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Tam VCW, Ching JCF, Yip SST, Kwong VHY, Chan CPL, Wong KCW, Lee SWY. Examining patient-reported late toxicity and its association with quality of life and unmet need for symptom management among nasopharyngeal cancer survivors: a cross-sectional survey. Front Oncol 2024; 14:1378973. [PMID: 38694788 PMCID: PMC11061844 DOI: 10.3389/fonc.2024.1378973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Alongside the improved survival of nasopharyngeal cancer (NPC), late radiation toxicities are alarmingly hampering survivors' quality of life. A patient-reported symptom burden survey is lacking to address the unmet need for symptom management among local NPC survivors. Methods A single-center cross-sectional survey was conducted on 211 NPC survivors who had completed radiation therapy for three to 120 months. We employed the Chinese version M. D. Anderson Symptom Inventory - Head & Neck Module (MDASI-HN-C), Functional Assessment of Cancer Therapy - Head & Neck (FACT-HN-C), and a question extracted from the Cancer Survivors' Unmet Needs Measure (CaSUN). Results Two hundred valid responses were collected. Participants suffered from at least four moderate to severe symptoms (mean = 4.84, SD = 4.99). The top five severe symptoms were dry mouth, mucus problems, difficulty swallowing or chewing, teeth or gum problems, and memory problems. MDASI-HN-C subscales were negatively correlated with the physical, emotional, functional, and HN-specific domains of the FACT-HN-C. The unmet need for symptom management was positively associated with symptom burden, either general symptoms (Adjusted odds ratio [ORadj] = 1.566, 95% CI = 1.282 - 1.914, p < 0.001) or top-5 symptoms (ORadj = 1.379, 95% CI = 1.185 - 1.604, p < 0.001), while negatively associated with post-RT time (ORadj = 0.981, 95% CI [0.972, 0.991], p < 0.001). Conclusion Virtually all NPC survivors suffer from late toxicities, which interplay with survivors' perceptions intricately to affect their unmet needs for symptom management. Personalized supportive care strategies with regular assessments and stratifications are warranted.
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Affiliation(s)
- Victor C. W. Tam
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Jerry C. F. Ching
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Sindy S. T. Yip
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Virginia H. Y. Kwong
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Catherine P. L. Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kenneth C. W. Wong
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Shara W. Y. Lee
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Chung CF, Huang BS, Wang YM, Huang YT, Chen SC. Quality of life in patients with nasopharyngeal carcinoma receiving IMRT vs IMPT: a multicenter prospective longitudinal study. Support Care Cancer 2024; 32:203. [PMID: 38430411 DOI: 10.1007/s00520-024-08412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Nasopharyngeal carcinoma (NPC) patients may experience symptom distress and depression during and after radiation therapy, which negatively impacts quality of life (QOL). We sought to identify trajectories of symptom distress, depression, social support, and QOL in patients with NPC receiving intensity-modulated radiation therapy (IMRT) vs intensity-modulated proton therapy (IMPT). METHODS A multicenter prospective longitudinal study recruited NPC patients from two leading medical centers in Taiwan. The 121 NPC patients were followed from before RT (T0), at 4 weeks after beginning RT (T1), at 6 weeks of RT or the end of treatment (T2), and at 4 weeks post-RT (T3). Generalized estimating equation analysis was used to identify the factors related to QOL. RESULTS Patients' symptom distress and depression increased from T0, peaked at T2, and decreased at T3. Physical-QOL and psychosocial-QOL decreased from T0 to T2, then increased by T3. Patients who had early-stage cancer, received a lower RT dose, had less symptom distress, and had less depression were more likely to have better QOL. Greater physical-QOL was associated with IMPT receipt, higher education level, early cancer stage, lower radiation dose, less symptom distress, and less depression. Patients who had good physical performance, received a lower radiation dose, had less symptom distress, and had less depression were more likely to have better psychosocial-QOL. CONCLUSION Radiation dose, symptom distress, and depression were the most important factors affecting QOL in patients with NPC. Understanding the factors associated with the trajectory of QOL can guide care during radiation treatment.
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Affiliation(s)
- Ching-Fang Chung
- Department of Nursing, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
| | - Bing-Shen Huang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Department of Radiation Oncology, and Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
| | - Yu-Ming Wang
- Department of Radiation Oncology, and Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China
- Department of Medicine, College of Medicine, Chang Gung University, Kaohsiung, Taiwan, Republic of China
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
| | - Shu-Ching Chen
- Department of Radiation Oncology, and Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.
- School of Nursing and Geriatric and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, Republic of China.
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
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Li W, Huang X, Liu J, Liang L, Wei L, Lu J. Quality evaluation index development for nutritional management in patients with nasopharyngeal carcinoma during peri-radiotherapy. Nutrition 2023; 116:112199. [PMID: 37722250 DOI: 10.1016/j.nut.2023.112199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES It is necessary to construct an evaluation index for patients with nasopharyngeal carcinoma during peri-radiotherapy to provide a reference for the evaluation of the quality of nutritional management of patients with nasopharyngeal carcinoma during peri-radiotherapy. The aim of this study was to construct a set of scientific, comprehensive, and feasible indicators for evaluating the quality of nutrition management in patients with nasopharyngeal carcinoma during peri-radiotherapy to provide a unified reference basis for objective nutritional evaluation of these patients during the peri-radiotherapy period and to provide insights to the clinical treatment and care of these patients. METHODS A multidisciplinary research team was set up from December 2021 to April 2022. We took the three-dimensional quality structure model as the theoretical framework; based on the literature review, the first draft of the nutrition management quality evaluation index for patients with nasopharyngeal carcinoma during peri-radiotherapy was formed by a semi-structured interview. The Delphi correspondence method was used to survey 18 experts from 12 cities in China. The multidimensional analytical hierarchy process was used to determine the evaluation index and weight of nutrition management quality of patients with nasopharyngeal carcinoma during peri-radiotherapy. RESULTS The effective questionnaire recovery rates of the two rounds of letters were 90.005% and 100%, respectively, and the expert authority coefficients were 0.906 and 0.918, respectively. The Kendall harmony coefficients of the two rounds of letters were 0.271 to 0.313 and 0.309 to 0.349, respectively. The nutrition management quality evaluation index of patients with nasopharyngeal carcinoma during peri-radiotherapy was constructed and included 3 first-level indexes, 10 second-level indexes, and 71 third-level indexes. CONCLUSION The evaluation index of the nutrition management quality of patients with nasopharyngeal carcinoma during peri-radiotherapy is scientific and reliable, and it may have a certain guiding significance for nurses to evaluate the quality of nutrition management of these patients during this period.
