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Lin Y, Bailey DE, Xiao C, Hammer M, Paul SM, Cooper BA, Conley YP, Levine JD, Kober KM, Miaskowski C. Distinct Co-occurring Morning and Evening Fatigue Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy. Cancer Nurs 2024; 47:E28-E37. [PMID: 36076314 PMCID: PMC10232668 DOI: 10.1097/ncc.0000000000001148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with gastrointestinal cancers experience diurnal variations in fatigue severity during chemotherapy that decrease their functional status and quality of life. OBJECTIVES Study purposes were to identify subgroups of patients with distinct co-occurring morning and evening fatigue profiles and evaluate for differences among these subgroups in demographic, clinical, stress, and symptom characteristics. METHODS Patients with gastrointestinal cancers (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. The Lee Fatigue Scale was used to evaluate diurnal variations in fatigue severity. Latent profile analysis was used to identify subgroups of patients with distinct co-occurring morning AND evening fatigue profiles. Differences among the subgroups in demographic, clinical, stress, and symptom characteristics at enrollment were evaluated using parametric and nonparametric analyses. RESULTS Two classes were identified, namely: low morning and moderate evening fatigue (ie, Low-Moderate, 60.0%) and high morning and high evening fatigue (ie, Both High, 40.0%). Compared with the Low-Moderate class, the Both High class was significantly younger, female, unmarried, and unemployed and lacked regular exercise. In addition, they had childcare responsibilities, lower annual income, lower functional status, higher comorbidity burden, and self-reported anemia and depression. Patients in the Both High class reported higher levels of anxiety, depressive symptoms, sleep disturbance, pain, and stress, and lower levels of energy and cognitive function. CONCLUSIONS Findings provide new insights into the risk factors for higher levels of co-occurring morning and evening fatigue in patients with gastrointestinal cancers. IMPLICATIONS FOR PRACTICE Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.
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Affiliation(s)
- Yufen Lin
- Author Affiliations: Nell Hodgson Woodruff School of Nursing, Emory University (Drs Lin and Xiao), Atlanta, Georgia; School of Nursing, Duke University (Dr Bailey), Durham, North Carolina; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; School of Nursing, University of California San Francisco (Drs Paul, Cooper, Kober, and Miaskowski); School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania; and School of Medicine, University of California San Francisco (Drs Levine and Miaskowski)
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Lin Y, Bailey DE, Docherty SL, Porter LS, Cooper B, Paul S, Kober K, Hammer MJ, Wright F, Conley Y, Levine J, Miaskowski C. Distinct morning and evening fatigue profiles in gastrointestinal cancer during chemotherapy. BMJ Support Palliat Care 2023; 13:e373-e381. [PMID: 34049967 PMCID: PMC8627530 DOI: 10.1136/bmjspcare-2021-002914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/08/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Purposes were to identify subgroups of patients with gastrointestinal cancers with distinct morning and evening fatigue severity profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, co-occurring symptoms and quality of life (QOL) outcomes. METHODS Patients with gastrointestinal cancers (n=405) completed questionnaires six times over two cycles of chemotherapy. Latent profile analysis was used to identify distinct morning and evening fatigue profiles. Differences in demographic and clinical characteristics, co-occurring symptoms and QOL outcomes among the subgroups were evaluated using parametric and nonparametric tests. RESULTS Two distinct mornings (ie, low and very high) and three distinct evenings (ie, low, moderate and very high) fatigue classes were identified. Common risk factors for both morning and evening fatigue included younger age, lower performance status, higher comorbidity burden and self-reported depression. Higher levels of morning fatigue were associated with being unmarried, living alone, being unemployed, having a lower income, lack of regular exercise and a self-reported diagnosis of anaemia. Higher levels of evening fatigue were associated with being women, white and having childcare responsibilities. Patients in the very high morning and evening fatigue classes reported higher levels of anxiety, depressive symptoms, sleep disturbance and pain and lower levels of attentional function and poorer QOL. CONCLUSION Findings provide new insights into risk factors for and deleterious effects of morning and evening fatigue in patients with gastrointestinal cancers. Clinicians can use this information to identify high-risk patients and develop individualised interventions for morning and evening fatigue and other co-occurring symptoms.
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Affiliation(s)
- Yufen Lin
- Duke University, Durham, North Carolina, USA
| | | | | | | | - Bruce Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Kord Kober
- School of Nursing, University of California, San Francisco, California, USA
| | | | - Fay Wright
- New York University, New York, New York, USA
| | - Yvette Conley
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jon Levine
- School of Medicine, University of California, San Francisco, California, USA
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Hammer MJ, Cooper BA, Chen LM, Wright AA, Pozzar R, Blank SV, Cohen B, Dunn L, Paul S, Conley YP, Levine JD, Miaskowski C. Identification of distinct symptom profiles in patients with gynecologic cancers using a pre-specified symptom cluster. Support Care Cancer 2023; 31:485. [PMID: 37480403 DOI: 10.1007/s00520-023-07954-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Pain, fatigue, sleep disturbance, and depression are four of the most common symptoms in patients with gynecologic cancer. The purposes were to identify subgroups of patients with distinct co-occurring pain, fatigue, sleep disturbance, and depression profiles (i.e., pre-specified symptom cluster) in a sample of patients with gynecologic cancer receiving chemotherapy and assess for differences in demographic and clinical characteristics, as well as the severity of other common symptoms and QOL outcomes among these subgroups. METHODS Patients completed symptom questionnaires prior to their second or third cycle of chemotherapy. Latent profile analysis was used to identify subgroups of patients using the pre-specified symptom cluster. Parametric and nonparametric tests were used to evaluate for differences between the subgroups. RESULTS In the sample of 233 patients, two distinct latent classes were identified (i.e., low (64.8%) and high (35.2%)) indicating lower and higher levels of symptom burden. Patients in high class were younger, had child care responsibilities, were unemployed, and had a lower annual income. In addition, these women had a higher body mass index, a higher comorbidity burden, and a lower functional status. Patients in the high class reported higher levels of anxiety, as well as lower levels of energy and cognitive function and poorer quality of life scores. CONCLUSIONS This study identified a number of modifiable and non-modifiable risk factors associated with membership in the high class. Clinicians can use this information to refer patients to dieticians and physical therapists for tailored interventions.
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Affiliation(s)
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Lee-May Chen
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Laura Dunn
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Wright F, Cooper BA, Paul SM, Hammer MJ, Conley YP, Levine JD, Miaskowski C, Kober KM. Distinct Profiles of Morning and Evening Fatigue Co-Occurrence in Patients During Chemotherapy. Nurs Res 2023; 72:259-271. [PMID: 37084242 PMCID: PMC10330127 DOI: 10.1097/nnr.0000000000000661] [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: 04/22/2023]
Abstract
BACKGROUND Morning and evening fatigue are distinct and distressing symptoms experienced during chemotherapy that demonstrate a large amount of interindividual variability. OBJECTIVES The objectives of this study were to identify subgroups of patients with distinct morning and evening fatigue co-occurrence profiles and evaluate for differences among these subgroups in demographic, clinical, and symptom characteristics and quality of life. METHODS Oncology patients ( n = 1,334) completed the Lee Fatigue Scale to self-report morning and evening fatigue, six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct morning and evening physical fatigue profiles. RESULTS Four distinct morning and evening fatigue profiles were identified (i.e., Both Low, Low Morning + Moderate Evening, Both Moderate, and Both High). Compared to the Both Low profile, the Both High profile was significantly younger, less likely to be married or partnered, more likely to live alone, had a higher comorbidity burden, and lower functional status. The Both High profile had higher levels of anxiety, depressive symptoms, sleep disturbance, and pain and lower levels of quality of life. DISCUSSION The variability in the morning and evening severity scores among the four profiles supports the hypothesis that morning and evening fatigue are distinct but related symptoms. Clinically meaningful levels of both morning and evening fatigue were reported by 50.4% of our sample, which suggests that the co-occurrence of these two symptoms is relatively common. Patients in Both Moderate and Both High profiles experienced an extremely high symptom burden that warrants ongoing assessments and aggressive symptom management interventions.
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Affiliation(s)
- Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY
| | - Bruce A. Cooper
- School of Nursing, University of California, San Francisco, CA
| | - Steven M. Paul
- School of Nursing, University of California, San Francisco, CA
| | | | | | - Jon D. Levine
- School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA
- School of Medicine, University of California, San Francisco, CA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA
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Kober KM, Roy R, Conley Y, Dhruva A, Hammer MJ, Levine J, Olshen A, Miaskowski C. Prediction of morning fatigue severity in outpatients receiving chemotherapy: less may still be more. Support Care Cancer 2023; 31:253. [PMID: 37039882 DOI: 10.1007/s00520-023-07723-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/01/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Fatigue is the most common and debilitating symptom experienced by cancer patients undergoing chemotherapy (CTX). Prediction of symptom severity can assist clinicians to identify high-risk patients and provide education to decrease symptom severity. The purpose of this study was to predict the severity of morning fatigue in the week following the administration of CTX. METHODS Outpatients (n = 1217) completed questionnaires 1 week prior to and 1 week following administration of CTX. Morning fatigue was measured using the Lee Fatigue Scale (LFS). Separate prediction models for morning fatigue severity were created using 157 demographic, clinical, symptom, and psychosocial adjustment characteristics and either morning fatigue scores or individual fatigue item scores. Prediction models were created using two regression and five machine learning approaches. RESULTS Elastic net models provided the best fit across all models. For the EN model using individual LFS item scores, two of the 13 individual LFS items (i.e., "worn out," "exhausted") were the strongest predictors. CONCLUSIONS This study is the first to use machine learning techniques to accurately predict the severity of morning fatigue from prior to through the week following the administration of CTX using total and individual item scores from the Lee Fatigue Scale (LFS). Our findings suggest that the language used to assess clinical fatigue in oncology patients is important and that two simple questions may be used to predict morning fatigue severity.
