Development and testing of the symptom experience scale

Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers

BACKGROUND

Primary malignant brain tumours can have an unpredictable course, but high-grade gliomas typically have a relentlessly progressive disease trajectory. They can cause profound symptom burden, affecting physical, neurocognitive, and social functioning from an early stage in the illness. This can significantly impact on role function and on the experiences and needs of informal caregivers. Access to specialist palliative and supportive care early in the disease trajectory, for those with high-grade tumours in particular, has the potential to improve patients' and caregivers' quality of life. However, provision of palliative and supportive care for people with primary brain tumours - and their informal caregivers - is historically ill-defined and ad hoc, and the benefits of early palliative interventions have not been confirmed. It is therefore important to define the role and effectiveness of early referral to specialist palliative care services and/or the effectiveness of other interventions focused on palliating disease impact on people and their informal caregivers. This would help guide improvement to service provision, by defining those interventions which are effective across a range of domains, and developing an evidence-based model of integrated supportive and palliative care for this population.

OBJECTIVES

To assess the evidence base for early palliative care interventions, including referral to specialist palliative care services compared to usual care, for improving outcomes in adults diagnosed with a primary brain tumour and their carers.

SEARCH METHODS

We conducted searches of electronic databases, CENTRAL, MEDLINE, CINAHL, Web of Science, and PsycINFO (last searched 16 November 2021). We conducted searches to incorporate both qualitative and quantitative search terms. In addition to this, we searched for any currently recruiting trials in ClinicalTrials.gov and in the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and undertook citation tracking via Scopus. We also handsearched reference lists of potentially eligible systematic review articles to identify any other relevant studies, contacted experts in the field and searched key authors via Web of Science and searched SIGLE (System of Information on Grey Literature in Europe).

SELECTION CRITERIA

We included studies looking at early referral to specialist palliative care services - or early targeted palliative interventions by other healthcare professionals - for improving quality of life, symptom control, psychological outcomes, or overall survival as a primary or secondary outcome measure. Studies included randomised controlled trials (RCTs), non-randomised studies (NRS), as well as qualitative and mixed-methods studies where both qualitative and quantitative data were included. Participants were adults with a confirmed radiological and/or histological diagnosis of a primary malignant brain tumour, and/or informal adult carers (either at individual or family level) of people with a primary malignant brain tumour.

DATA COLLECTION AND ANALYSIS

We followed standard Cochrane methodological procedures for data extraction, management, and analysis. We used GRADE to assess the certainty of the evidence for symptom control, i.e. cognitive function.

MAIN RESULTS

We identified 9748 references from the searches, with 8337 remaining after duplicates were removed. After full-text review, we included one trial. There were no studies of early specialist palliative care interventions or of early, co-ordinated generalist palliative care approaches. The included randomised trial addressed a single symptom area, focusing on early cognitive rehabilitation, administered within two weeks of surgery in a mixed brain tumour population, of whom approximately half had a high-grade glioma. The intervention was administered individually as therapist-led computerised exercises over 16 one-hour sessions, four times/week for four weeks. Sessions addressed several cognitive domains including time orientation, spatial orientation, visual attention, logical reasoning, memory, and executive function. There were no between-group differences in outcome for tests of logical-executive function, but differences were observed in the domains of visual attention and verbal memory. Risk of bias was assessed and stated as high for performance bias and attrition bias but for selective reporting it was unclear whether all outcomes were reported. We considered the certainty of the evidence, as assessed by GRADE, to be very low.

AUTHORS' CONCLUSIONS

Currently there is a lack of research focusing on the introduction of early palliative interventions specifically for people with primary brain tumours, either as co-ordinated specialist palliative care approaches or interventions focusing on a specific aspect of palliation. Future research should address the methodological shortcomings described in early palliative intervention studies in other cancers and chronic conditions. In particular, the specific population under investigation, the timing and the setting of the intervention should be clearly described and the standardised palliative care-specific components of the intervention should be defined in detail.

Symptom Clusters and Quality of Life over 1 Year in Breast Cancer Patients Receiving Adjuvant Chemotherapy

Objective:

Evidence is scant regarding symptom clusters and quality of life (QOL) over 1 year in women who receive adjuvant breast cancer chemotherapy (CTX). Our purpose was to identify the prevalence and severity of individual symptoms, symptom clusters, and QOL in women receiving adjuvant breast cancer CTX from baseline over 1 year.