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Affiliation(s)
- Wei Li
- Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaojun Huang
- Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jieying Liu
- Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Limin Liang
- Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Lina Wei
- Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jiamei Lu
- Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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Wang K, Diao M, Yang Z, Salvador JT, Zhang Y. Identification of Core Symptom Cluster in Patients With Digestive Cancer: A Network Analysis. Cancer Nurs 2023:00002820-990000000-00178. [PMID: 37903303 DOI: 10.1097/ncc.0000000000001280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
BACKGROUND A lack of identified core symptom clusters in digestive cancer patients hinders achieving precision symptom intervention. There are few studies on identifying digestive cancer symptom clusters based on network analysis. OBJECTIVES The aims of this study were to construct the symptom network of digestive cancer patients and identify the core symptom cluster. METHODS A cross-sectional study was conducted among 202 digestive cancer patients. The Chinese version of the MD Anderson Symptom Inventory for gastrointestinal cancer scale was used to assess the symptoms by convenience sampling. R software was used to construct a symptom network and identify core symptom clusters. Edge weight and centrality difference tests were used to test the accuracy of core symptom cluster identification. RESULTS The most common symptoms were distress, poor appetite, and sadness. The most serious symptoms were poor appetite, disturbed sleep, and fatigue. The core symptom cluster of the psychoemotional symptom group was distress, sadness, and numbness. The centrality index showed that the top 3 in strength were distress (Rs = 1.11), fatigue (Rs = 1.09), and sadness (Rs = 1.04). The edge weight difference test showed that the psychoemotional symptom group had high stability. CONCLUSIONS The psychoemotional symptoms of digestive cancer patients should be given priority for intervention. Network analysis must be extended to the symptom research of cancer patients as soon as possible to provide a scientific basis for symptom management. IMPLICATIONS FOR PRACTICE Nurses must perform comprehensive psychological and emotional assessments, initiate referrals for psychoemotional symptom management and psychological services, and administer pharmacologic and nonpharmacologic interventions to improve appetite loss in digestive cancer patients.
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Affiliation(s)
- Ke Wang
- Author Affiliations: Department of Nursing, The Second Affiliated Hospital of Shandong First Medical University (Dr Wang, and Mss Diao and Yang), Tai'an City, China; Nursing Education Department, College of Nursing, Imam Abdulrahman Bin Faisal University (Dr Salvador), Dammam, Saudi Arabia; and College of Nursing, Shandong First Medical University (Ms Zhang), Tai'an City, China
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Harris C, Kober KM, Paul SM, Cooper BA, Shin J, Oppegaard K, Morse L, Calvo-Schimmel A, Conley Y, Levine JD, Miaskowski C. Neurotransmitter Gene Polymorphisms Are Associated with Symptom Clusters in Patients Undergoing Radiation Therapy. Semin Oncol Nurs 2023; 39:151461. [PMID: 37419849 DOI: 10.1016/j.soncn.2023.151461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES Purpose was to evaluate for associations between the severity of three distinct symptom clusters (ie, sickness-behavior, mood-cognitive, treatment-related) and polymorphisms for 16 genes involved in catecholaminergic, GABAergic, and serotonergic neurotransmission. DATA SOURCES Patients with breast and prostate cancer (n = 157) completed study questionnaires at the completion of radiation therapy. Memorial Symptom Assessment Scale was used to assess the severity of 32 common symptoms. Three distinct symptom clusters were identified using exploratory factor analysis. Associations between the symptom cluster severity scores and neurotransmitter gene polymorphisms were evaluated using regression analyses. CONCLUSION Severity scores for the sickness-behavior symptom cluster were associated with polymorphisms for solute carrier family 6 (SLC6A) member 2 (SLC6A2), SLC6A3, SLC6A1, and 5-hydroxytryptamine receptor (HTR) 2A (HTR2A) genes. For the mood-cognitive symptom cluster, severity scores were associated with polymorphisms for adrenoreceptor alpha 1D, SLC6A2, SLC6A3, SLC6A1, HTR2A, and HTR3A. Severity scores for the treatment-related symptom cluster were associated with polymorphisms for SLC6A2, SLC6A3, catechol-o-methyltransferase, SLC6A1, HTR2A, SLC6A4, and tryptophan hydroxylase 2. IMPLICATIONS FOR NURSING PRACTICE Findings suggest that polymorphisms for several neurotransmitter genes are involved in the severity of sickness-behavior, mood-cognitive, and treatment-related symptom clusters in oncology patients at the completion of radiation therapy. Four genes with various associated polymorphisms were common across the three distinct symptom clusters (ie, SLC6A2, SLC6A3, SLC6A1, HTR2A) which suggest that these clusters have common underlying mechanisms.
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Affiliation(s)
- Carolyn Harris
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kord M Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Joosun Shin
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Kate Oppegaard
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Lisa Morse
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Alejandra Calvo-Schimmel
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Yvette Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- Department of Medicine, School of Nursing and School of Medicine, University of California, San Francisco, California
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California.
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Li X, Fu GF, Huang YY, Jiang QY, Huang XY, Zhang JT, Qu SH. Symptom clusters after chemoradiotherapy in discharged nasopharyngeal carcinoma patients. Front Oncol 2023; 13:920889. [PMID: 37388231 PMCID: PMC10306305 DOI: 10.3389/fonc.2023.920889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/16/2023] [Indexed: 07/01/2023] Open
Abstract
Objective To investigate the incidence of complications and types of chemoradiotherepy induces symptom clusters in patients with nasopharyngeal carcinoma (NPC) who were first diagnosed after treatment and discharged from hospital. Methods After their discharge home, 130 NPC patients who had been treated with chemoradiotherapy were asked to complete a modified Chinese version of the Quality of Life Questionnaire-Head and Neck Module developed by the European Organization for the Research and Treatment of Cancer in the Head and Neck. Symptom clusters in patients were identified through exploratory factor analysis. Results The most serious symptoms for discharged NPC patients who had received chemoradiotherapy were dental problems, a sense of obstruction while swallowing, embarrassment in physical contact with family members and friends, difficulty in speaking with others, and embarrassment in public. The six symptom clusters identified through exploratory factor analysis were (1) painful eating, (2) social difficulties, (3) psychological disorders, (4) symptomatic shame, (5) teeth/throat injuries, and (6) sensory abnormalities. The total contribution rate of variance was 65.73%. Conclusion NPC patients who are treated with chemoradiotherapy can experience adverse symptom clusters that continue after discharge. Nurses should evaluate the patients' symptoms before discharge and provide targeted health education services which would reduce the patients' complications and improve the quality of life at home. Besides, medical staff should evaluate the complications in a timely and comprehensive manner and provide individualized health education for the affected patients to help them manage chemoradiotherapy side effects.
