIONS Patient subgroups exist that share the unique experience of psychoneurologic symptoms. IMPLICATIONS FOR NURSING Findings are useful to determine who needs more intensive symptom management during cancer treatment. Future studies should examine whether specific symptom management strategies are more efficient for certain subgroups.
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Affiliation(s)
- Hee-Ju Kim
- College of Nursing, Catholic University of Korea, Seoul.
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Golan-Vered Y, Pud D. Chemotherapy-induced neuropathic pain and its relation to cluster symptoms in breast cancer patients treated with paclitaxel. Pain Pract 2012; 13:46-52. [PMID: 22533683 DOI: 10.1111/j.1533-2500.2012.00554.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The majority of patients with breast cancer receiving chemotherapy report multiple symptoms. Compelling evidence has shown that subgroups of patients can be clustered by the severity of symptoms. Recent studies demonstrate that chemotherapy with such substances as paclitaxel can cause neuropathic pain (CINP) and consequently neural damage. OBJECTIVES the present study examined the relationship between symptom clusters and CINP among 40 patients with breast cancer. The study was based on 2 sessions conducted before and during paclitaxel treatment. In each session, neuropathic pain was assessed by the DN4 Questionnaire. In the second session, the Lee Fatigue Scale, the General Sleep Disturbance Scale, and the Center for Epidemiological Studies-Depression Scale were also administered, and the worst pain intensity was assessed. Using cluster analysis, 2 symptom clusters were identified on the basis of the severity of the 4 symptoms scores. Patients in the High Cluster (37%) experienced a high level of all symptoms, whereas patients in the Low Cluster (63%) experienced a low level of all symptoms. Twenty patients (50%) were diagnosed with CINP. A subgroup of patients (23%) from the High Cluster was identified as having CINP; 35% were in the Low Cluster and free of CINP. In conclusion, there appears to be a specific subgroup of patients with hypersensitive cancer who need greater attention to symptom management. Early detection of symptoms, together with careful dose selection and assessment of early stages in the development of neuropathic pain, are essential for preventing the simultaneous occurrence of severe multiple symptoms and CINP.
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Affiliation(s)
- Yael Golan-Vered
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Patterson BJ, Doucette WR, Lindgren SD, Chrischilles EA. Living with disability: patterns of health problems and symptom mediation of health consequences. Disabil Health J 2012; 5:151-8. [PMID: 22726855 DOI: 10.1016/j.dhjo.2012.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/14/2012] [Accepted: 03/05/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with disability experience a range of symptoms that may serve as an important linkage between disability and other health consequences. The aims of this study were to describe and compare symptom experiences of people with and without disability using a population-based sample and to test direct relationships between disability and health status and indirect effects of disability mediated through symptom experience. METHODS A Midwestern sample of 12,249 adults aged 40 and older responded to a cross-sectional survey. Data collected included symptom prevalence and frequencies for 21 commonly reported symptoms, self-perceived health status and physical functioning, number of medications, and demographic variables. Two mediation analyses were conducted using cumulative symptom frequency as the mediator between disability status and both self-rated health and physical functioning. RESULTS Adults with disability reported significantly greater prevalence and frequencies for all 21 symptoms, with pain and fatigue being the most common. The indirect effect through cumulative symptom frequency explained roughly half of the total effect of disability on general health status, and about one third of the total effect of disability on physical functioning. CONCLUSIONS This study found evidence supporting the diverse and significant symptom experience of people living with disability, especially for symptoms of pain and fatigue. Moreover, symptom experience was found to partially mediate the effects of disability on self-reported general health status and physical functioning. This provides support for symptoms serving as an important link to health outcomes in patients with disability.
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Affiliation(s)
- Brandon J Patterson
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA 52242, USA.
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Forsberg A, Persson LO, Nilsson M, Lennerling A. The organ transplant symptom and well-being instrument - psychometric evaluation. Open Nurs J 2012; 6:30-40. [PMID: 22523527 PMCID: PMC3330362 DOI: 10.2174/1874434601206010030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/18/2012] [Accepted: 02/20/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a need for instruments combining measurements of symptom distress and well-being in the organ transplant population. OBJECTIVES The aim of this study was to describe the development and initial psychometric evaluation of a measure of symptoms and well-being in organ transplant recipients labelled the Organ Transplant Symptom and Well-being instrument (OTSWI) and to provide descriptive data on these matters. METHOD In this cross sectional survey, the study sample (n=185) completed several measures including demographic information, the Short form- 36 items (SF-36), and the OTSWI to assess concurrent validity by exploring relationships between OTSWI and measures of health related quality of life (HRQOL). The expected scale dimensionality of the OTSWI questionnaire was examined both by the confirmatory multi-trait analysis program and by explorative principal component analysis (with oblique, varimax rotation). Scale reliability was further estimated using the Cronbach's alpha. RESULTS There were eight factors built up from twenty of the initial fifty one items and were labelled fatigue, joint and muscle pain, cognitive functioning, basic activities in daily life, sleeping problems, mood, foot pain and economy. For the remaining twenty-one items no consistent and meaningful factors could be found leading to relevant symptoms acting as single items. All eight factors had satisfying internal convergent validity as well as good item-scale discriminatory validity or 'success rate'. DISCUSSION Results support the internal consistency, reliability and concurrent validity of the OTSWI as an instrument to measure symptom distress and well-being in relation to organ transplantation. (Word count 244).