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Affiliation(s)
- Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA.
| | - Ritu Roy
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburg, Pittsburg, PA, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Jon Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Adam Olshen
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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Kober KM, Harris C, Conley YP, Dhruva A, Dokiparthi V, Hammer MJ, Levine JD, Oppegaard K, Paul S, Shin J, Sucher A, Wright F, Yuen B, Olshen AB, Miaskowski C. Perturbations in common and distinct inflammatory pathways associated with morning and evening fatigue in outpatients receiving chemotherapy. Cancer Med 2022; 12:7369-7380. [PMID: 36373573 PMCID: PMC10067125 DOI: 10.1002/cam4.5435] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Moderate to severe fatigue occurs in up to 94% of patients with cancer. Recent evidence suggests that morning and evening fatigue are distinct dimensions of physical fatigue. The purposes of this study were to evaluate the transcriptome for common and distinct perturbed inflammatory pathways in patients receiving chemotherapy who reported low versus high levels of morning or low versus high levels of evening cancer-related fatigue. METHODS Patients completed questionnaires during the week prior to their chemotherapy treatment. Severity of morning and evening fatigue was evaluated using the Lee Fatigue Scale. Gene expression and pathway impact analyses (PIA) were performed in two independent samples using RNA-sequencing (n = 357) and microarray (n = 360). Patterns of interactions between and among these perturbed pathways were evaluated using a knowledge network (KN). RESULTS Across the PIA, nine perturbed pathways (FDR < 0.025) were common to both morning and evening fatigue, six were distinct for morning fatigue, and four were distinct for evening fatigue. KN (19 nodes, 39 edges) identified the phosphatidylinositol 3-kinase (PI3K)-Akt pathway node (perturbed in evening fatigue) with the highest betweenness (0.255) and closeness (0.255) centrality indices. The next highest betweenness centrality indices were seen in pathways perturbed in evening fatigue (i.e., nuclear factor kappa B: 0.200, natural killer cell-mediated cytotoxicity: 0.178, mitogen-activated protein kinase: 0.175). CONCLUSIONS This study describes perturbations in common and distinct inflammatory pathways associated with morning and/or evening fatigue. PI3K-Akt was identified as a bottleneck pathway. The analysis identified potential targets for therapeutic interventions for this common and devastating clinical problem.
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Affiliation(s)
- Kord M. Kober
- School of Nursing University of California San Francisco California USA
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - Carolyn Harris
- School of Nursing University of California San Francisco California USA
| | - Yvette P. Conley
- School of Nursing University of Pittsburg Pittsburg Pennsylvania USA
| | - Anand Dhruva
- School of Medicine University of California San Francisco California USA
| | - Vasuda Dokiparthi
- School of Nursing University of California San Francisco California USA
| | | | - Jon D. Levine
- School of Medicine University of California San Francisco California USA
| | - Kate Oppegaard
- School of Nursing University of California San Francisco California USA
| | - Steven Paul
- School of Nursing University of California San Francisco California USA
| | - Joosun Shin
- School of Nursing University of California San Francisco California USA
| | - Anatol Sucher
- School of Nursing University of California San Francisco California USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University New York New York USA
| | - Brian Yuen
- School of Nursing University of California San Francisco California USA
| | - Adam B. Olshen
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
- School of Nursing University of Pittsburg Pittsburg Pennsylvania USA
| | - Christine Miaskowski
- School of Nursing University of California San Francisco California USA
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
- School of Medicine University of California San Francisco California USA
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Bouvron B, Mackin L, Kober KM, Paul SM, Cooper BA, Conley YP, Hammer MJ, Wright F, Levine JD, Miaskowski C. Impact of worst pain severity and morning fatigue profiles on oncology outpatients’ symptom burden and quality of life. Support Care Cancer 2022; 30:9929-9944. [DOI: 10.1007/s00520-022-07431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
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Risk factors for cancer-related fatigue in patients with colorectal cancer: a systematic review and meta-analysis. Support Care Cancer 2022; 30:10311-10322. [DOI: 10.1007/s00520-022-07432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022]
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Kalantari E, Kouchaki S, Miaskowski C, Kober K, Barnaghi P. Network analysis to identify symptoms clusters and temporal interconnections in oncology patients. Sci Rep 2022; 12:17052. [PMID: 36224203 PMCID: PMC9556713 DOI: 10.1038/s41598-022-21140-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/22/2022] [Indexed: 12/30/2022] Open
Abstract
Oncology patients experience numerous co-occurring symptoms during their treatment. The identification of sentinel/core symptoms is a vital prerequisite for therapeutic interventions. In this study, using Network Analysis, we investigated the inter-relationships among 38 common symptoms over time (i.e., a total of six time points over two cycles of chemotherapy) in 987 oncology patients with four different types of cancer (i.e., breast, gastrointestinal, gynaecological, and lung). In addition, we evaluated the associations between and among symptoms and symptoms clusters and examined the strength of these interactions over time. Eight unique symptom clusters were identified within the networks. Findings from this research suggest that changes occur in the relationships and interconnections between and among co-occurring symptoms and symptoms clusters that depend on the time point in the chemotherapy cycle and the type of cancer. The evaluation of the centrality measures provides new insights into the relative importance of individual symptoms within various networks that can be considered as potential targets for symptom management interventions.
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Affiliation(s)
- Elaheh Kalantari
- grid.5475.30000 0004 0407 4824Centre for Vision, Speech and Signal Processing (CVSSP), University of Surrey, Guildford, UK ,grid.7445.20000 0001 2113 8111UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, UK
| | - Samaneh Kouchaki
- grid.5475.30000 0004 0407 4824Centre for Vision, Speech and Signal Processing (CVSSP), University of Surrey, Guildford, UK ,grid.7445.20000 0001 2113 8111UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, UK
| | - Christine Miaskowski
- grid.266102.10000 0001 2297 6811Department of Physiological Nursing, University of California San Francisco, San Francisco, CA USA
| | - Kord Kober
- grid.266102.10000 0001 2297 6811Department of Physiological Nursing, University of California San Francisco, San Francisco, CA USA
| | - Payam Barnaghi
- grid.7445.20000 0001 2113 8111Department of Brain Sciences, Imperial College London, London, UK ,grid.7445.20000 0001 2113 8111UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, London, UK
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Shin J, Harris C, Oppegaard K, Kober KM, Paul SM, Cooper BA, Hammer M, Conley Y, Levine JD, Miaskowski C. Worst Pain Severity Profiles of Oncology Patients Are Associated With Significant Stress and Multiple Co-Occurring Symptoms. THE JOURNAL OF PAIN 2022; 23:74-88. [PMID: 34298161 PMCID: PMC10788964 DOI: 10.1016/j.jpain.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022]
Abstract
Little is known about the associations between pain, stress, and co-occurring symptoms in oncology patients. Purpose was to identify subgroups of patients with distinct worst pain profiles and evaluate for differences among the subgroups in demographic and clinical characteristics, as well as stress and symptom scores. Oncology outpatients (n = 1305) completed questionnaires prior to their second or third chemotherapy cycle. Worst pain intensity was assessed 6 times over 2 chemotherapy cycles using a 0 to 10 numeric rating scale. The 371 patients (28.4%) who had ≤1 occurrence of pain over the 6 assessments were classified as the None class. For the remaining 934 patients whose data were entered into the latent profile analysis, 3 distinct worst pain profiles were identified (ie Mild [12.5%], Moderate [28.6%], Severe [30.5%]). Compared to None class, Severe class had fewer years of education and a lower annual income; were less likely to be employed and married; less likely to exercise on a regular basis, had a higher comorbidity burden, and a worse functional status. Compared to None class, Severe class reported higher levels of general, disease-specific, and cumulative life stress and lower levels of resilience, as well as higher levels of depressive symptoms, anxiety, fatigue, sleep disturbance, and cognitive dysfunction. This study is the first to identify distinct worst pain profiles in a large sample of oncology patients receiving chemotherapy and associated risk factors. PERSPECTIVE: Unrelieved pain remains a significant problem for oncology patients receiving chemotherapy. High levels of stress and co-occurring symptoms contribute to a more severe pain profile in these patients.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, California
| | - Carolyn Harris
- School of Nursing, University of California, San Francisco, California
| | - Kate Oppegaard
- School of Nursing, University of California, San Francisco, California
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California
| | | | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, California; School of Medicine, University of California, San Francisco, California.
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Joseph PV, Nolden A, Kober KM, Paul SM, Cooper BA, Conley YP, Hammer MJ, Wright F, Levine JD, Miaskowski C. Fatigue, Stress, and Functional Status are Associated With Taste Changes in Oncology Patients Receiving Chemotherapy. J Pain Symptom Manage 2021; 62:373-382.e2. [PMID: 33259906 PMCID: PMC8160023 DOI: 10.1016/j.jpainsymman.2020.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT A common complaint among oncology patients receiving chemotherapy is altered taste perception. OBJECTIVE The purpose of this study was to evaluate for differences in common symptoms and stress levels in patients who reported taste changes. METHODS Patients were receiving chemotherapy for breast, gastrointestinal, gynecological, or lung cancer. Change in the way food tastes (CFT) was assessed using the Memorial Symptom Assessment Scale before the patients' second or third cycle of chemotherapy. Valid and reliable instruments were used to assess for depressive symptoms, state and trait of anxiety, cognitive impairment, diurnal variations in fatigue and energy, sleep disturbance, and pain. Stress was assessed using the Perceived Stress Scale and the Impact of Events Scale-Revised. Multiple logistic regression was used to evaluate for risk factors associated with CFT. RESULTS Of the 1329 patients, 49.4% reported CFT. Patients in the CFT group reported higher levels of depression, anxiety, fatigue, and sleep disturbance as well as higher levels of general and disease specific stress. Factors associated with CFT group included being non-White; receiving an antiemetic regimen that contained a neurokinin-1 receptor antagonist with two other antiemetics; having a lower functional status; higher levels of morning fatigue; and reporting higher scores on the hyperarousal subscale of the Impact of Event Scale-Revised. CONCLUSIONS This study provides new evidence on associations between taste changes and common co-occurring symptoms and stress in oncology patients receiving chemotherapy. Clinicians need to evaluate for taste changes in these patients because this symptom can effect patients' nutritional intake and quality of life.