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Affiliation(s)
- Xiang Li
- Department of Otorhinolaryngology, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Gui-Fen Fu
- Department of Nursing, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Yu-Ying Huang
- Department of Otorhinolaryngology, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Qing-Yu Jiang
- Department of Otorhinolaryngology, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Xiao-Yan Huang
- Department of Otorhinolaryngology, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jin-Tao Zhang
- Department of Otorhinolaryngology, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Shen-Hong Qu
- Department of Otorhinolaryngology, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
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Wang Y, Zhang L, Zhang T, Jin S, Huang Z, Zhao D, Zheng B, Xiao S, Gong L, Sun Y, Lu Q. Predictive effect of pretreatment nutritional risk and GLIM-defined malnutrition on the nutrition impact symptom clusters in patients with head and neck cancer undergoing radiotherapy. Head Neck 2023; 45:380-390. [PMID: 36416281 DOI: 10.1002/hed.27250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/30/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence supporting predictive effects of pretreatment nutritional risk and nutritional status on nutrition impact symptom (NIS) clusters during radiotherapy in patients with head and neck cancer (HNC) is insufficient. METHODS At baseline (T1 ), we collected severity and interference of NIS (Head and Neck Patient Symptom Checklist), nutritional risk, and nutritional status. During (T2 ) and at the end of radiotherapy (T3 ), we re-evaluated NIS. Symptom clusters were identified by exploratory factor analysis using mean scores of NIS severity at T2 and T3 . Predictive effects were explored by generalized estimating equations. RESULTS Five hundred thirty-seven patients were recruited and 334 of them completed. Four clusters were identified; the oropharyngeal symptom cluster was the most severe and had the greatest interference with diet. Patients with pretreatment nutritional risk or malnutrition experienced more severe oropharyngeal symptom cluster. CONCLUSIONS Pretreatment nutritional risk or malnutrition could predict the oropharyngeal symptom cluster in patients with HNC undergoing radiotherapy.
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Affiliation(s)
- Yujie Wang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Lichuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Tong Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Sanli Jin
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Zhou Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Dan Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Baomin Zheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shaowen Xiao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Liqing Gong
- Division of Clinical Nutrition, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
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Wang Y, Xie Z, Liu Y, Wang J, Liu Z, Li S. Symptom clusters and impact on quality of life in esophageal cancer patients. Health Qual Life Outcomes 2022; 20:168. [PMID: 36564827 PMCID: PMC9783739 DOI: 10.1186/s12955-022-02084-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Esophageal cancer patients can experience co-occurring, related symptoms labeled symptom clusters. This study aimed to identify symptom clusters and explore which SCs independently affect the quality of life (QoL) among esophageal cancer patients. METHODS This cross-sectional study was performed in Shenyang, China, from February 2021 to February 2022. Finally, 118 esophageal cancer patients effectively completed the survey. Questionnaires' information included the Functional Assessment of Cancer Therapy-General (FACT-G), the MD Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI), the Multidimensions Scale of Perceived Social Support, and demographic and clinical characteristics. Exploratory factor analysis with principal axis factoring was used to identify symptom clusters, and multiple regression analysis was employed to analyze the influencing factors of QoL. RESULTS The mean score of FACT-G was 69.88 (SD = 17.85) among 118 esophageal cancer patients. Four symptom clusters were identified: psychological-somatic, dysphagia, fatigue-pain, and gastrointestinal symptom clusters. Results of regression analysis indicated a significant impact on QoL for chemotherapy (β = 0.140, P < 0.045), psychological-somatic symptom cluster (β = - 0.329, P = 0.013), and social support (β = 0.409, P < 0.001) after adjusting demographic and clinical characteristics. The linear combination explained 47.8% of the variance in QoL. CONCLUSIONS There is a critical need to emphasize the importance of psychological-somatic symptoms clusters management programs and increasing social support to improve QoL in esophageal cancer patients.
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Affiliation(s)
- Yanli Wang
- grid.412636.40000 0004 1757 9485Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Zhongfei Xie
- grid.412636.40000 0004 1757 9485Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Yuxia Liu
- grid.412636.40000 0004 1757 9485Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Jianing Wang
- grid.412636.40000 0004 1757 9485Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Zhijun Liu
- grid.412636.40000 0004 1757 9485Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning Province China
| | - Sihan Li
- grid.412636.40000 0004 1757 9485Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning Province China
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Huang ML, Luo WL. Engrailed homeobox 1 transcriptional regulation of COL22A1 inhibits nasopharyngeal carcinoma cell senescence through the G1/S phase arrest. J Cell Mol Med 2022; 26:5473-5485. [PMID: 36196630 PMCID: PMC9639036 DOI: 10.1111/jcmm.17575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022] Open
Abstract
EN1 is well known as a transcription factor in other tumours, but its role in NPC is unclear. In this study, we first used bioinformatics to analyse GEO data to obtain the differentially expressed gene EN1, and subsequently verified that EN1 was highly expressed in nasopharyngeal carcinoma cells by tissue microarrays as well as cell lines. Further, we down‐regulated the expression of EN1 in cells for RNA sequencing. The analysis of sequencing results using KEGG and GO revealed significant changes in cell proliferation and cycle function after downregulation of EN1. Meanwhile, we found that cells underwent senescence after inhibition of EN1 under electron microscopy and the SA‐β‐gal assays. Based on the sequencing results, we verified that EN1 can promote the proliferation and cycle of NPC cells in cell function experiments and animal experiments. To investigate how EN1 affects cell senescence, we found that EN1 transcriptional regulation of COL22A1 regulated cell proliferation and cycle via CDK4/6‐cyclin D1‐Rb signalling pathway by dual luciferase reporter, Immunoblotting and rescue experiment. Accordingly, we uncovered that EN1 could serve as a target for the regulation of senescence in NPC.
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Affiliation(s)
- Mao-Ling Huang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Long Luo
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lin Y, Bruner DW, Paul S, Miller AH, Saba NF, Higgins KA, Shin DM, Zhang W, Miaskowski C, Xiao C. A network analysis of self-reported psychoneurological symptoms in patients with head and neck cancer undergoing intensity-modulated radiotherapy. Cancer 2022; 128:3734-3743. [PMID: 35969226 PMCID: PMC9529994 DOI: 10.1002/cncr.34424] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with head and neck cancer experience psychoneurological symptoms (PNS) (i.e., depression, fatigue, sleep disturbance, pain, and cognitive dysfunction) during intensity-modulated radiotherapy (IMRT) that decrease their functional status, quality of life, and survival rates. The purpose of this study was to examine and visualize the relationships among PNS within networks over time and evaluate for demographic and clinical characteristics associated with symptom networks. METHODS A total of 172 patients (mean age, 59.8 ± 9.9 years; 73.8%, male; 79.4%, White) completed symptom questionnaires four times, namely, before IMRT (T1), 1 month (T2), 3 months (T3), and 12 months (T4) post IMRT. Network analysis was used to examine the symptom-symptom relationships among PNS. Centrality indices, including strength, closeness, and betweenness, were used to describe the degrees of symptom network interconnections. Network comparison test was used to assess the differences between two symptom networks. RESULTS Depression was associated with the other four symptoms, and fatigue was associated with the other three symptoms across the four assessments. Based on the centrality indices, depression (rstrength = 1.3-1.4, rcloseness = 0.06-0.08, rbetweeness = 4-10) was the core symptom in all symptom networks, followed by fatigue. Female gender, higher levels of stress, and no alcohol use were associated with stronger symptom networks in network global strength before IMRT. CONCLUSION Network analysis provides a novel approach to gain insights into the relationships among self-reported PNS and identify the core symptoms and associated characteristics. Clinicians may use this information to develop symptom management interventions that target core symptoms and interconnections within a network. LAY SUMMARY This study describes the symptom-symptom relationships for five common symptoms in patients with head and neck cancer receiving radiotherapy. Depression and fatigue appeared to be two core symptoms that were connected with sleep disturbance, pain, and cognitive dysfunction within a network. Several characteristics (i.e., female, higher stress, no alcohol use) were associated with stronger symptom networks.
