1
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An KY, Arthuso FZ, Filion M, Allen SJ, Ntoukas SM, Bell GJ, McNeil J, Wang Q, McNeely ML, Vallance JK, Yang L, Culos-Reed SN, Dickau L, Mackey JR, Friedenreich CM, Courneya KS. Associations between health-related fitness and patient-reported symptoms in newly diagnosed breast cancer patients. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:851-862. [PMID: 38697290 PMCID: PMC11336311 DOI: 10.1016/j.jshs.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Newly diagnosed breast cancer patients experience symptoms that may affect their quality of life, treatment outcomes, and survival. Preventing and managing breast cancer-related symptoms soon after diagnosis is essential. The purpose of this study was to investigate the associations between health-related fitness (HRF) and patient-reported symptoms in newly diagnosed breast cancer patients. METHODS This study utilized baseline data from the Alberta Moving Beyond Breast Cancer Cohort Study that were collected within 90 days of diagnosis. HRF measures included peak cardiopulmonary fitness (peak volume of oxygen consumption (VO2peak)), maximal muscular strength and endurance, flexibility, and body composition. Symptom measures included depression, sleep quality, and fatigue. Adjusted multivariable logistic regression was performed for analyses. RESULTS Of 1458 participants, 51.5% reported poor sleep quality, 26.5% reported significant fatigue, and 10.4% reported moderate depression. In multivariable-adjusted models, lower relative VO2peak was independently associated with a greater likelihood of all symptom measures, including moderate depression (p < 0.001), poor sleep quality (p = 0.009), significant fatigue (p = 0.008), any symptom (p < 0.001), and multiple symptoms (p < 0.001). VO2peak demonstrated threshold associations with all symptom measures such that all 3 lower quartiles exhibited similar elevated risk compared to the highest quartile. The strength of the threshold associations varied by the symptom measure with odds ratios ranging from ∼1.5 for poor sleep quality to ∼3.0 for moderate depression and multiple symptoms. Moreover, lower relative upper body muscular endurance was also independently associated with fatigue in a dose-response manner (p = 0.001), and higher body weight was independently associated with poor sleep quality in an inverted U pattern (p = 0.021). CONCLUSION Relative VO2peak appears to be a critical HRF component associated with multiple patient-reported symptoms in newly diagnosed breast cancer patients. Other HRF parameters may also be important for specific symptoms. Exercise interventions targeting different HRF components may help newly diagnosed breast cancer patients manage specific symptoms and improve outcomes.
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Affiliation(s)
- Ki-Yong An
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton T6G 2H9, Canada
| | - Fernanda Z Arthuso
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton T6G 2H9, Canada
| | - Myriam Filion
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton T6G 2H9, Canada
| | - Spencer J Allen
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton T6G 2H9, Canada
| | - Stephanie M Ntoukas
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton T6G 2H9, Canada
| | - Gordon J Bell
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton T6G 2H9, Canada
| | - Jessica McNeil
- Department of Kinesiology, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC 27412, USA
| | - Qinggang Wang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary T2S 3C3, Canada
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton T6G 2H9, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca T9S 3A3, Canada
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary T2S 3C3, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary T2N 4N1, Canada
| | - S Nicole Culos-Reed
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary T2N 4N1, Canada; Faculty of Kinesiology, University of Calgary, Calgary T2N 1N4, Canada
| | - Leanne Dickau
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary T2S 3C3, Canada
| | - John R Mackey
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton T6G 2H9, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary T2S 3C3, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary T2N 4N1, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton T6G 2H9, Canada.