Methods:

Symptoms were identified in a sample (n = 219) at three times: baseline (prior to the first adjuvant CTX treatment), 1 month after the last CTX (approximately 6 months after baseline), and 1 year after baseline. The Hospital Anxiety and Depression Scale and Symptom Experience Scale measured symptoms. The Medical Outcomes Study, Short-Form Survey, measured QOL. Exploratory factor analysis identified symptom clusters at each time and core symptoms in clusters over time.

Results:

The prevalence and severity of 10 symptoms decreased over time (P < 0.05). Fatigue, sleep disturbance, and pain were most prevalent; all were of mild severity. Two symptom clusters were identified at baseline and one met internal consistency reliability criteria at the later times. Core symptoms were identified. Both the physical and mental component scores of QOL improved over time (P < 0.01), but physical was below the general population norms 1 year after baseline.

Conclusions:

The symptom experience was dynamic, and symptom clusters changed over 1 year. Despite mild severity, core symptoms and clusters persisted over 1 year, and physical health was below the general population norms. Breast cancer survivors with persistent single and co-occurring symptoms need to be taught to manage the patterns of symptoms over time because they may not resolve by 1 year.

[A Structural Model for Chemotherapy Related Cognitive Impairment and Quality of Life in Breast Cancer Patients]

PURPOSE

This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model.

METHODS

The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs.

RESULTS

The modified model was a good fit for the data. The model fit indices were χ²=423.18 (p<.001), χ²/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (β=.38, p=.002), depression and anxiety (β=.25, p=.002), and symptom experiences (β=.19, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (β=-.51, p=.001), symptom experiences (β=-.27, p=.001), menopausal symptoms (β=-.22, p=.008), and chemotherapy-related cognitive impairment (β=-.15, p=.024) had direct effects on the quality of life and these variables explained 91.3%.

CONCLUSION

These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.

Patterns of Symptom Distress in Adults Receiving Treatment for Lung Cancer

Knowledge of the patterns of symptom distress in adults receiving treatment for lung cancer is an important first step in developing interventions that can potentially lessen symptom distress. The purposes of this secondary analysis were to describe the changes in patterns of symptom distress over time in adults receiving treatment for lung cancer, and to examine the relationship of selected demographic and clinical characteristics to symptom distress. Complete data were available for 117 patients. The patterns of symptom distress in adults receiving treatment for lung cancer varied between treatment groups and over time. Symptom distress scores were moderate to high on entry into the study, indicating that symptom management in newly diagnosed lung cancer patients is essential and should begin early in the course of illness. Moreover, clinical interventions should be tailored to the type of treatment. Various demographic and clinical variables were weak and inconsistent predictors of symptom distress, underscoring the importance of examining the role of psychosocial factors in mediating symptom distress.

Symptom Clusters Change Over Time in Women Receiving Adjuvant Chemotherapy for Breast Cancer

CONTEXT

Patients with breast cancer receiving chemotherapy (CTX) experience multiple concurrent symptoms, but little is known about how symptoms change during and after treatment. Knowledge of the identity and trajectory of symptom clusters (SCs) would enhance measurement and management.

OBJECTIVES

We aimed to identify SCs and their change over time from baseline to completion of breast cancer CTX.

METHODS

SCs were identified and assessed for change in 219 women from Nebraska at four times: baseline, during cycles #3 and #4 of CTX, and one month after finishing CTX. Ten symptoms were measured: two using the Hospital Anxiety and Depression Scale and eight using the Symptom Experience Scale. Exploratory factor analysis was conducted at each time point, then changes in SCs were evaluated at different times.

RESULTS

Two SCs were identified before and after initiating CTX: gastrointestinal and treatment-related. The number and type of symptoms in each cluster differed over time. Clusters were dynamic during CTX with changes in the number and type of symptoms. Only one treatment-related SC, which consisted of fatigue, pain, and sleep disturbance, was identified after CTX completion.

CONCLUSION

SCs during CTX appear to be dynamic, changing over time from before until after CTX completion. Repeated assessments of SCs reveal symptoms that are present and when patients are most burdened and in need of additional support.

[A structural model for psychosocial adjustment in patients with early breast cancer]

PURPOSE

This study was done to propose a structural model to explain and predict psychosocial adjustment in patients with early breast cancer and to test the model. The model was based on the Stress-Coping Model of Lazarus and Folkman (1984).

METHODS

Data were collected from February 18 to March 18, 2009. For data analysis, 198 data sets were analyzed using SPSS/WIN12 and AMOS 7.0 version.

