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Al-Hussaini M, Abdel-Razeq H, Shamieh O, Al-Ani A, Hammouri M, Mansour A. Assessment of psycho-oncology in the Middle East and North Africa region: a systematic review and meta-analysis. Oncologist 2024:oyae193. [PMID: 39137150 DOI: 10.1093/oncolo/oyae193] [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: 02/05/2024] [Accepted: 05/23/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The Middle East and North Africa (MENA) region is expected to witness a significant increase in the burden of cancer. Contrary to Western literature, the burden of psycho-oncology is yet to be established within the MENA region. This study reviews all available evidence characterizing the psychological burden among patients with cancer across the MENA region. METHODS We systematically explored the PubMed/MEDLINE, Cochrane/CENTRAL, and Web of Science (WoS) databases for reports on the psychiatric burden among patients with cancer residing within the MENA region from January 2000 until January 2023. Raw proportion were extracted and analyzed using a random-effects model. FINDINGS Eighty-three studies comprised of 16 810 participants, representing 14 countries, met our inclusion criteria. Across the MENA region, the prevalence of depression, anxiety, and distress were 44% (95% CI, 39%-50%), 47% (95% CI, 40%-54%), and 43% (95% CI, 30%-56%), respectively. Prevalence of depression was significantly different across countries, with Palestine (73%; 95% CI, 42%-91%) reporting the highest rate while Morocco (23%; 95% CI, 7%-56%) reported the lowest. Similarly, anxiety significantly differed across MENA nations ranging from 64% (95% CI, 3%-99%) in Morocco to 28% (95% CI, 18%-42%) in Tunisia. Rates of depression and anxiety were significantly different across measurement tools but not between Arabic-speaking versus Persian/Farsi-speaking countries. Meta-regression models showed that neither publication year nor age affected the prevalence of both anxiety and depression (P = .374 and .091 for depression and P = .627, and .546 for anxiety, respectively). INTERPRETATION We report an abnormally high rate of psychiatric burden among patients with cancer in the MENA region. Thus, establishing appropriate psycho-oncologic interventions within the MENA region is of utmost importance.
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Affiliation(s)
- Maysa Al-Hussaini
- Department of Cell Therapy and Applied Genomics, King Hussein Cancer Center, Amman 11941, Jordan
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman 11941, Jordan
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan
| | - Omar Shamieh
- Centre for Palliative and Cancer Care in Conflict, Department of Palliative Care, King Hussein Cancer Center, Amman 11941, Jordan
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman 11941, Jordan
| | | | - Asem Mansour
- Office of Director General, King Hussein Cancer Center, Amman 11941, Jordan
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MAJUMDAR JR, FROMKIN MMS JB, YERMAL SJ, FATATA-HAIM AM, BARTON-BURKE M, JAIRATH NN. Research Electronic Data Capture (REDCap) in an outpatient oncology surgery setting to securely email, collect, and manage survey data. J Adv Nurs 2024; 80:2592-2597. [PMID: 38041582 PMCID: PMC11088533 DOI: 10.1111/jan.15983] [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: 02/28/2023] [Revised: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Nursing interventions in the post-operative time period including psychological and emotional support, adverse event education, and instructions for follow-up care contribute patient satisfaction, safety, and quality of life. However, the time spent in the post-anesthesia care unit (PACU) and hospital continues to shorten around the world to reduce health care spending and improve patient outcomes. Nurses conducting research during the important post-operative recovery period need to utilize unique techniques and emerging technologies to contact, recruit and collect data outside of the hospital setting including the Research Electronic Data Capture (REDCap) platform. AIMS This paper describes the feasibility and acceptability, facilitators and barriers of the software application, REDCap, to complete a repeated-measures, descriptive correlational study in patients undergoing outpatient breast cancer surgeries. METHODS & MATERIALS The recruitment, data collection and storage were completed utilizing the secure REDCap Platform. The Institutional Research Board (IRB)-approved study was a repeated-measures, descriptive, correlational study with data collection at three time points. The data points aligned with important transitions and routine visits to improve data collection feasibility and increase relevance to clinical practice. RESULTS The sample consisted of women diagnosed with breast cancer undergoing breast conserving surgery between August 15 and October 15, 2020. There were 123 potential participants, of which 76 started the surveys and 75 participated (61%) responded and participated in the study on Post-operative Day 1. Fifty-nine participants (78%) completed the surveys on post-operative Day 14. DISCUSSION As the frequency of outpatient treatment increases, nurses conducting post-operative research will need to collect the data outside of the hospital setting. CONCLUSION Email provides a method of studying new phenomena by recruiting participants, providing information about the study, and collecting results in a non-traditional setting. REDCap provides a method to facilitate nursing research through a securely encrypted integrated process.
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Affiliation(s)
- Jennifer R MAJUMDAR
- Department of Nursing Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Hunter College School of Nursing, New York, NY, USA
| | - Jillian B FROMKIN MMS
- Department of Nursing Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Alexandria M FATATA-HAIM
- Department of Nursing Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Digital Informatics & Technology Solutions, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margaret BARTON-BURKE
- Department of Nursing Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Digital Informatics & Technology Solutions, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nalini N JAIRATH
- Conway School of Nursing, The Catholic University of America, Washington, DC, USA
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Majumdar JR, Assel M, Dannaoui A, Fatata-Haim A, Fromkin J, Nelson C, Laudone V, Carlsson SV. Incorporating the Distress Thermometer into preoperative vital signs in patients undergoing ambulatory oncology surgery: a pilot feasibility study. J Psychosoc Oncol 2024; 42:733-738. [PMID: 38757449 PMCID: PMC11344673 DOI: 10.1080/07347332.2024.2351038] [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] [Indexed: 05/18/2024]
Abstract
BACKGROUND Despite the extensive literature supporting distress screening at relevant transitions of care, the implementation of distress screening remains limited in ambulatory surgery settings. Our multidisciplinary team completed a pilot study to assess the feasibility and acceptability of including a standardized psychosocial assessment, the Distress Thermometer (DT), with the collection of admission vital signs by Patient Care Technicians (PCTs) in patients undergoing oncology surgery. METHODS We assessed feasibility by the response rate and acceptability through discussions with the PCTs. RESULTS Of the 189 men who underwent radical prostatectomy at our center, 71 were approached with the DT scale, and all patients who were approached completed the DT with no missing data. The staff reported no issues with data collection. A total of 21/71 (30%; 95% CI 19%, 42%) reported a clinically relevant distress DT ≥ 4. CONCLUSION Our results demonstrated that incorporating the DT into vital sign collection was feasible, acceptable, and provided a valuable assessment.
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Affiliation(s)
- Jennifer Ross Majumdar
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Hunter-Bellevue School of Nursing,, City of New York, New York, NY, USA
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aimee Dannaoui
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexandria Fatata-Haim
- Department of Digital Informatics and Technology Solutions, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jillian Fromkin
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vincent Laudone
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sigrid V. Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
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Slaghmuylder Y, Maingi L, Pype P, Lauwerier E. The use of written guides to empower breast cancer survivors in their management of chronic pain: A realist evaluation. PATIENT EDUCATION AND COUNSELING 2024; 120:108129. [PMID: 38181590 DOI: 10.1016/j.pec.2023.108129] [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: 08/23/2023] [Revised: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Many breast cancer survivors experience long-term complaints following treatment, such as pain, which are often not addressed in a sufficient way. To empower survivors in talking about their pain and related complaints and in searching for appropriate support when needed, we developed two written guides. With this study, we aimed to pilot test the guides and gain insight into the implementation process and influencing mechanisms through the perspective of a realist evaluation. METHODS Nine survivors were interviewed at two time points (i.e., post-intervention and at three-month follow-up). The data were thematically analysed and categorized into a context-implementation-mechanisms-outcomes hypothesis. RESULTS The guides empowered the participants to discuss pain with medical specialists and initiate support-seeking behaviour through underlying mechanisms such as awareness, acknowledgment, hope, reduced isolation, and motivation. Nonetheless, mechanisms and outcomes differed according to a survivor's unique context. CONCLUSION Written guides can offer a feasible way to empower survivors in their management of chronic pain. However, a one-size-fits-all approach is not desirable and other strategies might be necessary. PRACTICE IMPLICATIONS It is pivotal to engage survivors as well as professionals in adopting new interventions. As such, the role of nurses in introducing and endorsing the guides should be further explored.
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Affiliation(s)
- Yaël Slaghmuylder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Lydiah Maingi
- Department of Psychology, Kenyatta University, Nairobi, Kenya; Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Emelien Lauwerier
- Department of Psychology, Open University of the Netherlands, Heerlen, the Netherlands.
