1
|
Fleming L, Zibaite S, Kyle SD, Boyd K, Green V, Mansell J, Elsberger B, Young D. Insomnia prehabilitation in newly diagnosed breast cancer patients: Protocol for a pilot, multicentre, randomised controlled trial comparing nurse delivered sleep restriction therapy to sleep hygiene education (INVEST trial). PLoS One 2024; 19:e0305304. [PMID: 39141622 PMCID: PMC11324102 DOI: 10.1371/journal.pone.0305304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Insomnia is a prevalent sleep disorder that negatively impacts daytime functioning and quality of life. Breast cancer patients report higher rates of insomnia and more circadian disruption than other cancer groups. Approximately 50% of patients experience acute insomnia following breast cancer diagnosis, which often persists during cancer treatment and rehabilitation. Sleep Restriction Therapy (SRT) is a clinically effective and tolerable treatment for persistent insomnia in breast cancer survivors. However, SRT has never been tested on patients with early signs of sleep disturbance who are undergoing cancer treatment. The aim of this pilot randomised controlled trial is to explore the feasibility and preliminary effectiveness of nurse delivered SRT for newly diagnosed breast cancer patients with acute insomnia. The trial has been registered on ClinicalTrials.gov (identifier: NCT06294041). METHODS The INVEST (INvestigating the Value of Early Sleep Therapy) trial will recruit 50 newly diagnosed breast cancer patients who meet criteria for acute insomnia. Patients will be recruited from breast cancer results clinics within two Scottish health boards (NHS Grampian and NHS Greater Glasgow and Clyde) and will be block randomised (1:1) to receive nurse delivered SRT or Sleep Hygiene Education (SHE). SRT will be delivered over 4 weekly sessions comprising two face-to-face meetings (either in person or online) and two telephone calls, whereas SHE will be administered in booklet form. Outcomes will be collected at baseline, 6 weeks, and 12 weeks post-randomisation. Primary outcomes in this trial relate to the feasibility of SRT for newly diagnosed breast cancer patients with acute insomnia. Specifically, we will explore (i) rates of patient recruitment and retention, (ii) intervention fidelity, (iii) data collection procedures and outcome measure completion, (iv) intervention acceptability. Secondary outcomes will focus on preliminary evaluation of patient responses to SRT, including insomnia severity, rest-activity rhythms, and mental health. DISSEMINATION Our dissemination plan comprises publishing trial outcomes in high-impact, peer-reviewed journals and on breast cancer charity websites and other patient resources. The outcomes from this pilot trial will also inform the development of a full-scale, multicentre RCT of SRT for acute insomnia in newly diagnosed breast cancer patients. University of Strathclyde is the sponsor (reference: UEC23/52). Protocol version v1.2 4 October 2023. STRENGTHS AND LIMITATIONS OF THIS STUDY This trial is the first to explore the value of sleep prehabilitation for newly diagnosed breast cancer patients.This will be the first trial to assess the feasibility of delivering SRT during breast cancer treatment, providing valuable insight into its tolerability and preliminary effectiveness.An embedded process evaluation will assess the acceptability of SRT, providing insight into potential optimisation of the intervention and recommendations for enhancing its future scalability and translation within cancer care.Due to the nature of the SRT intervention, nurse therapists and patients cannot be blinded to treatment allocation, increasing the risk of bias.
Collapse
Affiliation(s)
- Leanne Fleming
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Solveiga Zibaite
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Simon D. Kyle
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - James Mansell
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Beatrix Elsberger
- NHS Grampian, Breast Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| |
Collapse
|
2
|
Haywood D, Kotov R, Krueger RF, Wright AGC, Forbes MK, Dauer E, Baughman FD, Rossell SL, Hart NH. Reconceptualizing mental health in cancer survivorship. Trends Cancer 2024; 10:677-686. [PMID: 38890021 DOI: 10.1016/j.trecan.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024]
Abstract
Mental health for cancer survivors in both research and clinical applications has strongly adopted a traditional nosological approach, involving the classification of psychopathology into discrete disorders. However, this approach has recently faced considerable criticism due to issues such as high comorbidity and within-disorder symptom heterogeneity across populations. Moreover, there are additional specific issues impacting the validity of traditional approaches in cancer survivorship populations, including the physiological effects of cancer and its treatments. In response, we provide the case for the hierarchical dimensional approach within psycho-oncology, in particular the Hierarchical Taxonomy of Psychopathology (HiTOP). We discuss not only the potential utility of HiTOP to research and clinical applications within psycho-oncology, but also its limitations, and what is required to apply this approach within cancer survivorship.
Collapse
Affiliation(s)
- Darren Haywood
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia; Department of Mental Health, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Department of Psychiatry, Melbourne Medical School, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia.
| | - Roman Kotov
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aidan G C Wright
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA; Eisenberg Family Depression Center, University of Michigan, Ann Arbor, MI, USA
| | - Miriam K Forbes
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Evan Dauer
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia; Department of Mental Health, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Frank D Baughman
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Susan L Rossell
- Department of Mental Health, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia; Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia; Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| |
Collapse
|
3
|
Chen MY, Bai W, Wu XD, Sha S, Su Z, Cheung T, Pang Y, Ng CH, Zhang Q, Xiang YT. The network structures of depressive and insomnia symptoms among cancer patients using propensity score matching: Findings from the Health and Retirement Study (HRS). J Affect Disord 2024; 356:450-458. [PMID: 38608763 DOI: 10.1016/j.jad.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/18/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Both depression and insomnia are found to be more prevalent in cancer patients compared to the general population. This study compared the network structures of depression and insomnia among cancer patients versus cancer-free participants (controls hereafter). METHOD The 8-item Center for Epidemiological Studies Depression Scale (CESD-8) and the 4-item Jenkins Sleep Scale (JSS-4) were used to measure depressive and insomnia symptoms, respectively. Propensity score matching (PSM) was used to construct the control group using data from the Health and Retirement Study (HRS). In total, a sample consisting of 2216 cancer patients and 2216 controls was constructed. Central (influential) and bridge symptoms were estimated using the expected influence (EI) and bridge expected influence (bridge EI), respectively. Network stability was assessed using the case-dropping bootstrap method. RESULT The prevalence of depression (CESD-8 total score ≥ 4) in cancer patients was significantly higher compared to the control group (28.56 % vs. 24.73 %; P = 0.004). Cancer patients also had more severe depressive symptoms relative to controls, but there was no significant group difference for insomnia symptoms. The network structures of depressive and insomnia symptoms were comparable between cancer patients and controls. "Felt sadness" (EI: 6.866 in cancer patients; EI: 5.861 in controls), "Felt unhappy" (EI: 6.371 in cancer patients; EI: 5.720 in controls) and "Felt depressed" (EI: 6.003 in cancer patients; EI: 5.880 in controls) emerged as the key central symptoms, and "Felt tired in morning" (bridge EI: 1.870 in cancer patients; EI: 1.266 in controls) and "Everything was an effort" (bridge EI: 1.046 in cancer patients; EI: 0.921 in controls) were the key bridge symptoms across both groups. CONCLUSION Although cancer patients had more frequent and severe depressive symptoms compared to controls, no significant difference was observed in the network structure or strength of the depressive and insomnia symptoms. Consequently, psychosocial interventions for treating depression and insomnia in the general population could be equally applicable for cancer patients who experience depression and insomnia.
Collapse
Affiliation(s)
- Meng-Yi Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China; Department of Epidemiology and Biostatistics, School of Public Health, Jilin University
| | - Xiao-Dan Wu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ying Pang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia.
| | - Qinge Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
| |
Collapse
|
4
|
Romanovska V, Block A, Paul SM, Cooper BA, Hammer MJ, Conley YP, Levine JD, Kober KM, Miaskowski C. Exploration of the Relationships Between Stress and Distinct Pain and Sleep Disturbance Profiles in Patients Undergoing Chemotherapy. Cancer Nurs 2024; 47:E108-E122. [PMID: 36584234 PMCID: PMC10300234 DOI: 10.1097/ncc.0000000000001185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Unrelieved pain and sleep disturbance are common symptoms in oncology patients. Increased stress may be an underlying cause for both symptoms. OBJECTIVES The purposes of this study were to identify subgroups of outpatients with distinct pain and sleep disturbance profiles and to evaluate differences among these subgroups in demographic and clinical characteristics. Differences in global stress, cancer-specific stress, and cumulative life stress, as well as resilience and coping, were evaluated. METHODS Patients (N = 1343) completed self-report questionnaires for demographic and clinical characteristics and stress, resilience, and coping. Latent profile analysis was used to identify subgroups of patients with distinct pain and sleep disturbance profiles. Differences among the subgroups were determined using parametric and nonparametric tests. RESULTS Three distinct profiles were identified (ie, No Pain + Moderate Sleep Disturbance (SD) (27.6%), Moderate Pain + Moderate SD (38.6%), Severe Pain + High SD (33.8%)). Compared with the other 2 classes, Severe Pain + High SD class was younger, had fewer years of education, was more likely to be female, more likely to live alone, less likely to be employed, and had a higher level of comorbidity. This class had the highest stress scores and was more likely to report higher rates of adverse childhood experiences. CONCLUSION Over 70% of our sample reported clinically meaningful levels of both symptoms, and 33.8% reported relatively high rates of adverse childhood experiences. IMPLICATION FOR PRACTICE Clinicians need to perform routine assessments, particularly of adverse childhood experiences, and initiate appropriate referrals.
Collapse
Affiliation(s)
- Vita Romanovska
- Author Affiliations: School of Nursing (Mss Romanovska and Block, Drs Paul, Cooper, Kober, and Miaskowski) and School of Medicine (Drs Levine and Miaskowski), University of California, San Francisco; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; and School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Chou HL, Chen TC, Yao CT. Comparing the sensitivity of fatigue and sleep disturbance assessment tools in women with advanced cancer undergoing chemotherapy. Asia Pac J Oncol Nurs 2024; 11:100331. [PMID: 38283667 PMCID: PMC10821379 DOI: 10.1016/j.apjon.2023.100331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/28/2023] [Indexed: 01/30/2024] Open
Abstract
Objective This study aims to investigate the variations in fatigue and sleep disturbances among female patients with advanced lung cancer (ALC) and advanced breast cancer (ABC) during chemotherapy. Methods A total of 36 female patients with ALC and 36 with ABC, all of whom had completed their first cycle of chemotherapy, were included. Fatigue was assessed using the General Fatigue Scale (GFS), and sleep disturbances were evaluated using the Pittsburgh Sleep Quality Index (PSQI) at designated time points throughout the chemotherapy process. Results Linear regression analysis indicated that variables such as age, education level, employment status, cancer type, clinical stage, and symptom distress had no significant correlation with either fatigue or sleep disturbances. The GFS significantly discriminated fatigue among the ALC, ABC, and combined groups, while the PSQI demonstrated a significant distinction in sleep disturbance only within the ALC and combined groups. Conclusions In summary, when considering the findings of both assessments in this study, the GFS score exhibited greater sensitivity in detecting fatigue than the PSQI score did for identifying sleep disturbances in advanced cancer patients undergoing chemotherapy.