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Affiliation(s)
- Paule V Joseph
- Sensory Science & Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Alissa Nolden
- Department of Food Science, College of Natural Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Kord M Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA; Department of Medicine, School of Medicine, University of California, San Francisco, California, USA.
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Psychological Symptoms and Stress Are Associated With Decrements in Attentional Function in Cancer Patients Undergoing Chemotherapy. Cancer Nurs 2021; 43:402-410. [PMID: 30998605 DOI: 10.1097/ncc.0000000000000713] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Decrements in attentional function-perceived effectiveness in everyday functioning related to cognitive dysfunction-are frequently reported by cancer patients during treatment. However, patients vary widely in their experiences of changes in attentional function. OBJECTIVE The aim of this study was to understand differences in attentional function among cancer patients during chemotherapy. METHODS Patients (n = 1329) undergoing chemotherapy were assessed at 6 time points during 2 rounds of chemotherapy. Latent profile analysis was used to identify subgroups of patients based on patterns in changes on the Attentional Function Index. Differences among the subgroups in demographic and clinical characteristics, psychological symptoms, and stress were evaluated. RESULTS Three latent classes (ie, high, moderate, and low attentional function) were identified. Patients in the low and moderate classes were younger, more likely to be female, and less likely to be employed compared with those in the high class. Patients in the low class had higher levels of depressive and anxiety symptoms, cancer-related distress, and perceived stress compared with those in the moderate class, who, in turn, reported higher levels of these symptoms compared with those in the high class. CONCLUSIONS Different experiences of changes in self-perceived attentional function are associated with psychological symptoms in cancer patients. IMPLICATIONS FOR PRACTICE Relationships between changes in attentional function and psychological symptoms and stress suggest that clinicians should attend to the potential that patients' cognitive and psychological experiences may be closely linked and may need to be addressed as related phenomena. Clinical trials are needed that evaluate treatments for both attentional and psychological symptoms.
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Kober KM, Roy R, Dhruva A, Conley YP, Chan RJ, Cooper B, Olshen A, Miaskowski C. Prediction of evening fatigue severity in outpatients receiving chemotherapy: less may be more. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2021; 9:14-32. [PMID: 34249477 DOI: 10.1080/21641846.2021.1885119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Fatigue is the most common and debilitating symptom experienced by oncology patients undergoing chemotherapy. Little is known about patient characteristics that predict changes in fatigue severity over time. Purpose To predict the severity of evening fatigue in the week following the administration of chemotherapy using machine learning approaches. Methods Outpatients with breast, gastrointestinal, gynecological, or lung cancer (N=1217) completed questionnaires one week prior to and one week following administration of chemotherapy. Evening fatigue was measured with the Lee Fatigue Scale (LFS). Separate prediction models for evening fatigue severity were created using clinical, symptom, and psychosocial adjustment characteristics and either evening fatigue scores or individual fatigue item scores. Prediction models were created using two regression and three machine learning approaches. Results Random forest (RF) models provided the best fit across all models. For the RF model using individual LFS item scores, two of the 13 individual LFS items (i.e., "worn out", "exhausted") were the strongest predictors. Conclusion This study is the first to use machine learning techniques to predict evening fatigue severity in the week following chemotherapy from fatigue scores obtained in the week prior to chemotherapy. Our findings suggest that the language used to assess clinical fatigue in oncology patients is important and that two simple questions may be used to predict evening fatigue severity.
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Affiliation(s)
- Kord M Kober
- School of Nursing, University of California, San Francisco, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, USA
| | - Ritu Roy
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, USA
| | - Raymond J Chan
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Australia
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, USA
| | - Adam Olshen
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
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14
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Chan R, Cooper B, Paul S, Conley Y, Kober K, Koczwara B, Chan A, Tan CJ, Gordon L, Thomy L, Levine J, Miaskowski C. Distinct financial distress profiles in patients with breast cancer prior to and for 12 months following surgery. BMJ Support Palliat Care 2020; 12:347-354. [PMID: 32913003 DOI: 10.1136/bmjspcare-2020-002461] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Study purposes were to identify subgroups of patients with breast cancer with distinct self-reported financial distress (FD) profiles and determine which demographic, clinical and symptom characteristics, as well as quality of life (QOL) outcomes were associated with subgroup membership. METHODS Patients (n=391) who were assessed for changes in FD a total of 10 times from prior to through 12 months after breast cancer surgery. Latent profile analysis was used to identify subgroups of patients with distinct FD profiles. RESULTS Three distinct FD profiles (ie, None (14.6%), Low (52.7%), High (32.7%)) were identified. Compared with None and/or Low subgroups, patients in the High subgroup were more likely to report a lower annual household income and performance status; had a higher body mass index, axillary lymph node dissection and more advanced stage disease; had a longer time from cancer diagnosis to surgery; and had received neoadjuvant or adjuvant chemotherapy. In addition, patients in the High subgroup reported higher fatigue, sleep disturbance, state/trait anxiety, depressive symptom scores, and lower attentional function and QOL scores. CONCLUSION This study provides new insights on risk factors for and evidence of a higher symptom burden associated with FD. Findings from this study provide clinicians with information on how to identify high-risk patients and to recommend appropriate interventions for both symptom management and FD. Additional research on the mechanisms that underlie the relationships among FD and common physical and psychological symptoms may inform future interventions.
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Affiliation(s)
- Raymond Chan
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bruce Cooper
- School of Nursing, UCSF, San Francisco, California, USA
| | - Steven Paul
- School of Nursing, UCSF, San Francisco, California, USA
| | - Yvette Conley
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kord Kober
- School of Nursing, UCSF, San Francisco, California, USA
| | - Bogda Koczwara
- Flinders University, Adelaide, South Australia, Australia
| | - Alexandre Chan
- University of California Irvine, Irvine, California, USA.,Department of Pharmacy, University of California Irvine, Irvine, CA, United States
| | | | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Lebogang Thomy
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jon Levine
- School of Medicine, UCSF, San Francisco, California, USA
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15
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Tejada M, Viele C, Kober KM, Cooper BA, Paul SM, Dunn LB, Hammer MJ, Wright F, Conley YP, Levine JD, Miaskowski C. Identification of subgroups of chemotherapy patients with distinct sleep disturbance profiles and associated co-occurring symptoms. Sleep 2020; 42:5541565. [PMID: 31361899 DOI: 10.1093/sleep/zsz151] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/31/2019] [Indexed: 01/09/2023] Open
Abstract
STUDY OBJECTIVES Purposes of this study were to identify subgroups of patients with distinct sleep disturbance profiles and to evaluate for differences in demographic, clinical, and various sleep characteristics, as well for differences in the severity of co-occurring symptoms among these subgroups. METHODS Outpatients with breast, gynecological, gastrointestinal, or lung cancer (n = 1331) completed questionnaires six times over two chemotherapy cycles. Self-reported sleep disturbance was evaluated using the General Sleep Disturbance Scale (GSDS). Latent profile analysis was used to identify distinct subgroups. RESULTS Three latent classes with distinct sleep disturbance profiles were identified (Low [25.5%], High [50.8%], Very High [24.0%]) across the six assessments. Approximately 75% of the patients had a mean total GSDS score that was above the clinically meaningful cutoff score of at least 43 across all six assessments. Compared to the Low class, patients in High and Very High classes were significantly younger, had a lower functional status, had higher levels of comorbidity, and were more likely to be female, more likely to have childcare responsibilities, less likely to be employed, and less likely to have gastrointestinal cancer. For all of the GSDS subscale and total scores, significant differences among the latent classes followed the expected pattern (Low < High < Very High). For trait and state anxiety, depressive symptoms, morning and evening fatigue, decrements in attentional function, and decrements in morning and evening energy, significant differences among the latent classes followed the expected pattern (Low < High < Very High). CONCLUSIONS Clinicians need to perform in-depth assessments of sleep disturbance and co-occurring symptoms to identify high-risk patients and recommend appropriate interventions.
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Affiliation(s)
- Maria Tejada
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Carol Viele
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Kord M Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Laura B Dunn
- Department of Physiological Nursing, School of Medicine, Stanford University, Stanford, CA
| | | | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
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16
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Abstract
BACKGROUND Morning fatigue is a distinct symptom experienced during chemotherapy that demonstrates significant interindividual variability. OBJECTIVES The aims of this study were to identify subgroups with distinct morning fatigue profiles and evaluate how these subgroups differed by demographic, clinical, and symptom characteristics. METHODS Outpatients (N = 1332) with breast, gastrointestinal, gynecological, or lung cancer completed questionnaires 6 times over 2 cycles of chemotherapy. Morning fatigue was assessed with the Lee Fatigue Scale. Latent profile analysis was used to identify distinct morning fatigue profiles. RESULTS Four morning fatigue profiles (ie, very low, low, high, and very high) were identified. In the high and very high classes, all 6 morning fatigue scores were higher than the clinical cutoff score. Compared with those in the very low and low classes, patients in the very high class were younger and not married/partnered; lived alone; had higher incomes, higher comorbidity, and higher body mass index; and did not exercise regularly. Across the 4 classes, functional status and attentional function scores decreased and anxiety, depression, sleep disturbance, morning fatigue, and evening fatigue scores increased across the 2 cycles. CONCLUSION Results provide insights into modifiable risk factors for morning fatigue. These risk factors can be used to develop more targeted interventions. IMPLICATIONS FOR PRACTICE Patients in the high and very high morning fatigue classes experienced high symptom and comorbidity burdens and significant decrements in functional status. Using this information, clinicians can identify patients who are at an increased risk for higher levels of morning fatigue and prescribe interventions to improve this devastating symptom.