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Peck SS, Vani MF, Smith-Turchyn J, Sabiston CM. Natural patterns of social support for physical activity participation in newly matched breast cancer survivor dyads. BMC Womens Health 2023; 23:289. [PMID: 37237401 DOI: 10.1186/s12905-023-02430-z] [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: 01/17/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Physical activity (PA) can be a beneficial strategy to mitigate physical, emotional, and social-related challenges in women living beyond breast cancer treatment (WBC). However, PA levels among WBC remain low. Optimizing social support provided in a peer-matched setting may increase PA behavior. Unfortunately, factors that lead to an ideal peer-match among WBC are not well understood. The purpose of this study was to contextualize the natural social support environment and PA behavior in newly formed peer WBC dyads participating in an ecological momentary assessment study. METHODS WBC were matched with a partner and provided with a Fitbit activity tracker. Social support was measured using 21-daily surveys, and a 3-week follow-up survey. Descriptive statistics were calculated. Open-ended survey questions were analyzed using content analysis. Data were analyzed based on (i) social support types (informational, tangible, esteem, and emotional support); and (ii) WBC' reports of being in a good, neutral, or poor match at the end of the study. RESULTS Women (n = 46; Mage = 42.4 ± 7.6 years; 89.2% stage I-III breast cancer) connected with their partner (58.1%) and participated in moderate-vigorous PA (MVPA)(77.1%) on most days over the 21-day study period. Women were identified as being in good (63%), neutral (20%), or poor (17%) dyad matches. The most frequently documented social support received by WBC was esteem support. Participants in a good match were more likely to report receiving all types of social support compared to neutral or poor matches. CONCLUSION & CLINICAL IMPLICATIONS Findings describe the social support characteristics important to WBC for facilitating their PA participation in a partner-based setting. This study provides valuable insight that can inform the development of partner-based PA interventions for WBC.
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Affiliation(s)
- Serena S Peck
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Madison F Vani
- Faculty of Kinesiology & Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | | | - Catherine M Sabiston
- Faculty of Kinesiology & Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada.
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Tang R, Zhang Y, Li X, Wang D, Bi L, Han J, Shi M. Construction of a cutoff and fusion model of breast cancer patients in family: a grounded theory study. Support Care Cancer 2023; 31:289. [PMID: 37083990 DOI: 10.1007/s00520-023-07731-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To construct a coping model for interactions between breast cancer patients and their families across the disease trajectory using the patients' voice, and to establish a mechanism for restoring family balance when faced with stresses related to breast cancer. METHODS This study employed a longitudinal qualitative study design using constructivist grounded theory. We divided breast cancer trajectory into four periods: suspicion, diagnosis, treatment, and rehabilitation. We then interviewed patients during each of these periods. RESULTS Twenty patients with breast cancer were interviewed. A cutoff and fusion model of the breast cancer patient's interactions with her family contained three coping themes: independence, coexistence, and interconversion. The coping trajectory of breast cancer patients in their families has specific themes in each period, such as anxiety, information, emotion, and experience. CONCLUSION We constructed a cutoff and fusion model of breast cancer patients' coping trajectory in their families. This model not only explains the opposite, coexistent, and interconvertible relationship between cutoff and fusion but also the specific challenges requiring cutoff and fusion during the four periods. Our findings highlight the dynamic balance of cutoff and fusion for patients' coping in their families. IMPLICATIONS FOR PRACTICE This model helps clinical staff understand the coping of breast cancer patients in their families. When providing family education, clinical staff should suggest that they not only provide support to the patient but give each other space as well.
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Affiliation(s)
- Ruijin Tang
- School of Nursing, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004, Jiangsu, China
| | - Yao Zhang
- School of Nursing, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004, Jiangsu, China
| | - Xiaoxu Li
- Department of Breast Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Dan Wang
- Department of Oncology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Liuna Bi
- School of Nursing, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004, Jiangsu, China
| | - Jing Han
- School of Nursing, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004, Jiangsu, China.
| | - Ming Shi
- First Clinical School, Xuzhou Medical University, Jiangsu, China
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Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 69] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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Slaghmuylder Y, Lauwerier E, Pype P. Survivors' perceptions regarding the follow-up of pain complaints after breast cancer treatment: Distinct coping patterns. Front Psychol 2023; 13:1063705. [PMID: 36710732 PMCID: PMC9879359 DOI: 10.3389/fpsyg.2022.1063705] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction After finishing cancer treatment, breast cancer survivors often experience both physical and psychosocial symptoms such as pain. In some, pain can persist for months or even years. Pain is a complex experience. Its occurrence and maintenance are explained through interactions between multiple factors, which are biological/physiological, psychological, and social in nature. Unaddressed needs related to this problem - such as insufficient pain relief, limited validation of the problem, and minimal physical and psychological support - may cause severe disability and negatively impact well-being and quality of life. This study investigated how breast cancer survivors perceive their (chronic) pain complaints to be addressed during follow-up care. Furthermore, we explored how they coped with the way their trajectories happened to unfold. Methods We conducted four focus groups with a total of thirty-one breast cancer survivors. Each focus group consisted of an asynchronous part with an online discussion platform and a synchronous part through video calls. Data analysis was guided by the Qualitative Analysis Guide of Leuven. Results Narratives revealed the unmet needs of survivors and showed variability in the lived experiences of having to deal with pain. Some survivors tend to ignore the pain, while others look for solutions to reduce pain. A third coping pattern is accepting pain and its impact. Furthermore, how survivors cope with pain is influenced by intrapersonal, interpersonal, and societal processes. For example, pain-related beliefs and prejudices among healthcare providers, family, friends, colleagues, other cancer survivors, and society could possibly steer a survivor towards a certain way of coping. In these processes, the role of healthcare providers seems pivotal. For instance, when survivors do not feel heard or taken seriously by healthcare providers, their acceptance of pain can be impeded. Discussion To conclude, a person's way of coping with pain and the associated needs is dynamic and influenced by factors at multiple levels such as the intrapersonal, interpersonal and societal level. To sufficiently address the problem of pain among cancer survivors, we therefore also need actions that tackle the health care system and its stakeholders, as well as the public debate concerning cancer follow-up care.
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Affiliation(s)
- Yaël Slaghmuylder
- InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium,*Correspondence: Yaël Slaghmuylder, ✉
| | - Emelien Lauwerier
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Peter Pype
- InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Salomon RE, Dobbins S, Harris C, Haeusslein L, Lin CX, Reeves K, Richoux S, Roussett G, Shin J, Dawson-Rose C. Antiracist symptom science: A call to action and path forward. Nurs Outlook 2022; 70:794-806. [PMID: 36400578 PMCID: PMC10916506 DOI: 10.1016/j.outlook.2022.07.014] [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: 04/06/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022]
Abstract
Nurse scientists recognize the experience of racism as a driving force behind health. However, symptom science, a pillar of nursing, has rarely considered contributions of racism. Our objective is to describe findings within symptom science research related to racial disparities and/or experiences of racism and to promote antiracist symptom science within nursing research. In this manuscript, we use an antiracist lens to review a predominant symptom science theory and literature in three areas of symptom science research-oncology, mental health, and perinatal health. Finally, we make recommendations for increasing antiracist research in symptom science by altering (a) research questions, (b) recruitment methods, (c) study design, (d) data analysis, and (e) dissemination of findings. Traditionally, symptom science focuses on individual level factors rather than broader contexts driving symptom experience and management. We urge symptom science researchers to embrace antiracism by designing research with the specific intent of dismantling racism at multiple levels.
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Affiliation(s)
- Rebecca E Salomon
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Sarah Dobbins
- San Francisco Department of Public Health, San Francisco, California
| | | | | | - Chen-Xi Lin
- University of California, San Francisco, San Francisco, California
| | - Katie Reeves
- University of California, San Francisco, San Francisco, California
| | - Sarah Richoux
- University of California, San Francisco, San Francisco, California
| | - Greg Roussett
- University of California, San Francisco, San Francisco, California
| | - Joosun Shin
- University of California, San Francisco, San Francisco, California
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Effects of Structured Expressive Writing on Quality of Life and Perceived Self-Care Self-Efficacy of Breast Cancer Patients Undergoing Chemotherapy in Central China: A Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10091762. [PMID: 36141374 PMCID: PMC9498690 DOI: 10.3390/healthcare10091762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Expressive writing is a supportive psychological intervention allowing an individual to disclose and express their deepest thoughts and feelings related to personal traumatic experiences through writing. Previous studies suggested that expressive writing could promote the physical and mental health of cancer patients. The current study was conducted to evaluate the effect of expressive writing based on the theory of cognitive adaptation (TCA) on the quality of life and self-care self-efficacy in patients with breast cancer undergoing chemotherapy. A sample of 82 Chinese women receiving chemotherapy for breast cancer was randomly assigned to an experimental group (four 20 min writing activities focusing on emotional disclosure) or a control group (no writing activities). The quality of life (QoL) and self-care self-efficacy were assessed at baseline, 2 weeks, 4 weeks, and 6 weeks after the intervention, respectively. The sociodemographic characteristics, QoL, and self-care self-efficacy at baseline were comparable between the two groups. Repeated-measures ANOVA revealed significant effects of the time×group (F = 3.65, p < 0.05) on the QoL and significant effects of time (F = 4.77, p <0.05) on self-care self-efficacy. Compared with the control group, the QoL in the intervention group showed a significant and temporary increase at 2 weeks after the intervention (mean difference = −7.56, p < 0.05). As a low-cost and easily delivered psychological intervention, expressive writing is recommended to reduce stress when there is a lack of available emotional support.