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Affiliation(s)
- Anna Forsberg
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Caring Sciences
- The Faculty of Medicine at Lund University, Department of Health Sciences
| | - Lars-Olof Persson
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Caring Sciences
| | - Madeleine Nilsson
- The Queen Silvia’s Children Hospital at Sahlgrenska University Hospital, Gothenburg
| | - Annette Lennerling
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Caring Sciences
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
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Abstract
AbstractDespite significant improvement in cancer survival, the fear of death still remains rooted in individuals' beliefs about cancer. Existential fears pertaining to cancer cut across the cancer control continuum and taint decisions related to prevention, screening, surveillance, and follow-up recommendations, as well as the overall management of cancer-related issues. However, individuals are innately predisposed to cope with their cancer-related fears through mechanisms such as reliance on the process of meaning making. To better appreciate the potential impact of existential concerns across the cancer control continuum, the Temporal Existential Awareness and Meaning Making (TEAMM) model is proposed. This tripartite model depicts three types of perceived threats to life related to cancer including a “social awareness” (i.e., cancer signals death), “personalized awareness” (i.e., I could die from cancer), and the “lived experience” (i.e., It feels like I am dying from cancer). This construal aims to enhance our understanding of the personal and contextual resources that can be mobilized to manage existential concerns and optimize cancer control efforts. As such, existential discussions should be considered in any cancer-related supportive approach whether preventive, curative, or palliative, and not be deferred only until the advanced stages of cancer or at end of life. Further delineation and validation of the model is needed to explicitly recognize and depict how different levels of existential awareness might unfold as individuals grapple with a potential, actual, or recurrent cancer.
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Factors related to daily life interference in lung cancer patients: a cross-sectional regression tree study. Eur J Oncol Nurs 2012; 16:345-52. [PMID: 22341717 DOI: 10.1016/j.ejon.2011.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/29/2011] [Accepted: 07/31/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE To identify the symptom combination patterns and symptom severity levels that induce severe symptom interference in daily life activities, including physical and psychological activity interference in lung cancer patients. METHODS In a cross-sectional descriptive study using convenience sampling, 131 participants were recruited at a medical center in northern Taiwan. The Eastern Cooperative Oncology Group (ECOG) performance status was used to assess performance status, and the Taiwanese version of the M.D. Anderson Symptom Inventory (MDASI-T) was used to assess symptom severity and symptom interference in daily life activities including physical and psychological activities. Regression tree models were applied to examine variable combinations for symptom interference level in daily life activities, including physical and psychological activity interference. RESULTS Study results revealed that the performance status is the key discriminator of the symptom interference level in daily life and physical activities, but distress severity is the key discriminating factor of the symptom interference level in psychological activities. The performance status and distress severity, plus other factors, further specifically show the discrimination paths and interactions between the risk groups. CONCLUSIONS This study provided an alternative approach to identify low- and high-risk groups of symptom interference among lung cancer patients in Taiwan. Increased awareness and further understanding of the risk combinations and discriminate levels of symptom severity that induced high symptom interference offer different perspectives to develop patient-centered care planning for lung cancer patient rehabilitation.
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Abstract
Esophageal cancer is an aggressive and physically and emotionally devastating disease. It has one of the poorest survival rates among all malignant tumors, mainly due to late symptom presentation and early metastatic dissemination. Cure is possible through extensive surgery, typically followed by a long recovery period, affecting general well-being, as well as basic aspects of life, such as eating, drinking and socializing. Health-related quality of life (HRQL) is a multidimensional concept assessing symptoms and functions related to a disease or its treatment from the patient's perspective. HRQL is a fundamental part of treatment in surgical oncology, particularly in esophageal cancer. This review assesses the scientific data regarding some HRQL aspects after esophageal cancer surgery, for example, postoperative recovery time, determinants of postoperative HRQL and long-term HRQL.
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Affiliation(s)
- Therese Djärv
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Brant JM, Beck SL, Dudley WN, Cobb P, Pepper G, Miaskowski C. Symptom trajectories during chemotherapy in outpatients with lung cancer colorectal cancer, or lymphoma. Eur J Oncol Nurs 2011; 15:470-7. [DOI: 10.1016/j.ejon.2010.12.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 12/03/2010] [Accepted: 12/09/2010] [Indexed: 11/26/2022]
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Symptom assessment in ambulatory oncology: initial validation of the nurse-developed Modified Ambulatory Care Flow Sheet (MACFS). Qual Life Res 2011; 21:899-908. [DOI: 10.1007/s11136-011-9998-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2011] [Indexed: 11/12/2022]
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Shun SC, Hsiao FH, Lai YH. Relationship between hope and fatigue characteristics in newly diagnosed outpatients with cancer. Oncol Nurs Forum 2011; 38:E81-6. [PMID: 21356645 DOI: 10.1188/11.onf.e81-e86] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the relationship between hope and fatigue (intensity, duration, and interference) in newly diagnosed patients with cancer receiving chemotherapy. DESIGN Cross-sectional and correlational. SETTING Oncology outpatient clinics of two medical centers in northern Taiwan. SAMPLE 182 patients diagnosed with various types of solid tumors in the previous six months and receiving chemotherapy treatment. METHODS Questionnaires were used to assess patients' fatigue intensity, duration, and interference, as well as level of hope and related background information before drug administration at a chemotherapy visit. The relationship between fatigue characteristics and level of hope was verified using Pearson's correlation analysis. MAIN RESEARCH VARIABLES Hope, fatigue intensity, duration, and interference. FINDINGS Compared to fatigue intensity, interference and its duration have a stronger association with level of hope. Further analysis of the seven individual items of fatigue interference found that interference with mood status and relations with others is significantly associated with level of hope in newly diagnosed patients. CONCLUSIONS Fatigue duration and interference caused by fatigue, particularly in mood status and relations with others, are associated with the perception of hope in newly diagnosed patients. IMPLICATIONS FOR NURSING Clinical nurses should assess intensity of fatigue as well as its interference and duration to better support patients' perception of hope by reducing interference caused by fatigue.