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2
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Gu S, Xu Y, Zhu X, Lam A, Yi D, Gong L, Wang J, Guo X, Fu L, Shi J, Wang F, Liu K. Characteristics of cancer-related fatigue and its correlation with anxiety, depression, and stress-related hormones among Chinese cancer survivors: a cross-sectional study. Front Oncol 2023; 13:1194673. [PMID: 37965458 PMCID: PMC10641402 DOI: 10.3389/fonc.2023.1194673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023] Open
Abstract
Background Fatigue is a common source of distress for cancer survivors. The severity of cancer-related fatigue varies significantly, which may be due to individual differences in host factors. Aim This cross-sectional study aims to explore how demographic, oncological, sociological, psychological, and stress-related hormones levels interact to influence the distinct experiences of fatigue (Cancer-related fatigue [CRF] occurrence and fatigue degree). Methods A cross-sectional study carried out at the oncology outpatient and ward department of Xiyuan Hospital of China Academy of Chinese Medical Sciences recruited 306 cancer patients between January 2021 to December 2021. General information, fatigue, psychological factors was evaluated by general information questionnaire, the Revised Piper's Fatigue Scale-Chinese Version (RPFS-CV), and the self-report Hospital Anxiety and Depression Scale (HADS). Stress-related hormones were measured with chemiluminescent enzyme immunoassay (Zhengzhou Antobio). Results 306 patients were included, 229 (74.8%) were diagnosed with CRF, including 94 (41.0%) with mild fatigue, 121 (52.8%) with moderate fatigue, and 14 (6.1%) with severe fatigue. Multivariate regression analysis showed that higher depression scores, aldosterone levels may increase the risk of CRF. Patients who are obese (Body mass index ≥ 28 kg/m2) may help to reduce the risk of CRF. Other contributing factors for increased levels of fatigue (p< 0.05) include being female, having anxiety, depression and high aldosterone levels. Conclusion The research suggested that CRF was a common symptom in cancer survivors and pay attention to these influencing factors may help to better identify patients susceptible to fatigue and provide long-term, targeted interventions.
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Affiliation(s)
- Shanshan Gu
- Oncology Department, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yun Xu
- Oncology Department, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoshu Zhu
- National Institute of Complementary Medicine (NICM) Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Anderson Lam
- National Institute of Complementary Medicine (NICM) Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Danhui Yi
- School of Statistics, Renmin University of China, Beijing, China
| | - Lutian Gong
- Oncology Department, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinghui Wang
- School of Beijing University of Chinese Medicine, Beijing, China
| | - Xinyu Guo
- School of Beijing University of Chinese Medicine, Beijing, China
| | - Li Fu
- Oncology Department, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiyan Shi
- School of Beijing University of Chinese Medicine, Beijing, China
| | - Feiye Wang
- Oncology Department, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Ketan Liu
- School of Statistics, Renmin University of China, Beijing, China
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3
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Bootsma TI, Schellekens MPJ, van Woezik RAM, van der Lee ML, Slatman J. Navigating severe chronic cancer-related fatigue: an interpretative phenomenological analysis. Psychol Health 2023; 38:494-517. [PMID: 34474619 DOI: 10.1080/08870446.2021.1973468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This article presents a phenomenological study on the embodied experiences of patients with Chronic Cancer-Related Fatigue (CCRF), aiming to better understand this complex phenomenon. DESIGN Data collection consisted of individual interviews with 25 participants who suffered from severe CCRF for at least three months after cancer treatment was finished. MAIN OUTCOME MEASURES Against the theoretical background of philosophical phenomenology, we explored embodied experiences, incorporated temporal and spatial aspects of living with CCRF. We applied interpretative phenomenological analysis (IPA) to analyze the transcripts of the interviews. RESULTS Using IPA, we identified four themes on how chronic fatigue is experienced post-cancer: (1) Worn out; (2) Diminishment of one's 'I can'; (3) Invisibility; and (4) Regaining one's 'I can'. CONCLUSION For clinical practice, these results imply that professionals could focus more on the role of the body and limitations of one's 'I can' when treating CCRF. By studying these embodied CCRF experiences in individual patients, future research could help personalize and optimize treatment.
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Affiliation(s)
- Tom I Bootsma
- Center for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands.,School of Humanities and Digital Sciences, Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
| | - Melanie P J Schellekens
- Center for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands.,School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology and Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Rosalie A M van Woezik
- Center for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands
| | - Marije L van der Lee
- Center for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands.,School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology and Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Jenny Slatman
- School of Humanities and Digital Sciences, Department of Culture Studies, Tilburg University, Tilburg, The Netherlands
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4
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Morse L, Paul SM, Cooper BA, Oppegaard K, Shin J, Calvo-Schimmel A, Harris C, Hammer M, Conley Y, Wright F, Levine JD, Kober KM, Miaskowski C. Higher Stress in Oncology Patients is Associated With Cognitive and Evening Physical Fatigue Severity. J Pain Symptom Manage 2023; 65:203-215. [PMID: 36423801 PMCID: PMC11189665 DOI: 10.1016/j.jpainsymman.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Cognitive and physical fatigue are common symptoms experienced by oncology patients. Exposure to stressful life events (SLE), cancer-related stressors, coping styles, and levels of resilience may influence the severity of both dimensions of fatigue. OBJECTIVES Evaluate for differences in global, cancer-specific, and cumulative life stress, as well as resilience and coping in oncology patients (n=1332) with distinct cognitive fatigue AND evening physical fatigue profiles. METHODS Latent profile analysis, which combined the two symptom scores, identified three subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles (i.e., Low, Moderate, High). Patients completed measures of global, cancer-specific, and cumulative life stress as well measures of resilience and coping. Differences among the latent classes in the various measures were evaluated using parametric and nonparametric tests. RESULTS Compared to Low class, the other two classes reported higher global and cancer-specific stress. In addition, they reported higher occurrence rates for sexual harassment and being forced to touch prior to 16 years of age. Compared to the other two classes, High class reported lower resilience scores and higher use of denial, substance use, and behavioral disengagement. CONCLUSION To decrease both cognitive and evening physical fatigue, clinicians need to assess for relevant stressors and initiate interventions to increase resilience and the use of engagement coping strategies. Additional research is warranted on the relative contribution of various social determinants of health to both cognitive and physical fatigue in oncology patients receiving chemotherapy.