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17
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Nolden A, Joseph PV, Kober KM, Cooper BA, Paul SM, Hammer MJ, Dunn LB, Conley YP, Levine JD, Miaskowski C. Co-occurring Gastrointestinal Symptoms Are Associated With Taste Changes in Oncology Patients Receiving Chemotherapy. J Pain Symptom Manage 2019; 58:756-765. [PMID: 31349034 PMCID: PMC6823134 DOI: 10.1016/j.jpainsymman.2019.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/24/2022]
Abstract
CONTEXT Over 80% of patients with cancer report taste changes. Despite the high prevalence of this symptom and its negative effects on health, few studies have assessed its association with other gastrointestinal (GI) symptoms. OBJECTIVES Determine the occurrence, frequency, severity, and distress of patient-reported "change in the way food tastes" (CFT) and identify phenotypic and GI symptoms characteristics associated with its occurrence. METHODS Patients receiving chemotherapy for breast, GI, gynecological, or lung cancer completed demographic and symptom questionnaires prior to their second or third cycle of chemotherapy. CFT was assessed using the Memorial Symptom Assessment Scale. Differences in demographic, clinical, and GI symptom characteristics were evaluated using parametric and nonparametric tests. RESULTS Of the 1329 patients, 49.4% reported experiencing CFT in the week prior to their second or third cycle of chemotherapy. In the univariate analysis, patients who reported CFT had fewer years of education; were more likely to be black or Hispanic, mixed race, or other; and had a lower annual household income. A higher percentage of patients with CFT reported the occurrence of 13 GI symptoms (e.g., constipation, diarrhea, abdominal cramps, feeling bloated). In a multivariable logistic regression analysis, compared with patients with breast cancer, patients with lung cancer (odds ratio = 0.55; P = 0.004) had a decrease in the odds of being in the CFT group. Patients who received a neurokinin-1 receptor antagonist and two other antiemetics were at an increased odds of being in the CFT group (odds ratio = 2.51; P = 0.001). Eight of the 13 GI symptoms evaluated were associated with an increased odds of being in the CFT group. CONCLUSIONS This study provides new evidence on the frequency, severity, and distress of CFT in oncology patients undergoing chemotherapy. These findings suggest that CFT is an important problem that warrants ongoing assessments and nutritional interventions.
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Affiliation(s)
- Alissa Nolden
- Food Science Department, College of Natural Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Paule V Joseph
- Sensory Science & Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Kord M Kober
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Marilyn J Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Stanford, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA.
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18
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Steffen LE, Cheavens JS, Vowles KE, Gabbard J, Nguyen H, Gan GN, Edelman MJ, Smith BW. Hope-related goal cognitions and daily experiences of fatigue, pain, and functional concern among lung cancer patients. Support Care Cancer 2019; 28:827-835. [PMID: 31152302 DOI: 10.1007/s00520-019-04878-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 05/16/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE Cross-sectional research suggests that thinking about multiple ways to reach goals (hope pathways) and the belief that one can reach them (hope agency) may be adaptive for lung cancer patients. We examined the between-person and within-person associations among aspects of hope agency and pathways thinking, daily fatigue, pain, and functional concerns (e.g., sense of independence, usefulness) among lung cancer patients during active treatment. METHODS Data from a daily diary study were used to examine relations among hope agency, hope pathways, fatigue, pain, and functional concern in 50 patients with advanced lung cancer. Participants were accrued from one outpatient cancer center and completed the study between 2014 and 2015. RESULTS Adjusting for covariates and the previous day's symptoms or concern, patients who engaged in higher pathways thinking reported lower daily symptoms, whereas those who engaged in higher agency thinking reported less functional concern. Within-person increases in pathways thinking were associated with less daily fatigue, pain, and functional concern; within-person increases in agency thinking were associated with less daily fatigue and pain. Models examining symptoms and concerns as predictors of hope suggested within-person increases in functional concern and fatigue and pain were related to lower agency and pathways thinking the same day. Patients with higher fatigue and pain did not report lower agency or pathways thinking, but patients with more functional concern did. CONCLUSIONS Increases in hope pathways thinking may be associated with lower symptoms and better functioning in lung cancer patients. This suggests that it is important to determine the efficacy of interventions that emphasize the pathways the component of hope.
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Affiliation(s)
- Laurie E Steffen
- Social Sciences & Health Policy - PHS, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | | | - Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Huynh Nguyen
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Gregory N Gan
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Martin J Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Bruce W Smith
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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19
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Flowers E, Flentje A, Levine J, Olshen A, Hammer M, Paul S, Conley Y, Miaskowski C, Kober KM. A Pilot Study Using a Multistaged Integrated Analysis of Gene Expression and Methylation to Evaluate Mechanisms for Evening Fatigue in Women Who Received Chemotherapy for Breast Cancer. Biol Res Nurs 2019; 21:142-156. [PMID: 30701989 PMCID: PMC6700896 DOI: 10.1177/1099800418823286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Fatigue is the most common symptom associated with cancer and its treatment. Investigation of molecular mechanisms associated with fatigue may identify new therapeutic targets. OBJECTIVE The objective of this pilot study was to evaluate the relationships between gene expression and methylation status and evening fatigue severity in women with breast cancer who received chemotherapy. METHODS Latent class analysis (LCA) was used to identify evening fatigue phenotypes. In this analysis, the lowest (i.e., moderate, n = 7) and highest (i.e., very high, n = 29) fatigue-severity classes identified using LCA were analyzed via two stages. First, a total of 32,609 transcripts from whole blood were evaluated for differences in expression levels between the classes. Next, 637 methylation sites located within the putative transcription factor binding sites for those genes demonstrating differential expression were evaluated for differential methylation state between the classes. RESULTS A total of 89 transcripts in 75 unique genes were differentially expressed between the moderate (the lowest fatigue-severity class identified) and very high evening fatigue classes. In addition, 23 differentially methylated probes and three differentially methylated regions were found between the moderate and very high evening fatigue classes. CONCLUSIONS Using a multistaged integrated analysis of gene expression and methylation, differential methylation was identified in the regulatory regions of genes associated with previously hypothesized mechanisms for fatigue, including inflammation, immune function, neurotransmission, circadian rhythm, skeletal muscle energy, carbohydrate metabolism, and renal function as well as core biological processes including gene transcription and the cell-cycle regulation.
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Affiliation(s)
- Elena Flowers
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Annesa Flentje
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Jon Levine
- School of Medicine, University of California, San Francisco, San Francisco,
CA, USA
| | - Adam Olshen
- School of Medicine, University of California, San Francisco, San Francisco,
CA, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Hospital, New York, NY, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburg, Pittsburg, PA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
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20
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Papachristou N, Barnaghi P, Cooper B, Kober KM, Maguire R, Paul SM, Hammer M, Wright F, Armes J, Furlong EP, McCann L, Conley YP, Patiraki E, Katsaragakis S, Levine JD, Miaskowski C. Network Analysis of the Multidimensional Symptom Experience of Oncology. Sci Rep 2019; 9:2258. [PMID: 30783135 PMCID: PMC6381090 DOI: 10.1038/s41598-018-36973-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
Oncology patients undergoing cancer treatment experience an average of fifteen unrelieved symptoms that are highly variable in both their severity and distress. Recent advances in Network Analysis (NA) provide a novel approach to gain insights into the complex nature of co-occurring symptoms and symptom clusters and identify core symptoms. We present findings from the first study that used NA to examine the relationships among 38 common symptoms in a large sample of oncology patients undergoing chemotherapy. Using two different models of Pairwise Markov Random Fields (PMRF), we examined the nature and structure of interactions for three different dimensions of patients’ symptom experience (i.e., occurrence, severity, distress). Findings from this study provide the first direct evidence that the connections between and among symptoms differ depending on the symptom dimension used to create the network. Based on an evaluation of the centrality indices, nausea appears to be a structurally important node in all three networks. Our findings can be used to guide the development of symptom management interventions based on the identification of core symptoms and symptom clusters within a network.
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Affiliation(s)
- Nikolaos Papachristou
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK.
| | - Payam Barnaghi
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK.
| | | | | | | | | | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, USA
| | - Fay Wright
- School of Nursing, Yale University, New Haven, USA
| | - Jo Armes
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK.,School of Health Sciences, University of Surrey, Guildford, UK
| | - Eileen P Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lisa McCann
- University of Strathclyde, Glasgow, Scotland
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, USA
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21
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Papachristou N, Puschmann D, Barnaghi P, Cooper B, Hu X, Maguire R, Apostolidis K, P. Conley Y, Hammer M, Katsaragakis S, M. Kober K, D. Levine J, McCann L, Patiraki E, P. Furlong E, A. Fox P, M. Paul S, Ream E, Wright F, Miaskowski C. Learning from data to predict future symptoms of oncology patients. PLoS One 2018; 13:e0208808. [PMID: 30596658 PMCID: PMC6312306 DOI: 10.1371/journal.pone.0208808] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/24/2018] [Indexed: 01/04/2023] Open
Abstract
Effective symptom management is a critical component of cancer treatment. Computational tools that predict the course and severity of these symptoms have the potential to assist oncology clinicians to personalize the patient's treatment regimen more efficiently and provide more aggressive and timely interventions. Three common and inter-related symptoms in cancer patients are depression, anxiety, and sleep disturbance. In this paper, we elaborate on the efficiency of Support Vector Regression (SVR) and Non-linear Canonical Correlation Analysis by Neural Networks (n-CCA) to predict the severity of the aforementioned symptoms between two different time points during a cycle of chemotherapy (CTX). Our results demonstrate that these two methods produced equivalent results for all three symptoms. These types of predictive models can be used to identify high risk patients, educate patients about their symptom experience, and improve the timing of pre-emptive and personalized symptom management interventions.