RESULTS

Social support, uncertainty, symptom experience, and coping had statistically significant direct, indirect and total effects on psychosocial adjustment, and optimism had significant indirect and total effects on psychosocial adjustment. These variables explained 57% of total variance of the psychosocial adjustment in patients with early breast cancer.

CONCLUSION

The results of the study indicate a need to enhance psychosocial adjustment of patients with early breast cancer by providing detailed structured information and various symptom alleviation programs to reduce perceived stresses such as uncertainty and symptom experience. They also suggest the need to establish support systems through participation of medical personnel and families in such programs, and to apply interventions strengthening coping methods to give the patients positive and optimistic beliefs.

The measurement of symptoms and side effects in clinical trials of chronic pain

Clinical trials in chronic pain have used various methods to assess the effect of medications. In addition to measuring symptom relief, researchers must also address adverse events (AEs) associated with the medication to evaluate overall therapeutic results. This paper reviews methods of measuring symptoms and AEs, including passive capture, scripted prompting, prospective assessments of side effects of interest, and prospective comprehensive symptom checklists. Methods of measuring therapeutic results have advantages and disadvantages. Although passive AE capture (unscripted, open-ended questions about symptoms) is not constrained by preconceptions of potential AEs, it sometimes fails to capture clinically significant AEs. Scripted prompting (prespecified, scripted, open-ended questions about symptoms) is likely to address the latter problem but preclude consistency across trials. Prospective assessments (prespecified symptom inventories) can offer greater sensitivity and consistency in detecting side effects of specific treatments. Comprehensive symptom distress inventories can be more sensitive measures of overall treatment benefit, which may be important when efficacy, passive AE capture, and comprehensive quality of life (QOL) batteries fail to differentiate between treatments. In cancer populations these inventories have been statistically correlated with survival and other important clinical outcomes, even after controlling for disease status, global QOL, psychological state, and performance status. Other important considerations are patient perceptions of the importance of symptoms, the correlations between QOL and symptom distress, and the usefulness of global ratings, in which patients integrate any perceived benefits of the medication with tolerability and other factors, such as convenience and cost.

Tools for assessing nausea, vomiting, and retching

BACKGROUND

Chemotherapy-induced nausea, vomiting, and retching are recognized as having an impact on patients' overall physical well-being, quality of life, and treatment decisions. Although there are many tools available to measure aspects of these symptoms, few offer a complete and concise clinical assessment.

OBJECTIVE

The purpose of this article was to provide a comprehensive overview of the various instruments available for the assessment of cancer-related nausea, vomiting, and retching. Analysis included symptoms measured, period evaluated, type of questions posed, and aspects of each symptom measured.

METHODS

Searches were conducted to find relevant articles using nationally recognized oncology Web sites and 4 electronic databases including PubMed, MEDLINE/CINAHL and CINAHL/EBSCO, and Cochrane.

RESULTS

This review includes a total of 25 instruments that were identified as meeting the inclusion criteria of having been developed, or adapted, for the adult population, with an oncology focus.

CONCLUSION

The ideal instrument would include measurement of all 3 symptoms while remaining clear, concise, and clinically relevant.

IMPLICATIONS FOR PRACTICE

Although only 1 instrument came close to meeting these criteria, this review provides nurses with specific information on a variety of instruments to assist providers in selecting the most appropriate instrument for their specific clinical setting. This comprehensive critique of instruments is important for nurses attempting to select a tool to guide optimum care for patients in the clinical setting.

Predictors of adherence to a behavioral therapy sleep intervention during breast cancer chemotherapy

BACKGROUND

This study's purpose was twofold: (1) to establish adherence rates to a behavioral therapy (BT) sleep intervention and (2) to identify psychological and physical symptom predictors of adherence to the intervention in women undergoing breast cancer chemotherapy.

METHODS

A randomized controlled trial began 48 h before the first of four chemotherapy treatments. Women with stages I-IIIA breast cancer (n = 113) received a BT sleep intervention composed of stimulus control, modified sleep restriction (MSR), relaxation therapy (RT), and sleep hygiene counseling components. A BT plan was developed by a research nurse and each participant, reinforced on day 8, and repeated for chemotherapy cycles 2, 3, and 4. Adherence to the BT plan was measured daily; total adherence score was computed at each chemotherapy cycle by combining adherence estimates of all BT plan components. Psychological and physical symptoms over the past 7 days were measured 2 days prior to and 7 days after each chemotherapy treatment.