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Affiliation(s)
- Lisa Morse
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Bruce A Cooper
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Kate Oppegaard
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Joosun Shin
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Alejandra Calvo-Schimmel
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Carolyn Harris
- School of Nursing (C.H.,Y.C.,), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marilyn Hammer
- Dana Farber Cancer Institute (M.H.), Boston, Massachusetts
| | - Yvette Conley
- School of Nursing (C.H.,Y.C.,), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fay Wright
- Rory Meyers College of Nursing (F.W.), New York University, New York, New York
| | - Jon D Levine
- School of Medicine (J.D.L, C.M.), University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Christine Miaskowski
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California;; School of Medicine (J.D.L, C.M.), University of California, San Francisco, California, USA.
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5
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Screening and Assessment of Cancer-Related Fatigue: An Executive Summary and Road Map for Clinical Implementation. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Fisher MI, Cohn JC, Harrington SE, Lee JQ, Malone D. Screening and Assessment of Cancer-Related Fatigue: A Clinical Practice Guideline for Health Care Providers. Phys Ther 2022; 102:pzac120. [PMID: 36179114 PMCID: PMC9525018 DOI: 10.1093/ptj/pzac120] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/23/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
Cancer-related fatigue (CRF) is the most common side effect of cancer treatment. Regular surveillance is recommended, but few clinical practice guidelines transparently assess study bias, quality, and clinical utility in deriving recommendations of screening and assessment methods. The purpose of this clinical practice guideline (CPG) is to provide recommendations for the screening and assessment of CRF for health care professions treating individuals with cancer. Following best practices for development of a CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) Statement and Emergency Care Research Institute (ECRI) Guidelines Trust Scorecard, this CPG included a systematic search of the literature, quality assessment of included evidence, and stakeholder input from diverse health care fields to derive the final CPG. Ten screening and 15 assessment tools supported by 114 articles were reviewed. One screen (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-30 Core Questionnaire) and 3 assessments (Piper Fatigue Scale-Revised, Functional Assessment of Chronic Illness Therapy-Fatigue, and Patient Reported Outcome Measurement Information System [PROMIS] Fatigue-SF) received an A recommendation ("should be used in clinical practice"), and 1 screen and 5 assessments received a B recommendation ("may be used in clinical practice"). Health care providers have choice in determining appropriate screening and assessment tools to be used across the survivorship care continuum. The large number of tools available to screen for or assess CRF may result in a lack of comprehensive research evidence, leaving gaps in the body of evidence for measurement tools. More research into the responsiveness of these tools is needed in order to adopt their use as outcome measures. IMPACT Health care providers should screen for and assess CRF using one of the tools recommended by this CPG.