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Affiliation(s)
- Yufen Lin
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Deborah W. Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Andrew H. Miller
- Winship Cancer Institute, Emory University, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | - Nabil F. Saba
- Winship Cancer Institute, Emory University, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | - Kristin A. Higgins
- Winship Cancer Institute, Emory University, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | - Dong M. Shin
- Winship Cancer Institute, Emory University, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | - Wenhui Zhang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesia and Perioperative Care, University of California, San Francisco, California
| | - Canhua Xiao
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
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11
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Effect of Standardized Nutritional Intervention in Patients with Nasopharyngeal Carcinoma Receiving Radiotherapy Complicated with Diabetes Mellitus. DISEASE MARKERS 2022; 2022:6704347. [PMID: 35756497 PMCID: PMC9217529 DOI: 10.1155/2022/6704347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/22/2022] [Accepted: 04/25/2022] [Indexed: 11/22/2022]
Abstract
Objective To evaluate the effect of standardized nutritional intervention in patients with nasopharyngeal carcinoma receiving radiotherapy complicated with diabetes mellitus and the impact on quality of life. Methods From January 2019 to December 2020, 100 diabetic patients with nasopharyngeal carcinoma receiving radiotherapy were assessed for eligibility and recruited. They were concurrently and randomly assigned (1 : 1) to receive either conventional nursing (control group) or standardized nutritional intervention (observation group). The outcomes include clinical efficacy and quality of life. Results Standardized nutritional intervention was associated with significantly lower levels of fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPBG), and glycated hemoglobin (HbA1c) versus conventional nursing (P < 0.001). The patients given standardized nutritional intervention showed significantly higher hemoglobin (Hb), prealbumin (PA), and albumin (ALB) levels versus those given conventional nursing at 4 weeks after the start of radiotherapy and at the end of radiotherapy (P < 0.001). The two groups showed similar Morisky scores before intervention (P > 0.05). After intervention, the observation group outperformed the control group in terms of treatment compliance (P < 0.05). Standardized nutritional intervention provided patients with a significantly better quality of life versus conventional nursing (P < 0.05). Standardized nutritional intervention was associated with a significantly lower incidence of adverse events and higher nursing satisfaction versus conventional nursing (P < 0.05). Conclusion Standardized nutritional intervention for patients with nasopharyngeal carcinoma given radiotherapy complicated with diabetes mellitus can efficiently restore the normal nutritional status of patients, reduce the complications of radiotherapy, and improve the quality of life of patients, so it is worthy of wide clinical application.
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Huang C, Chen H, Zhang X, Zhang Q, Liu J, Yu H, He Y, Liu Z. A Nomogram to Predict Critical Weight Loss in Patients with Nasopharyngeal Carcinoma During (Chemo) Radiotherapy. Clin Med Insights Oncol 2022; 16:11795549221103730. [PMID: 35754926 PMCID: PMC9218896 DOI: 10.1177/11795549221103730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Weight loss is an important side effect of long-term anticancer treatment for nasopharyngeal carcinoma patients. The decline in body function will cause many adverse effects, such as local recurrence and distant metastasis, and reduce the patient’s quality of life. Therefore, this study developed a predictive model for the probability of critical weight loss to provide timely appropriate nutritional interventions and prevent serious side effects. Methods: A 20-week prospective follow-up study of 137 nasopharyngeal carcinoma patients in West China Hospital of Sichuan University undergoing radiotherapy and chemotherapy from February 2018 to March 2020 was conducted to collect relevant clinical data. The clinical usefulness and calibration of the prediction model were assessed using the C-index, calibration plot, receiver operating curve, and decision curve analysis. Internal validation was assessed using bootstrapping validation. Results: The nomogram consisted of sex, smoking status, physical status, chemotherapy regimen, and body mass index. Good calibration was observed for the cohort, with an area under the curve of 0.924. Five independent prognostic factors were included in the nomogram, which showed a high C-index value of 0.815 in the interval validation. Decision curve analysis showed that the nomogram was clinically useful when the intervention was decided at the critical weight loss possibility threshold in the 0% to 97% range. Conclusions: We constructed and validated a nomogram for predicting the incidence of critical weight loss in nasopharyngeal cancer patients undergoing chemotherapy and radiotherapy.
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Affiliation(s)
- Chen Huang
- Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hongxiu Chen
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoxia Zhang
- West China School of Nursing, Sichuan University, Chengdu, China.,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Zhang
- West China School of Medicine, Department of Postgraduate Students, Sichuan University, Chengdu, China
| | - Juan Liu
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huaqin Yu
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yinbo He
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhe Liu
- Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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13
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Xiao W, Chan CW, Wang XS, Xiao J, Ng MS. Psychometric validation of the Chinese version of the M. D. Anderson Symptom Inventory-Head and Neck Module in patients with nasopharyngeal carcinoma. Asia Pac J Oncol Nurs 2021; 9:113-118. [PMID: 35529413 PMCID: PMC9072183 DOI: 10.1016/j.apjon.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The Chinese version of the M. D. Anderson Symptom Inventory—Head and Neck Module (MDASI-HN-C) has been linguistically validated. However, its psychometric properties have not been established yet. The purpose of the study was to psychometrically validate the MDASI-HN-C in patients with nasopharyngeal carcinoma (NPC). Methods 130 Chinese NPC patients who were undergoing radiotherapy (RT) participated in this cross-sectional study. The content, convergent, and construct validity of the MDASI-HN-C were examined. The reliability of the instrument was tested by examining the internal consistency and test–retest reliability. Results Cronbach's α coefficients ranged from 0.85 to 0.91 for the three subscales of the MDASI-HN-C. The 3-day test–retest reliability was acceptable with intraclass correlation coefficients (ICC) ranged from 0.52 to 0.71. The scale content validity index (S-CVI) was satisfactory (0.97). Subscale scores of the MDASI-HN-C were negatively correlated with the total score of the Chinese version of the Functional Assessment of Cancer Therapy—Head and Neck Scale (FACT-H&N-C) as hypothesized (r = −0.484 to −0.563, all P < 0.01). Exploratory factor analysis (EFA) revealed two factors for the 13 core and another two for the nine HNC-specific items. Only one factor was generated for the six interference items. Conclusions The MDASI-HN-C shows desirable psychometric properties for evaluating symptom burden in NPC patients, which can be used in both clinical and research contexts.