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Slaghmuylder Y, Pype P, Van Hecke A, Lauwerier E. Exploring healthcare providers’ perceptions regarding the prevention and treatment of chronic pain in breast cancer survivors: A qualitative analysis among different disciplines. PLoS One 2022; 17:e0273576. [PMID: 36006950 PMCID: PMC9409579 DOI: 10.1371/journal.pone.0273576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background The prevention and treatment of chronic pain problems in breast cancer follow-up care require an adequate response from healthcare providers. Generally, this involves the uptake of evidence-based principles regarding pain management in everyday practice. However, despite the extensive literature on effective pain interventions, systematic and coordinated follow-up care is lacking for breast cancer survivors with pain problems in Flanders, Belgium. Objective This study aimed to gather insight into healthcare providers’ perceptions of pain prevention and treatment in breast cancer follow-up care, particularly with attention to the multilevel influences on pain follow-up. Methods We conducted four online focus groups with twenty-two healthcare providers from different disciplines such as oncologists, pharmacists, nurses, physiotherapists, and psychologists. Data analysis was guided by the Qualitative Analysis Guide of Leuven. This guide is inspired by the constant comparison method, based on Grounded Theory. Results The identified influencing factors were thematically grouped into four levels: at the level of the individual healthcare provider, in interaction with the patient, in interaction with colleagues, and at the context level. At each level, we distinguished factors related to healthcare providers’ perceptions such as awareness, knowledge, attitudes, beliefs, experiences, and intentions. For example, because of a lack of knowledge and certain beliefs among healthcare providers, referral to other disciplines often does not happen in the context of pain. Conclusion This study points out the need to explore the prevention and treatment of chronic pain after breast cancer from a multidimensional point of view. This involves not only the characteristics of individual healthcare providers but is also inherently interactional and system-like in nature. This analysis provides opportunities for the development of interventions that target the influencing factors of prevention and treatment of chronic pain in breast cancer survivors.
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Affiliation(s)
- Yaël Slaghmuylder
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Ghent University, Ghent, Flanders, Belgium
- * E-mail:
| | - Peter Pype
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Ghent University, Ghent, Flanders, Belgium
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Ghent University, Ghent, Flanders, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Flanders, Belgium
| | - Emelien Lauwerier
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Ghent University, Ghent, Flanders, Belgium
- Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Flanders, Belgium
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Yu H, Li H, Zuo T, Cao L, Bi X, Xing H, Cai L, Sun J, Liu Y. Financial Toxicity and psychological distress in Adults with Cancer: A Treatment-based Analysis. Asia Pac J Oncol Nurs 2022; 9:100069. [PMID: 35669288 PMCID: PMC9166374 DOI: 10.1016/j.apjon.2022.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate disparities in financial toxicity and psychological distress in patients with cancer as a function of treatment and reveal the relationship between financial toxicity and psychological distress. Methods This was a multicenter cross-sectional study. Patients were recruited from March 2017 to October 2018, and questionnaires were completed regarding their demographics, financial toxicity, and psychological distress. A multiple linear regression model was used to examine factors associated with financial and psychological distress. Results Significant financial toxicity and psychological distress occurred in 47.9% and 56.5% of patients, respectively. Financial toxicity (P = 0.032) and psychological distress (P < 0.001) were statistically different among the single chemotherapy, adjuvant therapy, and surgery groups. Multivariable analysis revealed that patients aged 50–59 years (P = 0.035), 60–69 years (P = 0.007), and 70 years or older (P = 0.002) had higher the Comprehensive Score for financial Toxicity (COST) scores compared with patients less than 50 years old. Patients with personal annual income > 40,000 CNY reported higher COST scores than those who had < 20,000 CNY (P < 0.001). Patients who had Urban Resident Basic Medical Insurance (URBMI) (P = 0.030) or New Rural Cooperative Medical Scheme (NRCMS) (P = 0.006) compared with Urban Employee Basic Medical Insurance (UEBMI) presented lower COST scores than patients with UEBMI. The multiple analysis model of psychological distress showed that an age of more than 70 years (P = 0.010) was significantly associated with low the Distress Thermometer (DT) scores, and patients with colorectal cancer (P = 0.009), the surgery group (P < 0.001) and adjuvant therapy group (P < 0.001) were significantly associated with high DT scores. The correlations between financial toxicity and psychological distress were mild but statistically significant in the chemotherapy-related treatment groups. Conclusions The research highlights the high rates of financial and psychological distress in adult patients. Multidimensional distress screening and psychosocial interventions should be provided for patients with cancer according to related factors.
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Tu C, He Y, Ma X. Factors influencing psychological distress and effects of stepwise psychological care on quality of life in patients undergoing chemotherapy after breast cancer surgery. Am J Transl Res 2022; 14:1923-1933. [PMID: 35422923 PMCID: PMC8991156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate factors influencing psychological distress and the effect of stepwise psychological care on the quality of life in patients undergoing chemotherapy after breast cancer surgery. METHODS A retrospective study was conducted on 96 patients undergoing chemotherapy after breast cancer surgery. The patients were evenly divided into a routine care group (control group) and a stepwise psychological care group (observation group) according to the care method. The correlation between the psychological distress and the Self-Rating Anxiety Scale (SAS) score was investigated. The impact of care intervention on the psychological distress, SAS score, and the quality of life of patients before and after intervention were explored. Relevant factors that affect the psychological distress of patients undergoing chemotherapy after breast cancer surgery were also investigated. RESULTS A univariate analysis showed that age, residence, monthly income, education level, medical insurance status, occupation, surgery method, and anxiety score all contributed to the degree of psychological distress in patients with breast cancer mastectomy (all P<0.05). A multivariate regression analysis demonstrated that young age, low monthly income, no medical insurance, mastectomy, and high SAS score were risk factors for the psychological distress of patients who underwent mastectomy (all P<0.05). The psychological distress was positively correlated with anxiety scores of patients undergoing chemotherapy after breast cancer surgery (r=0.249, P=0.005). Both psychological distress and anxiety scores of the observation group after stepwise psychological care were significantly lower than those before treatment and those of the control group (both P<0.05). After treatment, both groups of patients showed better scores in additional concerning items, social/family well-being, functional well-being, physical well-being, emotional well-being, and overall quality of life than before treatment (all P<0.05). Of note, the observation group demonstrated better quality of life than that of the control group. CONCLUSION Age, low monthly income, radical mastectomy, and no medical insurance prior to undergoing chemotherapy after breast cancer surgery are independent factors that affect psychological distress. The distress was positively correlated with anxiety. Thus, stepwise psychological care may alleviate patients' psychological distress and anxiety.
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Affiliation(s)
- Congmei Tu
- Department of Hospice, Affiliated Hospital of Guangdong Medical University Zhanjiang 524001, Guangdong Province, China
| | - Yongping He
- Department of Hospice, Affiliated Hospital of Guangdong Medical University Zhanjiang 524001, Guangdong Province, China
| | - Xue Ma
- Department of Hospice, Affiliated Hospital of Guangdong Medical University Zhanjiang 524001, Guangdong Province, China
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14
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Samami E, Shahhosseini Z, Hamzehgardeshi Z, Elyasi F. Psychological Interventions in Chemotherapy-Induced Nausea and Vomiting in Women with Breast Cancer: A Systematic Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:95-106. [PMID: 35291438 PMCID: PMC8919308 DOI: 10.30476/ijms.2020.86657.1660] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/26/2020] [Accepted: 11/15/2020] [Indexed: 11/19/2022]
Abstract
Background Nausea and vomiting are considered the most common side effects of chemotherapy, and they can affect different dimensions of the lives of women with breast cancer. Thus, the management of these complications is of great significance. Various interventions are drawn upon to alleviate nausea and vomiting. This review aimed to investigate the effects of psychological interventions on chemotherapy-induced nausea and vomiting among women with breast cancer. Methods A systematic review of clinical or quasi-experimental clinical trials published from 2000 to 2020 on the effects of psychological interventions on nausea and vomiting induced by chemotherapy in women with breast cancer was conducted via a comprehensive search in web search engines including Google Scholar and PubMed and databases such as Web of Science, Scopus, ScienceDirect, Cochrane Library, Springer, Elsevier, Magiran, and Scientific Information Database (SID). Medical Subject Heading (MeSH) was employed with the following keywords: nausea, vomiting, breast cancer, chemotherapy, and psychological intervention. The quality of the included studies was assessed via the Jadad scale. Results Nine studies were included in this systematic review. Psychological interventions in chemotherapy-induced nausea and vomiting in women with breast cancer consisted of cognitive-behavioral therapy, progressive muscle relaxation training, yoga, and guided imagery. The results indicated that in all the studies, except one, the interventions improved conditions and reduced chemotherapy-induced nausea and vomiting. Conclusion The results of this study indicated that psychological interventions such as cognitive-behavioral therapy, progressive muscle relaxation training, guided imagery, and yoga alleviated nausea and vomiting induced by chemotherapy in women with breast cancer. Therefore, it is recommended that these interventions be applied by healthcare providers to ameliorate nausea and vomiting in these patients.The abstract was presented in the 15th International Congress on Obstetrics and Gynecology, Tehran, Iran, 8-11 October 2019, as a poster and published in the congress book.