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Affiliation(s)
- Shiow-Ching Shun
- Department of Nursing, College of Medicine, National Taiwan University, Taipei
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Lowe M, Molassiotis A. A longitudinal qualitative analysis of the factors that influence patient distress within the lung cancer population. Lung Cancer 2011; 74:344-8. [PMID: 21511356 DOI: 10.1016/j.lungcan.2011.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 03/05/2011] [Accepted: 03/21/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND The literature consistently shows that lung cancer patients experience both greater number of symptoms and concerns about health and existential issues compared with patients from other cancer populations and that patient distress near diagnosis predicts survival in lung cancer patients. Also evidence suggests that symptom characteristics (e.g. symptom intensity and frequency) influence distress. The relationship between aspects of patients' symptom experiences can be complex and the mechanisms underpinning this association are not fully understood at present. METHODS Semi-structured interviews were conducted with 17 lung cancer patients and 15 primary caregivers at four time points: at the beginning of treatment and then subsequently at three, six, and twelve months, providing a total of 44 patient and 32 caregiver interviews. Interpretative Phenomenological Analysis was employed in the data analysis. FINDINGS The analysis presented here concentrates on two areas which was reported to influence distress in this population: (1) patients' perception of symptoms and symptom characteristics and their associated distress; and (2) the relationship between patients' causal reasoning and their distress. CONCLUSION The complexity of the issues involved in the development of symptom distress needs to be recognised by health care professionals in this poor prognosis group of patients. Better patient preparation about symptoms may alleviate some of the symptom distress in lung cancer patients.
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Affiliation(s)
- M Lowe
- School of Nursing, Midwifery & Social Work, University of Manchester, UK
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Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas. Lancet Oncol 2011; 12:583-93. [PMID: 21474379 DOI: 10.1016/s1470-2045(11)70057-2] [Citation(s) in RCA: 394] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Although low-grade gliomas (LGG) have a less aggressive course than do high-grade gliomas, the outcome of these tumours is ultimately fatal in most patients. Both the tumour and its treatment can cause disabling morbidity, particularly of cognitive functions. Because many patients present with seizures only, with no other signs and symptoms, maintenance of quality of life and function constitutes a particular challenge in LGG. The slow growth pattern of most LGG, and the rare radiological true responses despite a favourable clinical response to treatment, interferes with the use of progression-free survival as the primary endpoint in trials. Overall survival as an endpoint brings logistical challenges, and is sensitive to other non-investigational salvage therapies. Clinical trials for LGG need to consider other measures of patient benefit such as cognition, symptom burden, and seizure activity, to establish whether improved survival is reflected in prolonged wellbeing. This Review investigates clinical and imaging endpoints in trials of LGG, and provides response assessment in neuro-oncology (RANO) criteria for non-enhancing tumours. Additionally, other measures for patients with brain tumours that assess outcome are described. Similar considerations are relevant for trials of high-grade gliomas, although for these tumours survival is shorter and survival endpoints generally have more value than they do for LGG.
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129
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Lee MK, Park HA. Development of data models for nursing assessment of cancer survivors using concept analysis. Healthc Inform Res 2011; 17:38-50. [PMID: 21818456 PMCID: PMC3092993 DOI: 10.4258/hir.2011.17.1.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/14/2011] [Indexed: 11/23/2022] Open
Abstract
Objectives Sharing of cancer-related information among healthcare professionals is crucial to ensuring the quality of long-term care for cancer survivors. Appropriate distribution of the essential facts can be achieved using data models. The purpose of this study was to develop and validate suitable data models for use in the nursing assessment of cancer survivors. Methods The models developed in this study were based on a modification of concept analysis developed by Walker and Avant. Our approach involved determining the purpose of the analysis, identifying data elements, defining these elements and their uses, determining critical attributes, value sets, and cardinalities, and ultimately constructing data models which were examined externally by domain experts. Results We developed 112 data models with 112 data elements, 29 critical attributes, 102 value sets, and 6 data types for the assessment of cancer survivors. External validation revealed that the data elements, critical attributes, and value sets proposed were comprehensive, relevant, and sufficiently useful to encompass nursing issues related to cancer survivors. Conclusions Data models developed in this study will contribute to ensuring the semantic consistency of data collected from cancer survivors, which will improve the quality of nursing assessments and in turn translate to improved long-term patient care.