RESULTS

Total adherence rates to the BT plan were 51-52% at all four treatments but adherence varied by component. Sleep disturbance, pain, and anxiety significantly decreased whereas depression significantly increased across chemotherapy. Structural equation modeling revealed a good model fit with decreasing sleep disturbances (0.409) and increasing depression (-0.711) contributing to lower total adherence rates. Increasing depression predicted lower MSR adherence (-0.203) and decreasing sleep disturbances predicted lower RT adherence (1.220).

CONCLUSIONS

Sleep disturbance and depression significantly impacted adherence rates during chemotherapy. Results warrant attention when promoting adherence to BT sleep interventions during chemotherapy treatment.

One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue

PURPOSE

To determine 1-year outcomes of a four-component behavioral therapy (BT) sleep intervention (Individualized Sleep Promotion Plan [ISPP]) versus a healthy eating control (HEC) on cancer-related fatigue in women receiving breast cancer adjuvant chemotherapy treatment (CTX).

PATIENTS AND METHODS

A total of 219 participants from 12 oncology clinics were randomly assigned in a clinical trial. Before CTX, research nurses coached intervention participants to develop a BT plan including stimulus control, modified sleep restriction, relaxation therapy, and sleep hygiene. BT plans were revised before each CTX and 30, 60, and 90 days after the last CTX and reinforced 7 to 9 days later. HEC participants received nutritional information and equal attention. Pittsburgh Sleep Quality Index (PSQI), Daily Diary, Wrist Actigraph, and Piper Fatigue Scale measures and Repeated Linear Mixed Model analysis following the Intent to Treat paradigm were used.

RESULTS

Sleep quality differed over 1 years time (F [4,162] = 7.7, P < .001; by group, F [1,173] = 4.8, P = .029; and over time by group, F [4,162] = 3.3, P = .013). Pairwise comparisons revealed significant differences between groups at 90 days (P = .002) but not at 1 year (P = .052). Seven days of diary and actigraphy data did not corroborate with monthly reflections (PSQI). The night awakenings (Actigraph) pattern was significantly different by group over time (P = .046), with no differences between groups at 90 days or at 1 year. Fatigue was lower at 1 year than before CTX; no group effects were found.

CONCLUSION

The BT group, on average, experienced significant improvement on global sleep quality compared with the HEC group, but not on objective sleep or fatigue outcomes.

Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue

BACKGROUND

To determine whether sleep quality and fatigue associated with breast cancer adjuvant chemotherapy treatments can be improved with behavioral therapy (BT) [Individualized Sleep Promotion Plan (ISPP)] including modified stimulus control, modified sleep restriction, relaxation therapy, and sleep hygiene.

METHODS

Randomized-controlled trial based on Piper Integrated Fatigue Model, 219 stages I-IIIA breast cancer patients. Prior to the initial chemotherapy treatment, BT participants developed an ISPP plan that was regularly reinforced and revised. Controls received healthy eating information and attention. Pittsburgh Sleep Quality Index (PSQI), daily diary, actigraph, and Piper Fatigue Scale (PFS) data were collected 2 days prior, during the 7 days after each treatment, and 30 days after the last treatment. Repeated measures analysis of variance was used.

RESULTS

Prior to chemotherapy, participants reported mild fatigue and fairly poor sleep quality. All variables changed over time. A group by time interaction was found for sleep quality (PSQI) improving in the BT group. Diary revealed group differences on number of awakenings, minutes awake after sleep onset, and sleep efficiency. Fatigue (PFS) was similar between groups.

CONCLUSIONS

The BT group showed improved sleep quality over time and better sleep (diary). Perceptions of improved sleep quality over time are not consistently associated with diary or actigraph, or result in lower fatigue.