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Affiliation(s)
- Elahe Samami
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Student Research Committee, Mazandaran University of Medical Sciences. Sari, Iran
| | - Zohreh Shahhosseini
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Hamzehgardeshi
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Department of Psychiatry, Sexual and Reproductive Health Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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ICOnnecta't: Development and Initial Results of a Stepped Psychosocial eHealth Ecosystem to Facilitate Risk Assessment and Prevention of Early Emotional Distress in Breast Cancer Survivors' Journey. Cancers (Basel) 2022; 14:cancers14040974. [PMID: 35205722 PMCID: PMC8869931 DOI: 10.3390/cancers14040974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 12/19/2022] Open
Abstract
Simple Summary In current clinical practice, between one third and a half of patients diagnosed with cancer experience distress. Moreover, many of these psychosocial needs often remain unaddressed, although effective interventions exist. Nowadays, eHealth solutions like ICOnnecta’t offer new tools to overcome these limitations and improve access to treatment. This digital ecosystem has been proved to be feasible to implement, reaching good acceptability, use, and satisfaction between users. In addition, it allowed symptom monitoring in real time, facilitating preventive early interventions. Overall, fostering social support appears as a key to facilitate a resilient response after diagnosis. Abstract Psychosocial interventions prevent emotional distress and facilitate adaptation in breast cancer (BC). However, conventional care presents accessibility barriers that eHealth has the potential to overcome. ICOnnecta’t is a stepped digital ecosystem designed to build wellbeing and reduce psychosocial risks during the cancer journey through a European-funded project. Women recently diagnosed with BC in a comprehensive cancer center were offered the ecosystem. ICOnnecta’t consists of four care levels, provided according to users’ distress: screening and monitoring, psychoeducation campus, peer-support community, and online-group psychotherapy. Descriptive analyses were conducted to assess the platform’s implementation, while multilevel linear models were used to study users’ psychosocial course after diagnosis. ICOnnecta’t showed acceptance, use and attrition rates of 57.62, 74.60, and 29.66%, respectively. Up to 76.19% of users reported being satisfied with the platform and 75.95% informed that it was easy to use. A total of 443 patients’ needs were detected and responsively managed, leading 94.33% of users to remain in the preventive steps. In general, strong social support led to a better psychosocial course. ICOnnecta’t has been successfully implemented. The results showed that it supported the development of a digital relation with healthcare services and opened new early support pathways.
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Smith-Turchyn J, McCowan ME, O'Loughlin E, Fong AJ, McDonough MH, Santa Mina D, Arbour-Nicitopoulos KP, Trinh L, Jones JM, Bender JL, Culos-Reed SN, Tomasone JR, Vani MF, Sabiston CM. Connecting breast cancer survivors for exercise: protocol for a two-arm randomized controlled trial. BMC Sports Sci Med Rehabil 2021; 13:128. [PMID: 34649590 PMCID: PMC8515152 DOI: 10.1186/s13102-021-00341-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Peer-based exercise interventions that cultivate new opportunities for support with a fellow cancer survivor may result in increased exercise volume. It is not clear whether adding qualified exercise professional (QEP) support to peer-based interventions improves health outcomes. Therefore, the purpose of this study is to determine whether breast cancer survivor (BCS) dyads who receive 10 weekly sessions of virtually delivered QEP support have improved outcomes compared to BCS dyads who do not receive QEP support. METHODS Participants Adult BCS with medical clearance for exercise, who have an internet-connected device, and currently engage in < 150 min of moderate-intensity exercise per week. Intervention BCS will be matched using evidence-based criteria. The intervention group will receive dyadic exercise information sessions and a program tailored by a QEP for 10 weeks (intervention period) and have access to the QEP for an additional 4 weeks (tapering period). The control will not receive any QEP support. Outcomes The primary outcome is post-intervention self-reported exercise volume. Secondary outcomes include device-assessed exercise volume (i.e., Fitbit), social support, and health-related quality of life. Randomization 108 participants, matched in dyads, will be randomized 1:1 to the MatchQEP or Match groups using a web-based scheme. Statistical analysis Outcomes will be measured at baseline, post-intervention, post-tapering, and at 12 weeks post-intervention follow-up. DISCUSSION The findings from this RCT will determine if matched BCS dyads who receive 10 weeks of virtually delivered QEP support have higher levels of self-report and device-measured exercise, social support, and health related quality of life compared to matched dyads without QEP-delivered exercise guidance. To our knowledge this will be the first study to assess the combined effect of peer- and QEP support on exercise volume. Project findings will inform and optimize intervention methods aimed to increase exercise among BCS through accessible exercise supports. TRIAL REGISTRATION The study is registered on ClinicalTrials.gov (study identifier: NCT04771975, protocol Version Number: 2, date: July 22, 2021).
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Affiliation(s)
- Jenna Smith-Turchyn
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
| | - Michelle E McCowan
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Erin O'Loughlin
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Angela J Fong
- Department of Kinesiology and Health, Rutgers University, New Brunswick, USA
| | | | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | | | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Jennifer M Jones
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jackie L Bender
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | | | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | - Madison F Vani
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.
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Gonzalez L, Sun C, Loscalzo M, Clark K, Kruper L, Mortimer J, Jones V. A Cross-Sectional Study of Distress Levels in Patients with Newly Diagnosed Breast Cancer: The Impact of Race, Ethnicity, and Language Preference. Ann Surg Oncol 2021; 29:981-988. [PMID: 34585296 DOI: 10.1245/s10434-021-10561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Our objective was to assess distress levels in female breast cancer patients as a function of race, ethnicity, and preferred language. We hypothesized minority patients and non-English screen-takers would report higher distress levels compared to English screen-takers and non-Hispanic whites. METHODS We conducted a retrospective observational study of female breast cancer patients at an NCI designated cancer center from 2009 to 2016 who were administered a validated biopsychosocial distress screening questionnaire. Self-reported data on race and ethnicity was collected. RESULTS A total of 3,156 patients were included in the analysis; mean age of 56.3 (SD 12.25) years. The racial/ethnic cohort distribution included 54% non-Hispanic white (NHW), 19% Hispanic, 16% Asian, 7% Black/African American, and 4% other. On multivariable analysis only Hispanic patients were significantly more likely to report overall distress compared to NHW (OR [1.39; CI [1.03-1.87; p=0.03). Asians were significantly less likely to report distress in the functional domain (OR 0.71, CI [0.58-0.88]; p=0.002), while Black patients were significantly more likely to report highest distress levels in the physical (OR 1.53, CI [1.11-2.12]; p=0.01) domain. Hispanic Spanish screen-takers reported significantly more distress compared to Hispanic English screen-takers across all four domains of distress (p<0.05 for all). CONCLUSIONS Top sources of distress in female breast cancer patients vary as a function of race, ethnicity, and preferred language. Future studies should focus on identifying effective, culturally appropriate targeted interventions to mitigate emotional distress levels in ethnic and racial minorities as well as non-English speaking patients with breast cancer.
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Affiliation(s)
- Lorena Gonzalez
- Division of Breast Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
| | - Canlan Sun
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Karen Clark
- Department of Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Laura Kruper
- Division of Breast Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Joanne Mortimer
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Veronica Jones
- Division of Breast Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
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18
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Distress among cancer patients attending rehabilitation in the community. Support Care Cancer 2021; 30:279-287. [PMID: 34273033 PMCID: PMC8636420 DOI: 10.1007/s00520-021-06422-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/06/2021] [Indexed: 01/30/2023]
Abstract
Purpose The aim of this study is to identify sources of distress among cancer patients attending rehabilitation in the community. Methods Participants were 430 patients recruited from a cancer rehabilitation center in Singapore between 2017 and 2018, who had rated their distress using the distress thermometer (DT) and indicated associated problems on the problem list. Chi-square tests were used to detect differences in the reported symptoms among three age groups. Exploratory factor analysis was used to identify symptom clusters. Partial correlational analysis was then performed to examine the relationship between distress, symptom clusters, and age controlling for gender and cancer type. Results About 30% of the participants reported distress ≥ 5 on the DT (mean 3.3 ± 2.5), and the mean number of problems endorsed was 8 ± 6. A higher total number of reported problems (r = .63) and younger age (r = − .21) were associated with increased distress. The younger age group also reported more problems surrounding emotions, finance, work/school, children-related issues, and physical symptoms such as sleep and nausea. Of the 12 factors identified, 9 psychosocial and physical symptom clusters correlated with distress (r ranging from .12 to .41). All results were statistically significant after adjustment (p ≤ 0.05). Conclusion Younger survivors are more at risk of distress and report greater role functioning concerns related to childcare, partner relationship, and work participation. Age-tailored and multimodal interventions may be necessary to adequately address age-related differences and help coordinate management of multiple symptom clusters across physical and psychosocial concerns.
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Fukui J, Bantum E, Meister M, Lim S, Marumoto AD, Pagano I. A cross-sectional study of breast pain in a diverse population of breast cancer patients. JOURNAL OF PSYCHOSOCIAL ONCOLOGY RESEARCH AND PRACTICE 2021; 3:e055. [PMID: 34458852 PMCID: PMC8389166 DOI: 10.1097/or9.0000000000000055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women, and postoperative breast pain has been reported to be anywhere from 25% to 60%. However, there is sparse data regarding racial/ethnic differences in breast pain among breast cancer patients. METHODS We performed a cross-sectional anonymous survey of breast cancer patients from the Hawaii Cancer Consortium over a 6-week period between 2019 and 2020. The 237 breast cancer participants were ages 29 to 98, 74% Asian, and mainly from outpatient oncology clinics. We evaluated the prevalence of breast pain in a diverse group of breast cancer patients and characterized the pain using a modified short-form McGill pain questionnaire (sfMPQ). RESULTS Eighty-fourrespondents(35.4%) reported breast pain. On univariable analysis, we found significant racial/ethnic differences in the amount of breast pain, where Chinese and Japanese participants reported significantly less pain compared to White participants on a 10-point pain scale. We found differences in breast pain according to age and endocrine therapy use as well as survey location, however, no differences were seen according to chemotherapy, radiation, or breast surgery. Based on the sfMPQ, the most common descriptors of breast pain were sensory (throbbing, shooting, and stabbing) compared to affective (tiring-exhausting, sickening, fearful, and punishing-cruel) characteristics. Although they were described as mild and intermittent, in women with breast pain, 33.4% reported the breast pain affected their sleep, 16.7% their work, and 15.4% their sexual activity. CONCLUSIONS Breast pain is a significant problem in our breast cancer community. This survey assessment has informed our understanding of breast pain in our diverse population. In turn, we are developing culturally appropriate pain management strategies to treat this challenging symptom common in breast cancer survivors.
