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Utne I, Stokke K, Ritchie C, Løyland B, Grov EK, Rasmussen HL, Lindemann K, Paul SM, Torstveit AH, Miaskowski C. Changes in Subjective Measures of Cognitive Function in Older Adults From the Initiation Through 12 Months After the Receipt of Chemotherapy. Cancer Nurs 2023; 46:E365-E374. [PMID: 35781267 DOI: 10.1097/ncc.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment has a negative impact on older patients with cancer. OBJECTIVES The aim of this study was to evaluate for interindividual differences in 2 subjective measures of cognitive function in older patients (n = 112), as well as determine which demographic, clinical, and symptom characteristics, and levels of physical function, were associated with initial levels and with the trajectory of each of these 2 measures. METHODS Cognitive function was assessed using the cognitive function scale from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Attentional Function Index at the initiation of chemotherapy and at 1, 3, 6, 9, and 12 months after its initiation. Hierarchical linear modeling was used to assess for interindividual differences in and characteristics associated with initial levels and changes in cognitive function. RESULTS Characteristics associated with decreases in Quality of Life Questionnaire Core 30 scores at the initiation of chemotherapy were longer time since the cancer diagnosis and higher depression scores. Characteristics associated with poorer Attentional Function Index scores at enrollment were lower levels of education and higher depression scores. No characteristics were associated with worse trajectories of either cognitive function measure. CONCLUSION Some older patients undergoing chemotherapy experience decrements in cognitive function. IMPLICATIONS FOR PRACTICE Our findings suggest that clinicians need to assess for depressive symptoms in older patients before the initiation of chemotherapy. Evidence-based interventions (eg, cognitive stimulation, increased physical activity) can be recommended to maintain and increase cognitive function in older oncology patients.
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Affiliation(s)
- Inger Utne
- Author Affiliations: Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University (Drs Utne, Løyland, and Grov, and Mss Rasmussen and Torstveit), Norway; Division of Cancer Medicine, Oslo University Hospital (Ms Stokke), Norway; Division of Palliative Care and Geriatric Medicine, Mongan Institute, Center for Aging and Serious Illness, Massachusetts General Hospital (Dr Ritchie), Boston; Department of Gynecological Oncology, Oslo University Hospital (Dr Lindemann), Norway; and School of Nursing, University of California, San Francisco (Drs Paul and Miaskowski)
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Johannessen MS, Miaskowski C, Kleven AG, Ritchie CS, Paul SM, Grov EK, Hareide M, Gaudernack H, Utne I. Age-related differences in the occurrence, severity, and distress of symptoms in older patients at the initiation of chemotherapy. BMC Geriatr 2023; 23:481. [PMID: 37558973 PMCID: PMC10413597 DOI: 10.1186/s12877-023-04198-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Evaluate for differences in occurrence, severity, and distress ratings for 32 symptoms between younger older adults (YOA, < 70 years) and older adults (OA, ≥ 70 years) at initiation of chemotherapy. METHODS Patients (n = 125) were recruited prior to the initiation of chemotherapy and completed the Memorial Symptom Assessment Scale. Differences in occurrence, severity, and distress ratings were evaluated using Independent sample t-tests and Chi-square or Fisher's exact tests. RESULTS On average, the older patients reported ten concurrent symptoms that equates with a moderate symptom burden. Symptoms with the highest occurrence rates were not always the most severe and/or the most distressing. Few age-related differences were found in patients' symptom experiences. When age-related differences were identified, OA reported lower occurrence, severity, and distress ratings. Nine of the ten symptoms with highest occurrence rates were common for both age groups. For severity and distress, only half of the symptoms were common. In terms of severity and distress, all of the top ten ranked symptoms were in the moderate to severe range. CONCLUSIONS Both YOA and OA reported a moderate symptom burden and severity and distress scores in the moderate to severe range. The symptoms with the highest occurrence rates were not always the most severe/or the most distressing. Our findings suggest that different dimensions of the symptom experience (i.e., occurrence, severity, and distress) warrant evaluation in older oncology patients.
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Affiliation(s)
- Marlen Sunde Johannessen
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | | | - Anne Grethe Kleven
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Ellen Karine Grov
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | - Martine Hareide
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | - Henrik Gaudernack
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | - Inger Utne
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway.