Predictors of patterns of pain, fatigue, and insomnia during the first year after a cancer diagnosis in the elderly

Pain (P), fatigue (F), and insomnia (I) are among the most prevalent, distressing, and undermanaged symptoms experienced by cancer patients. Research has demonstrated that PFI co-occur; what remain unclear are the patterns and stability of PFI and the patient, disease, and treatment characteristics that predict PFI patterns over time. This secondary analysis used a data set composed of 867 elders (46% women) who were newly diagnosed with breast, colorectal, lung, or prostate cancer and followed at 4 points during the year after diagnosis. The university's institutional review board approved this study. Descriptive statistics and multistate transition models using multinomial logistic regression were used. The typical participant was 72.6 years old, who reported 7.9 symptoms and 2.7 comorbidities. Previous PFI pattern was consistently associated with significantly increased risks of subsequent PFI pattern. At observations 1 to 3, lung cancer, treatment, higher comorbidity with breast cancer, and late-stage colorectal cancer were significantly associated with increased risks of PFI patterns. Advancing age was not significantly associated with increased risks of PFI patterns. Pain, fatigue, and insomnia co-occurrence declined over time but was associated with significantly increased risks of death or loss to follow-up and increased reports of other symptoms. Pain, fatigue, and insomnia co-occurrence is associated with adverse outcomes and should be proactively targeted for intervention.

Facing the challenges of hematopoietic stem cell transplantation with mindfulness meditation: a pilot study

The hematopoietic stem cell transplant (HSCT) experience is emotionally and physically stressful for cancer patients who undergo this procedure. Mindfulness-based interventions have been studied in patients with various diagnoses, including cancer, although minimal work has applied this intervention to hospitalized patients. Use of mindfulness meditation has potential to provide HSCT patients with coping skills to deal with unpleasant symptoms and an uncertain future. This exploratory study examined feasibility, physiological arousal, and psychological and physical symptoms in HSCT patients participating in a mindfulness meditation intervention that begins before and continues throughout hospitalization and involves one-on-one guided sessions and daily practice using a 17-minute meditation CD. Of the 20 participants, 78.9% completed the intervention. Statistically significant decreases in heart and respiratory rates and improvements in symptoms immediately before and after each session were found. These findings demonstrate feasibility and preliminary support of a mindfulness meditation intervention with symptomatic, hospitalized cancer patients.

How should we measure emesis in palliative care?

There are many assessment tools available to measure emesis. This Association for Palliative Medicine Science Committee Task Group undertook a review of the validity and suitability of the assessment tools available to measure nausea, vomiting and retching within a palliative care population. Electronic databases were searched from 1970 to 2004. Both specific and global tools were identified and reviewed for their validity, reliability and suitability for our patient population where coexisting cognitive impairment and significant co-morbidities may make accurate assessment of symptoms difficult. Within specific palliative care scenarios namely daily clinical assessment, prevalence surveys and randomized controlled trial settings, the team reached a consensus on which tools had the greatest evidence to recommend them, either for immediate use or for further validation studies. An ideal measurement tool for the assessment of nausea, vomiting and retching has not yet been developed.

The added value of assessing the 'most troublesome' symptom among patients with cancer in the palliative phase

OBJECTIVE

In this study among patients with cancer in the palliative phase, we analysed whether assessing the symptom, which is causing the most trouble in the patient's every day life ('most troublesome' symptom) had added value apart from the presence and severity of symptoms, which are most commonly assessed in clinical practice.

METHODS

Patients with cancer (lung, gastro-intestinal, breast cancer) in the palliative phase from two non-academic hospitals were included in the study. Using the Symptom Monitor tool, 10 physical symptoms were assessed with regard to presence and severity. The Symptom Monitor has an extra added item indicating as the 'most troublesome' symptom. This item was monitored to determine whether it had added value apart from the presence of symptoms and 'most severe' symptom. The severity score on the indicated 'most troublesome' symptom was subtracted from the severity score of the 'most severe' symptom. The generated delta score of 0 indicated no added value, whereas a score of one or more indicated that the 'most troublesome' symptom would have been missed if not specifically asked for by the physician, because its severity was lower that the 'most severe' symptom.

RESULTS

One hundred and forty-six patients reported 590 symptoms to be present. In total, 227 symptoms were reported as 'most severe' symptom (n = 138 patients). Among these, fatigue (n = 52) and pain (n = 24) were reported most frequently as 'most severe' symptom. In total, 134 patients indicated a symptom as 'most troublesome'. Fatigue (n = 33; 25%) and pain (n = 22; 16%) were also indicated by most of these patients as the 'most troublesome' symptom. One hundred and fifty-two comparisons could be made between the 'most severe' and the 'most troublesome' symptom. In 102 (67%) of the comparisons assessing the 'most troublesome' symptom had no added value: the score for 'most severe' symptom did not differ from the score for the 'most troublesome' symptom revealing a delta score of 0. In 23 times (15%) of the 152 comparisons made, the delta score was 1 and in 27 (18%) of the comparisons the delta score was 2 or more indicating that assessing the 'most troublesome' symptom substantially had added value.