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Affiliation(s)
- Jami Fukui
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
| | - Erin Bantum
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
| | - Madison Meister
- University of Louisville 2310S. Third Street, Louisville, KY 40292, USA
| | - Shannon Lim
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
| | | | - Ian Pagano
- University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI 96813, USA
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Rades D, Narvaez CA, Schild SE, Tvilsted S, Kjaer TW. Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer. In Vivo 2021; 35:2253-2260. [PMID: 34182504 DOI: 10.21873/invivo.12498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIM The anticipation of radiotherapy can cause distress and sleep disorders, which may be aggravated by the COVID-19 pandemic. This study investigated sleep disorders in a large cohort of patients with breast cancer before and during the pandemic. PATIENTS AND METHODS Twenty-three characteristics were retrospectively analyzed for associations with pre-radiotherapy sleep disorders in 338 patients. Moreover, 163 patients presenting before and 175 patients presenting during the COVID-19 pandemic were compared for sleep disorders. RESULTS Sleep disorders were significantly associated with age ≤60 years (p=0.006); high distress score (p<0.0001); more emotional (p<0.0001), physical (p<0.0001) or practical (p<0.0001) problems; psycho-oncological need (p<0.0001); invasive cancer (p=0.003); chemotherapy (p<0.001); and hormonal therapy (p=0.006). Sleep disorders were similarly common in both groups (prior to vs. during the pandemic: 40% vs. 45%, p=0.38). CONCLUSION Although additional significant risk factors for sleep disorders were identified, the COVID-19 pandemic appeared to have no significant impact on sleep disorders in patients scheduled for irradiation of breast cancer.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
| | - Carlos A Narvaez
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Soeren Tvilsted
- Research Projects and Clinical Optimization, Zealand University Hospital, Koege, Denmark
| | - Troels W Kjaer
- Neurological Department, Zealand University Hospital, Roskilde, Denmark
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21
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Hu X, Chehal PK, Kaplan C, Krukowski RA, Lan RH, Stepanski E, Schwartzberg L, Vidal G, Graetz I. Characterization of Clinical Symptoms by Race Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer Before Starting Chemotherapy. JAMA Netw Open 2021; 4:e2112076. [PMID: 34061200 PMCID: PMC8170541 DOI: 10.1001/jamanetworkopen.2021.12076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Race disparities persist in breast cancer mortality rates. One factor associated with these disparities may be differences in symptom burden, which may reduce chemotherapy tolerance and increase early treatment discontinuation. OBJECTIVES To compare symptom burden by race among women with early-stage breast cancer before starting chemotherapy and quantify symptom differences explained by baseline characteristics. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of symptom burden differences by race among Black and White women with a diagnosis of stage I to III, hormone receptor-positive breast cancer who had a symptom report collected before chemotherapy initiation in a large cancer center in the southern region of the US from January 1, 2007, through December 31, 2015. Analyses were conducted from November 1, 2019, to March 31, 2021. Blinder-Oaxaca decomposition was used, adjusting for baseline sociodemographic and clinical characteristics. MAIN OUTCOMES AND MEASURES Four symptom composite scores with a mean (SD) of 50 (10) were reported before starting chemotherapy (baseline) and were derived from symptom items: general physical symptoms (11 items), treatment adverse effects (8 items), acute distress (4 items), and despair (7 items). Patients rated the severity of each symptom they experienced in the past week on a scale of 0 to 10 (where 0 indicates not a problem and 10 indicates as bad as possible). RESULTS A total of 1338 women (mean [SD] age, 54.6 [11.6] years; 420 Black women [31.4%] and 918 White women [68.6%]) were included in the study. Before starting chemotherapy, Black women reported a statistically significantly higher (ie, worse) symptom composite score than White women for adverse effects (44.5 vs 43.8) but a lower acute distress score (48.5 vs 51.0). Decomposition analyses showed that Black patients' characteristics were associated with higher symptom burden across all 4 scores. However, these differences were offset by relatively greater, statistically significant, unexplained physical, distress, and despair symptom reporting by White patients. CONCLUSIONS AND RELEVANCE In this study, before starting chemotherapy, Black patients with early-stage breast cancer reported significantly higher burden for symptoms that may be exacerbated with chemotherapy and lower distress symptoms compared with White patients. Future studies should explore how symptoms change before and after treatment and differ by racial/ethnic groups and how they are associated with treatment adherence and mortality disparities.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Puneet K. Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cameron Kaplan
- Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine of University of Southern California, Los Angeles
| | | | - Roy H. Lan
- College of Medicine, University of Tennessee Health Science Center, Memphis
| | | | - Lee Schwartzberg
- West Cancer Center and Research Institute, Germantown, Tennessee
| | - Gregory Vidal
- West Cancer Center and Research Institute, Germantown, Tennessee
- Division of Hematology and Oncology, University of Tennessee Health Science Center, Memphis
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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22
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Samami E, Elyasi F, Mousavinasab SN, Shojaee L, Zaboli E, Shahhosseini Z. The effect of a supportive program on coping strategies and stress in women diagnosed with breast cancer: A randomized controlled clinical trial. Nurs Open 2021; 8:1157-1167. [PMID: 34482657 PMCID: PMC8046153 DOI: 10.1002/nop2.728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/07/2020] [Accepted: 11/05/2020] [Indexed: 12/31/2022] Open
Abstract
AIM To investigate the effect of a supportive program on coping strategies and stress in women with breast cancer. DESIGN A randomized, two-armed, controlled trial. METHODS Sixty women were randomly allocated to intervention group (N = 30) and control group (N = 30). The interventions were held in six sessions, weekly from August 2018-March 2019 It was consisting of education regarding breast cancer; progressive muscle relaxation; stress management; emotional coping; and problem-solving strategies. RESULTS At baseline, there was no difference between the two groups regarding the mean score of coping strategies and stress. Supportive program group participants experienced a significantly higher increase on their problem-oriented coping strategies score in comparison with the control group. At the same time, scores in emotion-oriented coping strategies and stress decreased significantly in the intervention group compared with the control group. Result of this study can be used to develop relevant interventions targeting coping strategies to reduce stress among women with breast cancer.
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Affiliation(s)
- Elahe Samami
- Student Research Committee, Mazandaran University of Medical SciencesSariIran
| | - Forouzan Elyasi
- School of MedicineSexual and Reproductive Health Research Center, Psychiatry and Behavioral Sciences Research Center, Addiction InstituteMazandaran University of Medical SciencesSariIran
| | | | - Leila Shojaee
- Department of SurgerySchool of MedicineGastrointestinal Cancer Research CenterMazandaran University of Medical SciencesSariIran
| | - Ehsan Zaboli
- Department of Hematology & OncologySchool of MedicineGastrointestinal Cancer Research CenterMazandaran University of Medical SciencesSariIran
| | - Zohreh Shahhosseini
- Sexual and Reproductive Health Research CenterMazandaran University of Medical SciencesSariIran
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23
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Zamanian H, Daryaafzoon M, Foroozanfar S, Fakhri Z, Jalali T, Ghotbi A, Amini-Tehrani M. Which Domains of Social Support Better Predict Quality of Life of Women with Breast Cancer? A Cross-Sectional Study. Asia Pac J Oncol Nurs 2021; 8:211-217. [PMID: 33688571 PMCID: PMC7934600 DOI: 10.4103/apjon.apjon_47_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/10/2020] [Indexed: 01/04/2023] Open
Abstract
Objectives: The study aimed at investigating the specific role of social support types (SSTs) on quality of life (QoL) and its domains of women with breast cancer in Iran. Methods: In this cross-sectional study, a number of 223 women with breast cancer visiting three cancer centers of Tehran, Iran, participated from October 2014 to May 2015. Medical Outcome Study-Social Support Scale and Functional Assessment of Cancer Therapy-Breast Cancer were used for data gathering. Backward multiple regression was utilized, adjusted by age, education, and family size. Results: The study indicated positive correlations between all SSTs and QoL domains, whereas only positive social interaction (PSI) showed a significant association with physical well-being. PSI showed the only predictive performance in terms of all QoL outcomes, beyond the covariates. Conclusions: The study revealed the PSI as the most influential support type to enhance all domains of QoL of women with breast cancer.
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Affiliation(s)
- Hadi Zamanian
- Department of Health Education and Promotion, School of Health, Qom University of Medical Sciences, Qom, Iran.,Health Psychology and Behavior Medicine Research Group, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Daryaafzoon
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Sahar Foroozanfar
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Zinat Fakhri
- Department of Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Tina Jalali
- Health Psychology and Behavior Medicine Research Group, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amene Ghotbi
- Health Psychology and Behavior Medicine Research Group, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadali Amini-Tehrani
- Health Psychology and Behavior Medicine Research Group, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
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24
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Deng SM, Chiu AF, Wu SC, Huang YC, Huang SC, Chen SY, Tsai MY. Association between cancer-related fatigue and traditional Chinese medicine body constitution in female patients with breast cancer. J Tradit Complement Med 2021; 11:62-67. [PMID: 33511063 PMCID: PMC7817705 DOI: 10.1016/j.jtcme.2020.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is a common psychosomatic problem in breast cancer patients. Traditional Chinese medicine (TCM) has been used to address symptoms in patients with CRF. Identification of the specific constitution in TCM is essential for personalized care. AIM To explore the relationship between fatigue and specific constitutions in breast cancer. EXPERIMENTAL PROCEDURE We conducted a cross-sectional study in all breast cancer patients at Kaohsiung Chang Gung Memorial Hospital in Taiwan. The severity of fatigue was determined using the Brief Fatigue Inventory-Taiwanese (BFI-T) form. TCM patterns were determined using the Body Constitution Questionnaire (BCQ). The relationship between constitution and fatigue was analyzed using logistic regression. RESULTS We recruited 110 breast cancer patients with fatigue (mean age: 55 ± 11 years). The mean duration of breast cancer was 17.4 months. The major constitution among these patients with fatigue was Yang-Qi deficiency (50%). Phlegm-Stasis syndrome was correlated with a duration of breast cancer of more than 18 months (p = 0.02). Out of all participants, 42.7% (n = 47) reported clinically significant fatigue (BFI-T score ≥4). According to logistic regression, the score of Yang-Qi deficiency [odds ratio (OR): 3.5, 95% confidence interval (CI): 1.49-8.21, p < 0.01] was also associated with clinically significant fatigue. CONCLUSION Yang-Qi deficiency is associated with clinically significant fatigue in breast cancer patients. However, the association of Phlegm-Stasis syndrome and fatigue as disease duration increases cannot be ignored. Further studies are needed to determine whether treating both constitutions integrating TCM treatment can alleviate patients' fatigue symptoms.