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Affiliation(s)
| | - Joy C Cohn
- Good Shepherd Penn Partners, Philadelphia, Pennsylvania, USA
| | - Shana E Harrington
- Exercise Science Department, University of South Carolina, Columbia, South Carolina, USA
| | - Jeanette Q Lee
- Department of Physical Therapy and Rehabilitation Science, University of California at San Francisco/San Francisco State University, San Francisco, California, USA
| | - Daniel Malone
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
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7
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Pépin AJ, Lippé S, Drouin S, Krajinovic M, Laverdière C, Michon B, Robaey P, Rondeau É, Sinnett D, Sultan S. Screening for distress in pediatric cancer survivors: A systematic comparison of one-step and two-step strategies to minimize detection errors. J Psychosoc Oncol 2021; 40:441-456. [PMID: 33939599 DOI: 10.1080/07347332.2021.1906377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Childhood cancer survivors should be routinely screened for psychological distress. However, existing screening tools promoted by cancer care institutions, such as the Distress Thermometer (DT) generate high rates of errors. The aim of this study is to help refining strategies of screening psychological distress in this population by exploring two-step methods combining the DT on step #1 with one question on step #2. PROCEDURE Data from 255 survivors of childhood acute lymphoblastic leukemia aged 13-40 years were analyzed (38% 13-18 years, 62% 19+ years, 53% females). We used the DT on step #1 and the individual emotion items from the Pediatric Quality of Life Questionnaire (PedsQL) on step #2, to detect distress, depression and anxiety as measured by standard instruments. We compared sensitivity, specificity, negative and positive predictive values, Youden index, and clinical utility indices, in newly developed two-step strategies. RESULTS The best two-step strategies to screen anxious-depressive distress were DT ≥ 2 on step #1, with the item of Sadness on step #2, and DT ≥ 2 combined with the item of Concerns. Two-step strategies outperformed the DT alone on the correct identification of distressed survivors. However, two-step strategies did not outperform the DT used alone on the correct detection of no distressed survivors. Results were similar when predicting depression or anxiety alone. CONCLUSION Completing the DT with one single question on emotions from the PedsQL may minimize the number of participants falsely identified as distressed, which could be particularly pertinent in resource-limited clinics.
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Affiliation(s)
- Annie-Jade Pépin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Bruno Michon
- Laval University Health Center (Laval UHC) Québec, Québec, Québec, Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Émélie Rondeau
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
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8
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Johnson LA, Schreier AM, Swanson M, Ridner S. Dimensions of Distress in Lung Cancer. Oncol Nurs Forum 2020; 47:732-738. [PMID: 33063781 DOI: 10.1188/20.onf.732-738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To (a) compare the domains of distress between patients who were distressed and patients who were not distressed and (b) examine the relationship between the National Comprehensive Cancer Network Distress Thermometer and Problem List for Patients (DT-PL) and the Hospital Anxiety and Depression Scale (HADS) in individuals with advanced lung cancer. SAMPLE & SETTING Individuals with advanced lung cancer receiving chemotherapy were recruited from a comprehensive cancer center in the southeastern United States. METHODS & VARIABLES A cross-sectional, descriptive, exploratory design was used. Individuals with lung cancer completed the DT-PL and the HADS. Data were analyzed using descriptive statistics, t tests, and chi-square analysis. RESULTS Significant differences were found between the nondistressed group and the clinically distressed group in three domains of distress. IMPLICATIONS FOR NURSING Distress in individuals with advanced lung cancer goes beyond psychological stressors and includes family problems and physical problems.
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9
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Ludwigson A, Huynh V, Bronsert M, Sloan K, Murphy C, Christian N, Jaiswal K, Ahrendt G, Tevis SE. A screening tool identifies high distress in newly diagnosed breast cancer patients. Surgery 2020; 168:935-941. [PMID: 32591140 DOI: 10.1016/j.surg.2020.04.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Many breast cancer patients and survivors experience clinically significant distress, which poses a danger to both their psychologic and clinical well-being. Improved understanding of the types of distress that patients experience at the time of breast cancer diagnosis may reveal areas for intervention to improve quality of life and long-term outcomes. METHODS We retrospectively evaluated newly diagnosed breast cancer patients who completed a cancer distress screening tool at their initial multidisciplinary clinic visit. The screening tool, which has not yet been validated, asked patients to rate their distress and identify specific concerns related to emotional, social, health, and practical distress. To evaluate predictors of distress, patient characteristics were collected through review of the electronic medical record. RESULTS The study population consisted of 379 patients. The number of patients experiencing high distress varied by domain: emotional (66.5%), social (25.1%), health (57.8%), and practical (36.4%). With the exception of marital status, no demographic, clinical, or pathologic factors were found to be significantly associated with distress in any domain. CONCLUSION Breast cancer patients experience significant distress at the time of initial diagnosis. Additional investigation assessing modifiable contributors to distress and developing clinical interventions to decrease distress from the time of diagnosis throughout treatment is needed to improve quality of life in this patient population.