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130
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Symptom cluster among hemodialysis patients in Taiwan. Appl Nurs Res 2011; 25:190-6. [PMID: 21273045 DOI: 10.1016/j.apnr.2010.11.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 11/09/2010] [Accepted: 11/17/2010] [Indexed: 11/23/2022]
Abstract
This cross-sectional study aimed to investigate the prevalence and severity of symptom disturbance and to identify symptom clusters among hemodialysis patients. A convenience sample of 117 Taiwanese dialysis patients completed the Somatic Symptoms Disturbance Index, the Taiwanese Depression Scale, and a demographic questionnaire. Findings indicated that four symptom clusters emerged from the factor analysis. Relationships within symptom clusters were offered and explored.
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131
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Farrell D, Savage E. Symptom burden in inflammatory bowel disease: rethinking conceptual and theoretical underpinnings. Int J Nurs Pract 2011; 16:437-42. [PMID: 20854340 DOI: 10.1111/j.1440-172x.2010.01867.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Symptom control is fundamental to the nursing management of inflammatory bowel disease (IBD). However, symptom control can be problematic for individuals with IBD, which could result in symptom burden. Symptom burden is an evolving concept in the discipline of nursing and to date little is known about how the defining characteristics of this concept have been applied to symptom research in IBD. In this discussion paper, the concept of symptom burden and the theory of unpleasant symptoms are explored as a basis for understanding symptom research in IBD. This is followed by a critical examination of previous symptom research in IBD. Our conclusion is that there is a need to rethink conceptual and theoretical underpinnings of symptom burden when researching IBD to take account of its defining characteristics, namely symptom severity, frequency and duration, quality and distress. Research knowledge on these defining characteristics will be important to inform nursing assessment of symptom burden in clinical practice.
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Affiliation(s)
- Dawn Farrell
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland.
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Symptom experiences and quality of life of rural and urban older adult cancer survivors. Cancer Nurs 2010; 32:359-69. [PMID: 19661799 DOI: 10.1097/ncc.0b013e3181a52533] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study examined the symptom experience, health-related quality of life, and functional performance of elderly cancer survivors at 1 and 3 months after the completion of initial treatment. The study used a descriptive, comparative, repeated-measures design. A mixed-methods approach combined completion of survey instruments with qualitative interviews. Of the 52 participants, 22 resided in rural (n = 12) or semirural (n = 10) areas and 30 lived in urban settings. There were 23 women and 29 men ranging in age from 65 to 81 years (mean age, 71.53 years). Survivors experienced a significant number of symptoms (mean, 4.58), which were, on average, moderate in intensity and did not differ based on urban or rural residence. The Medical Outcomes Study SF-12 Physical Component Summary was less than the national norm for elderly individuals or those with a chronic disease. There was minimal improvement 3 months after treatment. Elderly survivors, regardless of whether they were rural or urban, experienced a significant number of unrelieved symptoms, including fatigue, pain, and difficulty sleeping. Eighty-eight percent had other chronic diseases. Comorbidities were associated with greater symptom intensity and less physical health status. Survivorship care for elderly adults should include a comprehensive geriatric assessment and tailored strategies for symptom management.
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Denieffe S, Gooney M. A meta-synthesis of women's symptoms experience and breast cancer. Eur J Cancer Care (Engl) 2010; 20:424-35. [PMID: 20825463 DOI: 10.1111/j.1365-2354.2010.01223.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this paper is to examine the symptom experience of women with breast cancer using meta-synthesis. Women with breast cancer may experience many symptoms resulting from the primary disease and/or treatment of the disease. It is very important the overall symptom experience from the patients' perspective is captured and understood by health professionals. The question developed was 'What is the symptom experience of women with breast cancer from time of diagnosis to completion of treatment'. The meta-synthesis process as developed by Sandelowski and Barroso was used to collect and analyse the data. The overarching idea emerging from this meta-synthesis is that the symptoms experience for women with breast cancer has effects on the very 'self' of the individual. Emerging is women's need to consider the existential issues that they face while simultaneously dealing with a multitude of physical and psychological symptoms. This meta-synthesis develops a new, integrated, and more complete interpretation of findings on the symptom experience of women with breast cancer. The results offer the clinician a greater understanding in depth and breadth than the findings from individual studies on symptom experiences.
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Affiliation(s)
- S Denieffe
- Department of Nursing, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland.
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135
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Coolbrandt A, Van den Heede K, Vanhove E, De Bom A, Milisen K, Wildiers H. Immediate versus delayed self-reporting of symptoms and side effects during chemotherapy: does timing matter? Eur J Oncol Nurs 2010; 15:130-6. [PMID: 20685164 DOI: 10.1016/j.ejon.2010.06.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 06/25/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to examine how patients recall symptoms at a delayed self-report. Accurate insight into toxicity symptoms during chemotherapy is essential so that nurses and doctors can assess therapeutic tolerance and adjust supportive care accordingly. METHOD A non-experimental, longitudinal design was employed. Using the Therapy-Related Symptoms Checklist (TRSC), respondents (n = 142) reported their initial symptoms during the first 7 days of the chemotherapy cycle at two different times: (1) each day of the first seven days after the chemotherapy administration (immediate self-report), and (2) at their next hospital visit for chemotherapy (delayed self-report). We compared the number and severity of symptoms and side effects reported in the immediate and delayed self-reports. RESULTS Respondents reported significantly fewer symptoms and fewer severe symptoms in the delayed self-report. For 22 out of 25 symptoms the delayed-reported grade was significantly lower than the immediate-reported maximum grade. Compared to the immediate-reported median grade, significant differences occurred in only 10 out of the 25 symptoms. In all cases, except fatigue, the delayed-reported grade was significantly higher than the immediate-reported median grade. CONCLUSIONS This study indicates that delayed self-report of chemotherapy side effects is not an appropriate measure of actual symptoms and side effects experienced by patients. Delayed self-report gives a weaker insight into actual symptom burden. Fatigue is at particular risk to be minimized at the delayed self-report. Therefore it is recommended to assess chemotherapy-related symptoms and side effects by means of immediate self-report.