Collapse
Affiliation(s)
- Hsiu-Ling Chou
- Department of Nursing, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tsan-Chi Chen
- Department of Medical Research, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chung-Tay Yao
- Department of Emergency, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| |
Collapse
|
6
|
Naz I, Turgut B, Gunay Ucurum S, Komurcuoglu B, Ozer Kaya D. Investigation of factors associated with static and dynamic balance in early-stage lung cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01492-0. [PMID: 37964048 DOI: 10.1007/s11764-023-01492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Balance impairment and falls are common among patients after cancer treatment. This study aimed to compare static and dynamic balance functions in lung cancer survivors (LCS) and healthy controls and to investigate the factors related to balance in LCS. METHODS Cross-sectional data were collected from lung cancer patients whose treatment had been completed within the previous 3 months (n = 60) and age and gender-matched healthy controls (n = 60). Clinical characteristics and history of falls were recorded. Pulmonary function tests and measurements of respiratory muscle strength were performed. Dynamic and static balance, fear of falling, knee-extension strength, physical activity level, dyspnea, comorbidity, and quality of life (QoL) were assessed using the Time Up and Go Test, Single Leg Standing Test, the Fall Efficacy Scale-International, hand-held dynamometer, the International Physical Activity Questionnaire, the Modified Medical Research Dyspnea Scale, the Charlson Comorbidity Index, and the European Organization for Research and Treatment of Cancer QoL Scale. RESULTS LCS reported a higher fall rate and exhibited lower dynamic balance compared to controls (p < 0.05). The number of chemotherapy cycles, number of falls in the past year, fear of falling, perceived dyspnea, forced expiratory volume in 1 s (%), maximal inspiratory pressure (%), knee-extension strength, physical activity score, and QoL score related to physical function were correlated with balance function in LCS (p < 0.05). CONCLUSION LCS had a higher risk of falls and lower dynamic balance function which might be related to various clinical and physical parameters. IMPLICATIONS FOR CANCER SURVIVORS Identifying factors related to balance should be considered within the scope of fall prevention approaches for these patients.
Collapse
Affiliation(s)
- Ilknur Naz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Balatçık Mahallesi Havaalanı Şosesi No:33/2 Balatçık, 35620, İzmir, Turkey.
| | - Büsra Turgut
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Izmir Katip Celebi University, Balatçık Mahallesi Havaalanı Şosesi No:33/2 Balatçık, 35620, İzmir, Turkey
| | - Sevtap Gunay Ucurum
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Balatçık Mahallesi Havaalanı Şosesi No:33/2 Balatçık, 35620, İzmir, Turkey
| | - Berna Komurcuoglu
- Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, University of Health Sciences, Yenisehir Mah. Gaziler Cad. No:331 Konak, 35170, Izmir, Turkey
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Balatçık Mahallesi Havaalanı Şosesi No:33/2 Balatçık, 35620, İzmir, Turkey
| |
Collapse
|
7
|
Liu Z, Xu X, Ding K, Fu R. Quality of life considerations and management in patients with myelodysplastic syndrome. Expert Rev Hematol 2023; 16:849-860. [PMID: 37819160 DOI: 10.1080/17474086.2023.2268837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION This study aimed to identify the factors affecting the quality of life (QOL) and functional status of patients with MDS. AREAS COVERED We reviewed the literature published in PUBMED over the past 30 years and searched for keywords such as 'quality of life' and 'myelodysplastic syndromes'. By observing the influence of their symptoms, the possibility of improving patients' QOL was considered by improving these related factors. Concurrently, the effects of related clinical treatments based on the unique disease characteristics of MDS on the patients' QOL were examined, and lifestyle factors were considered in clinical practice, providing an important path to improve the QOL and functional status of patients with MDS. EXPERT OPINION This review summarized several areas that can improve the quality of survival of MDS patients and discusses them in depth. Although the clinical benefits may be minimal, we still hope to improve patients' daily life outcomes and enhance their quality of life at minimal cost. Also, we hope more researchers will focus on this area in the future to find more factors that may exist to supplement the limitations of these understanding and thinking, and to provide assistance in clinical work.
Collapse
Affiliation(s)
- Zhaoyun Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xintong Xu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kai Ding
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
8
|
Gerhart J, Ramos K, Porter LS, Ravyts S, Malhotra S, Mossman B, Eaton England A, Alonzi S, Peyser T, Kim S, O'Mahony S, Burns JW, Hoerger M. Top Ten Tips Palliative Care Clinicians Should Know About Behavioral Pain Management for Persistent Pain. J Palliat Med 2023; 26:992-998. [PMID: 36706441 PMCID: PMC10398738 DOI: 10.1089/jpm.2022.0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/28/2023] Open
Abstract
Seriously ill patients often experience persistent pain. As a part of a comprehensive repertoire of pain interventions, palliative care clinicians can help by using behavioral pain management. Behavioral pain management refers to evidence-based psychosocial interventions to reduce pain intensity and enhance functional outcomes and quality of life. Conceptualized using the biopsychosocial model, techniques involve promoting helpful behaviors (e.g., activity pacing, stretching, and relaxation exercises) and modifying underlying patterns of thinking, feeling, and communicating that can exacerbate pain. The authors have expertise in pain management, clinical health psychology, geropsychology, behavioral science, and palliative medicine. The article reviews the current evidence for behavioral interventions for persistent pain and provides 10 recommendations for behavioral pain management.
Collapse
Affiliation(s)
- James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura S. Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Scott Ravyts
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonia Malhotra
- Department of Palliative and Supportive Medicine, University Medical Center, New Orleans, Louisiana, USA
| | - Brenna Mossman
- Department of Psychology and Tulane University, New Orleans, Louisiana, USA
| | - Ashley Eaton England
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Sarah Alonzi
- Department of Psychology, University of California—Los Angeles, Los Angeles, California, USA
| | - Tristen Peyser
- Department of Psychology and Tulane University, New Orleans, Louisiana, USA
| | - Seowoo Kim
- Department of Psychology and Tulane University, New Orleans, Louisiana, USA
| | - Sean O'Mahony
- Department of Internal Medicine and Rush University Medical Center, Chicago, Illinois, USA
| | - John W. Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Hoerger
- Department of Palliative and Supportive Medicine, University Medical Center, New Orleans, Louisiana, USA
- Department of Psychology and Tulane University, New Orleans, Louisiana, USA
- Department of Psychiatry and Medicine, Tulane University, New Orleans, Louisiana, USA
| |
Collapse
|
9
|
Yang M, Baser RE, Liou KT, Li SQ, Piulson L, Panageas KS, Mao JJ. Effect of acupuncture versus usual care on sleep quality in cancer survivors with chronic pain: Secondary analysis of a randomized clinical trial. Cancer 2023; 129:2084-2094. [PMID: 36989257 PMCID: PMC10330176 DOI: 10.1002/cncr.34766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/31/2023] [Accepted: 02/21/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Chronic pain negatively affects sleep; it is unclear whether pain relief from acupuncture contributes to sleep quality improvements in cancer survivors. This study aimed to evaluate the effect of acupuncture versus usual care on sleep quality among cancer survivors with comorbid sleep disturbance and chronic musculoskeletal pain. METHODS Sleep outcome data from the Personalized Electroacupuncture Versus Auricular Acupuncture Comparative Effectiveness (PEACE) randomized clinical trial were analyzed. Electroacupuncture or auricular acupuncture was compared with usual care for sleep quality improvement over 10 weeks of treatment among cancer survivors with clinically significant sleep disturbance and chronic musculoskeletal pain at baseline. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) global score. RESULTS Among 268 participants (mean [standard deviation (SD)] age, 61.4 [12.6] years; 191 women [71.3%]; mean [SD] baseline PSQI global score, 10.3 [3.3] points), electroacupuncture and auricular acupuncture resulted in greater reductions in the PSQI global score from baseline to 10 weeks in comparison with usual care: 1.42 points (95% confidence interval [CI], 0.45-2.38; p = .004) and 1.59 points (95% CI, 0.62-2.55; p = .001), respectively. The improvement in sleep quality for the acupuncture groups was sustained for 24 weeks from randomization. Furthermore, a greater proportion of patients in the electroacupuncture and auricular acupuncture groups had clinically meaningful improvement in sleep quality compared to the usual care group (41.0% and 42.9% vs. 21.4%; p = .044). CONCLUSIONS Among cancer survivors with comorbid sleep disturbance and chronic pain, electroacupuncture and auricular acupuncture produced a clinically relevant and persistent improvement in sleep quality. These findings suggest that acupuncture may be an evidence-based nonpharmacologic intervention to improve sleep health for cancer survivors with pain. PLAIN LANGUAGE SUMMARY This study analyzed the sleep quality data from a published randomized clinical trial that evaluated the effect of electroacupuncture or auricular acupuncture versus usual care on pain relief among people who survived cancer. This analysis included a prespecified subgroup of 268 participants with co-occurring sleep disturbance and chronic musculoskeletal pain at baseline and found that patients who used acupuncture for pain relief demonstrated greater improvements in sleep quality compared with patients who received usual care. Sleep quality improvement by acupuncture was sustained after the treatment ended.
Collapse
Affiliation(s)
- Mingxiao Yang
- Integrative Medicine Service, Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kevin T. Liou
- Integrative Medicine Service, Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan Q. Li
- Integrative Medicine Service, Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lauren Piulson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katherine S. Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jun J. Mao
- Integrative Medicine Service, Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
10
|
Cabrera Jaime S, Martinez C, Gonzalo Bachiller V, Zarza Arnau N, Martin Maldonado L, Belén Manrique Palles A, Artiga Sarrion I, Tierno Sanchez N, Julià Torras J, Sancho JM, Cabrera Jaime L. Participatory action research intervention for improving sleep in inpatients with cancer. J Clin Nurs 2023; 32:1218-1229. [PMID: 35289008 DOI: 10.1111/jocn.16279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 12/01/2022]
Abstract
AIM To design and implement a plan to improve oncohaematological patients' sleep. BACKGROUND The hospital environment can compromise inpatients' sleep, negatively impacting on health outcomes and patient satisfaction. DESIGN AND METHOD The improvement plan was designed in collaboration with 18 professionals, 3 patients and 3 accompanying relatives. The study designed followed the SQUIRE 2.0 guidelines. Outcome variables were self-reported patient satisfaction regarding sleep, measured using a 30-item, ad hoc questionnaire and a 10-point visual analogue scale, completed by 318 oncohaematological inpatients (pre-intervention n = 120, post-intervention, n = 198) in a comprehensive cancer centre in Spain from 2017 to 2019. RESULTS Overall, 61.5% (n = 190) of the inpatients reported sleep alterations, and 92.6% reported interruptions in their nightly sleep. Half slept less than 6 h/night, but 58.0% said they felt rested upon waking, despite the interruptions. These outcomes were similar before and after the intervention. The improvement plan identified four domains for work (professionals, care procedures, instruments/environment and patients/relatives), 10 areas for improvement and 35 actions for implementation. However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. The intervention significantly improved variables related to professionals' behaviour, including noise during the shift change, conversations at the control desk and the use of corridor lights. Sleep disturbances were mainly caused by pain/discomfort and infuser alarms, and collectively they decreased significantly after the intervention (p = .008). However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. CONCLUSIONS Pain, clinical devices and noise made by professionals are the main causes of sleep disturbances. Involving professionals in decision-making to improve patients' sleep have a positive impact on noise levels. RELEVANCE TO CLINICAL PRACTICE This study proposes new strategies for improving sleep by increasing staff awareness and changing attitudes towards patients' sleep. Nurses should be involved in addressing sleep disturbances during hospitalization.