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Affiliation(s)
- Nikolaos Papachristou
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
| | - Daniel Puschmann
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
| | - Payam Barnaghi
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
| | - Bruce Cooper
- University of California, San Francisco, United States of America
| | - Xiao Hu
- University of California, San Francisco, United States of America
| | | | | | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, United States of America
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, United States of America
| | | | - Kord M. Kober
- University of California, San Francisco, United States of America
| | - Jon D. Levine
- University of California, San Francisco, United States of America
| | - Lisa McCann
- University of Strathclyde, Glasgow, Scotland
| | | | - Eileen P. Furlong
- UCD School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Patricia A. Fox
- UCD School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Steven M. Paul
- University of California, San Francisco, United States of America
| | - Emma Ream
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
| | - Fay Wright
- School of Nursing, Yale University, New Haven, United States of America
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22
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Wong ML, Paul SM, Mastick J, Ritchie C, Steinman MA, Walter LC, Miaskowski C. Characteristics Associated With Physical Function Trajectories in Older Adults With Cancer During Chemotherapy. J Pain Symptom Manage 2018; 56:678-688.e1. [PMID: 30144536 PMCID: PMC6195841 DOI: 10.1016/j.jpainsymman.2018.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 12/27/2022]
Abstract
CONTEXT Studies on physical function trajectories in older adults during chemotherapy remain limited. OBJECTIVES The objective of this study was to determine demographic, clinical, and symptom characteristics associated with initial levels as well as trajectories of physical function over two cycles of chemotherapy in adults aged ≥65 years with breast, gastrointestinal, gynecological, or lung cancer. METHODS Older adults with cancer (n = 363) who had received chemotherapy within the preceding four weeks were assessed six times over two cycles of chemotherapy using the Short Form-12 Physical Component Summary (PCS) score. Hierarchical linear modeling was used to evaluate for interindividual variability in initial levels and trajectories of PCS scores. RESULTS Mean age was 71.4 years (SD 5.5). Mean PCS score at enrollment was 40.5 (SD .45). On average, PCS scores decreased slightly (i.e., 0.21 points) at each subsequent assessment. Lower PCS scores at enrollment were associated with older age, greater comorbidity, being unemployed, lack of regular exercise, higher morning fatigue, lower evening energy, occurrence of pain, lower trait anxiety, and lower attentional function. Only higher morning fatigue and lower enrollment PCS scores were associated with decrements in physical function over time. CONCLUSION While several symptoms were associated with decrements in PCS scores at enrollment in older adults with cancer receiving chemotherapy, morning fatigue was the only symptom associated with decreases in physical function over time. Regular assessments of symptoms and implementation of evidence-based interventions should be considered to maintain physical function in older adults during chemotherapy.
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Affiliation(s)
- Melisa L Wong
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA.
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Judy Mastick
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Christine Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Michael A Steinman
- Division of Geriatrics, Department of Medicine, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Louise C Walter
- Division of Geriatrics, Department of Medicine, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
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23
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Singh KP, Kober KM, Dhruva AA, Flowers E, Paul SM, Hammer MJ, Cartwright F, Wright F, Conley YP, Levine JD, Miaskowski C. Risk Factors Associated With Chemotherapy-Induced Nausea in the Week Before the Next Cycle and Impact of Nausea on Quality of Life Outcomes. J Pain Symptom Manage 2018; 56:352-362. [PMID: 29857180 PMCID: PMC10919143 DOI: 10.1016/j.jpainsymman.2018.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 12/18/2022]
Abstract
CONTEXT Despite current advances in antiemetic treatments, between 19% and 58% of oncology patients experience chemotherapy-induced nausea (CIN). OBJECTIVES Aims of this post hoc exploratory analysis were to determine occurrence, severity, and distress of CIN and evaluate for differences in demographic and clinical characteristics, symptom severity, stress; and quality of life (QOL) outcomes between oncology patients who did and did not report CIN in the week before chemotherapy (CTX). Demographic, clinical, symptom, and stress characteristics associated with CIN occurrence were determined. METHODS Patients (n = 1296) completed questionnaires that provided information on demographic and clinical characteristics, symptom severity, stress, and QOL. Univariate analyses evaluated for differences in demographic and clinical characteristics, symptom severity, stress, and QOL scores between the two patient groups. Multiple logistic regression analysis was used to evaluate for factors associated with nausea group membership. RESULTS Of the 1296 patients, 47.5% reported CIN. In the CIN group, 15% rated CIN as severe and 23% reported high distress. Factors associated with CIN included less education; having childcare responsibilities; poorer functional status; higher levels of depression, sleep disturbance, evening fatigue, and intrusive thoughts; as well as receipt of CTX on a 14-day CTX cycle and receipt of an antiemetic regimen that contained serotonin receptor antagonist and steroid. Patients in the CIN group experienced clinically meaningful decrements in QOL. CONCLUSION This study identified new factors (e.g., poorer functional status, stress) associated with CIN occurrence. CIN negatively impacted patients' QOL. Pre-emptive and ongoing interventions may alleviate CIN occurrence in high-risk patients.
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Affiliation(s)
- Komal P Singh
- School of Nursing, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Anand A Dhruva
- School of Medicine, University of California, San Francisco, California, USA
| | - Elena Flowers
- School of Nursing, University of California, San Francisco, California, USA
| | - Steve M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Marilyn J Hammer
- Department of Nursing, Mount Sinai Hospital, New York, New York, USA
| | | | - Fay Wright
- School of Nursing, New York University, New York, New York, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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24
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Utne I, Løyland B, Grov EK, Rasmussen HL, Torstveit AH, Cooper BA, Mastick J, Mazor M, Wong M, Paul SM, Conley YP, Jahan T, Ritchie C, Levine JD, Miaskowski C. Distinct attentional function profiles in older adults receiving cancer chemotherapy. Eur J Oncol Nurs 2018; 36:32-39. [PMID: 30322507 DOI: 10.1016/j.ejon.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/25/2018] [Accepted: 08/17/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE While attentional function is an extremely important patient outcome for older adults, research on changes in function in this group is extremely limited. The purposes of this study were to: identify subgroups of older patients (i.e., latent growth classes) based on changes in their level of self-reported attentional function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality of life (QOL) outcomes. METHODS Older oncology outpatients (n = 365) who were assessed for changes in attention and working memory using the Attentional Function Index a total of six times over two cycles of chemotherapy (CTX). QOL was assessed using the Medical Outcomes Study-Short Form 12 and the QOL-Patient Version Scale. Latent profile analysis (LPA) was used to identify subgroups of older adults with distinct attentional function profiles. RESULTS Three distinct attentional functional profiles were identified (i.e., low, moderate, and high attentional function). Compared to the high class, older adults in the low and moderate attentional function classes had lower functional status scores, a worse comorbidity profile and were more likely to be diagnosed with depression. In addition, QOL scores followed an expected pattern (low class < moderate class < high attentional function class). CONCLUSIONS Three distinct attentional function profiles were identified among a relatively large sample of older adults undergoing CTX. The phenotypic characteristics associated with membership in the low and moderate latent classes can be used by clinicians to identify high risk patients.
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Affiliation(s)
- Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Hege Lund Rasmussen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ann Helen Torstveit
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Bruce A Cooper
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Judy Mastick
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Melissa Mazor
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Melisa Wong
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Steven M Paul
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thierry Jahan
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Christine Ritchie
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Jon D Levine
- Schools of Medicine, University of California, San Francisco, CA, USA
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25
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Murillo-Rodríguez E, Barciela Veras A, Barbosa Rocha N, Budde H, Machado S. An Overview of the Clinical Uses, Pharmacology, and Safety of Modafinil. ACS Chem Neurosci 2018; 9:151-158. [PMID: 29115823 DOI: 10.1021/acschemneuro.7b00374] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Modafinil (MOD) is a wakefulness-inducing compound prescribed for treatment of excessive daytime sleepiness as a consequence of sleep disturbances such as shift work sleep disorder, obstructive sleep apnea, restless leg syndrome, or narcolepsy. While providing effective results in patients with sleepiness, MOD also produces positive outcomes in the management of fatigue associated with different conditions including depression, cancer, or tiredness in military personnel. Although there is clear evidence of the stimulant effects of MOD, current data also show that administration of this drug apparently induces positive neurobiological effects, such as improvement in memory. However, serious concerns have been raised since some reports have suggested MOD dependence. Taken together, these findings highlight the need to characterize the changes induced by MOD which have been observed in several neurobiological functions. Moreover, further work should follow up on the likely long-term effects of this drug if used for treatment of drowsiness and tiredness. Here, we review and summarize recent findings of the medical uses of MOD in the management of sleepiness and fatigue associated with depression or cancer as well as exhaustion in military personnel. We also discuss the available literature related with the cognitive enhancing properties of this stimulant, as well as what is known and unknown about MOD addiction.