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Xiao W, Chan CWH, Xiao J, Wong CL, Chow KM. Development of A Nurse-Led Educational Intervention Program in Managing the Nutrition Impact Symptom Cluster in Patients with Nasopharyngeal Carcinoma following the Medical Research Council Framework. Asia Pac J Oncol Nurs 2021; 8:653-661. [PMID: 34790849 PMCID: PMC8522592 DOI: 10.4103/apjon.apjon-2141] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/04/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: This article aimed to report the experience of developing a complex nurse-led, theory-driven, and evidence-based educational intervention program intended to manage the nutrition impact symptom cluster experienced by patients with nasopharyngeal carcinoma (NPC) during radiotherapy, based on the Medical Research Council (MRC) framework. Methods: The “development” and “feasibility and piloting” phases of the MRC framework were used to guide the intervention development. The development phase included identifying the evidence base through a systematic review, exploring the relevant and guiding theory to enhance the effectiveness of the intervention and conducting a qualitative study to identify the intervention modelling. For the feasibility and piloting phase, we conducted a pilot study to examine the feasibility and estimate the effectiveness of the intervention. Results: The systematic review revealed that nurse-led educational interventions were used commonly for symptom cluster management, with promising effectiveness. The theoretical foundation was provided by the Theory of Unpleasant Symptoms, which indicates that an educational intervention can help patients to manage symptom cluster by influencing psychological, situational, and physiological factors. The qualitative study further provided contents of the intervention based on the perspectives of NPC patients and health professionals. The resulting program involves a nurse-led, family caregiver involvement, educational intervention with two sessions that uses a booklet as a medium. The pilot study found that conducting the educational intervention program was feasible and it also had some favorable effects on managing the nutrition impact symptom cluster in NPC patients. Conclusions: The MRC framework provided a strong structure with which to develop a complex intervention for nutrition impact symptom cluster management through a theory-driven and evidence-based approach. The evaluation of the intervention, the delivery process and the mediation mechanism of change using a rigorous randomized controlled trial design is recommended.
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Affiliation(s)
- Wenli Xiao
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Jinnan Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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Yan MH, Fan YY, Zhang JE. Stigma, self-efficacy and late toxicities among Chinese nasopharyngeal carcinoma survivors. Eur J Cancer Care (Engl) 2021; 31:e13528. [PMID: 34668257 DOI: 10.1111/ecc.13528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/24/2021] [Accepted: 10/04/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study explores the level of stigma among Chinese nasopharyngeal carcinoma survivors, its influencing factors and relationship with self-efficacy. METHODS In total, 281 nasopharyngeal carcinoma survivors were recruited from China, who completed the demographic, disease-related and late toxicities questionnaire, as well as the General Self-Efficacy Scale and Social Impact Scale. RESULTS The mean scores for stigma and self-efficacy were 57.22 ± 9.58 and 28.06 ± 3.97, respectively, both showing a moderate level. The late toxicities with the highest incidence were xerostomia (91.8%), fatigue (78.3%) and hearing loss (63.0%). Stigma was significantly and negatively related to self-efficacy (r = -0.295, P < 0.001). Multivariable linear regression showed that self-efficacy, number of children, educational level, perceived support from spouse and other family members and some late toxicities (nasal obstruction and toothache) were influencing factors of stigma, accounting for 49.4% of the variance. CONCLUSION Medical staff should be more aware of stigma among Chinese nasopharyngeal carcinoma survivors, especially those with more children and weaker educational backgrounds who are at a higher risk of stigma. They should take effective measures to alleviate stigma by improving patients' self-efficacy, relieving late toxicities and encouraging spouses and family members to provide more support for them.
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Affiliation(s)
- Ming-Hui Yan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yu-Ying Fan
- Department of Nasopharyngeal Carcinoma, Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | - Jun-E Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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Mathew A, Tirkey AJ, Li H, Steffen A, Lockwood MB, Patil CL, Doorenbos AZ. Symptom Clusters in Head and Neck Cancer: A Systematic Review and Conceptual Model. Semin Oncol Nurs 2021; 37:151215. [PMID: 34483015 PMCID: PMC8492544 DOI: 10.1016/j.soncn.2021.151215] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The two approaches to symptom-cluster research include grouping symptoms and grouping patients. The objective of this systematic review was to examine the conceptual approaches and methodologies used in symptom-cluster research in patients with head and neck cancer. DATA SOURCES Articles were retrieved from electronic databases (CINAHL, MEDLINE via Ovid, APA PsycINFO, Scopus, Embase, and Cochrane Central Register of Controlled Trials-CENTRAL), five grey literature portals, and Google Scholar. Seventeen studies met the eligibility criteria. Eight studies grouped symptoms to identify symptom clusters, of which two used qualitative methods. The number of symptom clusters ranged from two to five, and the number of symptoms in a cluster ranged from 2 to 11. Nine studies grouped patients based on their experiences with multiple symptoms. Cluster analysis and factor analysis were most commonly used. Despite variable names and composition of symptom clusters, synthesis revealed three prominent symptom clusters: general, head and neck cancer-specific, and gastrointestinal. Being female and quality of life were significantly associated with high symptom group or cluster severity. Biological mechanisms were sparsely examined. CONCLUSION Symptom cluster research in head and neck cancer is emerging. Consensus on nomenclature of a symptom cluster will facilitate deduction of core clinically relevant symptom clusters in head and neck cancer. Further research is required on understanding patients' subjective experiences, identifying predictors and outcomes, and underlying mechanisms for symptom clusters. IMPLICATIONS FOR NURSING PRACTICE Identification of clinically relevant symptom clusters would enable targeted symptom assessment and management strategies, thus improving treatment efficiencies and patient outcomes.
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Affiliation(s)
- Asha Mathew
- College of Nursing, University of Illinois, Chicago; Christian Medical College, Vellore, India.
| | | | - Hongjin Li
- College of Nursing, University of Illinois, Chicago; Christian Medical College, Vellore, India
| | | | | | | | - Ardith Z Doorenbos
- College of Nursing, University of Illinois, Chicago; University of Illinois Cancer Center, Chicago
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de Oliveira Faria S, Hurwitz G, Kim J, Liberty J, Orchard K, Liu G, Barbera L, Howell D. Identifying Patient-Reported Outcome Measures (PROMs) for Routine Surveillance of Physical and Emotional Symptoms in Head and Neck Cancer Populations: A Systematic Review. J Clin Med 2021; 10:jcm10184162. [PMID: 34575271 PMCID: PMC8470145 DOI: 10.3390/jcm10184162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
The aims of this review were to identify symptoms experienced by head and neck cancer (HNC) patients and their prevalence, as well as to compare symptom coverage identified in HNC specific patient-reported outcome measures (PROMs). Searches of Ovid Medline, Embase, PsychInfo, and CINAHL were conducted to identify studies. The search revealed 4569 unique articles and identified 115 eligible studies. The prevalence of reported symptoms was highly variable among included studies. Variability in sample size, timing of the assessments, and the use of different measures was noted across studies. Content mapping of commonly used PROMs showed variability and poor capture of prevalent symptoms, even though validation studies confirmed satisfactory reliability and validity. This suggests limitations of some of the tools in providing an accurate and comprehensive picture of the patient's symptoms and problems.