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Key Words
- BCQ, Body Constitution Questionnaire
- BFI-T, Brief Fatigue Inventory–Taiwan
- BMI, body mass index
- Breast cancer
- CAM, complementary and alternative medicine
- CI, confidence interval
- CRF, Cancer-related fatigue
- Chemotherapy
- Constitution
- Fatigue
- Hb, hemoglobin
- OR, odds ratio
- TCM, traditional Chinese medicine
- Traditional Chinese medicine
- VAS, visual analogue scale
- WBC, white blood cell
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Affiliation(s)
- Sheuh-Mei Deng
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
- Department of Nursing, Fooyin University, Kaohsiung, 83102, Taiwan
| | - Aih-Fung Chiu
- Department of Nursing, Meiho University, Pingtung, 91202, Taiwan
| | - Shin-Chung Wu
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Yu-Chuen Huang
- Department of Medical Research, China Medical University Hospital and School of Chinese Medicine, China Medical University, Taichung, 41354, Taiwan
| | - Shu-Chuan Huang
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Shih-Yu Chen
- Department of Pediatrics, E-Da Hospital and I-Shou University, Kaohsiung, 82445, Taiwan
| | - Ming-Yen Tsai
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
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25
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McFarland DC, Nelson C, Miller AH. Early childhood adversity in adult patients with metastatic lung cancer: Cross-sectional analysis of symptom burden and inflammation. Brain Behav Immun 2020; 90:167-173. [PMID: 32791210 PMCID: PMC7544656 DOI: 10.1016/j.bbi.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Psychological and physical symptoms commonly occur in patients with metastatic lung cancer and are associated with reduced quality of life and decreased survival. Previous work has associated these symptoms with inflammation. The experience of Early Childhood Adversity (ECA) is linked to chronic inflammation and may identify adult cancer patients who are at-risk for psychological and physical symptoms. We thus hypothesized that ECA in lung cancer patients would be associated with increased psychological symptoms (distress, anxiety, and depression) and physical symptoms and that this relationship would be explained by inflammation. METHODS Patients with metastatic lung cancer (n = 92) were evaluated for ECA using the Risky Families Questionnaire. Concomitant assessments were made of distress (Distress Thermometer and Problem List [DT&PL]), anxiety (Generalized Anxiety Disorder-7), depression (Patient Hospital Questionniare-9), physical symptoms (DT&PL), and inflammation (C-reactive protein [CRP]). Multivariate models were created to explain associations of ECA with depression, anxiety, distress, number of physical problems, and inflammation. RESULTS ECA was associated with distress (r = 0.24, p = .03), anxiety (r = 0.30, p = .004), depression (r = 0.35, p = .001), greater physical problems (r = 0.25, p = .03), younger age (r = -0.29, p = .006), and elevated CRP (r = 0.22, p = .04). Multivariate analyses of outcomes found that depression severity was independently explained by both ECA and inflammation (β = 0.37, p = .001) but not distress or anxiety, while controlling for age and sex. Number of physical problems were also associated with ECA (β = 0.35, p = .004) but not inflammation. The association between ECA and physical problems was not significant after controlling for depression. CONCLUSION ECA is associated with increased depression and physical symptoms independent of inflammation. Moreover, depression appears to mediate the impact of ECA on physical symptoms. ECA may identify patients at risk for psychological and physical symptoms.
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Affiliation(s)
- Daniel C. McFarland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Corresponding author at: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, New York, NY 10024, United States, (D.C. McFarland)
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrew H. Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
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26
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Byun HS, Hwang H, Kim GD. Crying Therapy Intervention for Breast Cancer Survivors: Development and Effects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134911. [PMID: 32646037 PMCID: PMC7370158 DOI: 10.3390/ijerph17134911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND crying therapy is currently being applied in some countries to treat cancer patients, manage pain, and promote mental health. However, little nursing and medical research on the effects of crying therapy has been conducted in other parts of the world. This study aimed to develop a crying therapy program for breast cancer survivors and assess its effects. Interventions/method: data from 27 breast cancer survivors in South Korea were analyzed. The intervention, employing a single group, pre-post-test quasi-experimental design, was divided into three phases, and effects were verified for emotional (distress, fatigue, and mood conditions) and physiological (cortisol, immunoglobulin G, and blood pressure) variables. RESULTS there were significant changes in distress, mood changes, and immunoglobulin G and smaller changes in blood pressure postintervention. Fatigue and cortisol showed no significant changes. CONCLUSIONS this study demonstrated the effectiveness of a short-term crying therapy program that can induce positive emotional changes and physiological effects in breast cancer survivors. This intervention can improve quality of life, indicating its value as a self-care program for cancer survivors.
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Affiliation(s)
- Hye-Sun Byun
- School of Nursing, Yeungnam University College, Daegu 42415, Korea;
| | - Hyenam Hwang
- Department of Nursing, Daegu University, Daegu 42400, Korea
- Correspondence: ; Tel.: +82-53-650-8398
| | - Gyung-Duck Kim
- Department of Nursing, Dongyang University, Kyungpook 36040, Korea;
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27
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Admiraal JM, Hoekstra-Weebers JEHM, Schröder CP, Tuinier W, Hospers GAP, Reyners AKL. Distress, problems, referral wish, and supportive health care use in breast cancer survivors beyond the first year after chemotherapy completion. Support Care Cancer 2020; 28:3023-3032. [PMID: 31511981 PMCID: PMC7256025 DOI: 10.1007/s00520-019-05030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/06/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE We examined distress levels, problems, referral wish, and supportive health care use in a cross-sectional group of breast cancer survivors at two-time points with a 1-year time interval. Also, factors related to continuing elevated distress were explored. METHODS Breast cancer survivors, 1-5 years after chemotherapy completion, filled in the Dutch Distress Thermometer/Problem List (DT/PL) and questions on background characteristics at study inclusion (T1). DT/PL responses and health care use were discussed during semi-structured interviews. One year later, re-assessment took place (T2). The data were analyzed by descriptive and univariate analyses. Continuing elevated distress was defined as a DT score ≥ 5 at T1 and T2. RESULTS Seventy-three survivors completed all questionnaires (response = 84.6%). Eighteen (25%) experienced continuing elevated distress. Fatigue (T1 N = 48 (66%); T2 N = 41 (56%)) and lack of physical fitness (T1 N = 44 (60%); T2 N = 36 (49%)) were most often reported. Time since diagnosis, health care use, and practical, social, emotional and physical problems were significantly associated with continuing elevated distress. Between diagnosis and T1, N = 49(67%) used supportive healthcare services, mostly a psychologist and/or a physical/lymphedema therapist, and between T1 and T2, 39 (53%) did. At T1, 8 (11%) expressed a referral wish and at T2, 11 (16%) did. CONCLUSIONS Screening and management of distress, problems, and referral wish are important, even years after chemotherapy completion as a substantial proportion of breast cancer survivors continue to report elevated distress and problems. Special attention should be paid to survivors reporting physical problems, especially fatigue and lack of physical fitness, since these problems are most strongly related to continuing elevated distress.
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Affiliation(s)
- J M Admiraal
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - J E H M Hoekstra-Weebers
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, Groningen, The Netherlands
| | - C P Schröder
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - W Tuinier
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - G A P Hospers
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - Anna K L Reyners
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands.
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28
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McCall MK, Connolly M, Nugent B, Conley YP, Bender CM, Rosenzweig MQ. Symptom Experience, Management, and Outcomes According to Race and Social Determinants Including Genomics, Epigenomics, and Metabolomics (SEMOARS + GEM): an Explanatory Model for Breast Cancer Treatment Disparity. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:428-440. [PMID: 31392599 PMCID: PMC7245588 DOI: 10.1007/s13187-019-01571-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Even after controlling for stage, comorbidity, age, and insurance status, black women with breast cancer (BC) in the USA have the lowest 5-year survival as compared with all other races for stage-matched disease. One potential cause of this survival difference is the disparity in cancer treatment, evident in many population clinical trials. Specifically, during BC chemotherapy, black women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared with white women. Symptom incidence, cancer-related distress, and ineffective communication, including the disparity in patient-centeredness of care surrounding patient symptom reporting and clinician assessment, are important factors contributing to racial disparity in dose reduction and early therapy termination. We present an evidence-based overview and an explanatory model for racial disparity in the symptom experience during BC chemotherapy that may lead to a reduction in dose intensity and a subsequent disparity in outcomes. This explanatory model, the Symptom Experience, Management, Outcomes and Adherence according to Race and Social determinants + Genomics Epigenomics and Metabolomics (SEMOARS + GEM), considers essential factors such as social determinants of health, clinician communication, symptoms and symptom management, genomics, epigenomics, and pharmacologic metabolism as contributory factors.