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Affiliation(s)
- Eric Murillo-Rodríguez
- Laboratorio
de Neurociencias Moleculares e Integrativas, Escuela de Medicina División
Ciencias de la Salud, Universidad Anáhuac Mayab, 97310 Mérida, Yucatán, México
- Grupo
de Investigación en Envejecimiento, División Ciencias
de la Salud, Universidad Anáhuac Mayab, 97310 Mérida, Yucatán, México
- Intercontinental Neuroscience Research Group, Yucatán, México
| | - André Barciela Veras
- Intercontinental Neuroscience Research Group, Yucatán, México
- Grupo de Pesquisa Translacional em
Saúde Mental, Universidade Católica Dom Bosco, Campo
Grande, Mato Grosso del Sur 79117-900, Brazil
- Panic
and Respiration Laboratory, Institute of Psychiatry Federal, University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Nuno Barbosa Rocha
- Intercontinental Neuroscience Research Group, Yucatán, México
- Health School, Polytechnic Institute of Porto, 4200-465 Porto, Portugal
| | - Henning Budde
- Intercontinental Neuroscience Research Group, Yucatán, México
- Faculty
of Human Sciences, Medical School Hamburg, 20457 Hamburg, Germany
- Physical
Activity, Physical Education, Health and Sport Research Centre (PAPESH),
Sports Science Department, School of Science and Engineering, Reykjavik University, 101 Reykjavik, Iceland
- Lithuanian Sports University, Kaunas 44221, Lithuania
| | - Sérgio Machado
- Intercontinental Neuroscience Research Group, Yucatán, México
- Panic
and Respiration Laboratory, Institute of Psychiatry Federal, University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
- Physical
Activity Neuroscience Laboratory, Physical Activity Sciences Postgraduate
Program-Salgado de Oliveira University, Salgado de Oliveira University, Niterói 24030-060, Brazil
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26
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Papachristou N, Barnaghi P, Cooper BA, Hu X, Maguire R, Apostolidis K, Armes J, Conley YP, Hammer M, Katsaragakis S, Kober KM, Levine JD, McCann L, Patiraki E, Paul SM, Ream E, Wright F, Miaskowski C. Congruence Between Latent Class and K-Modes Analyses in the Identification of Oncology Patients With Distinct Symptom Experiences. J Pain Symptom Manage 2018; 55:318-333.e4. [PMID: 28859882 PMCID: PMC5794511 DOI: 10.1016/j.jpainsymman.2017.08.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 12/20/2022]
Abstract
CONTEXT Risk profiling of oncology patients based on their symptom experience assists clinicians to provide more personalized symptom management interventions. Recent findings suggest that oncology patients with distinct symptom profiles can be identified using a variety of analytic methods. OBJECTIVES The objective of this study was to evaluate the concordance between the number and types of subgroups of patients with distinct symptom profiles using latent class analysis and K-modes analysis. METHODS Using data on the occurrence of 25 symptoms from the Memorial Symptom Assessment Scale, that 1329 patients completed prior to their next dose of chemotherapy (CTX), Cohen's kappa coefficient was used to evaluate for concordance between the two analytic methods. For both latent class analysis and K-modes, differences among the subgroups in demographic, clinical, and symptom characteristics, as well as quality of life outcomes were determined using parametric and nonparametric statistics. RESULTS Using both analytic methods, four subgroups of patients with distinct symptom profiles were identified (i.e., all low, moderate physical and lower psychological, moderate physical and higher Psychological, and all high). The percent agreement between the two methods was 75.32%, which suggests a moderate level of agreement. In both analyses, patients in the all high group were significantly younger and had a higher comorbidity profile, worse Memorial Symptom Assessment Scale subscale scores, and poorer QOL outcomes. CONCLUSION Both analytic methods can be used to identify subgroups of oncology patients with distinct symptom profiles. Additional research is needed to determine which analytic methods and which dimension of the symptom experience provide the most sensitive and specific risk profiles.
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Affiliation(s)
| | - Payam Barnaghi
- School of Health Sciences, University of Surrey, Guilford, UK
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Xiao Hu
- School of Nursing, University of California, San Francisco, California, USA
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | | | - Jo Armes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College, London, UK
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Stylianos Katsaragakis
- Faculty of Nursing, University of Peloponnese, Efstathiou & Stamatikis Valioti and Plateon, PC, Sparti, Greece
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Lisa McCann
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Elisabeth Patiraki
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guilford, UK
| | - Fay Wright
- School of Nursing, Yale University, New Haven, Connecticut, USA
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27
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Morgan S, Cooper B, Paul S, Hammer MJ, Conley YP, Levine JD, Miaskowski C, Dunn LB. Association of Personality Profiles with Depressive, Anxiety, and Cancer-related Symptoms in Patients Undergoing Chemotherapy. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017; 117:130-138. [PMID: 29479128 PMCID: PMC5822738 DOI: 10.1016/j.paid.2017.05.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background This study identified latent classes of cancer patients based on Big Five personality dimensions and evaluated for differences in demographic and clinical characteristics, depression, anxiety, and cancer-related symptoms. Methods Patients (n=1248) with breast, gastrointestinal, gynecological, or lung cancer completed the Center for Epidemiological Studies-Depression scale, Spielberger State-Trait Anxiety Inventories, NEO-Five Factor Inventory (NEO-FFI), and Memorial Symptom Assessment Scale (MSAS). Latent class profile analysis of NEO-FFI scores was used to identify patient subgroups. Results Three latent classes were identified. The "Distressed" class (14.3%) scored highest on neuroticism and lowest on extraversion, agreeableness, and conscientiousness. The "Resilient" class (31.9%) scored lowest on neuroticism and highest on extraversion, agreeableness, and conscientiousness. The "Normative" class (53.8%) was intermediate on all dimensions except openness. Compared to the Resilient class, patients in the Distressed class were younger, less educated, more likely to care for another adult, had more comorbidities, and exercised less. The three classes differed by performance status, marital and employment status, and income, but not by gender, time since diagnosis, or type of prior cancer treatment. The classes differed (Distressed > Normative > Resilient) in depression, anxiety, and cancer symptoms. Conclusions Personality is associated with psychological and physical symptoms in cancer patients.
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Affiliation(s)
- Stefana Morgan
- Department of Psychiatry, University of California, San Francisco
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco
| | - Steven Paul
- School of Nursing, University of California, San Francisco
| | | | | | - Jon D. Levine
- School of Dentistry, University of California, San Francisco
| | | | - Laura B. Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University
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28
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Salmon M, Blanchin M, Rotonda C, Guillemin F, Sébille V. Identifying patterns of adaptation in breast cancer patients with cancer-related fatigue using response shift analyses at subgroup level. Cancer Med 2017; 6:2562-2575. [PMID: 28994209 PMCID: PMC5673928 DOI: 10.1002/cam4.1219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 01/11/2023] Open
Abstract
Fatigue is the most prevalent symptom in breast cancer. It might be perceived differently among patients over time as a consequence of the differing patients’ adaptation and psychological adjustment to their cancer experience which can be related to response shift (RS). RS analyses can provide important insights on patients’ adaptation to cancer but it is usually assumed that RS occurs in the same way in all individuals which is unrealistic. This study aimed to identify patients’ subgroups in which different RS effects on self‐reported fatigue could occur over time using a combination of methods for manifest and latent variables. The FATSEIN study comprised 466 breast cancer patients followed over a 2‐year period. Fatigue was measured with the Multidimensional Fatigue Inventory questionnaire (MFI‐20) during 10 visits. A novel combination of Mixed Models, Growth Mixture Modeling, and Structural Equation Modeling was used to assess the occurrence of RS in fatigue changes to identify subgroups displaying different RS patterns over time. An increase in fatigue was evidenced over the 8‐month follow‐up, followed by a decrease between the 8‐ and 24‐month. Four latent classes of patients were identified. Different RS patterns were detected in all latent classes between the inclusion and 8 months (last cycle of chemotherapy). No RS was evidenced between 8‐ and 24‐month. Several RS effects were evidenced in different groups of patients. Women seemed to adapt differently to their treatment and breast cancer experience possibly indicating differing needs for medical/psychological support.
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Affiliation(s)
- Maxime Salmon
- University of Nantes, University of Tours, INSERM, SPHERE U1246, Nantes, France
| | - Myriam Blanchin
- University of Nantes, University of Tours, INSERM, SPHERE U1246, Nantes, France
| | - Christine Rotonda
- University of Lorraine, University of Paris Descartes, EA 4360 APEMAC, Nancy, France.,Center Pierre Janet, University of Lorraine, EA4630 APEMAC/EPSAM, Metz, France
| | - Francis Guillemin
- University of Lorraine, University of Paris Descartes, EA 4360 APEMAC, Nancy, France.,INSERM CIC, 1433 Clinical eidemiology - Nancy University Hospital, Nancy, France
| | - Véronique Sébille
- University of Nantes, University of Tours, INSERM, SPHERE U1246, Nantes, France.,Department of Biostatistics, Nantes University Hospital, Nantes, France
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29
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Differential expression of genes and differentially perturbed pathways associated with very high evening fatigue in oncology patients receiving chemotherapy. Support Care Cancer 2017; 26:739-750. [PMID: 28944404 DOI: 10.1007/s00520-017-3883-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Fatigue is the most common symptom associated with cancer and its treatment. Investigation of molecular mechanisms associated with fatigue in oncology patients may identify new therapeutic targets. The objectives of this study were to evaluate the relationships between gene expression and perturbations in biological pathways and evening fatigue severity in oncology patients who received chemotherapy (CTX). METHODS The Lee Fatigue Scale (LFS) and latent class analysis were used to identify evening fatigue phenotypes. We measured 47,214 ribonucleic acid transcripts from whole blood collected prior to a cycle of CTX. Perturbations in biological pathways associated with differential gene expression were identified from public data sets (i.e., Kyoto Encyclopedia Gene and Genomes, BioCarta). RESULTS Patients were classified into Moderate (n = 65, mean LFS score 3.1) or Very High (n = 195, mean LFS score 6.4) evening fatigue groups. Compared to patients with Moderate fatigue, patients with Very High fatigue exhibited differential expression of 29 genes. A number of the perturbed pathways identified validated prior mechanistic hypotheses for fatigue, including alterations in immune function, inflammation, neurotransmission, energy metabolism, and circadian rhythms. Based on our findings, energy metabolism was further divided into alterations in carbohydrate metabolism and skeletal muscle energy. Alterations in renal function-related pathways were identified as a potential new mechanism. CONCLUSIONS This study identified differential gene expression and perturbed biological pathways that provide new insights into the multiple and likely inter-related mechanisms associated with evening fatigue in oncology patients.