CONCLUSION

In patients in the palliative phase of their disease, extra attention for the 'most troublesome' symptom is needed. In our study, in almost 1/3 of the cases, this symptom would have been missed the physicians attention if not specifically asked for.

PRACTICE IMPLICATIONS

We recommend not only to assess the presence and severity of symptoms, but furthermore to assess the patient's 'most troublesome' symptom in addition.

Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life

PURPOSE/OBJECTIVES

To identify differences in fatigue, other physical symptoms, and psychological symptoms and their relationship to quality of life (QOL) during chemotherapy and as long as one year after.

DESIGN

Longitudinal, descriptive design embedded in a pilot intervention study.

SETTING

Midwestern urban oncology clinics and patient homes.

SAMPLE

25 Caucasian women, aged 40-65 years (-X = 54.3), with stage I or II breast cancer receiving doxorubicin-based chemotherapy.

METHODS

The Piper Fatigue Scale, Hospital Anxiety and Depression Scale, Symptom Experience Scale, and Medical Outcomes Study Short-Form General Health Survey were completed before and after each treatment; 30, 60, and 90 days after the last treatment; and one year after the first treatment.

MAIN RESEARCH VARIABLES

Fatigue, physical and psychological symptoms, and QOL.

FINDINGS

Fatigue levels were moderately intense during treatments and decreased significantly over time. Sleep disturbances and pain were the most frequent, intense, and distressing other physical symptoms. Anxiety was highest at baseline, and depression was highest during the fourth chemotherapy treatment. Fatigue was correlated with other physical and psychological symptoms at some times during treatments and consistently following treatments. Higher fatigue was associated with lower QOL in several domains.

CONCLUSIONS

Fatigue is associated with other physical and psychological symptoms that fluctuate during and after treatment. Higher fatigue compromises QOL.

IMPLICATIONS FOR NURSING

Interventions targeting primary or cluster symptoms can reduce the impact of adjuvant chemotherapy on fatigue, other symptoms, and QOL.

Telephone social support and education for adaptation to prostate cancer: a pilot study

PURPOSE/OBJECTIVES

To evaluate the feasibility of an intervention of telephone social support and education to increase the physical, emotional, functional, and interpersonal adaptation of men to prostate cancer.

DESIGN

Prospective, random assignment to experimental or control treatments.

SETTING

Urban New Jersey.

SAMPLE

17 men diagnosed with prostate cancer within four weeks of study entry. Mean age was 66 years (range = 51-78); 59% were Caucasian, 35% were African American, and 6% were American Indian.

METHODS

Subjects in the experimental group received telephone social support over a 12-month period in addition to education via mailed resource kits. The control group received education through mailed resource kits only. The Functional Assessment of Cancer Therapy Scale-General Physical, Emotional, Functional, and Social/Family Well-Being subscales; Symptom Experience Scale-Prostate; and the Relationship Change Scale were administered initially and at the end of each of the three phases; the International Index of Erectile Function Scale was administered at the end of each of the three phases. Qualitative information was gathered throughout and at the conclusion of the study.

MAIN RESEARCH VARIABLES

Physiologic, emotional, functional, and social adaptation to prostate cancer.

FINDINGS

Results were somewhat more favorable for the experimental group on all outcome measures; however, differences were not statistically significant. Structured interviews with 14 of 17 subjects revealed that telephone social support and education were effective in increasing adaptation to prostate cancer.

CONCLUSIONS

Despite the lack of a significant difference between the experimental and treatment groups in this small sample of men, analysis of trends and interview feedback indicated that telephone social support, in addition to education through a mailed resource kit, has the potential to be beneficial by increasing access to supportive services.

IMPLICATIONS FOR NURSING

Telephone social support when supplementing patient education may assist men in adapting during the year following a prostate cancer diagnosis.

The effect of telephone social support and education on adaptation to breast cancer during the year following diagnosis

PURPOSE/OBJECTIVES

To find the most effective methods of providing social support for women diagnosed with breast cancer by testing the effectiveness of a telephone social support and education intervention to promote emotional and interpersonal adaptation to breast cancer.

DESIGN

Multisite, two-group experimental study with repeated measures.

SETTING

Arkansas and New Jersey.