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Affiliation(s)
- Maura K. McCall
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Mary Connolly
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Bethany Nugent
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Yvette P. Conley
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Catherine M. Bender
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Margaret Q. Rosenzweig
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
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29
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McFarland DC, Jutagir DR, Miller A, Nelson C. Physical problem list accompanying the distress thermometer: Its associations with psychological symptoms and survival in patients with metastatic lung cancer. Psychooncology 2020; 29:910-919. [PMID: 32096582 DOI: 10.1002/pon.5367] [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] [Received: 12/13/2019] [Revised: 02/01/2020] [Accepted: 02/19/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The distress thermometer and problem list (DT&PL) is a recommended screening measure but the utility of the physical problem list (PPL) has not been evaluated in patients with metastatic lung cancer who typically have high rates of both physical and psychological symptoms. We hypothesized that the PPL will provide an accurate representation of lung cancer symptoms and be associated with concomitant distress, anxiety, depression, and worsened survival. METHODS Stage IV lung cancer patients (n = 116) reported physical symptoms from 22 PPL variables and completed the DT&PL for distress, general anxiety disorder-7 for anxiety, and Patient Health Questionnaire 9 for depression. Inferential analyses were controlled for demographic and clinical characteristics. RESULTS The average number of physical problems was 4.7 (SD = 3.8) while the median was 3.0. Fatigue, sleep, pain, and breathing problems were most common. Physical symptom burden was associated with nonmarried/partnered status (P = .003) and depression (P < .001) on multivariate analysis accounting for 43% of physical symptom burden variance. Greater number of physical symptoms and lower BMI were associated with worsened survival. Individual physical symptoms were most often associated with depression. CONCLUSION The PPL of the DT&PL appears to have clinical utility given its associations with the most common lung cancer symptoms, depression, and worsened survival. In addition to its potential role in clinics worldwide already using the DT&PL, physical symptom burden on the DT&PL should trigger a concomitant psychological assessment.
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Affiliation(s)
- Daniel C McFarland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Devika R Jutagir
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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30
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Jewett PI, Teoh D, Petzel S, Lee H, Messelt A, Kendall J, Hatsukami D, Everson-Rose SA, Blaes AH, Vogel RI. Cancer-Related Distress: Revisiting the Utility of the National Comprehensive Cancer Network Distress Thermometer Problem List in Women With Gynecologic Cancers. JCO Oncol Pract 2020; 16:e649-e659. [PMID: 32091952 DOI: 10.1200/jop.19.00471] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The Distress Thermometer (DT) includes a measure of cancer-related distress and a list of self-reported problems. This study evaluated the utility of the DT problem list in identifying concerns most associated with distress and poorer quality of life (QOL) in survivors of gynecologic cancer. METHODS Demographic, clinical, psychosocial functioning, and DT data were described among 355 women participating in a gynecologic cancer cohort. Problems from the DT list were ranked by prevalence, distress, and QOL. Logistic regression models explored factors associated with problems that were common (≥ 25% prevalence) and associated with distress and QOL. RESULTS The average age of participants was 59.9 years (standard deviation [SD], 10.8 years). Most participants were non-Hispanic white (97%) and had ovarian (44%) or uterine (42%) cancer. The mean DT score was 2.7 (SD, 2.7); participants reported a mean of 7.3 problems (SD, 5.9 problems). The most common problems were fatigue (53.6%), worry (49.9%), and tingling (46.3%); least common problems were childcare (2.1%), fevers (2.1%), and substance abuse (1.1%). Report of some common problems, including tingling, sleep, memory, skin issues, and appearance, was not associated with large differences in distress or QOL. In contrast, some rarer problems such as childcare, treatment decisions, eating, housing, nausea, and bathing/dressing were associated with worse distress or QOL. Younger age, lower income, and chemotherapy were risk factors across common problems that were associated with worse distress or QOL (fatigue, nervousness, sadness, fears, and pain). CONCLUSION The DT problem list did not easily identify concerns most associated with distress and low QOL in patients with gynecologic cancer. Adaptations that enable patients to report their most distressing concerns would enhance clinical utility of this commonly used tool.
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Affiliation(s)
- Patricia I Jewett
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN.,Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | - Deanna Teoh
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | - Sue Petzel
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | - Heewon Lee
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | - Audrey Messelt
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | | | | | - Susan A Everson-Rose
- Department of Medicine, Division of General Internal Medicine, and Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Anne H Blaes
- Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
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The association between health-related quality of life and achievement of personalized symptom goal. Support Care Cancer 2020; 28:4737-4743. [PMID: 31970517 DOI: 10.1007/s00520-020-05316-0] [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] [Received: 08/08/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of study was to explore the potential association between patient's self-reported physical symptom management goals as personalized symptom goal (PSGs) and health-related quality of life (HRQOL) in cancer patients. The secondary outcome was to investigate the relationship between number of physical symptoms not achieving the PSGs and HRQOL in cancer patients. METHODS This single-center prospective observational study comprised 140 consecutive outpatients. We evaluated the PSGs and HRQOL using the Functional Assessment of Cancer Therapy-General (FACT-G). Patients were administered a self-report questionnaire, including reports on their physical symptom intensity and PSGs using Edmonton Symptom Assessment System-revised (ESAS-r) scores. We investigated the correlation between PSGs achievement (ESAS-r score ≤ PSG score) and FACT-G total scores, and relationship between and number of physical symptoms not achieving the PSGs (ESAS-r score > PSG score) and FACT-G total scores. RESULTS The patients who did not achieve PSGs of pain, tiredness, lack of appetite, and shortness of breath had a lower FACT-G total score (p < 0.05). Multivariate linear regression showed that higher number of physical symptoms not achieving the PSGs correlated with lower FACT-G scores (decreasing by 1.826 points for each such symptom, p < 0.01). Predictors of increased number of physical symptoms not achieving the PSGs were younger age and a higher symptom intensity of anxiety. CONCLUSION PSGs achievement was associated with HRQOL in cancer patients. Additionally, the number of unachieved PSGs were independent determinant of poor HRQOL, particularly in younger cancer patients and those with higher symptom intensity of anxiety.
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32
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Lo-Fo-Wong DNN, de Haes HCJM, Aaronson NK, van Abbema DL, den Boer MD, van Hezewijk M, Immink M, Kaptein AA, Menke-Pluijmers MBE, Reyners AKL, Russell NS, Schriek M, Sijtsema S, van Tienhoven G, Verdam MGE, Sprangers MAG. Risk factors of unmet needs among women with breast cancer in the post-treatment phase. Psychooncology 2019; 29:539-549. [PMID: 31785043 PMCID: PMC7065096 DOI: 10.1002/pon.5299] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/30/2019] [Accepted: 11/18/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Unmet health care needs require additional care resources to achieve optimal patient well-being. In this nationwide study we examined associations between a number of risk factors and unmet needs after treatment among women with breast cancer, while taking into account their health care practices. We expected that more care use would be associated with lower levels of unmet needs. METHODS A multicenter, prospective, observational design was employed. Women with primary breast cancer completed questionnaires 6 and 15 months post-diagnosis. Medical data were retrieved from medical records. Direct and indirect associations between sociodemographic and clinical risk factors, distress, care use, and unmet needs were investigated with structural equation modeling. RESULTS Seven hundred forty-six participants completed both questionnaires (response rate 73.7%). The care services received were not negatively associated with the reported levels of unmet needs after treatment. Comorbidity was associated with higher physical and daily living needs. Higher age was associated with higher health system-related and informational needs. Having had chemotherapy and a mastectomy were associated with higher sexuality needs and breast cancer-specific issues, respectively. A higher level of distress was associated with higher levels of unmet need in all domains. CONCLUSIONS Clinicians may use these results to timely identify which women are at risk of developing specific unmet needs after treatment. Evidence-based, cost-effective (online) interventions that target distress, the most influential risk factor, should be further implemented and disseminated among patients and clinicians.