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Affiliation(s)
- Annemarie Coolbrandt
- Department of Oncology/Hematology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Brant JM, Beck S, Miaskowski C. Building dynamic models and theories to advance the science of symptom management research. J Adv Nurs 2010; 66:228-40. [PMID: 20423447 DOI: 10.1111/j.1365-2648.2009.05179.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a description, comparison, and critique of two models and two theories used to guide symptom management research, and a proposal of directions for new theory or model development. BACKGROUND Symptom management research has undergone a paradigmatic shift to include symptom clusters, longitudinal studies that examine symptom trajectories, and the effects of interventions on patient outcomes. Models and theories are used to guide descriptive and intervention research. Over the past 15 years, four conceptual models or theories (i.e. Theory of Symptom Management, the Theory of Unpleasant Symptoms, the Symptoms Experience Model and the Symptoms Experience in Time Model) were used in a variety of symptom management studies. DATA SOURCES Literature searches were performed in Medline and the Cumulative Index of Nursing and Allied Health Literature between 1990 and 2008 for models and theories that guide symptom management research. Related papers and book chapters were used as supporting documentation. DISCUSSION Comparison and critique of the models and theories revealed important gaps including lack of consideration of symptom clusters, failure to incorporate temporal aspects of the symptom experience and failure to incorporate the impact of interventions on patient outcomes. CONCLUSION New models and theories should incorporate current trends in symptom management research, capture the dynamic nature of symptoms and incorporate concepts that will facilitate transdisciplinary research in symptom management. Researchers and clinicians need to build more expansive and dynamic symptom management models and theories that parallel advances in symptom research and practice.
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Johansson E, Wilson B, Brunton L, Tishelman C, Molassiotis A. Symptoms before, during, and 14 months after the beginning of treatment as perceived by patients with lymphoma. Oncol Nurs Forum 2010; 37:E105-13. [PMID: 20189909 DOI: 10.1188/10.onf.e105-e113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore occurrence of symptoms and relationships between them as perceived by patients with lymphoma before, during, and 14 months after the beginning of treatment. RESEARCH APPROACH Qualitative and longitudinal. SETTING A major oncology center in the United Kingdom. PARTICIPANTS 10 adult patients with lymphoma (3 women and 7 men) were recruited at treatment initiation. METHODOLOGIC APPROACH Semistructured audiotaped interviews were conducted with participants in median 15 days, 4 months, and 14 months after diagnosis. Analysis of the verbatim transcripts was inspired by interpretive description, which is a grounded approach articulating patterns emerging in relation to clinical phenomena. MAIN RESEARCH VARIABLES Symptoms. FINDINGS Symptoms commonly reported by patients in this sample were lack of energy, lymphadenopathy, weight loss, itching, pain, sadness, night sweats, sleeping difficulties, and hair loss. Co-occurring prediagnosis symptoms seem to have led patients to seek medical attention; co-occurring symptoms during treatment seem to have a cumulatively distressing effect. Several of the symptoms were described as interrelated, with one symptom leading to one or more other symptoms. CONCLUSIONS The data confirm a complex symptomatology in patients with lymphoma. In addition, the findings support that co-occurring symptoms may have a synergistic effect on patients' health outcomes and add new knowledge about relationships between symptoms from patients' perspectives. INTERPRETATION Illustrating symptoms and interrelationships between symptoms using diagrams may be useful to support communication as well as in identifying targets for symptom management.
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Affiliation(s)
- Eva Johansson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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138
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Karabulut N, Karabulu N, Erci B, Ozer N, Ozdemir S. Symptom clusters and experiences of patients with cancer. J Adv Nurs 2010; 66:1011-21. [PMID: 20337795 DOI: 10.1111/j.1365-2648.2009.05254.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This study is a report of a study to characterize the prevalence and severity of symptoms in patients with cancer and describing the clustering of symptoms. BACKGROUND Patients with cancer experience multiple symptoms caused by multiple factors, including progression of the cancer, acute physiological changes associated with treatment, delayed side effects of treatment and long-term consequences of the disease. METHODS A convenience sample of 287 patients with cancer at a Turkish university hospital completed a structured questionnaire on demographical characteristics and a symptom inventory for patients with cancer. Cluster analysis, principal components and internal consistency reliability analyses were used to analyse the data. The study was conducted in 2007. FINDINGS The most common symptoms experienced were fatigue, difficulty remembering, sadness, loss of appetite, lack of enjoyment of life, pain, distress, difficulty walking and dry mouth. The least experienced symptoms were shortness of breath and vomiting. Overall, 37.5% of the patients experienced moderate symptoms and 12.5% experienced severe symptoms. Among the severe symptoms were loss of appetite, fatigue, sadness, dry mouth and distress; however, 48% rated these as moderate or severe. CONCLUSIONS Symptom cluster research is still in its early years. Further work is needed to reach a standard definition of a symptom cluster and a consensus of its criteria. Additional studies are needed to examine symptom clusters in cancer survivors. As individuals are living longer with the disease, comprehensive understanding of the symptom clusters that may be unique to cancer survivors is critical.