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Affiliation(s)
- Sheilla de Oliveira Faria
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
- Correspondence: ; Tel.: +55-11-3061-8278
| | - Gillian Hurwitz
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Jaemin Kim
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Jacqueline Liberty
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Kimberly Orchard
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada
- Temerty Faculty of Medicine, Toronto, ON M5S 1A8, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Lisa Barbera
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
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Wang Y, Lu Q, Zhang L, Zhuang B, Zhang T, Jin S, Sun Y, Xiao S, Zheng B, Fang Y, Gong L, Wang Y, Cao Y, Wang W. Nutrition Impact Symptom Clusters in Patients With Head and Neck Cancer Receiving Concurrent Chemoradiotherapy. J Pain Symptom Manage 2021; 62:277-285. [PMID: 33348033 DOI: 10.1016/j.jpainsymman.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objective of this study was to identify the nutrition impact symptom (NIS) clusters in patients with head and neck cancer (HNC) receiving concurrent chemoradiotherapy (CCRT) and explore their relationships with the weight loss rate (WLR). METHODS This longitudinal study included 169 patients. At baseline (T1), the demographics, clinical information, and weight before radiotherapy (RT) were recorded. At the third week (T2) and the end of RT (T3), we assessed the weight, prevalence, severity, and interference of the NIS with the Head and Neck Patient Symptom Checklist. The mean scores of the severity of NIS at T2 and T3 were used as a whole to perform the exploratory factor analysis and identify the symptom clusters. Cronbach's α coefficient was used to evaluate the internal consistency of the symptom clusters. Generalized estimating equations were used to analyze the relationships between clusters and the WLR. RESULTS We extracted three clusters from 14 NISs: the RT-specific symptom cluster including pain, difficulty swallowing, oral mucositis, thick saliva, difficulty chewing, and dry mouth (Cronbach's α = 0.820); the gastrointestinal symptom cluster including nausea, loss of appetite, feeling full, vomiting, and taste change (Cronbach's α = 0.592); the psychological status cluster including depressed, anxious, and lack of energy (Cronbach's α = 0.710). The multivariable model showed that participants with more serious RT-specific symptom cluster (β = 1.020, 95% CI: 0.570-1.471, P < 0.001) had higher WLR. CONCLUSIONS The NIS had close internal connections with each other, so the strategies applied by healthcare professionals should focus on multiple related symptoms, especially to manage the RT-specific symptom cluster.
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Affiliation(s)
- Yujie Wang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China.
| | - Lichuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Bing Zhuang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Tong Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Sanli Jin
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Yan Sun
- Department of Radiation Oncology, Key laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shaowen Xiao
- Department of Radiation Oncology, Key laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital & Institute, Beijing, China
| | - Baomin Zheng
- Department of Radiation Oncology, Key laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yu Fang
- Department of Clinical Nutrition, Key laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital & Institute, Beijing, China
| | - Liqing Gong
- Department of Clinical Nutrition, Key laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yanli Wang
- Department of Clinical Nutrition, Key laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yiwei Cao
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, China
| | - Weihu Wang
- Department of Radiation Oncology, Key laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital & Institute, Beijing, China
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Xiao W, Chan CW, Jinnan X, Lyu Q, Gong N, Wong CL, Chow KM. Managing the nutrition impact symptom cluster in patients with nasopharyngeal carcinoma using an educational intervention program: A pilot study. Eur J Oncol Nurs 2021; 53:101980. [PMID: 34275745 DOI: 10.1016/j.ejon.2021.101980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aimed to test the feasibility and estimate the effectiveness of a theory-driven and evidence-based educational intervention program to manage the nutrition impact symptom cluster in patients undergoing radiotherapy for nasopharyngeal carcinoma (NPC). METHODS A pilot randomized controlled trial was performed. Forty patients were divided equally into the intervention and control groups. The patients in the intervention group attended 2 face-to-face individual instructional sessions to enhance their knowledge and skills in managing the cluster. The study outcomes were the severity of the nutrition impact symptom cluster, body weight, symptom interference, and quality of life (QOL). A generalized estimating equation model was used to compare the differences in the outcome variables between the groups over 3-time points. RESULTS The consent rate for the study was 95.2%, and the attrition rate was 5.0%. Although no significant differences between the groups were detected from T1 to T3, favorable effects on relieving the cluster itself (B [95% confidence interval (CI)] = -0.844 [-2.261, 0.572], p = 0.243, Cohen's d [95% CI] = -0.37 [-1.00, 0.28]) and improvements in physical well-being (B [95% CI] = 0.833 [-3.965, 5.632], p = 0.734, Cohen's d [95% CI] = -0.15 [-0.78, 0.49]) and in head and neck cancer-specific QOL (B [95% CI] = 0.061 [-4.061, 4.182], p = 0.977, Cohen's d [95% CI] = -0.05 [-0.68, 0.59]) were observed in the intervention group compared with the control. CONCLUSIONS The educational intervention program is feasible and has promising effects on relieving the cluster.
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Affiliation(s)
- Wenli Xiao
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Carmen Wh Chan
- The Nethersole School of Nursing, The Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Xiao Jinnan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Qiyuan Lyu
- School of Nursing, Ji Nan University, Guangzhou, Guangdong, China
| | - Ni Gong
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, The Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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20
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Pan X, Liu H, Feng G, Xiao J, Wang M, Liu H, Xie X, Rong Z, Wu J, Liu M. Role of Muscle Mass and Nutritional Assessment Tools in Evaluating the Nutritional Status of Patients With Locally Advanced Nasopharyngeal Carcinoma. Front Nutr 2021; 8:567085. [PMID: 33763439 PMCID: PMC7982395 DOI: 10.3389/fnut.2021.567085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/12/2021] [Indexed: 01/04/2023] Open
Abstract
Objective: This study was to explore the role and necessity of muscle mass [fat-free mass index (FFMI) and appendicular skeletal muscle index (ASMI) measured by bioelectrical impedance analysis (BIA)] in nutritional status evaluation of patients with locally advanced (III, IVa) nasopharyngeal carcinoma (NPC). Methods: One hundred and thirty locally advanced NPC patients were recruited. Their nutritional status was assessed by albumin (ALB), body mass index (BMI), Nutritional Risk Screening 2002 (NRS 2002), Patient generated-Subjective Global Assessment (PG-SGA), and muscle mass. Consistency test and McNemar test were used to evaluate the consistency of muscle mass with ALB, BMI, NRS 2002, and PG-SGA, and correlation analysis was performed on muscle mass and PG-SGA or BMI. Results: 61/130 (46.9%) of the patients had nutritional risks according to NRS 2002, 68/130 (53.1%) of the patients had malnutrition according to PG-SGA assessment. FFMI and ASMI could determine the loss of muscle mass that cannot be detected by albumin (30.2 and 65.6%), BMI (28.0 and 35.3%), NRS 2002 (26.1 and 25.0%), and PG-SGA (18.6 and 55.6%). McNemar test showed that the malnutrition results assessed by FFMI and BMI were inconsistent (P <0.001), but further Pearson correlation analysis showed that BMI was positively correlated with FFMI (rs = 0.300, P = 0.001). Conclusion: The commonly used nutritional assessment scale/parameters cannot identify the muscle mass loss in patients with locally advanced NPC. Analysis of human body composition is important for nutritional assessment in patients with locally advanced NPC.