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Affiliation(s)
| | - Victoria Huynh
- Department of Surgery, University of Colorado, Aurora, CO
| | - Michael Bronsert
- University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO
| | - Kara Sloan
- University of Colorado, Cancer Center, Aurora, CO
| | - Colleen Murphy
- Department of Surgery, University of Colorado, Aurora, CO
| | | | - Kshama Jaiswal
- Department of Surgery, University of Colorado, Aurora, CO
| | | | - Sarah E Tevis
- Department of Surgery, University of Colorado, Aurora, CO.
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10
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Wright F, Kober KM, Cooper BA, Paul SM, Conley YP, Hammer M, Levine JD, Miaskowski C. Higher levels of stress and different coping strategies are associated with greater morning and evening fatigue severity in oncology patients receiving chemotherapy. Support Care Cancer 2020; 28:4697-4706. [PMID: 31956947 PMCID: PMC7223171 DOI: 10.1007/s00520-020-05303-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/09/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE A cancer diagnosis and associated treatments are stressful experiences for most patients. Patients' perceptions of stress and their use of coping strategies may influence fatigue severity. This study extends our previous work describing distinct profiles of morning (i.e., Very Low, Low, High, and Very High) and evening (i.e., Low, Moderate, High, and Very High) fatigue in oncology patients by evaluating for differences in stress and coping strategies among these fatigue classes. METHODS This longitudinal study evaluated for changes in morning and evening fatigue in oncology patients (n = 1332) over two cycles of chemotherapy (CTX). Patients completed measures of cumulative exposure to stressful life events (SLEs) (i.e., the Life Stressor Checklist-Revised), general stress (i.e., Perceived Stress Scale [PSS]), cancer-specific stress (i.e., Impact of Event Scale-Revised [IES-R]), and coping strategies (i.e., Brief Cope). Differences among the latent classes were evaluated using analyses of variance, Kruskal-Wallis, or chi-square tests. RESULTS Patients in both the Very High morning and evening fatigue classes reported higher numbers of and a higher impact from previous SLEs and higher PSS scores than the other fatigue classes. The IES-R scores for the Very High morning fatigue class met the criterion for subsyndromal PTSD. Patients in the Very High evening fatigue class used a higher number of engagement coping strategies compared with the Very High morning fatigue class. CONCLUSIONS Our findings suggest that interventions to reduce stress and enhance coping warrant investigation to decrease fatigue in patients undergoing CTX.
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Affiliation(s)
- Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA. .,School of Medicine, University of California, San Francisco, CA, USA. .,Department of Physiological Nursing, University of California, 2 Koret Way - N631F, San Francisco, CA, 94143-0610, USA.
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11
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van Egdom LSE, Lagendijk M, van der Kemp MH, van Dam JH, Mureau MAM, Hazelzet JA, Koppert LB. Implementation of Value Based Breast Cancer Care. Eur J Surg Oncol 2019; 45:1163-1170. [PMID: 30638807 DOI: 10.1016/j.ejso.2019.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/19/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Adding value of care to patients is crucial for all stakeholders. The use of both provider and patient reported outcome data was implemented in a single academic breast cancer center. We describe the development of the outcomes set, data integration within electronical health records (EHR) and clinical use. METHODS An Integrated Practice Unit (IPU) was constructed providing the full care cycle for breast cancer patients. Provider reported outcomes and patient reported outcomes (PROs) were defined, reflecting the entire cycle of care and long-term sustainability of quality of life. Multidisciplinary provider and patient perspectives were obtained via focus groups and surveys. Patient pathways were redesigned in order to identify suitable opportunities for data collection during the entire care cycle. RESULTS A Standard Set for Breast Cancer Outcomes together with case-mix variables and timelines was agreed upon within the IPU. A secure electronic platform, directly linked to the EHR, was designed to measure PROs during the outpatient phase. First year evaluation showed a decrease of response rates over time, from 83.3% at baseline to 45.2% at 12 months after surgery. Patients reacted positively to the use of PROMs in daily clinical cancer care. CONCLUSION Assessment of patient reported as well as provider reported outcomes was implemented within our standard of breast cancer care. For this, dedicated resources, change of culture and practice, and improved knowledge and awareness about Value-based healthcare (VBHC) were essential. Our proposed framework aims to serve as a blueprint for implementation of VBHC in daily care.
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Affiliation(s)
- L S E van Egdom
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - M Lagendijk
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M H van der Kemp
- Value Based HealthCare Strategy & Tactics, VDKMP, Amsterdam, the Netherlands
| | - J H van Dam
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC, Cancer Institute, Rotterdam, the Netherlands
| | - J A Hazelzet
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - L B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
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