SAMPLE

The Arkansas sample consisted of 106 women who entered the study two to four weeks postsurgery for nonmetastatic breast cancer and were randomly assigned to an experimental or control group. The comparison group consisted of 91 women from New Jersey who had participated in a previously completed study that used the same interventions and found that telephone support resulted in more positive, statistically significant adaptation to the disease.

METHODS

The experimental group received 13 months of telephone social support and education. Both groups received educational materials via a mailed resource kit. The Profile of Mood States; Visual Analogue Scale-Worry; Relationship Change Scale; University of California, Los Angeles, Loneliness Scale-Version 3; and the modified Symptom Distress Scale provided data regarding the variables of interest. Data analysis included descriptive statistics, t tests, and multivariate analysis of variance with repeated measures.

MAIN RESEARCH VARIABLES

Mood, worry, relationships with significant others, loneliness, and symptoms.

FINDINGS

Data analysis showed no significant differences between groups, and both improved on some of the outcomes. Significant time-by-location interaction effects were found when comparing the Arkansas and New Jersey samples, thereby supporting the need to consider regional differences when developing interventions.

CONCLUSIONS

The mailed educational resource kit alone appeared to be as effective as the telephone social support provided by oncology nurses in conjunction with the mailed resource kit.

IMPLICATIONS FOR NURSING

Mailed educational resource kits may be the most efficient and cost-effective way to provide educational support to newly diagnosed patients with breast cancer, but their effect may differ according to region.

Relationships of mood disturbance and social support to symptom experience in Korean women with breast cancer

The purpose of this study was to identify how mood disturbance and social support were related to the symptoms experienced by Korean women with breast cancer. A cross-sectional, correlational design was used for the study. A convenience sample of 134 Korean women receiving chemotherapy for breast cancer was recruited. The participants completed questionnaires on symptom experience using the Symptom Experience Scale, mood disturbance using the Linear Analogue Self-Assessment Scale, and social support using the Social Support Scale. Mood disturbance and social support had a significant interaction effect on symptom experience. A higher level of mood disturbance led to a higher level of symptoms when the level of social support was average or low, which implies that clinical interventions for attenuating the impact of mood disturbance on symptom experience might be effective only for women perceiving average or low levels of social support.

Measurement of Symptom Distress in Women With Early-Stage Breast Cancer

While symptom distress can alter the cancer experience, it is difficult to define and measure. This study's aims were (1) to determine whether the McCorkle Symptom Distress Scale (SDS) or the Rhodes Adapted Symptom Distress Scale (ASDS) was the more accurate measure of symptom distress in women with breast cancer; (2) correlate both scales with a visual analogue scale (VAS) measuring anxiety, a symptom frequently reported clinically; (3) determine tool preference; and (4) establish when during the first cycle of chemotherapy the highest levels of symptom distress were experienced. One hundred twenty women were recruited and measurement of symptom distress (SDS and ASDS) and anxiety (VAS) taken at the start of chemotherapy (Time 1), at the nadir (Time 2), and at the end of the cycle (Time 3). Both instruments were highly correlated and detected change over time; none was correlated with the VAS anxiety scale. Symptom distress scores were generally low, with fatigue, appearance, insomnia, and concentration causing the greatest distress. Other factors like functioning, body image, and menopausal symptoms cited as contributors to symptom distress levels were not measured and could account for low scores and perhaps suggest that symptom distress may not be accurately measured in today's women with early-stage breast cancer.

Symptom Occurrence, Symptom Intensity, and Symptom Distress in Patients Undergoing High-dose Chemotherapy With Stem-cell Transplantation

The main aim of this study was to investigate the patients' self-reported symptom occurrence, symptom intensity (SI), and symptom distress (SD) from admission for stem-cell transplantation (SCT) until discharge from the ward. Forty-three patients participated and data were collected at 7 different time-points by using the self-administered Symptom Frequency, Intensity, and Distress questionnaire for SCT (SFID-SCT). The results showed that symptom occurrence followed a curve on which the highest frequencies of symptoms were reported from the day of the SCT (T2) until the end of the protective care period (T5). The mean SI and SD scores became higher when the number of reported symptoms increased. Between T2 and T5, 33% to 54% of the patients reported >10 simultaneous symptoms. Symptoms reported by more than 50% of the patients during T2-T5 were tiredness, loss of appetite, mouth dryness, nausea, sleeping disturbances, diarrhea, and changes of taste. Loss of appetite, tiredness, and mouth dryness were, in descending order, the 3 symptoms reported as most intense and distressing. A statistically significantly higher SD-score was found for the patients undergoing allogeneic SCT on the day before start of the conditioning regimen, as compared to the patients undergoing autologous SCT. Patients reporting no anxiety on admission were found to have higher, mean SD-scores at the end of the hospital stay than anxious patients. The SFID-SCT questionnaire was found to give useful information not only about symptom occurrence but also about SI and SD. To use an instrument that distinguishes between these aspects of the symptom experience may help health care professionals to support the patients through the SCT-process.