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Affiliation(s)
- Xi Pan
- Department of Oncology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hong Liu
- Department of Nutrition, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Guo Feng
- Department of Nutrition, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jie Xiao
- Department of Oncology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Meng Wang
- Department of Nutrition, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hua Liu
- Department of Central Sterile Supply, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xueyi Xie
- Department of Oncology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhipeng Rong
- Department of Oncology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinru Wu
- Department of Nutrition, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Min Liu
- Department of Nutrition, The Third Xiangya Hospital, Central South University, Changsha, China
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21
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Zhang X, Liu J, Yu H, Su X, Chen H, He Y, Liu Z, Hu X. Weight Change Trajectory in Patients With Locally Advanced Nasopharyngeal Carcinoma During the Peri-Radiation Therapy Period. Oncol Nurs Forum 2021; 48:65-79. [PMID: 33337441 DOI: 10.1188/21.onf.65-79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To analyze the weight change trajectory in patients with locally advanced nasopharyngeal carcinoma (LANPC) before, during, and after radiation therapy for a time span of 40 weeks. SAMPLE & SETTING 147 patients from a university-affiliated medical center in China were included. METHODS & VARIABLES Body weight was measured weekly during intensive treatment and biweekly after radiation therapy. RESULTS All 147 patients experienced critical weight loss during the peri-radiation therapy period. Overall, body weight remained basically unchanged during induction chemotherapy, followed by a sharp and severe decrease during radiation therapy. At 20 weeks after radiation therapy, body weight had increased only slightly from the lowest point. IMPLICATIONS FOR NURSING A time-tailored intervention based on the weight change trajectory is necessary for patients with LANPC. According to the weight change trajectory, relevant interventions for maintaining body weight should be initiated as early as the second week of radiation therapy and no later than the fourth week of radiation therapy, and these interventions should continue for at least four weeks after radiation therapy.
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Validation of the Chinese version of chemotherapy-induced Taste Alteration Scale among patients with head and neck cancer undergoing radiotherapy. Eur J Oncol Nurs 2020; 48:101818. [PMID: 32937262 DOI: 10.1016/j.ejon.2020.101818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To validate the Chinese version of the Chemotherapy-induced Taste Alteration Scale (CiTAS) among patients with head and neck cancer (HNC) undergoing radiotherapy (RT). METHODS Patients with HNC undergoing RT were enrolled from a cancer hospital. Data were collected by face-to-face interview. Patients' subjective taste alterations (TAs) were assessed by the CiTAS. The content validity was evaluated by five experts. Confirmatory and exploratory factor analysis were used to assess construct validity. Convergent validity was assessed by the correlation between the CiTAS score and the Quality of Life Questionnaire-Core 30 (QLQ-C30) score. A single-item subjective intensity taste alteration question and quartiles of RT duration were used to assess the discriminant validity. The reliability was assessed by the Cronbach's alpha and test-retest reliability. RESULTS 253 patients participated this investigation and 25 patients completed twice. Confirmatory factor analysis showed that the original CiTAS structure with four dimensions was not applicable to patients with HNC undergoing RT. The Chinese version of modified-CiTAS (m-CiTAS) retained 17 items (the item "bothered by the smell of food" was deleted) loading onto three factors: decline in taste, discomfort, and phantogeusia and parageusia. The m-CiTAS showed acceptable correlations with the QLQ-C30. It could effectively discriminate the intensity of subjective TAs according to the single-item question and quartiles of RT duration. The m-CiTAS showed acceptable internal consistency (Cronbach's alpha = 0.573-0.958) and test-retest reliability (r = 0.726-0.831, P < 0.05). CONCLUSIONS The Chinese version of m-CiTAS is an acceptable and applicable instrument to evaluate TAs among patients with HNC undergoing RT.
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Symptom clusters in head and neck cancer patients with endotracheal tube: Which symptom clusters are independently associated with health-related quality of life? Eur J Oncol Nurs 2020; 48:101819. [PMID: 32937263 DOI: 10.1016/j.ejon.2020.101819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE The point of view of symptom clusters (SCs) may develop an efficient symptom management strategy to enhance health-related quality of life (HRQoL) in head and neck (HNC) patients with endotracheal tube (ETT). The study aims to investigate the possible SCs in HNC patients with ETT and determine whether there was an independent relationship between one or more SCs and HRQoL. METHODS A cross-sectional study design was adopted, and 203 HNC patients with ETT were recruited. They took measurements of General Information Questionnaire, MD Anderson Symptom Inventory-Head & Neck, and Twelve-Item Short-Form Health Survey (SF-12). Spearman correlations, partial correlations, and hierarchical cluster analysis were performed to determine latent number of SCs, and covariance analyses were used to determine independent associations between SCs and SF-12. This study followed STROBE Statement. RESULTS Pain SCs (pain, distressed, short of breath, and sadness), fatigue SCs (fatigue/weakness, restless, and sleepy), digestive SCs (appetite loss, constipation, and nausea), HNC-specific SCs (dry mouth and mucus), and tracheostomy-related SCs (difficulty swallowing and difficulty with voice and speech) were found. After adjusting covariant variables, this study found independent relationships of pain SCs and fatigue SCs with physical component summary of SF-12, and between fatigue SCs and mental component summary of SF-12. CONCLUSIONS Multiple SCs were found in those HNC patients. Pain SCs and fatigue SCs were independently associated with HRQoL. In process of caring HNC patients with ETT, it is vital to focus on SCs, especially on pain SCs and fatigue SCs, which might effectively improve patients' HRQoL.
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Hu ZY, Feng XQ, Fu MR, Yu R, Zhao HL. Symptom patterns, physical function and quality of life among head and neck cancer patients prior to and after surgical treatment: A prospective study. Eur J Oncol Nurs 2020; 46:101770. [PMID: 32504879 DOI: 10.1016/j.ejon.2020.101770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/22/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to evaluate patterns of symptoms, physical function and quality of life (QoL) among patients with head and neck cancer (HNC) prior to, 3-9 days post-surgery, and one month post-surgery. METHODS A prospective, repeated-measures design with consecutively-identified sampling was used to recruit HNC patients undergoing surgical treatment. Data collected included demographic and clinical characteristics, symptoms by M.D. Anderson Symptom Inventory-Head and Neck Module-Chinese version (MDASI-H&N-C), physical function and QoL by Function Subscales of European Cancer Research Treatment Organization Quality of Life Core Scale (EORTC QLQ C30). RESULTS 105 HNC patients suffered multiple symptoms prior to and after surgery. Pain, difficulty with voice/speech, disturbed sleep and problems with mucus (30.48%~91.43%) were the most prevalent symptoms prior to and post-surgery. Numbers of symptoms as well as specific symptoms, such as fatigue, dry mouth, problems with mucus, pain and disturbed sleep, were significantly associated with poor physical function (p < 0.05). Tracheostomy, feeding tube and age were also linked with poor physical function and poor QoL (p < 0.05). CONCLUSIONS Findings of our study underscore the importance of managing symptoms in HNC patients to ensure patients' physical function and QoL prior to and after surgical treatment. Further research should focus on developing targeted interventions for symptoms that are linked to HNC patients' poor physical function and QoL.