Collapse
Affiliation(s)
- Sandra Cabrera Jaime
- Nursing Research, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
- GRIN Group, IDIBELL, Institute of Biomedical Research, University of Barcelona, Nursing School, Campus of Health Sciences, Barcelona, Spain
| | - Cristina Martinez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Catalan Institute of Oncology (ICO), Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Nursing Departament, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
- Centre for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | | | - Nuria Zarza Arnau
- Nursing Department, Catalan Institute of Oncology-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Luis Martin Maldonado
- Nursing Department, Catalan Institute of Oncology-Hospital Germans Trias i Pujol, Badalona, Spain
| | | | | | - Noelia Tierno Sanchez
- Nursing Department, Catalan Institute of Oncology-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Joaquim Julià Torras
- Palliative Medicine Departament, Catalan Institute of Oncology-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Juan Manuel Sancho
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | | |
Collapse
|
11
|
Targeting Underlying Inflammation in Carcinoma Is Essential for the Resolution of Depressiveness. Cells 2023; 12:cells12050710. [PMID: 36899845 PMCID: PMC10000718 DOI: 10.3390/cells12050710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
In modern clinical practice and research on behavioral changes in patients with oncological problems, there are several one-sided approaches to these problems. Strategies for early detection of behavioral changes are considered, but they must take into account the specifics of the localization and phase in the course and treatment of somatic oncological disease. Behavioral changes, in particular, may correlate with systemic proinflammatory changes. In the up-to-date literature, there are a lot of useful pointers on the relationship between carcinoma and inflammation and between depression and inflammation. This review is intended to provide an overview of these similar underlying inflammatory disturbances in both oncological disease and depression. The specificities of acute and chronic inflammation are considered as a basis for causal current and future therapies. Modern therapeutic oncology protocols may also cause transient behavioral changes, so assessment of the quality, quantity, and duration of behavioral symptoms is necessary to prescribe adequate therapy. Conversely, antidepressant properties could be used to ameliorate inflammation. We will attempt to provide some impetus and present some unconventional potential treatment targets related to inflammation. It is certain that only an integrative oncology approach is justifiable in modern patient treatment.
Collapse
|
12
|
Cos H, Zárate Rodríguez JG, Srivastava R, Bewley A, Raper L, Li D, Dai R, Williams GA, Fields RC, Hawkins WG, Lu C, Sanford DE, Hammill CW. 4,300 steps per day prior to surgery are associated with improved outcomes after pancreatectomy. HPB (Oxford) 2023; 25:91-99. [PMID: 36272956 DOI: 10.1016/j.hpb.2022.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/04/2022] [Accepted: 09/28/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Decreased preoperative physical fitness and low physical activity have been associated with preoperative functional reserve and surgical complications. We sought to evaluate daily step count as a measure of physical activity and its relationship with post-pancreatectomy outcomes. METHODS Patients undergoing pancreatectomy were given a remote telemonitoring device to measure their preoperative levels of physical activity. Patient activity, demographics, and perioperative outcomes were collected and compared in univariate and multivariate logistic regression analysis. RESULTS 73 patients were included. 45 (61.6%) patients developed complications, with 17 (23.3%) of those patients developing severe complications. These patients walked 3437.8 (SD 1976.7) average daily steps, compared to 5918.8 (SD 2851.1) in patients without severe complications (p < 0.001). In logistic regression analysis, patients who walked less than 4274.5 steps had significantly higher odds of severe complications (OR = 7.5 (CI 2.1, 26.8), p = 0.002). CONCLUSION Average daily steps below 4274.5 before surgery are associated with severe complications after pancreatectomy. Preoperative physical activity levels may represent a modifiable target for prehabilitation protocols.
Collapse
Affiliation(s)
- Heidy Cos
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Jorge G Zárate Rodríguez
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Rohit Srivastava
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Alice Bewley
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Lacey Raper
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Dingwen Li
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Ruixuan Dai
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Chenyang Lu
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA.
| |
Collapse
|
13
|
Cheng H, Lin L, Wang S, Zhang Y, Liu T, Yuan Y, Chen Q, Tian L. Aromatherapy with single essential oils can significantly improve the sleep quality of cancer patients: a meta-analysis. BMC Complement Med Ther 2022; 22:187. [PMID: 35836211 PMCID: PMC9284915 DOI: 10.1186/s12906-022-03668-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the effect of aromatherapy on sleep quality in cancer patients. Methods Published literature on the effect of aromatherapy in cancer patients with sleep disorders in the form of randomized controlled trials (RCTs) were systematically retrieved and screened from PubMed, Cochrane Library, Embase, CBM, CNKI, VIP, and Wanfang databases from inception to November 2021. The methodological quality of the included studies was critically and independently evaluated by two reviewers using the Cochrane Risk of Bias Assessment Tool for RCTs. The correlated data were extracted using the pre-designed form, and all analyses were performed using Reviewer Manager version 5.4. Due to the difference in sleep quality instruments, the data extracted in this study were in the form of standard mean difference (SMD). Results Ten RCTs included 933 patients (experimental group: 474, control group: 459), and the risk of bias in the included studies was moderate. Aromatherapy could significantly improve the sleep quality of cancer patients [SMD = − 0.79, 95% CI (− 0.93, − 0.66), p < 0.01], especially those with breast cancer [SMD = − 0.98, 95% CI (− 1.57, − 0.40), p < 0.01]. Aromatherapy with single essential oil had a better effect on sleep quality [SMD = -0.94, 95%CI (− 1.25, − 0.62), p < 0.01], of which lavender essential oil had the best effect [SMD = -1.06,95%CI (− 1.49, − 0.63), p < 0.01] while compound essential oils had no effect on sleep quality improvement in cancer patients [SMD = -0.21, 95%CI (− 0.57, 0.14), p = 0.23]. Four of the ten RCTs reported the occurrence of adverse events, of which only one RCT indicated that patients had headache and sneezing while the remaining six did not. Conclusions This meta-analysis of 10 RCTs reveals that aromatherapy with single essential oil had a substantial effect on the sleep quality of cancer patients and should be recommended as a beneficial complementary therapy to promote sleep quality in cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03668-0.
Collapse
|
14
|
Strøm L, Danielsen JT, Amidi A, Cardenas Egusquiza AL, Wu LM, Zachariae R. Sleep During Oncological Treatment - A Systematic Review and Meta-Analysis of Associations With Treatment Response, Time to Progression and Survival. Front Neurosci 2022; 16:817837. [PMID: 35516799 PMCID: PMC9063131 DOI: 10.3389/fnins.2022.817837] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/02/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction Disrupted sleep and sleep-wake activity are frequently observed in cancer patients undergoing oncological treatment. These disruptions are often associated with aggravated symptom burden and diminished health-related quality of life that in turn may compromise treatment adherence and, thus, effectiveness. In addition, disrupted sleep has been linked to carcinogenic processes, which ultimately could result in worse prognostic outcomes. Aims Our aim was to systematically review and conduct a meta-analysis of studies examining the associations between sleep and sleep-wake activity and prognostic outcomes in cancer patients undergoing oncological treatment. Methods A comprehensive systematic search of English language papers was undertaken in June 2020 using PubMed, The Cochrane Library, and CINAHL. Two reviewers independently screened 4,879 abstracts. A total of 26 papers were included in the narrative review. Thirteen papers reporting hazard ratios reflecting associations between a dichotomized predictor variable (sleep) and prognostic outcomes were subjected to meta-analysis. Results Nineteen of the 26 eligible studies on a total of 7,092 cancer patients reported associations between poorer sleep and poorer response to treatment, shorter time to progression, and/or reduced overall survival, but were highly heterogeneous with respect to the sleep and outcome parameters investigated. Meta-analysis revealed statistically significant associations between poor self-reported sleep and reduced overall survival (HR = 1.33 [95% CI 1.09-1.62], k = 11), and shorter time to progression (HR = 1.40 [95% CI 1.23-1.59], k = 3) and between poor objectively assessed sleep and reduced overall survival (HR = 1.74 [95% CI 1.05-2.88], k = 4). Conclusion The current findings indicate that disturbed sleep during treatment may be a relevant behavioral marker of poor cancer prognosis. The limited number of studies, the common use of single item sleep measures, and potential publication bias highlight the need for further high quality and longitudinal studies.
Collapse
Affiliation(s)
- Louise Strøm
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Josefine T. Danielsen
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Ali Amidi
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Ana Lucia Cardenas Egusquiza
- Department of Psychology and Behavioral Sciences, Center for Autobiographical Memory Research, Aarhus University, Aarhus, Denmark
| | - Lisa Maria Wu
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
15
|
Amidi A, Buskbjerg CD, Damholdt MF, Dahlgaard J, Thorndike FP, Ritterband L, Zachariae R. Changes in sSleep following iInternet-dDelivered cCognitive-bBehavioral tTherapy for iInsomnia in Women tTreated for bBreast cCancer: A 3-year fFollow-up Assessment. Sleep Med 2022; 96:35-41. [DOI: 10.1016/j.sleep.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
|
16
|
Chavez MN, Tyson DM, Lake PW, Gutierrez A, Sherry P, Rigg KK, Marshall V, Henderson H, Rajasekhara S, Pabbathi S, Lubrano B. 'They say you can get addicted': Exploring factors that fuel the fear of addiction to prescription opioids among cancer survivors. Eur J Cancer Care (Engl) 2022; 31:e13582. [PMID: 35354227 DOI: 10.1111/ecc.13582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/21/2021] [Accepted: 03/02/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To explore misconceptions regarding addiction potential of prescription opioids among cancer survivors. METHODS A qualitative study using semi-structured interviews were conducted with a purposive sample of cancer survivors (N = 25) treated with prescription opioids for pain management. Interviews were audio recorded, transcribed and coded using Atlas.ti version 8. Inductive applied thematic analysis techniques were employed to identify emergent themes. RESULTS The majority of participants were breast cancer survivors (88%) who underwent a combination of surgery, chemotherapy and radiation (72%). Thematic analysis revealed that (1) cancer survivors view opioids as an illicit drug, (2) media narrative of the opioid epidemic increased negative perception of opioid use for cancer-related pain, (3) perceptions of opioids were also informed by experiences of friends and family with an opioid use disorder, (4) poor understanding of terminology resulted in misconceptions of opioid use and addiction and (5) fear of opioid addiction resulted in unrelieved cancer pain and poor quality of life. CONCLUSION Our findings support previously identified concerns among cancer patients about fear of addiction to opioids, a barrier to effective pain management. It highlights the importance for health care providers caring for cancer survivors to continue to address misconceptions about prescribed opioids.
Collapse
Affiliation(s)
- Melody N Chavez
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Paige W Lake
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Ana Gutierrez
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Khary K Rigg
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida, USA
| | - Victoria Marshall
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Heather Henderson
- Department of Anthropology, University of South Florida, Tampa, Florida, USA
| | | | | | | |
Collapse
|
17
|
Shapiro YN, Peppercorn JM, Yee AJ, Branagan AR, Raje NS, Donnell EKO. Lifestyle considerations in multiple myeloma. Blood Cancer J 2021; 11:172. [PMID: 34702799 PMCID: PMC8548591 DOI: 10.1038/s41408-021-00560-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
As the prognosis for multiple myeloma (MM) has significantly improved and patients remain on therapy longer, there is a need for supportive care interventions to optimize patient quality of life (QOL) and functional status over the course of cancer treatment. MM is characterized by a significant symptom burden and a relatively lower QOL compared to other cancers. This review evaluates the role of healthy lifestyle behaviors in improving both the physical functioning and psychological well-being of the MM population. We (1) describe the current literature on physical activity, weight management, diet, sleep, and substance use in the context of MM, (2) present important considerations for incorporating lifestyle factors into clinical practice, and (3) identify directions for future research. Developing MM-specific guidelines for modifiable lifestyle changes that take into account both the length of treatment and the unique disease features (i.e. osteolytic lesions and anemia) may provide a promising path for improved patient QOL and functioning.