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Affiliation(s)
- Deborah N N Lo-Fo-Wong
- Academic Medical Center, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Hanneke C J M de Haes
- Academic Medical Center, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Neil K Aaronson
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Doris L van Abbema
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | | | - Ad A Kaptein
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Anna K L Reyners
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nicola S Russell
- Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Sieta Sijtsema
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geertjan van Tienhoven
- Academic Medical Center, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Mathilde G E Verdam
- Academic Medical Center, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Mirjam A G Sprangers
- Academic Medical Center, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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33
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Zhou K, Huo L, He X, Li M, An J, Wang W, Li J, Li X. The Needs Self-Rating Questionnaire for Breast Cancer (NSQ-BC): Development of a tool for the needs assessment of women with breast cancer in mainland China. J Eval Clin Pract 2019; 25:889-895. [PMID: 30773748 DOI: 10.1111/jep.13113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 01/03/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES A needs assessment tool considering the cultural background of mainland China has not been reported. This study developed a Needs Self-rating Questionnaire for Breast Cancer (NSQ-BC) based on Maslow's hierarchy of needs for mainland Chinese patients. METHODS The Delphi technique and pilot cross-sectional surveys (two rounds) were performed for item selection. In the Delphi technique, items were selected according to the experts' perspective on the item's significance (ie, 1-5 Likert-scale ratings of importance; mean > 4.0 and coefficients of variation <0.25). In the pilot cross-sectional surveys, items were selected according to internal consistency reliability (Cronbach's α ≥ 0.70), discriminant validity (stronger correlations of the item with the hypothesized subscale than for other subscales), and convergent validity (hypothesized item-subscale correlations ≥0.40). All decisions were made based on the results of statistical analyses, recommendations of the experts, and in-depth discussion among research team members. RESULTS Following the two evaluation rounds, the revised NSQ-BC comprised 26 items across five subscales of needs: physical, psychological, respect/self-esteem, information, and rehabilitation. Item ratings from the expert panellists met the aforementioned criteria (ie, Kendall's W = 0.329, P < 0.001). Except for the "respect/self-esteem needs" subscale, Cronbach's α for all subscales exceeded 0.70. All items had acceptable discriminant and convergent validity. Additionally, two new items-good environment/facilities and economic support-were added to the NSQ-BC, as recommended by the experts. CONCLUSIONS The NSQ-BC was developed fully via the comprehensive use of Delphi technique and pilot cross-sectional surveys. It provides evidence of a proper instrument for needs assessment and evaluation among women with breast cancer in mainland China.
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Affiliation(s)
- Kaina Zhou
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Lanting Huo
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Xiaole He
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Minjie Li
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Jinghua An
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Wen Wang
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Jin Li
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
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Faller H, Hass HG, Engehausen D, Reuss-Borst M, Wöckel A. Supportive care needs and quality of life in patients with breast and gynecological cancer attending inpatient rehabilitation. A prospective study. Acta Oncol 2019; 58:417-424. [PMID: 30632891 DOI: 10.1080/0284186x.2018.1543947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Among patients with breast or gynecological cancer, supportive care needs are both highly prevalent and enduring. However, little is known about whether meeting patients' needs is accompanied by increased quality of life (QoL). We aimed to explore patients' supportive care needs reported at the beginning of inpatient rehabilitation and examined whether meeting these needs resulted in improved QoL. MATERIAL AND METHODS In a multicenter, prospective cohort study with 2 measurement occasions (beginning and end of inpatient rehabilitation), 292 patients with breast and gynecological cancer (mean age 55 years; 71% breast cancer) were enrolled. In 73%, time since diagnosis was longer than 6 months. We obtained self-reports of supportive care needs in 12 domains and measured QoL using the EORTC QLQ-C30 functioning subscales. RESULTS At the beginning of inpatient rehabilitation, top-ranking severe supportive care needs concerned coordination of care (48%), medical information (45%), alleviation of physical symptoms (42%) and support with improving health behaviors (36%). At the end of inpatient rehabilitation, all needs assessed declined significantly, although many patients still expressed strong needs in some domains. However, meeting patients' needs was accompanied by improvements in all functioning subscales. CONCLUSIONS This is the first study to show that meeting breast and gynecological cancer patients' supportive care needs during inpatient rehabilitation resulted in improved QoL. Given the considerable proportions of patients still reporting unmet needs at the end of their stay, stronger and continuing efforts seem warranted to meet these needs and thus further increase QoL.
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Affiliation(s)
- Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | | | - Dirk Engehausen
- Sinntal Clinic Bad Brückenau, German Statutory Pension Insurance of Northern Bavaria, Bad Brückenau, Germany
| | - Monika Reuss-Borst
- Center for Rehabilitation and Prevention Bad Bocklet, Bad Bocklet, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
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Ai Z, Gao X, Zheng S, Lu C. Variability and Influencing Factors of QOL in Breast Cancer Patients Having Chemotherapy. Clin Nurs Res 2018; 29:571-578. [PMID: 30280583 DOI: 10.1177/1054773818803691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Variability and factors influencing quality of life (QOL) in breast cancer patients having chemotherapy were examined in a longitudinal prospective cohort study in two teaching hospitals in China. Physical, mental, social/family, and functional QOL changed significantly over time with varying patterns. In addition, various factors influenced the QOL of breast cancer patients at each chemotherapy cycle. Health professionals should focus on critical time periods during chemotherapy, particularly at baseline and during the fourth and fifth cycles when the QOL in our sample was at the lowest point, and they should provide additional support to patients to ensure that chemotherapy is delivered in an optimal fashion.
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Affiliation(s)
- Zhongping Ai
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaolan Gao
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Silin Zheng
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Changbi Lu
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Bergerot CD, Bergerot PG, Philip EJ, De Domenico EBL, Manhaes MFM, Pedras RN, Salgia MM, Dizman N, Ashing KT, Li M, Dale W, Pal SK. Assessment of distress and quality of life in rare cancers. Psychooncology 2018; 27:2740-2746. [DOI: 10.1002/pon.4873] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Cristiane Decat Bergerot
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - Paulo Gustavo Bergerot
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - Errol J. Philip
- The Notre Dame Laboratory for Psycho-Oncology Research; University of Notre Dame; Notre Dame IL USA
| | | | | | | | - Meghan M. Salgia
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Nazli Dizman
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Kimlin Tam Ashing
- Department of Population Sciences; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Min Li
- Department of Biostatistics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - William Dale
- Department of Supportive Care Medicine; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Sumanta K. Pal
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
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Levkovich I, Cohen M, Alon S, Kuchuk I, Nissenbaum B, Evron E, Pollack S, Fried G. Symptom cluster of emotional distress, fatigue and cognitive difficulties among young and older breast cancer survivors: The mediating role of subjective stress. J Geriatr Oncol 2018; 9:469-475. [PMID: 29759914 DOI: 10.1016/j.jgo.2018.05.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/24/2018] [Accepted: 05/01/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To examine the nature of the symptom cluster of emotional distress, fatigue, and cognitive difficulties in young and older breast cancer survivors (BCS); To assess the mediating role of subjective stress and coping strategies (emotional control and meaning-focused coping) in the association between age and symptom cluster. MATERIALS AND METHODS Participants were 170 BCS, stages I-III, 1-12 months post-chemotherapy, filled-out the Fatigue, Emotional Control, Meaning-focused Coping, Emotional Distress and the Cognitive Difficulties Questionnaires. Statistical analyses included tests for difference between-groups Pearson correlations and Structural Equation Modeling for the assessment of the study model. RESULTS Older BCS (aged 60-82) reported lower levels of emotional distress (M = 0.87, SD = 0.87), fatigue (M = 3.85, SD = 2.38), and cognitive difficulties (M = 1.17, SD = 1.07) compared to the younger BCS (aged 24-59) (emotional distress M = 1.17, SD = 0.85, fatigue M = 5.02, SD = 2.32, and cognitive difficulties M = 1.66, SD = 1.23, p < .01-,05). The older survivors reported lower levels of subjective stress and used more emotional control strategies compared to the younger BCS. The empirical model had good fit indices (χ2 = 27.60, p = 0.20, χ2/df = 1.26; CFI = 0.98; TLI = 0.98; NFI = 0.95; RMSEA = 0.04 (90% CI = 0.00, 10) and showed that subjective stress, but not coping strategies, mediated the effect of age on symptom cluster severity. CONCLUSIONS Lower levels of subjective stress, but not coping strategies, mediated the association of age with the symptom cluster of emotional distress, fatigue and cognitive difficulties. Further research is needed to explore differences in subjective stress by age.
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Affiliation(s)
- Inbar Levkovich
- The Division of Family Medicine, The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Miri Cohen
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
| | - Shirly Alon
- Oncology Department, Meir Medical Center, Israel.
| | - Iryna Kuchuk
- Oncology Department, Meir Medical Center, Israel.
| | | | - Ella Evron
- Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Sackler Faculty of Medicine, Israel.
| | | | - Georgeta Fried
- Oncology Unit, Rambam Health Care Campus, Haifa, Israel.
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Physical Symptom Burden and Its Association With Distress, Anxiety, and Depression in Breast Cancer. PSYCHOSOMATICS 2018. [PMID: 29525522 DOI: 10.1016/j.psym.2018.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Physical symptom burden and psychologic symptoms are highly prevalent in women with breast cancer. The Distress Thermometer and Problem List (DT&PL) is commonly used in oncology clinics to screen for distress and its accompanying Physical Problem List (PPL) identifies pertinent physical symptoms. OBJECTIVE We sought to identify physical symptoms found on the PPL and evaluate whether they are associated with psychologic symptoms in women with breast cancer. METHODS Patients (n=125) with breast cancer (Stage 0-IV) completed the DT&PL and the Hospital Anxiety and Depression Scale. They reported bother from any of 22 PPL items on the DT&PL. PPL items were assessed for their associations with distress, Hospital Anxiety and Depression Scale-anxiety, and Hospital Anxiety and Depression Scale-depression. The total number of PPL items endorsed per patient was evaluated for associations with psychologic outcomes, controlling for relevant demographic factors. RESULTS Most physical problems were associated with depression (n = 13, 87%), and anxiety (n = 8, 53%), but fewer were associated with distress (n = 4, 27%). In multivariate analyses, a higher total number of problems was associated with younger age (p = 0.03) and more depressive symptoms (p < 0.001). CONCLUSION Physical symptom burden detected by the DT&PL co-occurs with depression most commonly and to a lesser extent anxiety and distress in women with breast cancer. Depression is associated with more types of physical symptoms and a total number of physical symptoms. The endorsement of multiple PPL items on the DT&PL should prompt an evaluation for depression. Similarly, depression should prompt the evaluation and treatment of physical symptom burden.
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