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30
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Armstrong TS, Vera E, Zhou R, Acquaye AA, Sullaway CM, Berger AM, Breton G, Mahajan A, Wefel JS, Gilbert MR, Bondy M, Scheurer ME. Association of genetic variants with fatigue in patients with malignant glioma. Neurooncol Pract 2017; 5:122-128. [PMID: 31386001 DOI: 10.1093/nop/npx020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Fatigue is a consistently reported, severe symptom among patients with gliomas throughout the disease trajectory. Genomic pathways associated with fatigue in glioma patients have yet to be identified. Methods Clinical factors (performance status, tumor details, age, gender) were collected by chart review on glioma patients with fatigue ("I have lack of energy" on Functional Assessment of Cancer Therapy-Brain), as well as available genotyping data. Candidate genes in clock and inflammatory pathways were identified from a literature review, of which 50 single nucleotide polymorphisms (SNPs) in 7 genes were available. Clinical factors and SNPs identified by univariate analyses were included in a multivariate model for moderate-severe fatigue. Results The study included 176 patients (median age = 47 years, 67% males). Moderate-severe fatigue was reported by 43%. Results from multivariate analysis revealed poor performance status and 2 SNPs were associated with fatigue severity. Moderate-severe fatigue was more common in patients with poor performance status (OR = 3.52, P < .01). For each additional copy of the minor allele in rs934945 (PER2) the odds of fatigue decreased (OR = 0.51, P < .05). For each additional copy of the minor allele in rs922270 (ARTNL2) the odds of fatigue increased (OR = 2.38, P < .01). Both of these genes are important in the circadian clock pathway, which has been implicated in diurnal preference, and duration and quality of sleep. No genes in the inflammatory pathway were associated with fatigue in the current study. Conclusions Identifying patients at highest risk for fatigue during treatment allows for improved clinical monitoring and enrichment of patient selection for clinical trials.
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Affiliation(s)
- Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Renke Zhou
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Alvina A Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Catherine M Sullaway
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ann M Berger
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Melissa Bondy
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Michael E Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
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31
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Miaskowski C, Wong ML, Cooper BA, Mastick J, Paul SM, Possin K, Steinman M, Cataldo J, Dunn LB, Ritchie C. Distinct Physical Function Profiles in Older Adults Receiving Cancer Chemotherapy. J Pain Symptom Manage 2017; 54:263-272. [PMID: 28716620 PMCID: PMC5610084 DOI: 10.1016/j.jpainsymman.2017.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/01/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
CONTEXT Although physical function is an important patient outcome, little is known about changes in physical function in older adults receiving chemotherapy (CTX). OBJECTIVES Identify subgroups of older patients based on changes in their level of physical function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality-of-life (QOL) outcomes. METHODS Latent profile analysis was used to identify groups of older oncology patients (n = 363) with distinct physical function profiles. Patients were assessed six times over two cycles of CTX using the Physical Component Summary score from the Short Form 12. Differences, among the groups, in demographic and clinical characteristics and QOL outcomes were evaluated using parametric and nonparametric tests. RESULTS Three groups of older oncology patients with distinct functional profiles were identified: Well Below (20.4%), Below (43.8%), and Above (35.8%) normative Physical Component Summary scores. Characteristics associated with membership in the Well Below class included the following: lower annual income, a higher level of comorbidity, being diagnosed with depression and back pain, and lack of regular exercise. Compared with the Above class, patients in the other two classes had significantly poorer QOL outcomes. CONCLUSION Almost 65% of older oncology patients reported significant decrements in physical function that persisted over two cycles of CTX. Clinicians can assess for those characteristics associated with poorer functional status to identify high-risk patients and initiate appropriate interventions.
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Affiliation(s)
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Katherine Possin
- School of Medicine, University of California, San Francisco, California, USA
| | - Michael Steinman
- School of Medicine, University of California, San Francisco, California, USA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, California, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Palo Alto, California, USA
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, California, USA
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32
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Langford DJ, Cooper B, Paul S, Humphreys J, Keagy C, Conley YP, Hammer MJ, Levine JD, Wright F, Melisko M, Miaskowski C, Dunn LB. Evaluation of coping as a mediator of the relationship between stressful life events and cancer-related distress. Health Psychol 2017; 36:1147-1160. [PMID: 28825498 DOI: 10.1037/hea0000524] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Lifetime stressful life events (SLEs) may predispose oncology patients to cancer-related distress (i.e., intrusive thoughts, hyperarousal, avoidance). Coping may influence cancer-related distress by mediating this relationship. This study sought to (a) determine the prevalence and impact of lifetime SLEs among oncology outpatients receiving chemotherapy and (b) examine the relationship between SLEs and cancer-related distress and the mediating role of coping on this relationship. METHOD Patients (n = 957), with breast, gastrointestinal, gynecologic or lung cancer, who were undergoing chemotherapy, completed the Life Stressor Checklist-Revised (LSC-R), a measure of lifetime SLEs. Cancer-related distress was assessed with the Impact of Event Scale-Revised. Coping strategies since beginning chemotherapy were assessed with the Brief COPE; 2 latent variables (engagement and disengagement coping) were identified based on these scores. LSC-R scores (number of SLEs and perceived impact during the prior year) were evaluated in relation to demographic and clinical characteristics. Structural equation modeling was used to evaluate the relationship between LSC-R and Impact of Event Scale-Revised scores and the mediating role of engagement and disengagement coping on this relationship. RESULTS On average, patients reported 6.1 (SD = 4.0; range = 0-23 out of 30) SLEs. Patients who were not married/partnered, had incomes <$30,000/year, or who had lower functional status or greater comorbidity had higher LSC-R scores. The relationship between more SLEs and more severe cancer-related distress was completely mediated by disengagement coping. Engagement coping did not mediate this relationship. CONCLUSIONS Disengagement coping, including behavioral disengagement, avoidance, and denial, should be targeted to mitigate cancer-related distress. (PsycINFO Database Record
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Affiliation(s)
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco
| | - Steven Paul
- School of Nursing, University of California, San Francisco
| | | | | | | | | | - Jon D Levine
- School of Dentistry, University of California, San Francisco
| | | | | | | | - Laura B Dunn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University
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Wright F, Cooper BA, Conley YP, Hammer MJ, Chen LM, Paul SM, Levine JD, Miaskowski C, Kober KM. Distinct Evening Fatigue Profiles in Oncology Outpatients Receiving Chemotherapy. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2017; 5:131-144. [PMID: 29725554 DOI: 10.1080/21641846.2017.1322233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Fatigue is the most common and debilitating symptom experienced by oncology patients during chemotherapy (CTX). Fatigue severity demonstrates a large amount of inter-individual and diurnal variability. Purpose Study purposes were to evaluate for subgroups of patients with distinct evening fatigue profiles and evaluate how these subgroups differed on demographic, clinical, and symptom characteristics. Methods Outpatients with breast, gastrointestinal, gynecological, or lung cancer (n=1332) completed questionnaires six times over two cycles of CTX. Lee Fatigue Scale (LFS) evaluated evening fatigue severity. Latent profile analysis was used to identify distinct evening fatigue profiles. Results Four distinct evening fatigue classes (i.e., Low (14.0%), Moderate (17.2%), High (36.0%), Very High (32.8%)) were identified. Compared to the Low class, patients in the Very High evening fatigue class were: younger, female, had childcare responsibilities, had more years of education, had a lower functional status, had a higher comorbidity burden, and were diagnosed with breast cancer. Patients in the Very High class reported higher levels of depressive symptoms, sleep disturbance, and evening fatigue at enrollment. Conclusions Findings provide new insights into modifiable risk factors for higher levels of evening fatigue. Clinicians can use this information to identify higher risk patients and plan appropriate interventions.
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Affiliation(s)
- Fay Wright
- School of Nursing, Yale University, New Haven, CT
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA
| | | | | | - Lee-May Chen
- School of Medicine, University of California, San Francisco, CA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA
| | | | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA
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Abid H, Kober KM, Smoot B, Paul SM, Hammer M, Levine JD, Lee K, Wright F, Cooper BA, Conley YP, Miaskowski C. Common and Distinct Characteristics Associated With Trajectories of Morning and Evening Energy in Oncology Patients Receiving Chemotherapy. J Pain Symptom Manage 2017; 53:887-900.e2. [PMID: 28063861 PMCID: PMC5410179 DOI: 10.1016/j.jpainsymman.2016.12.339] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/11/2016] [Accepted: 12/27/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT Although energy conservation strategies are recommended in clinical practice guidelines, little is known about changes in energy levels in oncology patients undergoing cancer treatment. OBJECTIVES The objective of this study was to identify variations in the trajectories of morning and evening energy levels and determine which characteristics predicted initial levels and the trajectories of morning and evening energy. METHODS Outpatients receiving chemotherapy (CTX) completed demographic and symptom questionnaires six times over two CTX cycles. Energy was assessed using the Lee Fatigue Scale. Hierarchical linear modeling was used to analyze the data. RESULTS A large amount of interindividual variability was found in the morning and evening energy trajectories. Patients who lived alone, had childcare responsibilities, had a lower functional status, did not exercise on a regular basis, had lower hemoglobin levels, had lower attentional function, higher trait anxiety, and higher sleep disturbance reported lower morning energy levels at enrollment. Variations in the trajectories of morning energy were associated with a higher body mass index and higher levels of morning energy and higher sleep disturbance scores. For evening energy, patients who were female, white, had lower functional status, and had lower attentional function and higher sleep disturbance reported lower evening energy levels at enrollment. Evening energy levels at enrollment were associated with changes in evening energy over time. CONCLUSION Patients undergoing CTX experience decrements in both morning and evening energy. The modifiable characteristics associated with these decrements can be used to design intervention studies to increase energy levels in these patients.