Collapse
Affiliation(s)
| | - Jeffrey M Peppercorn
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrew J Yee
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrew R Branagan
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Noopur S Raje
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Elizabeth K O' Donnell
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
18
|
Mercadante S, Valle A, Cartoni C, Pizzuto M. Insomnia in patients with advanced lung cancer admitted to palliative care services. Int J Clin Pract 2021; 75:e14521. [PMID: 34120396 DOI: 10.1111/ijcp.14521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022] Open
Abstract
AIM To assess the prevalence of insomnia and possible associated factors in patients with advanced lung cancer admitted to different settings of palliative care. METHODS Secondary analysis of a consecutive sample of patients with advanced lung cancer receiving palliative care. Epidemiological and clinical data, treatments received in the last month, Karnofsky status, Edmonton Symptom Assessment System (ESAS), Athens Insomnia Scale and the Hospital Anxiety and Depression Scale (HADS), as well as concomitant medical treatment were recorded. RESULTS One-hundred-eight-two patients with advanced lung cancer were surveyed. The mean age was 69.9 years (SD 10.8), and 121 patients (66%) were men. The majority of patients showed consistent levels of insomnia. A poor Karnofsky level, pain, nausea, and drowsiness, time from diagnosis (1-3 years), HADS anxiety, and HADS depression, were positively associated with insomnia. CONCLUSIONS About 50% of patients with advanced lung cancer admitted to palliative care services had relevant insomnia. Several factors associated with insomnia have been identified and should prompt physicians for a careful examination and subsequent treatment.
Collapse
Affiliation(s)
| | | | - Claudio Cartoni
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Home Care Service of the Rome Section of the Italian Association Against Leukemias (Rome AIL), Rome, Italy
| | - Massimo Pizzuto
- Palliative Care Unit, Istituti Clinici di Perfezionamento Hospital, Milan, Italy
| |
Collapse
|
19
|
Relationship of Circadian Rhythm and Psychological Health in Adolescents and Young Adults With Cancer. Cancer Nurs 2021; 44:E659-E669. [PMID: 34387235 DOI: 10.1097/ncc.0000000000000971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence shows that adolescent and young adult (AYA) cancer patients have an increasing survival rate but experience psychological distress and circadian rhythm dysregulation. Little is known about the effect of circadian rhythm on psychological distress. OBJECTIVE To investigate the type of circadian rhythm in Chinese AYA cancer survivors and examine the associations among chronotype, demographic characteristics, psychological distress, anxiety and depression, character strengths, and medical coping in this group. METHODS This cross-sectional study enrolled 800 AYA cancer participants, 728 of whom completed the Chinese version of the Morningness-Eveningness Questionnaire, the Distress Thermometer, the Hospital Anxiety and Depression Scale, the Three-Dimensional Inventory of Character Strengths, and the Medical Coping Modes Questionnaire. RESULTS Evening- and morning-type participants accounted for 35.0% and 19.1%, respectively, among participants, which was significantly higher than those found in the general population. The prevalence of psychological distress was 84.9% among AYA cancer participants. Exercise, Distress Thermometer, and depression were important predictive factors for the circadian rhythm. CONCLUSIONS Circadian rhythm disorder and psychological distress were common among AYA cancer survivors. Evening-type participants performed worse on character strength, confrontation, and avoidance of medical coping. IMPLICATIONS FOR PRACTICE Healthcare professionals need to understand the circadian rhythm and psychological health of AYA cancer survivors. Psychological rehabilitation guidance, especially within the 6 months after diagnosis, may benefit AYA survivors according to their chronotype. Character strengths can also be used during rehabilitation to properly guide AYA survivors.
Collapse
|
20
|
Strik H, Cassel W, Teepker M, Schulte T, Riera-Knorrenschild J, Koehler U, Seifart U. Why Do Our Cancer Patients Sleep So Badly? Sleep Disorders in Cancer Patients: A Frequent Symptom with Multiple Causes. Oncol Res Treat 2021; 44:469-475. [PMID: 34350870 DOI: 10.1159/000518108] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION On the one hand, sleep disorders in cancer patients are reported in 30-50% of cancer patients. On the other hand, specific causes for these sleep disorders are little known. This study was done to evaluate factors which may affect sleep of cancer patients. To our knowledge, this is the first study which includes return to work as one factor of sleep disturbance. METHODS 107 patients with various types of cancer treated in 2 hospitals were interviewed with a battery of questionnaires after having given informed consent. The questionnaires intended to detect abnormalities of sleep and related pain, breathing disorders, restless legs syndrome, depression, rumination, medication, and psychosocial distress. The study was approved by the ethics committee of the University of Marburg. RESULTS The analysis of the 6 sleep-related questionnaires indicated a sleep disorder of any kind in 68% of all patients. Insomnia symptoms were present in 48 patients (44.9%). Pain, depression, anxiety, and worries about the workplace were significantly related to sleep disorders. CONCLUSION Sleep disorders are common in cancer patients. The causes are manifold and should be considered by caregivers during diagnosis, therapy, and aftercare of cancer patients. Tumour patients should actively be asked about sleep disorders. If these are present, they should be addressed, and as they have a large impact on quality of life, treatment options should be offered in cooperation with sleep specialists.
Collapse
Affiliation(s)
- Herwig Strik
- Department of Neurology, Philipps-University, Marburg, Germany.,Department of Neurology, Klinikum, Sozialstiftung Bamberg, Bamberg, Germany
| | - Werner Cassel
- Department of Internal Medicine, Pulmonology, Intensive Care and Sleep Medicine, Philipps-University, Marburg, Germany
| | - Michael Teepker
- Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Thomas Schulte
- Fachklinik onkologische Rehabilitation, Bad Oexen, Bad Oeynhausen, Germany
| | | | - Ulrich Koehler
- Department of Internal Medicine, Pulmonology, Intensive Care and Sleep Medicine, Philipps-University, Marburg, Germany
| | - Ulf Seifart
- Sonnenblick Hospital, Deutsche Rentenversicherung Hessen, Marburg, Germany
| |
Collapse
|
21
|
The effect of melatonin on sleep quality and insomnia in patients with cancer: a systematic review study. Sleep Med 2021; 82:96-103. [PMID: 33910162 DOI: 10.1016/j.sleep.2021.03.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Considering the importance of sleep in the treatment success and quality of life in patients with cancer, it is necessary to seek effective solutions to improve their sleep quality. In this regard, a comprehensive review of the effect of melatonin on sleep can be very useful to provide an evidence-based clinical guide. Therefore, the aim of the present systematic review was to investigate effect of melatonin on sleep quality and insomnia in patients with cancer. METHODS The present systematic review was conducted in 2021. To find evidence related to the study objective, Iranian databases (SID, Magiran) and international databases (Google scholar, Web of Science, ProQuest, Medline via PubMed, Scopus) were searched using specified keywords (Melatonin, Sleep, insomnia, Cancer, Neoplasms, Carcinomas, Tumor, Carcinomatosis, Carcinomatoses, Sarcomas) from the beginning of the establishment of the mentioned databases until 31st December of 2020. After primary and secondary screening, and selection of studies according to inclusion and exclusion criteria, information obtained from studies were extracted in a checklist with items such as author (year), study design, sample size, age, melatonin dose, duration of intervention, results, and conclusion. RESULTS From 295 articles found, finally six relevant studies entered the review process. The intervention used in the studies included oral melatonin administration. The minimum and maximum dose of melatonin was 3 mg and 20 mg, respectively, which was taken by patients for 10 days and to four months, usually every night before bedtime in studies. The results of the review showed that melatonin had a significant effect on sleep quality and insomnia in four studies. However, two studies showed no significant improvement on sleep quality after the intervention and melatonin administration, although melatonin had significant effect on increasing sleep efficiency in the short term. CONCLUSIONS The present review study showed that melatonin may be effective in improving sleep quality and insomnia in patients with cancer. It is suggested to carry out further extensive and detailed studies to achieve the most effective and safest method of melatonin administration in terms of dose and duration of use in order to improve sleep quality among patients with cancer.
Collapse
|
22
|
Suh HW, Jeong HY, Hong S, Kim JW, Yoon SW, Lee JY, Chung SY. The mindfulness-based stress reduction program for improving sleep quality in cancer survivors: A systematic review and meta-analysis. Complement Ther Med 2021; 57:102667. [PMID: 33460741 DOI: 10.1016/j.ctim.2021.102667] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION This study aims to evaluate the efficacy and effectiveness of a mindfulness-based stress reduction (MBSR) program in improving sleep in cancer survivors. METHODS Four electronic databases (Cochrane Library, EMBASE, PubMed, and PsycARTICLES) were searched for randomized controlled trials evaluating the effects of MBSR on the sleep of cancer survivors from their inception to May 2020. The primary outcome was sleep quality measured by validated questionnaires such as the Insomnia Severity Index and Pittsburgh Sleep Quality Index. The secondary outcomes were sleep parameters obtained from a sleep diary, polysomnography, and actigraphy. The included studies were critically appraised by the Cochrane risk of bias tool and meta-analyzed. RESULTS Ten studies were included, and nine studies were analyzed quantitatively. MBSR significantly improved sleep quality compared to usual care (standardized mean difference -0.29, 95 % confidence interval -0.55 to -0.04, I2 = 58 %). However, there were no favorable results with sleep parameters. Compared to active controls, MBSR presented mixed results with sleep quality according to the outcomes and negative results with sleep parameters. CONCLUSION This review suggests that MBSR helps cancer survivors improve sleep quality. Our results support the possibility of using MBSR for cancer survivors. However, its efficacy and effectiveness in improving sleep quality and sleep parameters are inconclusive because the number of included studies was few with inconsistent results. Further studies with high methodological quality are required to establish conclusive evidence about the efficacy and effectiveness of MBSR in improving sleep quality and sleep parameters in cancer survivors.
Collapse
Affiliation(s)
- Hyo-Weon Suh
- College of Korean Medicine, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Ha Yeong Jeong
- Department of Physiology, College of Korean Medicine, Gachon University, Seongnam-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 13120, Republic of Korea.
| | - Sunggyu Hong
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Jong Woo Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul, 02447, Republic of Korea; Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Dongnam-ro 892, Gangdong-gu, Seoul, 05278, Republic of Korea.
| | - Seong Woo Yoon
- Department of Internal Medicine, Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Dongnam-ro 892, Gangdong-gu, Seoul, 05278, Republic of Korea.
| | - Jee Young Lee
- Department of Internal Medicine, Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Dongnam-ro 892, Gangdong-gu, Seoul, 05278, Republic of Korea.
| | - Sun-Yong Chung
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul, 02447, Republic of Korea; Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Dongnam-ro 892, Gangdong-gu, Seoul, 05278, Republic of Korea.
| |
Collapse
|
23
|
Wang J, Zhou BY, Lian CL, Zhou P, Lin HJ, Wu SG. Evaluation of Subjective Sleep Disturbances in Cancer Patients: A Cross-Sectional Study in a Radiotherapy Department. Front Psychiatry 2021; 12:648896. [PMID: 33868056 PMCID: PMC8044927 DOI: 10.3389/fpsyt.2021.648896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/25/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The factors associated with sleep disturbances in cancer patients remains unclear. This study aimed to explore the prevalence of sleep disorders and predictors associated with sleep disturbance in cancer patients from a radiotherapy department. Methods: Patients with cancers were recruited before the start of radiotherapy from our institution between January 2019 and February 2020. Pittsburgh Sleep Quality Index (PSQI) scale was used to assess sleep quality. Descriptive statistics, Chi-square test, and multivariate logistic regression analysis were used to conduct statistical analysis. Results: A total of 330 eligible patients were included. Of them, 38.3% (n = 127) had the globe PSQI score >7, indicating that they suffered from sleep disorders. Patients with lung cancer (45.2%) were more likely to suffer from sleep disturbance, followed by cervical cancer (43.8%), nasopharyngeal carcinoma (41.7%), esophageal cancer (41.5%), breast cancer (37.7%), and colorectal cancer (30%). With regard to the PSQI components, the mean sleep duration was 8 h, 20.3% (n = 67) of them reported poor subjective sleep quality, 6.1% (n = 20) needed medication to improve sleep, and 53.6% (n = 177) suffered daytime dysfunction. Multivariate logistic regression models showed body mass index (BMI) ≥ 20 kg/m2 [odds ratio (OR) 0.599, 95% confidence interval (CI) 0.329-0.948, P = 0.031] and the receipt of surgery (OR 0.507, 95% CI 0.258-0.996, P = 0.048) were the significant favorable predictors for sleep disturbance, while age, gender, marital status, education level, comorbidity, metastasis status, diagnostic status, and cancer type were not significantly associated with sleep disturbance. Conclusions: Approximately 40% of the cancer patients suffer from sleep disturbance before the start of radiotherapy. Patients with BMI ≥ 20 kg/m2 and receiving surgery are less likely to develop sleep disturbance in comparison with others.