A cluster of symptoms over time in patients with lung cancer

BACKGROUND

Patients with lung cancer present late in the disease and have multiple symptoms. Previous research has shown the symptom cluster of fatigue, weakness, weight loss, appetite loss, nausea, vomiting, and altered taste to be present at time of lung cancer diagnosis.

OBJECTIVES

The study determined whether the symptom cluster identified at the time of diagnosis remained 3 and 6 months later, and whether there was a difference in the mean number of symptoms and the mean level of symptom severity over time. The relation of the severity rating for individual symptoms at the time of diagnosis and at 3 and 6 months after diagnosis was examined. Predictors for the number of symptoms and whether the symptom cluster was predictive of death were determined.

METHODS

Secondary analysis of an existing data set for 112 patients with newly diagnosed lung cancer assessed at diagnosis and at 3 and 6 months was performed and determined whether they were alive or dead 19 months after diagnosis.

RESULTS

The cluster of seven symptoms had internal consistency that remained at 3 and 6 months. The mean symptom severity and the number of symptoms at diagnosis were correlated with later ratings, but decreased in severity over time. A similar decrease in severity rating was seen for the individual symptoms in the cluster. The stage of cancer at diagnosis was the most predictive of the number of cluster symptoms reported. Death 6 to 19 months after diagnosis was predicted by age, stage of cancer at diagnosis, and symptom severity at 6 months.

CONCLUSIONS

The symptom cluster remains over the course of lung cancer and is an independent predictor of the patient's death. Symptom severity, the number of symptoms reported, and the severity of the individual symptoms decreased over time. The stage of cancer at diagnosis is the best predictor of symptoms later in the disease.

Symptoms in adults with lung cancer. A systematic research review

Health care providers play a key role in providing adequate symptom management and promoting quality of life during chronic illness. Several studies have noted that adults with lung cancer experience more symptom distress than patients with other types of cancer. Therefore, symptom management in this group of patients is particularly important. An understanding of the research conducted in this area is important for further knowledge development and for potentially improving symptom management. This paper presents a systematic review of empirical studies examining symptoms in adults with lung cancer. The results of this systematic review revealed that although major strides have been made in understanding symptoms associated with lung cancer, further progress is needed to decrease the morbidity associated with uncontrolled symptoms. Theoretical, conceptual, and/or methodological issues identified through this review must be addressed in future research. In particular, the researcher should provide information about the theoretical or empirical framework guiding the study, give an explicit definition about the dimensions of the symptom experience being studied, report refusal rates and attrition, and use instruments that are reliable and valid.

A comparison of patient and proxy symptom assessments in advanced cancer patients

The purpose of this study was to compare patient and proxy (physician and nurse) assessments of symptoms in advanced cancer patients. The sample consisted of 49 patients with advanced cancer admitted to an acute palliative care unit. Three independent assessments were completed for each patient on two occasions within 11 days of admission. On each occasion, symptoms were rated independently by the patient and two proxies (treating physician and nurse), using the Edmonton Symptom Assessment System (ESAS). The ESAS is a nine-item visual analogue scale (VAS) for assessing pain, activity, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath. Symptom ratings were compared using a repeated-measures ANOVA procedure and correlations. Average physician ratings were generally lower than average patient ratings for both occasions. Average nurse ratings agreed more closely with patient ratings, with a trend towards lower ratings on occasion 1 and higher ratings on occasion 2. There was a significant rater (person rating the effects) effect (P < 0.01) for three of the nine symptoms: physicians rated drowsiness, shortness of breath and pain significantly lower than patients. For drowsiness and shortness of breath, these differences were clinically relevant, representing a difference of more than 12 mm on a 100-mm VAS. The accuracy of assessments amongst those rating the symptoms did not improve over time. Proxy assessments of symptom intensity, particularly by physicians, were significantly lower than patient assessments for three of the nine symptoms. Further research regarding the reliability of patient and proxy assessments is needed to assess and manage symptoms in advanced cancer effectively.