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Affiliation(s)
- Neziha Karabulut
- Surgical Nursing Department, School of Nursing, Atatürk University, Erzurum, Turkey
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139
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Hadi S, Zhang L, Hird A, de Sa E, Chow E. Validation of symptom clusters in patients with metastatic bone pain. ACTA ACUST UNITED AC 2010; 15:211-8. [PMID: 19008995 PMCID: PMC2582516 DOI: 10.3747/co.v15i5.289] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Symptom clusters (scs) are a dynamic construct. They consist of at least 2 or 3 interrelated symptoms that may be a significant predictor of patient morbidity. In a previous study, we identified 2 scs in patients with bone metastases: These scs may be clinically important in the pain and symptom management of patients with metastatic bone pain. It is therefore important to validate the reported scs to determine if they hold true across similar patient populations. Patients and Methods From February to September 2007, our study accrued 52 patients with bone metastases [29 men (56%), 23 women (44%); median age: 68.5 years (range: 39–87 years)] who were referred for palliative radiotherapy (rt). Prostate (31%), breast (29%), and lung (19%) were the most common primary cancer sites. Treatment arms ranged from single to multiple fractions, with most patients receiving a single 8-Gy fraction (77%) or 20 Gy in 5 fractions (21%). The most prevalent sites for rt were spine (42%), hips (17%), and pelvis (14%). Worst pain at the site of rt and functional interference scores were assessed using the Brief Pain Inventory (bpi), a multidimensional pain instrument that uses 11-point numeric rating scales. Patients provided their symptom severity scores on the bpi at baseline and at 4, 8, and 12 weeks post rt. At all time points, a principal component analysis with varimax rotation was performed on 8 items (worst pain and 7 functional interference items) to determine relationships between symptoms before and after rt for bone pain. Results Two scs were identified. Cluster 1 included worst pain and interference with general activity, normal work, and walking ability; cluster 2 consisted of interference with mood, sleep, enjoyment of life, and relations with others. Our statistical analysis produced varied results for the 2 clusters found in our previous investigation. These differences may be an indicator for the instability of scs or may be a result of the fewer number of patients accrued in the present validation study. Conclusions The scs in our two studies were not identical for patients receiving palliative rt for symptomatic bone metastases. Another sc validation study should be conducted with a larger sample before a conclusion is drawn about the existence of an unstable phenomenon in sc research.
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Affiliation(s)
- S Hadi
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON
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Rosedale M, Fu MR. Confronting the Unexpected: Temporal, Situational, and Attributive Dimensions of Distressing Symptom Experience for Breast Cancer Survivors. Oncol Nurs Forum 2009; 37:E28-33. [DOI: 10.1188/10.onf.e28-e33] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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142
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The experience of a sore mouth and associated symptoms in patients with cancer receiving outpatient chemotherapy. Cancer Nurs 2009; 32:259-70. [PMID: 19444079 DOI: 10.1097/ncc.0b013e3181a38fc3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to describe sore mouth (SM) severity and distress, associated symptoms, and consequences in cancer chemotherapy outpatients. Secondary analysis was used in this study. A total of 223 patients in 4 treatment centers participated in the study. Data from an intervention study using a computer-based telephone communication system to assess patients' daily symptom experience were analyzed to obtain highest, average, and lowest ratings of severity and distress for SM, fatigue, trouble sleeping, feeling down/blue, and feeling anxious. Consequence data included oral intake, time spent lying down, ability to work, and daily activity. Approximately 51% reported SM, with a mean highest, average, and lowest severity score of 3.1 in cycle 2 and 3.09 in cycle 3. Sore mouth severity was correlated with severity of fatigue, feeling down/blue, feeling anxious, and trouble sleeping. Sore mouth distress was correlated with the same symptoms. Sore mouth severity was correlated with the number of 8-oz glasses of liquid consumed, effect on daily activity, time spent lying down, but not with ability to work. Half of patients experienced SM, which was associated with several other symptoms and led to specific consequences. Understanding the complex symptom experience of patients with SM, including consequences, will assist nurses in developing more comprehensive clinical assessments and interventions. In addition, the association of multiple symptoms with SM will provide a foundation for further research investigation in oral mucositis.