Collapse
Affiliation(s)
- Jun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Bei-Yun Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Chen-Lu Lian
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ping Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Hui-Juan Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - San-Gang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| |
Collapse
|
24
|
Low SLK, Cheema BS, Tan HY, Birling Y, Zhu X. The Feasibility and Effects of Qigong Intervention (Mind-Body Exercise) in Cancer Patients With Insomnia: A Pilot Qualitative Study. Integr Cancer Ther 2020. [PMCID: PMC7716076 DOI: 10.1177/1534735420977671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Up to 80% of cancer patients experience insomnia that significantly affects their quality of life. This pilot qualitative study investigated the feasibility and effects of a 3-week Qigong (mind-body exercise) intervention with a 1-week follow-up in cancer patients experiencing insomnia. Methods: Cancer patients with insomnia who had completed radiotherapy or chemotherapy treatment and/or were at least 8 weeks post-cancer-related surgery were recruited. Primary outcomes were feasibility outcomes, which included recruitment, retention, attendance, completion of assessment, adverse events and participant feedback via a questionnaire and focus group/individual interview. Secondary outcomes on insomnia severity and sleep quality were measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) at baseline, mid, post-intervention and follow-up. Results: Seven participants were recruited and two withdrew from the study. The participant retention rate was 71.4% with an overall attendance rate of more than 84% and participants were able to complete all required assessments. An adverse event relating to the worsening of existing musculoskeletal condition was reported. Qualitative analysis of participant feedback identified 4 emerging themes: (1) experience from Qigong intervention; (2) class preferences; (3) barriers to participation; and (4) recommendation for improvement. Participants reported increased relaxation, improved sleep and energy level, better upper body flexibility and reduced stress. Both ISI and PSQI scores improved significantly (P < .05). Conclusion: This study demonstrated that it is feasible to employ the current clinical trial design using Qigong intervention on insomnia in cancer patients. Preliminary data suggest that the intervention may improve sleep outcomes, however, these findings need to be confirmed by future robust randomized controlled trials. Trial registration: The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001670268) http://www.ANZCTR.org.au/ACTRN12618001670268.aspxon10October2018.
Collapse
Affiliation(s)
- Sara L. K. Low
- School of Health Science, Western Sydney University, NSW, Australia
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
| | - Birinder S. Cheema
- School of Health Science, Western Sydney University, NSW, Australia
- NICM Health Research Institute, Western Sydney University, NSW, Australia
| | - Hsiewe Ying Tan
- School of Health Science, Western Sydney University, NSW, Australia
| | - Yoann Birling
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
- NICM Health Research Institute, Western Sydney University, NSW, Australia
| | - Xiaoshu Zhu
- School of Health Science, Western Sydney University, NSW, Australia
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
- NICM Health Research Institute, Western Sydney University, NSW, Australia
| |
Collapse
|
25
|
Associated factors of distress in patients with advanced cancer: A retrospective study. Palliat Support Care 2020; 19:447-456. [PMID: 33222720 DOI: 10.1017/s1478951520001066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study was to assess the psychosocial distress and associated factors in advanced cancer patients consulting at the outpatient Palliative Care Unit at the National Cancer Institute in Mexico City. DESIGN A retrospective study was conducted using electronic records (June 2015 to December 2016). SAMPLE A total of 646 patients with advanced cancer during their first visit to the outpatient palliative care unit at the National Cancer Institute in Mexico were evaluated using the Distress Thermometer (DT) and ECOG performance status scores. FINDINGS Overall, 62% were women, with a median age of 57 years, and married (54.8%). The most frequent diagnosis was gastrointestinal cancer (28.6%), and 38.9% had a functional performance status of ECOG 2. The median DT score was 4.0 (IQR = 2-6), with 56% reporting DT scores ≥4. The three most frequent problems ≥4 were sadness (82.6%), feeling weak (81.2%), worry (79.6%), and <4 were feeling weak (57.7%), fatigue (55.6%), and financial security (52.1%). The variables associated with distress according to the multiple logistic regression analysis were problems with housing (OR = 2.661, 95% CI = 1.538-4.602), sadness (OR = 2.533, 95% CI = 1.615-3.973), transportation (OR = 1.732, 95% CI = 1.157-2.591), eating (OR = 1.626, 95% CI = 1.093-2.417), nervousness (OR = 1.547, 95% CI = 1.014-2.360), and sleep (OR = 1.469, 95% CI = 1.980-2.203). CONCLUSION The principal factors were related to distress levels, housing problems, transportation issues, and emotional problems such as sadness, nervousness, lower functionality, and younger age. Therefore, psychosocial support is of considerable relevance in palliative care. These findings will help clinicians understand the distress of patients with advanced cancer in palliative care in Latin American countries.
Collapse
|
26
|
Hirschey R, Nyrop KA, Mayer DK. Healthy Behaviors: Prevalence of Uptake Among Cancer Survivors. Clin J Oncol Nurs 2020; 24:19-29. [PMID: 32945809 DOI: 10.1188/20.cjon.s2.19-29] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most cancer survivors adhere to recommendations to refrain from tobacco and minimize alcohol use, survivors of certain cancers are not meeting these recommendations. In addition, most cancer survivors do not achieve optimal recommendations for diet and physical activity, further decreasing survivor health and quality of life. Sun protective and sleep behaviors also tend to be suboptimal among survivors. Uptake of age-appropriate vaccinations is variable among survivors. OBJECTIVES The purpose of this article is to review the prevalence of healthy behavior uptake among cancer survivors and provide nurses with an overview of effective interventions, strategies, and resources to help patients improve these behaviors. METHODS An expert panel was convened to conduct an integrative review and synthesis on the state of the science of healthy behavior uptake among cancer survivors. FINDINGS Not meeting recommendations for healthy lifestyle behaviors increases the risk of second cancers and mortality and decreases overall health and quality of life. Healthy lifestyle behaviors can contribute to improved function, quality of life, and overall survival for cancer survivors. Nurses can help survivors to understand and improve their behaviors.
Collapse
|
27
|
Luo H, Galvão DA, Newton RU, Fairman CM, Taaffe DR. Sport Medicine in the Prevention and Management of Cancer. Integr Cancer Ther 2020; 18:1534735419894063. [PMID: 31838880 PMCID: PMC6913064 DOI: 10.1177/1534735419894063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Physical inactivity is a major concern in cancer patients despite the established preventative and therapeutic effects of regular physical exercise for this patient group. Sport not only plays an important role in supporting the development and maintenance of a physically active lifestyle but also is increasingly used as a health promotion activity in various populations. Nevertheless, the potential of sport as an effective strategy in the prevention and management of cancer has gained little attention. Based on the scant evidence to date, participation of cancer patients in supervised, well-tailored sport programs appears to be safe and feasible and is associated with an array of physical and psychological benefits. We propose that sport participation may serve as an alternative strategy in the prevention of cancer and sport medicine in the management of cancer. As with the traditional exercise modes, benefits derived from sport participation will be dependent on the sport undertaken and the physical/physiological, motor, and cognitive demands required. To this end, further work is required to develop a solid evidence base in this field so that targeted sport participation can be recommended for cancer patients.
Collapse
Affiliation(s)
- Hao Luo
- Guangdong Vocational Institute of Sport, Guangzhou, Guangdong, China.,Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel A Galvão
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U Newton
- Edith Cowan University, Joondalup, Western Australia, Australia.,University of Queensland, Brisbane, Queensland, Australia.,The University of Hong Kong, Hong Kong
| | | | - Dennis R Taaffe
- Edith Cowan University, Joondalup, Western Australia, Australia.,University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
28
|
Youn S, Kim C, Lee J, Yeo S, Suh S, Chung S. Development of Dysfunctional Beliefs and Attitude about Sleep Scale for Cancer Patients. Behav Sleep Med 2020; 18:287-297. [PMID: 30789064 DOI: 10.1080/15402002.2019.1578773] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Study objectives: This study aimed to develop a scale utilizing the original Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale that measured maladaptive cognitions associated with sleep that is especially sensitive to cancer patients. In addition to the original scale, we added two additional items that reflected cancer-specific dysfunctional beliefs about sleep. Methods: Participants consisted of 337 cancer patients (mean age 54.0 ± 11.8 years, 32.0% men). All participants completed the DBAS-16, two cancer specific items, and the Insomnia Severity Index. Item-to-total-score correlations, internal consistency, item selection, and factor structure were examined. Results: The DBAS-16 was found to be reliable, and internal consistency was also adequate when adding two cancer-specific questions (Cronbach's alpha = 0.89). A total of 14 items were selected, and a four-factor model was selected using exploratory factor analysis (Tucker-Lewis index = 0.86, root mean square error of approximation = 0.08). The four factors were (a) sleep expectations, (b) worry about insomnia, (c) perceived consequences of insomnia and medication, and (d) two cancer-related items. The modified 14 items of the Cancer-related DBAS (C-DBAS-14) well differentiated cancer patients with and without insomnia. Conclusions: The C-DBAS-14 is a promising measure that has adequate internal consistency. It is also sensitive to sleep-related cognitions in cancer patients and can discriminate patients with cancer who are experiencing insomnia from those who are good sleepers. The enhanced utility of the shortened 14-item scale tailored specifically to cancer patients may be useful in both clinical practice and research settings.Abbreviations: CBT: cognitive behavioral therapy; C-DBAS-14: Cancer-Related Dysfunctional Beliefs and Attitude about Sleep; C-DBS: Cancer-Related Dysfunctional Beliefs about Sleep; DBAS-16: Dysfunctional Beliefs and Attitudes about Sleep; ISI: Insomnia Severity Index.
Collapse
Affiliation(s)
- Soyoung Youn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Changnam Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joohee Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungook Yeo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Kirsch JL, Robinson ME, McCrae CS, Kacel EL, Wong SS, Patidar S, Sannes TS, Garey S, Castagno JC, Pereira DB. Associations Among Sleep Latency, Subjective Pain, and Thermal Pain Sensitivity in Gynecologic Cancer. PAIN MEDICINE 2020; 21:5-12. [PMID: 30481329 DOI: 10.1093/pm/pny236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pain is common among women with gynecologic cancer and contributes to depressed mood, sleep disturbances, and likelihood of future chronic pain. Little is known about how psychosocial factors are associated with central sensitization of pain in gynecologic cancer. This study examined relations among depressive symptoms, sleep, subjective pain, and aftersensation pain (a proxy for central sensitization of pain) in gynecologic cancer. METHODS Participants were 42 women (mean age [SD] = 59.60 [10.11] years) enrolled in a randomized clinical trial examining psychological intervention effects on sleep, pain, mood, and stress hormones/cytokines in gynecologic cancer. Six to eight weeks after surgery, participants completed an assessment of depressive symptoms, sleep, and subjective pain and a temporal summation of pain protocol via quantitative sensory testing (QST). RESULTS Controlling for recent chemotherapy, history of chronic pain, and analgesic medication use, regression analyses revealed that longer sleep onset latency (SOL; B = 3.112, P = 0.039, bias-corrected and accelerated (BCa) 95% confidence interval [CI] = 0.371 to 6.014) and greater sensory pain (B = 0.695, P = 0.023, BCa 95% CI = 0.085 to 1.210) were associated with greater aftersensation pain at 15 seconds. Greater sensory pain scores were associated with greater aftersensation pain at 30 seconds (B = 0.286, P = 0.045, BCa 95% CI = 0.008 to 0.513). Depression was not associated with aftersensation pain. The overall models accounted for 44.5% and 40.4% of the variance in aftersensation pain at 15 and 30 seconds, respectively. Conclusions. Longer SOL and higher subjective sensory pain were related to greater aftersensation of experimentally induced pain in women postsurgery for gynecologic cancers. Interventions that improve sleep and subjective sensory pain during the perisurgical period may reduce risk for central sensitization of pain.