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Affiliation(s)
- Hamza Abid
- School of Nursing, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Kathryn Lee
- School of Nursing, University of California, San Francisco, California, USA
| | - Fay Wright
- School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Differences in symptom clusters identified using symptom occurrence rates versus severity ratings in patients with breast cancer undergoing chemotherapy. Eur J Oncol Nurs 2017; 28:122-132. [PMID: 28478849 DOI: 10.1016/j.ejon.2017.04.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/07/2017] [Accepted: 04/11/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE One of the unanswered questions in symptom clusters research is whether the number and types of symptom clusters vary based on the dimension of the symptom experience used to create the clusters. Given that patients with breast cancer receiving chemotherapy (CTX), report between 10 and 32 concurrent symptoms and studies of symptom clusters in these patients are limited, the purpose of this study, in breast cancer patients undergoing CTX (n = 515), was to identify whether the number and types of symptom clusters differed based on whether symptom occurrence rates or symptom severity ratings were used to create the clusters. METHODS A modified version of the Memorial Symptom Assessment Scale was used to assess for the occurrence and severity of 38 symptoms, one week after the administration of CTX. Exploratory factor analysis was used to extract the symptom clusters. RESULTS Both the number and types of symptom clusters were similar using symptom occurrence rates or symptom severity ratings. Five symptom clusters were identified using symptom occurrence rates (i.e., psychological, hormonal, nutritional, gastrointestinal, epithelial). Six symptom clusters (i.e., psychological, hormonal, nutritional, gastrointestinal, epithelial, chemotherapy neuropathy) were identified using symptom severity ratings. Across the two dimensions, the specific symptoms within each of the symptom clusters were similar. CONCLUSIONS Identification of symptom clusters in patients with breast cancer may be useful in guiding symptom management interventions. Future studies are warranted to determine if symptom clusters remain stable over a cycle of CTX in patients with breast cancer.
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Wright F, Hammer M, Paul SM, Aouizerat BE, Kober KM, Conley YP, Cooper BA, Dunn LB, Levine JD, DEramo Melkus G, Miaskowski C. Inflammatory pathway genes associated with inter-individual variability in the trajectories of morning and evening fatigue in patients receiving chemotherapy. Cytokine 2017; 91:187-210. [PMID: 28110208 DOI: 10.1016/j.cyto.2016.12.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/05/2016] [Accepted: 12/25/2016] [Indexed: 01/28/2023]
Abstract
Fatigue, a highly prevalent and distressing symptom during chemotherapy (CTX), demonstrates diurnal and interindividual variability in severity. Little is known about the associations between variations in genes involved in inflammatory processes and morning and evening fatigue severity during CTX. The purposes of this study, in a sample of oncology patients (N=543) with breast, gastrointestinal (GI), gynecological (GYN), or lung cancer who received two cycles of CTX, were to determine whether variations in genes involved in inflammatory processes were associated with inter-individual variability in initial levels as well as in the trajectories of morning and evening fatigue. Patients completed the Lee Fatigue Scale to determine morning and evening fatigue severity a total of six times over two cycles of CTX. Using a whole exome array, 309 single nucleotide polymorphisms SNPs among the 64 candidate genes that passed all quality control filters were evaluated using hierarchical linear modeling (HLM). Based on the results of the HLM analyses, the final SNPs were evaluated for their potential impact on protein function using two bioinformational tools. The following inflammatory pathways were represented: chemokines (3 genes); cytokines (12 genes); inflammasome (11 genes); Janus kinase/signal transducers and activators of transcription (JAK/STAT, 10 genes); mitogen-activated protein kinase/jun amino-terminal kinases (MAPK/JNK, 3 genes); nuclear factor-kappa beta (NFkB, 18 genes); and NFkB and MAP/JNK (7 genes). After controlling for self-reported and genomic estimates of race and ethnicity, polymorphisms in six genes from the cytokine (2 genes); inflammasome (2 genes); and NFkB (2 genes) pathways were associated with both morning and evening fatigue. Polymorphisms in six genes from the inflammasome (1 gene); JAK/STAT (1 gene); and NFkB (4 genes) pathways were associated with only morning fatigue. Polymorphisms in three genes from the inflammasome (2 genes) and the NFkB (1 gene) pathways were associated with only evening fatigue. Taken together, these findings add to the growing body of evidence that suggests that morning and evening fatigue are distinct symptoms.
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Affiliation(s)
- Fay Wright
- Yale School of Nursing, New Haven, CT, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Hospital, New York, NY, USA
| | - Steven M Paul
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, CA, USA
| | - Bradley E Aouizerat
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, NY, USA
| | - Kord M Kober
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bruce A Cooper
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, CA, USA
| | - Laura B Dunn
- Department of Psychiatry, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Jon D Levine
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California at San Francisco, San Francisco, CA, USA
| | - Gail DEramo Melkus
- Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, NY, USA
| | - Christine Miaskowski
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, CA, USA.
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Colley A, Halpern J, Paul S, Micco G, Lahiff M, Wright F, Levine JD, Mastick J, Hammer MJ, Miaskowski C, Dunn LB. Factors associated with oncology patients' involvement in shared decision making during chemotherapy. Psychooncology 2016; 26:1972-1979. [PMID: 27649058 DOI: 10.1002/pon.4284] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Oncology patients are increasingly encouraged to play an active role in treatment decision making. While previous studies have evaluated relationships between demographic characteristics and decision-making roles, less is known about the association of symptoms and psychological adjustment characteristics (eg, coping styles and personality traits) and decision-making roles. METHODS As part of a larger study of symptom clusters, patients (n = 765) receiving chemotherapy for breast, gastrointestinal, gynecological, or lung cancer provided information on demographic, clinical, symptom, and psychological adjustment characteristics. Patient-reported treatment decision-making roles (ie, preferred role and role actually played) were assessed using the Control Preferences Scale. Differences among patients, who were classified as passive, collaborative, or active, were evaluated using χ2 analyses and analyses of variance. RESULTS Over half (56.3%) of the patients reported that they both preferred and actually played a collaborative role. Among those patients with concordant roles, those who were older, those with less education and lower income, and those who were less resilient were more likely to prefer a passive role. Several psychological adjustment characteristics were associated with decision-making role, including coping style, personality, and fatalism. CONCLUSIONS Oncology patients' preferences for involvement in treatment decision making are associated with demographic characteristics as well as with symptoms and psychological adjustment characteristics, such as coping style and personality. These results reaffirm the complexities of predicting patients' preferences for involvement in decision making. Further study is needed to determine if role or coping style may be influenced by interventions designed to teach adaptive coping skills.
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Affiliation(s)
- Alexis Colley
- UC Berkeley-UC San Francisco Joint Medical Program, University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Jodi Halpern
- UC Berkeley-UC San Francisco Joint Medical Program, University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Guy Micco
- UC Berkeley-UC San Francisco Joint Medical Program, University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Maureen Lahiff
- School of Public Health, Division of Biostatistics, University of California, Berkeley, CA, USA
| | - Fay Wright
- School of Nursing, Yale University, New Haven, CT, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, CA, USA
| | | | | | - Laura B Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Bischel LE, Ritchie C, Kober KM, Paul SM, Cooper BA, Chen LM, Levine JD, Hammer M, Wright F, Miaskowski C. Age differences in fatigue, decrements in energy, and sleep disturbance in oncology patients receiving chemotherapy. Eur J Oncol Nurs 2016; 23:115-23. [PMID: 27456383 DOI: 10.1016/j.ejon.2016.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The number of older adults with cancer is increasing. Given the limited amount of research and the inconsistent findings regarding age differences in common physical symptoms associated with cancer and its treatments, the purposes of this study, in a sample of oncology outpatients receiving chemotherapy (CTX), were to evaluate for age differences in demographic and clinical characteristics, as well as in occurrence rates of and severity ratings for fatigue, decrements in energy, and sleep disturbance. In addition, using regression analysis techniques, within and across age groups, demographic and clinical characteristics associated with the severity of each symptom were evaluated. METHODS Patients (n = 1343) were dichotomized into younger (<65 years) and older (≥65 years) age groups. Patients completed self-report questionnaires prior to their next dose of CTX. RESULTS Overall, our findings suggest that compared to younger patients, older adults experience a lower or similar level of fatigue, decrements in energy, and sleep disturbance. However, it should be noted that both age groups experienced high occurrence rates and moderate to severe levels of all three symptoms. CONCLUSIONS Clinicians need to assess all oncology patients receiving CTX for these three symptoms. Future research needs to determine the biopsychosocial reasons that underlie these age-related differences in fatigue, decrements in energy, and sleep disturbance.
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Affiliation(s)
- Lindsey E Bischel
- School of Nursing, University of California, San Francisco, CA, United States
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, CA, United States
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, United States
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, United States
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, United States
| | - Lee-May Chen
- School of Medicine, University of California, San Francisco, CA, United States
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, United States
| | - Marilyn Hammer
- College of Nursing, New York University, New York, NY, United States
| | - Fay Wright
- College of Nursing, New York University, New York, NY, United States
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Carnio S, Di Stefano RF, Novello S. Fatigue in lung cancer patients: symptom burden and management of challenges. LUNG CANCER (AUCKLAND, N.Z.) 2016; 7:73-82. [PMID: 28210163 PMCID: PMC5310693 DOI: 10.2147/lctt.s85334] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Lung cancer (LC) remains the most common cause of cancer death in several countries across the world. Fatigue is the most frequently reported symptom in LC patients throughout the entire course of disease, and all international guidelines recommend early screening for cancer-related fatigue (CRF) and symptoms that can affect patients' quality of life. In patients with LC, fatigue belongs to the symptom cluster of pain, depression, and insomnia, which are commonly observed simultaneously, but are typically treated as separate although they may have common biological mechanisms. The treatment of CRF remains one of the difficult areas in the oncology field: scarce evidence supports pharmacological therapies, while some interesting data arising indicates alternative remedies and physical exercise seem to be one of the most effective approaches for CRF at any stage of LC.
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Affiliation(s)
- Simona Carnio
- Oncology Department, University of Turin, AOU San Luigi, Orbassano, Italy
| | | | - Silvia Novello
- Oncology Department, University of Turin, AOU San Luigi, Orbassano, Italy
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