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143
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Shun SC, Lai YH, Hsiao FH. Patient-related barriers to fatigue communication in cancer patients receiving active treatment. Oncologist 2009; 14:936-43. [PMID: 19738002 DOI: 10.1634/theoncologist.2009-0048] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore barriers to reporting fatigue in cancer patients receiving active treatment and the significant factors associated with those barriers from fatigue characteristics (i.e., intensity, duration, and interference with daily life), to demographic characteristics and disease/treatment variables. METHODS Patients with various types of cancer (n = 288) were recruited from an outpatient chemotherapy center, and from seven oncology and hematology units in a teaching hospital in northern Taiwan. Data were collected using the Fatigue Management Barriers Questionnaire to explore barriers to fatigue communication. RESULTS Fear of distracting the doctor was rated as the highest barrier of reporting fatigue. The degree of fatigue interference with daily life by patients was associated with the willingness to report fatigue. Patients with gastrointestinal cancer experienced more barriers to reporting fatigue than those with hematological cancer. Patients without religion perceived the highest level of barriers to fatigue communication. Outpatients had higher levels of concern than inpatients. CONCLUSIONS Discussion with patients about their high level of perceived fatigue barriers before implementing patient education is recommended. Assessing fatigue interference with daily life and identifying factors associated with barriers to reporting fatigue (i.e., type of cancer, religion, and the setting for receiving treatment) are suggested in order to provide better fatigue management in clinical settings.
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Affiliation(s)
- Shiow-Ching Shun
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Browall M, Persson LO, Ahlberg K, Karlsson P, Danielson E. Daily assessment of stressful events and coping among post-menopausal women with breast cancer treated with adjuvant chemotherapy. Eur J Cancer Care (Engl) 2009; 18:507-16. [PMID: 19490004 DOI: 10.1111/j.1365-2354.2008.00994.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of the study was twofold: to examine what type of daily stressful events post-menopausal woman with breast cancer experience during adjuvant chemotherapy and how bothersome these are and to identify coping strategies used by these women used to manage such stressful events. The patient group comprised 75 consecutively invited women (>or=55 years of age) at two university hospitals and one county hospital in Sweden. The Daily Coping Assessment was used to collect data over time. Data were analysed both qualitatively and quantitatively. Six categories of stressful events were identified: 'nausea and vomiting', 'fatigue', 'other symptoms', 'isolation and alienation', 'fear of the unknown' and 'being controlled by the treatment'. The first three categories were subsumed under the domain physical problems and the latter three under psychosocial problems. Almost 30% of the diary entries recorded no stressful event. Physical problems were three times as frequent as psychosocial problems. 'Nausea/vomiting' was the most frequently observed stressful event (21.6%). 'Isolation and alienation' and 'fear of the unknown' were less frequent, but when they occurred they were rated as the most distressing. Several coping strategies were used to manage each stressful event. The most common strategies were acceptance, relaxation and distraction. Religion was rarely used as a coping strategy.
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Affiliation(s)
- Maria Browall
- The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden.
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145
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Landrum L. Description of Symptom Severity in Heart Failure. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2009. [DOI: 10.1177/1084822308318205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this article is to critically analyze research that describes symptom severity in heart failure. Medline, CINAHL, Psych Info, and Science Direct databases (2000 to July 2006) were searched to locate published studies that described or defined symptom severity or like terms in heart failure. A total of 323 publications were initially reviewed, from which 21 articles (6.51%) were selected based on the inclusion criteria for this article. Multiple terms are used synonymously, and inappropriately at times, to describe symptom severity. Rarely, symptom severity is adequately defined or fully described. Varying instruments and methods are used to measure symptom severity. The literature includes inappropriate measurement methods of symptom severity. Symptom severity should be clearly defined, differentiated from related terms, and measured appropriately. Comparisons across studies are impeded when terms are not clearly defined or inappropriately measured.
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Taste and smell changes in patients receiving cancer chemotherapy: distress, impact on daily life, and self-care strategies. Cancer Nurs 2009; 32:45-54. [PMID: 19104201 DOI: 10.1097/01.ncc.0000343368.06247.74] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Few studies have described how patients receiving chemotherapy experience taste/smell changes (TSCs). Food and meal situations have important meaning beyond nutrition, so these common symptoms may affect daily lives. This study aims to investigate distress and impact on daily life from TSCs in patients receiving cancer chemotherapy, analyze reported levels of distress and impact on daily life from TSCs with regard to sociodemographic and clinical factors, and explore patients' reports of self-care strategies and communication with staff. The 340 patients reporting TSCs on a multicenter survey (n = 518) were grouped into subsets by level of TSC-related distress and impact on daily life, which served as the basis for statistical comparison. Written comments were analyzed inductively using content analysis. Nearly one-third of participating patients reported both high levels of distress and impact on daily life (high distress and high impact on daily life [HDHI]) from TSCs. The HDHI subset reported other symptoms more often than others did (P = .01) and also more often responded to open questions about distress, impact, and self-care strategies (P = .01). Taste/smell changes were not always reported to staff, even in the HDHI subset. The specific aspects of TSCs resulting in distress and impact on daily life varied greatly, affecting both psychological and somatic aspects, with little consensus and great individual differences described in self-care strategies. The variety of distress, impact, and strategies used to alleviate TSCs clarifies the importance of situational meaning.