Collapse
Affiliation(s)
- Janae L Kirsch
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
| | - Michael E Robinson
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
| | | | - Elizabeth L Kacel
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
| | - Shan S Wong
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Seema Patidar
- Department of Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Timothy S Sannes
- Division of Hematology, University of Colorado-Denver Anschutz Medical Campus, Aurora, Colorado
| | | | - Jacqueline C Castagno
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
| | - Deidre B Pereira
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida
| |
Collapse
|
30
|
Anuk D, Özkan M, Kizir A, Özkan S. The characteristics and risk factors for common psychiatric disorders in patients with cancer seeking help for mental health. BMC Psychiatry 2019; 19:269. [PMID: 31481035 PMCID: PMC6724340 DOI: 10.1186/s12888-019-2251-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the adverse effects of cancer diagnoses and treatments on mental health are known, about less than 10% of patients are estimated to be referred to seek help. The primary purpose of this study was to obtain the baseline information on patients with cancer seeking help for mental health who presented for the first time to the psycho-oncology outpatient clinic, and to identify risk factors that may provide clues healthcare practitioners in recognizing those needing psychological help in oncology practice. METHODS We reviewed the charts of 566 patients with cancer who were referred to the psycho-oncology outpatient clinic over a two-year period. The study includes the socio-demographic data, illness characteristics, psychiatric characteristics, psychiatric diagnoses, and treatment recommendations for these patients. RESULTS The incidence of diagnoses of psychiatric disorders was 97.5%. The distributions of psychiatric diagnoses were as follows: any kind of adjustment disorders, mood disorders, anxiety disorders, organic brain syndrome, personality disorders, delusional disorder, and insomnia. Recurrence of cancer, other chronic medical illnesses, a history of psychiatric disorders, poor social support, and low income comprised the common significant risk factors for adjustment disorders, mood disorders, and anxiety disorders. These risk factors were also seen to be significant in the regression analysis in terms of sex. CONCLUSION This study identifies the distribution of psychiatric disorders, the risk factors for specific psychiatric disorders, and draws attention to the fact that there are serious delays in patients seeking psychiatric help and in the referrals of oncologists for psychological assessment. Identifying risk factors and raising oncologists' awareness toward risk factors could help more patients gain access to mental health care much earlier.
Collapse
Affiliation(s)
- Dilek Anuk
- Department of Consultation Liaison Psychiatry, Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Mine Özkan
- 0000 0001 2166 6619grid.9601.eDepartment of Consultation Liaison Psychiatry, Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390 Istanbul, Turkey
| | - Ahmet Kizir
- 0000 0001 2166 6619grid.9601.eDepartment of Radiation Oncology, Institute of Oncology, Istanbul University, 34390 Istanbul, Capa Turkey
| | - Sedat Özkan
- 0000 0001 2166 6619grid.9601.eDepartment of Consultation Liaison Psychiatry, Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390 Istanbul, Turkey
| |
Collapse
|
31
|
Chandra S, Gupta V, Chandra H, Dhyani M, Kotwal A, Verma SK, Gupta R. Serum Interleukin-6 is Not Linked with Sleep-Quality, Restless Legs Syndrome, and Depression, But with 6-Month Survival in Hematological Malignancies. J Neurosci Rural Pract 2019; 10:94-100. [PMID: 30765978 PMCID: PMC6338000 DOI: 10.4103/jnrp.jnrp_159_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Serum interleukin (IL)-6 has been found to be associated with sleep quality, mood, and survival in patients with solid tumors. Results in these studies were confounded by knowledge of diagnosis to study subjects. Moreover, such data among subjects with hematological malignancies and data regarding restless legs syndrome is limited. The present study was, therefore, conducted to assess the sleep quality, depression, and restless leg syndrome in hematological malignancies and to study if there is any role of IL6 associated with it. Methods: Sixty-six subjects having hematological malignancy were included in this study after excluding the potential confounders. Sleep quality was examined using Pittsburg Sleep Quality Index, depression by the Patient Health Questionnaire-9. Diagnosis of RLS was made through clinical examination. Serum for measurement of IL-6 was collected at baseline and after 1 month of initiation of chemotherapy. Patients were followed up for 6 months. Results: Average age of study subjects was 50.16 years with male predominance. Nearly 22.7% had clinical depression, 28.8% had poor quality sleep, and restless legs syndrome (RLS) was reported in 6.1% cases. Nearly 22.7% patients died at 6 months. Disturbed sleep at baseline was associated with depression (odds ratio [OR] =7.89) and poor 6 months survival. Serum IL-6 did not show any association with sleep quality, restless-legs-syndrome, and depression. However, baseline high level of serum IL-6 (OR = 26.06) and low level after chemotherapy (OR = 0.03) were associated with poor survival at 6 months. Conclusion: Poor quality sleep, depression, and RLS are prevalent among adult subjects with hematological malignancies. Sleep disturbance, high pretreatment inflammatory and lowering of inflammatory load after chemotherapy increase likelihood for poor prognosis. Serum IL-6 did not show any association with sleep quality, restless legs syndrome and depression.
Collapse
Affiliation(s)
- Smita Chandra
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Vibha Gupta
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Harish Chandra
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Mohan Dhyani
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Aarti Kotwal
- Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Sanjiv Kumar Verma
- Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Ravi Gupta
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| |
Collapse
|
32
|
Roberts AL, Potts HW, Koutoukidis DA, Smith L, Fisher A. Breast, Prostate, and Colorectal Cancer Survivors' Experiences of Using Publicly Available Physical Activity Mobile Apps: Qualitative Study. JMIR Mhealth Uhealth 2019; 7:e10918. [PMID: 30609982 PMCID: PMC6329432 DOI: 10.2196/10918] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/30/2018] [Accepted: 09/10/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Physical activity (PA) can improve a range of outcomes following a cancer diagnosis. These include an improvement in experience of side effects of treatment (eg, fatigue) and management of comorbid conditions. PA might also increase survival and reduce recurrence. Digital interventions have shown potential for PA promotion among cancer survivors, but most in a previous review were Web-based, and few studies used mobile apps. There are many PA apps available for general public use, but it is unclear whether these are suitable as a PA intervention after a cancer diagnosis. OBJECTIVE This study sought posttreatment nonmetastatic breast, prostate, and colorectal cancer survivors' opinions of using smartphone apps to promote PA and gathered their views on existing publicly available PA apps to inform a future intervention. METHODS Each participant was randomly assigned to download 2 of 4 apps (Human, The Walk, The Johnson & Johnson Official 7 Minute Workout, and Gorilla Workout). Participants used each app for 1 week consecutively. In-depth semistructured telephone interviews were then conducted to understand participants' experiences of using the apps and how app-based PA interventions could be developed for cancer survivors. The interviews were analyzed using thematic analysis. RESULTS Thirty-two participants took part: 50% (16/32) had prostate cancer, 25% (8/32) had breast cancer, and 25% (8/32) had colorectal cancer. Three core themes were identified. The first theme was that multiple factors affect engagement with PA apps and this is highly personalized. Factors affecting engagement included participants' perceptions of (1) the advantages and disadvantages of using apps to support PA, (2) the relevance of the app to the user (eg, in terms of cancer-related factors, their PA goals, the difficulty level of the app, the way in which they interact with their mobile phone, and the extent to which the app fits with their self-identity), (3) the quality of the app (eg, usability, accuracy, quality of production, and scientific evidence-base), and (4) the behavior change techniques used to promote PA. In the second theme, participants recommended that apps that promote walking are most appealing, as walking removes many barriers to PA. Finally, the participants suggested that PA apps should be integrated into cancer care, as they valued guidance and recommendations from health care professionals. CONCLUSIONS This sample of breast, prostate, and colorectal cancer survivors was receptive to the use of apps to promote PA. Although no publicly available PA app was deemed wholly suitable, many suggestions for adaptation and intervention development were provided. The results can inform the development of an app-based PA intervention for cancer survivors. They also highlight the wide-ranging and dynamic influences on engagement with digital interventions, which can be applied to other evaluations of mobile health products in other health conditions and other health behaviors.
Collapse
Affiliation(s)
- Anna L Roberts
- Research Department of Behavioural Science & Health, University College London, London, United Kingdom
| | - Henry Ww Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Abigail Fisher
- Research Department of Behavioural Science & Health, University College London, London, United Kingdom
| |
Collapse
|
33
|
Boinon D, Journiac J, Charles C, Fasse L, Savard J, Dauchy S. La prise en charge non médicamenteuse de l’insomnie chez les patients atteints de cancer : état des connaissances selon l’approche cognitivo-comportementale et émotionnelle. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
34
|
Eriksen WT, Singerman L, Romero SAD, Bussell J, Barg FK, Mao JJ. Understanding the Use of Acupuncture for Insomnia Among Cancer Survivors: A Qualitative Study. J Altern Complement Med 2018; 24:962-967. [PMID: 30247951 DOI: 10.1089/acm.2018.0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To understand cancer survivors' perceptions regarding the use of acupuncture for the treatment of cancer-related insomnia. DESIGN Semistructured interviews with cancer survivors participating in a randomized controlled trial comparing the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) and acupuncture for the treatment of insomnia. Interviews were conducted before randomization into either treatment option, and structured to elicit participants' experiences with insomnia as well as their beliefs and understanding surrounding acupuncture for the treatment of insomnia. An integrated approach was used for data analysis. SUBJECTS Sixty-three cancer survivors with DSM-V diagnosed insomnia. RESULTS Participants shared a broad lack of understanding regarding acupuncture for the treatment of insomnia. Specifically, individuals in this study expressed confusion surrounding what symptoms or medical conditions acupuncture could be used to treat, how acupuncture works, and how long the effects of acupuncture last. CONCLUSIONS This study identified three specific gaps in knowledge, including treatment target, mechanism, and durability, surrounding the use of acupuncture for insomnia in cancer survivors. Addressing these gaps by providing appropriate and timely education surrounding the use of acupuncture to treat insomnia is essential to increase the evidence-informed utilization of acupuncture and to better meet patients' needs among cancer survivors.