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Affiliation(s)
- Zi-Yi Hu
- West China Hospital/West China Medical School, Sichuan University, Department of Thyroid Surgery, Chengdu, Sichuan, 610041, China.
| | - Xian-Qiong Feng
- West China Hospital/West China Medical School, Sichuan University, Department of Nursing, Chengdu, Sichuan, 610041, China.
| | - Mei Rosemary Fu
- Barry Family & Goldman Sachs Endowed Professor, BOSTON COLLEGE William F. Connell School of Nursing, United States.
| | - Rong Yu
- West China Hospital/West China Medical School, Sichuan University, Department of Otolaryngology and Head & Neck Surgery, Chengdu, Sichuan, 610041, China.
| | - Hui-Ling Zhao
- West China Hospital/West China Medical School, Sichuan University, Department of Otolaryngology and Head & Neck Surgery, Chengdu, Sichuan, 610041, China.
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The Correlation of Symptom Clusters and Functional Performance in Adult Acute Leukemia Patients Under Chemotherapy. Cancer Nurs 2020; 44:E287-E295. [PMID: 32404584 DOI: 10.1097/ncc.0000000000000816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adult acute leukemia (AL) patients who receive chemotherapy usually experience multiple symptoms during the treatment course. The symptom clusters (SCs) as well as subsets of concurrent symptoms in AL patients have not yet been demonstrated. OBJECTIVE To investigate the SCs of adult AL patients who were receiving chemotherapy and to determine their correlations with functional performance. METHODS A total of 132 hospitalized adult AL patients were included in this study. A cross-sectional survey aimed to examine symptoms and functional performance was conducted. The patients' symptoms were assessed using the Chinese version of the Condensed Memorial Symptom Assessment Scale, and functional performance was evaluated through activities of daily living and quality of life. RESULTS We identified 4 SCs in adult AL patients: psychological SC, pain-fatigue-sleep SC, dry mouth-constipation SC, and nutrition-impaired SC. The psychological SC was the most common and most distressing SC. The different SCs were each differentially correlated with patient characteristics. The distress of the psychological SC, pain-fatigue-sleep SC, and nutrition-impaired SC was adversely correlated with functional performance. CONCLUSIONS Adult AL patients undergoing chemotherapy experience multiple symptoms that can be further categorized into 4 SCs. The distress from some SCs is negatively associated with patients' functional performance. IMPLICATIONS FOR PRACTICE Symptom burden remains a major problem for adult AL patients undergoing chemotherapy. Identifying SCs of AL patients should be the basis for accurate and cost-effective interventions. Personalized SC management may improve the functional performance and healthcare quality of adult AL patients.
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Gouvêa Vasconcellos A, Palmier N, Ribeiro A, Normando A, Morais-Faria K, Gomes-Silva W, Vechiato Filho A, de Goes M, Paes Leme A, Brandão T, Lopes M, Marsh P, Santos-Silva A. Impact of Clustering Oral Symptoms in the Pathogenesis of Radiation Caries: A Systematic Review. Caries Res 2020; 54:113-126. [DOI: 10.1159/000504878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022] Open
Abstract
Radiation-related caries (RRC) is a disease with a high potential for destruction of the dentition, which impairs quality of life in head-and-neck (HN) cancer (HNC) patients who undergo radiotherapy. In light of the recently described “clustering of oral symptoms theory,” the present systematic review (PROSPERO CRD42019132709) aims to assess HN and gastrointestinal (GI) symptom clusters among HNC patients and discusses how these indirect effects of cancer therapy play a pivotal role in the pathophysiology of RRC. The search was performed at PubMed, Scopus, and Embase and resulted in 11 studies that met the inclusion criteria. Data extraction was performed with respect to the presence of HN/GI symptom clusters among HNC patients. The methodological data of the studies included were assessed using the MAStARI and GRADE instruments. The most prevalent reported HN symptoms were dysphagia, xerostomia, and pain. Taste alterations and fatigue were also commonly reported by the patients. Loss of appetite and weight loss were regularly reported in the studies, as well as nausea and vomiting. The results of the present study suggest that HNC treatment generates clusters of oral symptoms, leading to dietary changes, impaired oral hygiene, enamel fragility, and a highly cariogenic oral environment, which may impact the risk for RRC. A better understanding of oral symptom clustering could be of considerable clinical significance for the oral health and quality of life of HNC patients. Therefore, contemporary protocols of RRC prevention must take this broader treatment scenario of symptom clusters such as oral side effects into account.
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Yang D, Zhou F, Fu X, Hou J, Lin L, Huang Q, Yeh CH. Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study. Int J Nurs Sci 2019; 6:278-282. [PMID: 31508447 PMCID: PMC6722474 DOI: 10.1016/j.ijnss.2019.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 05/13/2019] [Accepted: 05/31/2019] [Indexed: 01/10/2023] Open
Abstract
Objective Osteoradionecrosis of the jaws (ORNJ) is among the most serious oral complications of head and neck cancer treatment with radiation therapy. This study aimed to examine the level of symptom distress and interference of ORNJ in head and neck cancer patients in China. Methods A cross-sectional study was conducted to profile patient reported symptom severity. Ninety-five hospitalized ORNJ patients were recruited. Participants completed the MD Anderson Symptom Inventory–Head and Neck Module-Chinese version. Results The percentage of participants who reported that they experienced at least one type of symptom was 97.9%, and 85.2% patients reported interference. The 10 most severe symptoms were as follows: limited mouth opening, problem with teeth/gums, difficulty swallowing/chewing, dry mouth, oral malodor, difficulty with voice/speech, dental ulcer, tinnitus/ear obstruction, skin pain/burning/rash, and difficulty hearing. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. The interference of patients positively correlated with core symptoms (r = 0.612), head and neck symptoms (r = 0.709), and ORNJ symptoms (r = 0.440) (P < 0.01). The longer time to the onset of ORNJ after radiotherapy was positively and significantly correlated with symptom distress (r = 0.479, P < 0.001), and mouth opening correlated negatively with symptom distress (r = −0.298, P = 0.003). Conclusions ORNJ patients suffered mainly from limited mouth opening and other maxillofacial symptoms. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. ORNJ patients commonly had symptom distress, which influenced their quality of life.
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Affiliation(s)
- Dongye Yang
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Feng Zhou
- Center for Adverse Drug Reaction Monitoring of Chengdu, Sichuan, China
| | - Xinyu Fu
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Jinsong Hou
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Liting Lin
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Qiuyu Huang
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
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McDowell LJ, Rock K, Xu W, Chan B, Waldron J, Lu L, Ezzat S, Pothier D, Bernstein LJ, So N, Huang SH, Giuliani M, Hope A, O’Sullivan B, Bratman SV, Cho J, Kim J, Jang R, Bayley A, Ringash J. Long-Term Late Toxicity, Quality of Life, and Emotional Distress in Patients With Nasopharyngeal Carcinoma Treated With Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:340-352. [DOI: 10.1016/j.ijrobp.2018.05.060] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 10/14/2022]
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