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147
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Cheng KKF, Wong EMC, Ling WM, Chan CWH, Thompson DR. Measuring the symptom experience of Chinese cancer patients: a validation of the Chinese version of the memorial symptom assessment scale. J Pain Symptom Manage 2009; 37:44-57. [PMID: 18538976 DOI: 10.1016/j.jpainsymman.2007.12.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 12/14/2007] [Accepted: 12/28/2007] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to translate the Memorial Symptom Assessment Scale (MSAS) into Chinese and evaluate the psychometric properties of this version. The original MSAS is a 32-item, patient-rated measure that was developed to assess common cancer-related physical and psychological symptoms with respect to frequency, intensity, and distress. In this study, a two-phase design was used. Phase I involved iterative forward-backward translation, testing of content validity (CVI) and a pretest. Phase II established the psychometric properties of the Chinese version MSAS (MSAS-Ch). Results showed that the MSAS-Ch achieved content relevancy CVI of 0.94 and semantic equivalence CVI of 0.94. Pretesting was performed in 10 cancer patients, and the results revealed adequate content coverage and comprehensibility of the MSAS-Ch. A convenience sample of 370 patients undergoing cancer therapy or at the early post-treatment stage was recruited for psychometric evaluation. Confirmatory factor analysis confirmed the construct validity of the MSAS-Ch, with a good fit between the factor structure of the original version and our present sample data (goodness-of-fit indices all above 0.95). The internal consistency reliability of subscales and total MSAS-Ch was moderately high, with Cronbach alpha coefficients ranging from 0.79 to 0.87. The test-retest intraclass correlation results for the subscale and total MSAS-Ch ranged from 0.68 to 0.79. The subscale scores of MSAS-Ch were moderately correlated with the scores on various validation measurements that assessed psychological distress, pain, and health-related quality of life (r = 0.46-0.65, P < 0.01), confirming that they were measurements of similar constructs. The validity of the construct validity was also supported by comparing the MSAS-Ch scores for subpopulations that varied clinically. Inpatients and patients with poorer performance status scored higher on the MSAS-Ch subscale and total scores than outpatients and patients with higher performance status (P < 0.05). Our study shows that the MSAS-Ch has adequate psychometric properties of validity and reliability, and can be used to assess symptoms during cancer therapy and at the early post-treatment stage in Chinese-speaking patients.
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Affiliation(s)
- Karis K F Cheng
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong.
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148
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Hägglund L, Boman K, Lundman B. The Experience of Fatigue among Elderly Women with Chronic Heart Failure. Eur J Cardiovasc Nurs 2008; 7:290-5. [DOI: 10.1016/j.ejcnurse.2007.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 10/15/2007] [Accepted: 12/20/2007] [Indexed: 10/22/2022]
Abstract
Background: Fatigue is a common and distressing symptom in chronic heart failure (CHF). Most of the current methods for evaluating patients' symptoms fail to consider the meaning or importance that these symptoms have for the patient. Aim: To illuminate the lived experience of fatigue among elderly women with CHF. Method: Narrative interviews were conducted with 10 women with CHF, aged 73–89 years. Interviews were analysed with qualitative content analysis. Results: The findings are presented in two themes and five subthemes. The first theme, ‘living with the loss of physical energy’, was based on three subthemes describing the experience of fatigue: ‘experiencing a substantial presence of feebleness and unfamiliar bodily sensations’, ‘experiencing unpredictable variations in physical ability’, and ‘needing help from others in daily life’. The second theme, ‘striving for independence while being aware of deteriorating health’, describes how the women managed their life situation; it was based on two subthemes: ‘acknowledging one's remaining abilities’, and ‘being forced to adjust and struggle for independence’. Conclusions: Fatigue was experienced as loss of physical energy, leading to discrepancies between intention and capacity. The will to reduce dependency on others involved a daily struggle against fatigue.
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Affiliation(s)
- Lena Hägglund
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Medicine-Geriatrics, Skellefteå County Hospital, Sweden
| | - Kurt Boman
- Department of Medicine-Geriatrics, Skellefteå County Hospital, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Berit Lundman
- Department of Nursing, Umeå University, Umeå, Sweden
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149
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Lindqvist O, Rasmussen BH, Widmark A, Hydén LC. Time and bodily changes in advanced prostate cancer: talk about time as death approaches. J Pain Symptom Manage 2008; 36:648-56. [PMID: 18504095 DOI: 10.1016/j.jpainsymman.2007.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 12/10/2007] [Accepted: 12/28/2007] [Indexed: 11/30/2022]
Abstract
The disease trajectory of living with incurable cancer is characterized by increasing bodily deterioration and problems. In this paper, we have focused on the change in temporal awareness as manifested in the narrations of two men with hormone refractory prostate cancer and skeletal metastases as they approach death. The two men participated in in-depth research interviews during the last part of their lives, sharing a similar disease trajectory with increasing bodily change and decreasing physical function. Both died a lingering, cancer-related death. The first and last research interviews were analyzed using a discourse analytic method. Findings show that the temporal awareness in the interviews changes as the illness progresses and death approaches. In the last interviews, the present is flooded with bodily problems; the past and the future are hardly present except for the future beyond the men's own deaths. Pain, fatigue, nausea, and other symptoms figure largely in this change, and there is no time for much more than attending to bodily needs in a present that is dominated by problems. Here, the importance of alleviating bodily problems once again becomes paramount, and two questions are raised: Is the often reported withdrawal from life, when death is imminent, a physical necessity rather than a psychological one, and is it possible to free time from the time-consuming problems of the present by means of a more concentrated attempt to alleviate these problems?
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150
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Motl RW, Snook EM, Schapiro RT. Symptoms and physical activity behavior in individuals with multiple sclerosis. Res Nurs Health 2008; 31:466-75. [DOI: 10.1002/nur.20274] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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