Collapse
Affiliation(s)
- Whitney T Eriksen
- 1 Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | | | | | - Jason Bussell
- 3 Memorial Sloan Kettering Cancer Center , New York, New York
| | - Frances K Barg
- 1 Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Jun J Mao
- 3 Memorial Sloan Kettering Cancer Center , New York, New York
| |
Collapse
|
35
|
Lillis TA, Gerhart J, Bouchard LC, Cvengros J, O'Mahony S, Kopkash K, Kabaker KB, Burns J. Sleep Disturbance Mediates the Association of Post-Traumatic Stress Disorder Symptoms and Pain in Patients With Cancer. Am J Hosp Palliat Care 2017; 35:788-793. [PMID: 29084448 DOI: 10.1177/1049909117739299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sleep disturbance is a common complaint of patients with cancer and is well established in both pain conditions and post-traumatic stress disorder (PTSD). An estimated one-third of patients with cancer develop symptoms of PTSD at some point in their treatment. However, few studies have evaluated the contributions of PTSD and sleep disturbance to pain processes in cancer populations. The current study used mediation models to test the hypothesis that sleep disturbance would mediate the relationships between PTSD symptoms and pain intensity and PTSD symptoms and pain interference in a sample of patients with cancer. METHODS A cross-sectional, retrospective chart review was conducted of the electronic medical records of 85 adult patients with cancer (89.4% female; 59% white; 42% metastatic) who sought individual psychosocial support services at our institution. RESULTS Post-traumatic stress disorder symptoms, sleep disturbance, pain intensity, and pain interference were all positively correlated ( P < .01). Clinical levels of PTSD symptoms were reported by 30% to 60% of the sample. Even after controlling for metastatic disease, race, and cancer type, sleep disturbance mediated the relationships between PTSD symptoms and pain intensity ( B = 0.27; 95% CI: 0.10-0.44) and PTSD symptoms and pain-related interference ( B = 0.58; 95% CI: 0.28-0.87). CONCLUSIONS The relationships among PTSD symptoms, pain intensity, and pain interference could be explained by co-occurring sleep disturbance. Given the high frequency of PTSD symptoms among patients with cancer and PTSD's known links to sleep problems and pain, clinicians should be attentive to the role that traumatogenic processes may play in eliciting sleep and pain-related complaints among patients with cancer.
Collapse
Affiliation(s)
- Teresa A Lillis
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - James Gerhart
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Laura C Bouchard
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jamie Cvengros
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sean O'Mahony
- 2 Palliative Medicine Section, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Katherine Kopkash
- 3 Department of General Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - John Burns
- 1 Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
36
|
Kudubeş AA, Bektas M, Bektas İ, Selekoglu Y, Sal Altan S, Ayar D. The effect of symptom frequency on the fatigue and sleep quality of adolescent cancer patients. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2016.1227936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Aslı A. Kudubeş
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Murat Bektas
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - İlknur Bektas
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Yasemin Selekoglu
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Sema Sal Altan
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Dijle Ayar
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
37
|
González-Fernández S, Fernández-Rodríguez C, Mota-Alonso MJ, García-Teijido P, Pedrosa I, Pérez-Álvarez M. Emotional state and psychological flexibility in breast cancer survivors. Eur J Oncol Nurs 2017; 30:75-83. [PMID: 29031317 DOI: 10.1016/j.ejon.2017.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 08/04/2017] [Accepted: 08/18/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE This study analyses the premise that less time spent carrying out valuable activities and inflexible avoidance of thoughts, feelings and memories related to the oncological process may play an important role in the emotional problems of cancer survivors. METHODS Emotional state was evaluated, as was quality of life and psychological flexibility in a sample of 122 breast cancer survivors (Mage = 52.40; SDage = 7.26). The analysis was carried out using a cross-sectional predictive study. RESULTS Approximately half of those in the sample suffered from clinically significant emotional distress. The predictor variables selected explained a high percentage of the variability in emotional problems and quality of life (51.10-77.10%). CONCLUSION Avoidance explained a high percentage of the variance in anxiety, depression and general distress. A lower degree of participation in valuable activities contributed, more specifically, to explaining variability in depression. The quantity and availability of environmental reinforcement was closely related to quality of life. A decisive contribution towards promoting emotional well-being and quality of life can be made by nursing action aimed at diminishing those avoidance strategies related to the oncological experience which may distance patients from daily activities which are gratifying and congruent with their values.
Collapse
Affiliation(s)
| | | | | | | | - Ignacio Pedrosa
- Department of Psychology, University of Oviedo, Oviedo, Asturias, Spain
| | | |
Collapse
|
38
|
Kim M, Kim JE, Lee HY, Kim AR, Park HJ, Kwon OJ, Kim BK, Cho JH, Kim JH. Electroacupuncture for treating insomnia in patients with cancer: a study protocol for a randomised pilot clinical trial. BMJ Open 2017; 7:e016269. [PMID: 28801421 PMCID: PMC5629657 DOI: 10.1136/bmjopen-2017-016269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Although insomnia is one of the most prevalent and disturbing symptoms among patients with cancer, it has not been properly managed. Electroacupuncture (EA) has received attention as a promising intervention for insomnia, and a few previous studies have reported that this intervention may be beneficial for treating insomnia in patients with cancer. The aim of this pilot study is to explore the feasibility and preliminary effectiveness of EA on the sleep disturbance of patients with cancer with insomnia using a subjective method, patient-reported questionnaires and an objective tool, actigraphy, to measure the quality of sleep. METHODS AND ANALYSIS This is a study protocol for a randomised, three-arm, multicentre, pilot clinical trial. A total of 45 patients with cancer who have continuous insomnia related to cancer treatment or cancer itself will be randomly allocated to an EA group, sham EA group or usual care group in equal proportions. The EA group will receive 10 sessions of EA treatment over 4 weeks. The sham EA group will receive sham EA at non-acupoints using non-penetrating Streitberger acupuncture needles with mock EA. The usual care group will not receive EA treatment. All participants will be provided a brochure on the management of sleep disorders regardless of their group assignment. The primary outcome measure is the mean change in the insomnia severity index from the baseline to week 5. Information related to sleep quality will also be obtained through the Pittsburgh Sleep Quality Index, a sleep diary and actigraphy. Participants will complete the trial by visiting the research centre at week 9 for follow-up assessment. ETHICS AND DISSEMINATION This study protocol was approved by the institutional review boards of each research centre. Written informed consent will be obtained from all participants. The result of this study will be published in peer-reviewed journals or presented at academic conferences. TRIAL REGISTRATION NUMBER KCT0002162; Pre-results.
Collapse
Affiliation(s)
- Mikyung Kim
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jung-Eun Kim
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Hye-Yoon Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ae-Ran Kim
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Hyo-Ju Park
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - O-Jin Kwon
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Bo-Kyung Kim
- Department of Neuropsychiatry, College of Oriental Medicine, Dong-eui University, Busan, Republic of Korea
| | - Jung Hyo Cho
- Department of Internal Medicine, College of Traditional Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Joo-Hee Kim
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| |
Collapse
|
39
|
Irwin MR, Olmstead R, Carrillo C, Sadeghi N, Nicassio P, Ganz PA, Bower JE. Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial. J Clin Oncol 2017; 35:2656-2665. [PMID: 28489508 PMCID: PMC5549450 DOI: 10.1200/jco.2016.71.0285] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose Cognitive behavioral therapy for insomnia (CBT-I) and Tai Chi Chih (TCC), a movement meditation, improve insomnia symptoms. Here, we evaluated whether TCC is noninferior to CBT-I for the treatment of insomnia in survivors of breast cancer. Patients and Methods This was a randomized, partially blinded, noninferiority trial that involved survivors of breast cancer with insomnia who were recruited from the Los Angeles community from April 2008 to July 2012. After a 2-month phase-in period with repeated baseline assessment, participants were randomly assigned to 3 months of CBT-I or TCC and evaluated at months 2, 3 (post-treatment), 6, and 15 (follow-up). Primary outcome was insomnia treatment response-that is, marked clinical improvement of symptoms by the Pittsburgh Sleep Quality Index-at 15 months. Secondary outcomes were clinician-assessed remission of insomnia; sleep quality; total sleep time, sleep onset latency, sleep efficiency, and awake after sleep onset, derived from sleep diaries; polysomnography; and symptoms of fatigue, sleepiness, and depression. Results Of 145 participants who were screened, 90 were randomly assigned (CBT-I: n = 45; TCC: n = 45). The proportion of participants who showed insomnia treatment response at 15 months was 43.7% and 46.7% in CBT-I and TCC, respectively. Tests of noninferiority showed that TCC was noninferior to CBT-I at 15 months ( P = .02) and at months 3 ( P = .02) and 6 ( P < .01). For secondary outcomes, insomnia remission was 46.2% and 37.9% in CBT-I and TCC, respectively. CBT-I and TCC groups showed robust improvements in sleep quality, sleep diary measures, and related symptoms (all P < .01), but not polysomnography, with similar improvements in both groups. Conclusion CBT-I and TCC produce clinically meaningful improvements in insomnia. TCC, a mindful movement meditation, was found to be statistically noninferior to CBT-I, the gold standard for behavioral treatment of insomnia.
Collapse
Affiliation(s)
- Michael R. Irwin
- All authors: University of California Los Angeles, Los Angeles, CA
| | - Richard Olmstead
- All authors: University of California Los Angeles, Los Angeles, CA
| | - Carmen Carrillo
- All authors: University of California Los Angeles, Los Angeles, CA
| | - Nina Sadeghi
- All authors: University of California Los Angeles, Los Angeles, CA
| | - Perry Nicassio
- All authors: University of California Los Angeles, Los Angeles, CA
| | - Patricia A. Ganz
- All authors: University of California Los Angeles, Los Angeles, CA
| | | |
Collapse
|
40
|
Roberts AL, Fisher A, Smith L, Heinrich M, Potts HWW. Digital health behaviour change interventions targeting physical activity and diet in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 2017; 11:704-719. [PMID: 28779220 PMCID: PMC5671545 DOI: 10.1007/s11764-017-0632-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 07/14/2017] [Indexed: 12/21/2022]
Abstract
Purpose The number of cancer survivors has risen substantially due to improvements in early diagnosis and treatment. Health behaviours such as physical activity (PA) and diet can reduce recurrence and mortality, and alleviate negative consequences of cancer and treatments. Digital behaviour change interventions (DBCIs) have the potential to reach large numbers of cancer survivors. Methods We conducted a systematic review and meta-analyses of relevant studies identified by a search of Medline, EMBASE, PubMed and CINAHL. Studies which assessed a DBCI with measures of PA, diet and/or sedentary behaviour were included. Results Fifteen studies were identified. Random effects meta-analyses showed significant improvements in moderate-vigorous PA (seven studies; mean difference (MD) = 41 min per week; 95% CI 12, 71) and body mass index (BMI)/weight (standardised mean difference (SMD) = −0.23; 95% CI −0.41, −0.05). There was a trend towards significance for reduced fatigue and no significant change in cancer-specific measures of quality of life (QoL). Narrative synthesis revealed mixed evidence for effects on diet, generic QoL measures and self-efficacy and no evidence of an effect on mental health. Two studies suggested improved sleep quality. Conclusions DBCIs may improve PA and BMI among cancer survivors, and there is mixed evidence for diet. The number of included studies is small, and risk of bias and heterogeneity was high. Future research should address these limitations with large, high-quality RCTs, with objective measures of PA and sedentary time. Implications for cancer survivors Digital technologies offer a promising approach to encourage health behaviour change among cancer survivors. Electronic supplementary material The online version of this article (doi:10.1007/s11764-017-0632-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna L Roberts
- Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Abigail Fisher
- Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, UK
| | - Malgorzata Heinrich
- Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, UK
| |
Collapse
|
41
|
Wang YC, Lin CC. Spiritual Well-being May Reduce the Negative Impacts of Cancer Symptoms on the Quality of Life and the Desire for Hastened Death in Terminally Ill Cancer Patients. Cancer Nurs 2017; 39:E43-50. [PMID: 26378401 DOI: 10.1097/ncc.0000000000000298] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Spirituality is a central component of the well-being of terminally ill cancer patients. OBJECTIVE The aim of this study was to examine the mediating or moderating role of spiritual well-being in reducing the impact of cancer-related symptoms on quality of life and the desire for hastened death in terminally ill cancer patients. METHODS Eighty-five terminally ill cancer patients were assessed using the Taiwanese version of the M. D. Anderson Symptom Inventory, the Functional Assessment of Cancer Therapy-General, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being, the Beck Hopelessness Scale, and the Schedule of Attitudes Toward Hastened Death. RESULTS Spiritual well-being was significantly negatively correlated with symptom severity (r = -0.46, P < .01). Symptom severity negatively correlated with quality of life (r = -0.54) and positively correlated with hopelessness (r = 0.51, P < .01) and the desire for hastened death (r = 0.61, P < .01). Spiritual well-being was a partial mediator and moderator between symptom severity and quality of life. Spiritual well-being was a partial mediator between symptom severity and the desire for hastened death. The meaning subscale of spiritual well-being was a more significant predictor of the desire for hastened death and quality of life than the faith subscale was. CONCLUSION Spiritual well-being may reduce the negative impacts of cancer on quality of life and the desire for hastened death. IMPLICATIONS FOR PRACTICE Appropriate spiritual care may reduce the negative impact of severe cancer symptoms on quality of life and the desire for hastened death in terminally ill cancer patients.
Collapse
Affiliation(s)
- Yin-Chih Wang
- Author Affiliations: Graduate Institute of Nursing (Ms Wang) and School of Nursing (Dr Lin), College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
| | | |
Collapse
|
42
|
Cognitive-Behavioral Therapy for Insomnia in Cancer Patients: An Update of Efficacy Evidence and Areas for Future Research. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0067-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Walker J, Wanat M, Fielding J, Martin P, Petit A, Burke K, Sharpe M. Screening Medical Patients for Depression: Lessons From a National Program in Cancer Clinics. PSYCHOSOMATICS 2017; 58:274-280. [PMID: 28336194 DOI: 10.1016/j.psym.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Screening has been recommended to improve the identification of depression in medical patients. There is, therefore, a need for useful practical information on how to successfully implement large-scale depression screening in medical clinics. OBJECTIVE To describe the practical lessons learned from our experience of implementing a large-scale depression screening program in cancer clinics throughout Scotland, UK. METHOD Reflective review based on the experience of the screening team and records of the iterative development of the program. FINDINGS Systematic screening for depression in patients with medical illnesses can be delivered in clinics as long as the program is well designed. Design issues include ensuring the engagement of staff and patients, implementing efficient 2-stage screening processes and effectively managing workflow and quality assurance. DISCUSSION Screening has the potential to offer a solution to the well-documented problem of missed depression and other psychiatric diagnoses, thereby improving patient care if closely linked to treatment provision.
Collapse
Affiliation(s)
- Jane Walker
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Marta Wanat
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Josephine Fielding
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Paul Martin
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ariane Petit
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Katy Burke
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Michael Sharpe
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
| |
Collapse
|
44
|
Abstract
To illuminate the course of insomnia in the presence of an acute comorbidity, we examined the association between insomnia severity and breast cancer symptom severity over time and determined if this association varies with insomnia history and presleep arousal. Twenty-nine newly diagnosed breast cancer patients, who also exhibited insomnia, completed sleep diary and cancer symptom severity questionnaires every other week (total of 28 days) over 7 weeks, as well as baseline and postobservation measures. Participants were defined as having insomnia prior to cancer (IPC) or insomnia secondary to cancer (ISC) based on precancer sleep status. Insomnia and cancer symptom severity were strongly correlated at baseline but significantly declined over the evaluation period. Among ISC individuals, there was an association between sleep severity and cancer severity at baseline but not 7 weeks later. IPC individuals showed a consistent pattern of no significant association between sleep severity and cancer symptom severity. IPC had higher levels of cognitive presleep arousal than ISC. The current study documented the evolution of the relation between insomnia and breast cancer symptom severity over time and identified factors (premorbid insomnia and presleep hyperarousal) that may influence this association.
Collapse
Affiliation(s)
| | | | - Cynthia K Perkins
- c Lewis and Faye Manderson Cancer Center, DCH Hospital , Tuscaloosa , Alabama
| |
Collapse
|
45
|
Tateo S. State of the evidence: Cannabinoids and cancer pain-A systematic review. J Am Assoc Nurse Pract 2016; 29:94-103. [PMID: 27863159 DOI: 10.1002/2327-6924.12422] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/06/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Cannabinoids are widely used to alleviate intractable symptoms such as pain, nausea, and muscle spasticity. The purpose of this review was to ascertain the current state of the science regarding use of cannabinoids for cancer pain. METHODS Four electronic databases were searched for randomized control trials of cannabinoids and cancer pain. Studies included examined the analgesic effects of cannabinoids for cancer pain. Methodological quality was assessed using the Jadad scale. CONCLUSIONS Eight randomized control trials met the inclusion criteria for review. Most trials found analgesic effects from cannabinoids when compared to placebo, although not all associations reached statistical significance. The analgesic effects of cannabinoids were also limited by dose-dependent side effects. Side effects most commonly reported were changes in cognition, sedation, and dizziness. IMPLICATIONS FOR PRACTICE There is evidence that cannabinoids are effective adjuvants for cancer pain not completely relieved by opioid therapy, but there is a dearth of high-quality studies to support a stronger conclusion. Cannabinoids appear to be safe in low and medium doses. Methodological limitations of the trials limited the ability to make sound conclusions. Further research is warranted before efficacy, safety, and utility of cannabinoids for cancer pain can be determined.
Collapse
|
46
|
Abstract
Patients with cancer tend to suffer sleep-wake disturbances at a higher rate than the general population. Insomnia and fatigue should be regarded as a significant patient safety issue, as poor sleep can elevate patients' risks of falls, motor vehicle accidents, and acute infectious illnesses. To alleviate those risks, oncology nurses should be familiar with effective evidence-based practices for assessing and improving patients' sleep quality.
Collapse
Affiliation(s)
- Mary Patricia Lamberti
- Department of Nursing, Student Health Services at Southern Connecticut State University, New Haven
| |
Collapse
|
47
|
George GC, Iwuanyanwu EC, Anderson KO, Yusuf A, Zinner RG, Piha-Paul SA, Tsimberidou AM, Naing A, Fu S, Janku F, Subbiah V, Cleeland CS, Mendoza TR, Hong DS. Sleep quality and its association with fatigue, symptom burden, and mood in patients with advanced cancer in a clinic for early-phase oncology clinical trials. Cancer 2016; 122:3401-3409. [PMID: 27412379 DOI: 10.1002/cncr.30182] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/21/2016] [Accepted: 05/16/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Limited data exist about sleep quality for patients with advanced cancer in phase 1 clinical trials. Poor sleep quality is often not captured as an adverse event, and its association with fatigue, one of the most frequently reported adverse events, is not documented routinely. This article describes sleep quality and its relation with fatigue, symptom burden, and mood in patients recruited from an early-phase clinic for targeted therapy. METHODS Sleep, fatigue, symptom burden, and mood were assessed with the Pittsburgh Sleep Quality Index (PSQI), the Brief Fatigue Inventory, the MD Anderson Symptom Inventory (MDASI), and the Brief Profile of Mood States, respectively; the Eastern Cooperative Oncology Group (ECOG) performance status (PS) was determined from medical records. RESULTS The sample (n = 256) was 51.2% female, 90% had an ECOG PS of 0 or 1, and the mean age was 58 ± 0.8 years. Poor sleepers (global PSQI score > 5) constituted 64% of the sample. In separate multiple regression models, poor sleepers had higher levels of fatigue (P < .001), symptom burden (P < .001), and overall mood disturbance (P < .001) than good sleepers. Also, compared with good sleepers, poor sleepers had greater fatigue-related and symptom-related interference with daily activities (all P values < .001). The MDASI disturbed-sleep item correlated well with the global PSQI score (Pearson's r = 0.679, P < .001), and this suggests its usefulness as a patient-reported outcome screener of sleep quality in early-phase clinical trials clinics. CONCLUSIONS Poor sleep quality was a significant problem in the current study and was associated with greater fatigue, symptom burden, and mood disturbance. Sleep quality should be routinely assessed in patients with advanced cancer who are participating in early-phase clinical trials. Cancer 2016;122:3401-3409. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Goldy C George
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas. .,Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Eucharia C Iwuanyanwu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen O Anderson
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alizeh Yusuf
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ralph G Zinner
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarina A Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
48
|
van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, Tjan-Heijnen VCG, Janssen DJA. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage 2016; 51:1070-1090.e9. [PMID: 27112310 DOI: 10.1016/j.jpainsymman.2015.12.340] [Citation(s) in RCA: 941] [Impact Index Per Article: 117.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/10/2015] [Accepted: 12/23/2015] [Indexed: 12/17/2022]
Abstract
CONTEXT Cancer pain has a severe impact on quality of life and is associated with numerous psychosocial responses. Recent studies suggest that treatment of cancer pain has improved during the last decade. OBJECTIVES The aim of this review was to examine the present status of pain prevalence and pain severity in patients with cancer. METHODS A systematic search of the literature published between September 2005 and January 2014 was performed using the databases PubMed, Medline, Embase, CINAHL, and Cochrane. Articles in English or Dutch that reported on the prevalence of cancer pain in an adult population were included. Titles and abstracts were screened by two authors independently, after which full texts were evaluated and assessed on methodological quality. Study details and pain characteristics were extracted from the articles with adequate study quality. Prevalence rates were pooled with meta-analysis; meta-regression was performed to explore determinants of pain prevalence. RESULTS Of 4117 titles, 122 studies were selected for the meta-analyses on pain (117 studies, n = 63,533) and pain severity (52 studies, n = 32,261). Pain prevalence rates were 39.3% after curative treatment; 55.0% during anticancer treatment; and 66.4% in advanced, metastatic, or terminal disease. Moderate to severe pain (numerical rating scale score ≥5) was reported by 38.0% of all patients. CONCLUSION Despite increased attention on assessment and management, pain continues to be a prevalent symptom in patients with cancer. In the upcoming decade, we need to overcome barriers toward effective pain treatment and develop and implement interventions to optimally manage pain in patients with cancer.
Collapse
Affiliation(s)
- Marieke H J van den Beuken-van Everdingen
- Center of Expertise for Palliative Care, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Anesthesiology and Pain Management, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
| | - Laura M J Hochstenbach
- School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Health Services Research, Maastricht University (UM), Maastricht, The Netherlands
| | - Elbert A J Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; School of Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Medical Oncology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Daisy J A Janssen
- Center of Expertise for Palliative Care, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Research and Education, Center of Expertise for Chronic Organ Failure, CIRO+, Horn, The Netherlands
| |
Collapse
|
49
|
Huang YC, Chang HH, Chiu SC, Lai YL, Chen YJ. Modified Dang Gui Liu Huang Tang Eases Sleep Sweats in Elderly Patients with Terminal Cancer. INT J GERONTOL 2016. [DOI: 10.1016/j.ijge.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
50
|
Puszkiewicz P, Roberts AL, Smith L, Wardle J, Fisher A. Assessment of Cancer Survivors' Experiences of Using a Publicly Available Physical Activity Mobile Application. JMIR Cancer 2016; 2:e7. [PMID: 28410168 PMCID: PMC5369632 DOI: 10.2196/cancer.5380] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/24/2016] [Accepted: 04/10/2016] [Indexed: 01/06/2023] Open
Abstract
Background Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors’ attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results Of the people who responded to the study advertisement, 73% (16/22) agreed to participate and 100% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one’s lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population.
Collapse
Affiliation(s)
- Patrycja Puszkiewicz
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Anna L Roberts
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Lee Smith
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom.,The Cambridge Centre for Sport and Exercise Sciences, Department of Life Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Abigail Fisher
- Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, London, United Kingdom
| |
Collapse
|