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Shin J, Harris C, Oppegaard K, Kober KM, Paul SM, Cooper BA, Hammer M, Conley Y, Levine JD, Miaskowski C. Worst Pain Severity Profiles of Oncology Patients Are Associated With Significant Stress and Multiple Co-Occurring Symptoms. THE JOURNAL OF PAIN 2022; 23:74-88. [PMID: 34298161 PMCID: PMC10788964 DOI: 10.1016/j.jpain.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022]
Abstract
Little is known about the associations between pain, stress, and co-occurring symptoms in oncology patients. Purpose was to identify subgroups of patients with distinct worst pain profiles and evaluate for differences among the subgroups in demographic and clinical characteristics, as well as stress and symptom scores. Oncology outpatients (n = 1305) completed questionnaires prior to their second or third chemotherapy cycle. Worst pain intensity was assessed 6 times over 2 chemotherapy cycles using a 0 to 10 numeric rating scale. The 371 patients (28.4%) who had ≤1 occurrence of pain over the 6 assessments were classified as the None class. For the remaining 934 patients whose data were entered into the latent profile analysis, 3 distinct worst pain profiles were identified (ie Mild [12.5%], Moderate [28.6%], Severe [30.5%]). Compared to None class, Severe class had fewer years of education and a lower annual income; were less likely to be employed and married; less likely to exercise on a regular basis, had a higher comorbidity burden, and a worse functional status. Compared to None class, Severe class reported higher levels of general, disease-specific, and cumulative life stress and lower levels of resilience, as well as higher levels of depressive symptoms, anxiety, fatigue, sleep disturbance, and cognitive dysfunction. This study is the first to identify distinct worst pain profiles in a large sample of oncology patients receiving chemotherapy and associated risk factors. PERSPECTIVE: Unrelieved pain remains a significant problem for oncology patients receiving chemotherapy. High levels of stress and co-occurring symptoms contribute to a more severe pain profile in these patients.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, California
| | - Carolyn Harris
- School of Nursing, University of California, San Francisco, California
| | - Kate Oppegaard
- School of Nursing, University of California, San Francisco, California
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California
| | | | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, California; School of Medicine, University of California, San Francisco, California.
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Symptom experience of older oncology patients with low versus high levels of multimorbidity prior to chemotherapy. Eur J Oncol Nurs 2021; 54:102029. [PMID: 34520997 DOI: 10.1016/j.ejon.2021.102029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Evaluate for differences in demographic and clinical characteristics between older oncology patients with low multimorbidity (<2 multimorbidities) and high multimorbidity (≥2 multimorbidities) and evaluate for differences in symptom occurrence, severity, and distress ratings between the two groups. METHODS Symptoms of older oncology patients (n = 125) were assessed using the Memorial Symptom Assessment Scale prior to chemotherapy administration. Data were analyzed using t-tests for continuous variables and Chi-square or Fisher's exact tests for categorical variables. RESULTS For the total sample, lack of energy and pain were the two most common symptoms. Compared to the low multimorbidity group, the high multimorbidity group had a higher number of symptoms and significantly higher occurrence rates for feeling nervous, difficulty sleeping, dry mouth, and pain. Compared to the low multimorbidity group, the high multimorbidity group had significantly higher severity ratings for pain, feeling sad, lack of energy, feeling drowsy, and worrying. For distress, the high multimorbidity group reported significantly higher ratings for pain, worrying, feeling sad, feeling nervous, and "I don't look like myself". No differences were found in any demographic or clinical characteristics between the two multimorbidity groups. CONCLUSIONS Multimorbidity is associated with higher symptom occurrence, severity, and distress in older oncology patients. Our findings suggest that the symptoms with the highest severity ratings were not the most distressing. Clinicians should identify multimorbidities and assess symptoms prior to chemotherapy to identify patients at increased risk and initiate referrals for interventions.
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Chao S, Lv X, Ma N, Shen Z, Zhang F, Pei Y, Pei Z. A supramolecular nanoprodrug based on a boronate ester linked curcumin complexing with water-soluble pillar[5]arene for synergistic chemotherapies. Chem Commun (Camb) 2021; 56:8861-8864. [PMID: 32638757 DOI: 10.1039/d0cc04315j] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A supramolecular nanoprodrug based on the host-guest complexation of water-soluble pillar[5]arene (WP5) and a boronate ester linked curcumin (Cur) was constructed, which had dual-responsiveness towards pH and GSH, allowing the drug to be selectively released in hepatoma cells. In vitro studies revealed that the Dox-loaded WP5G-Cur nanoprodrug achieved co-delivery of Dox/Cur. The anti-cancer efficiency could be enhanced through synergistic chemotherapies of Dox/Cur.
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Affiliation(s)
- Shuang Chao
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling 712100, P. R. China.
| | - Xiukai Lv
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling 712100, P. R. China.
| | - Ning Ma
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling 712100, P. R. China.
| | - Ziyan Shen
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling 712100, P. R. China.
| | - Feiyu Zhang
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling 712100, P. R. China.
| | - Yuxin Pei
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling 712100, P. R. China.
| | - Zhichao Pei
- Shaanxi Key Laboratory of Natural Products & Chemical Biology, College of Chemistry & Pharmacy, Northwest A&F University, Yangling 712100, P. R. China.
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Grov EK, Dahl AA. Is neuroticism relevant for old cancer survivors? A controlled, population-based study (the Norwegian HUNT-3 survey). Support Care Cancer 2020; 29:3623-3632. [PMID: 33174077 PMCID: PMC8163664 DOI: 10.1007/s00520-020-05870-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/30/2020] [Indexed: 11/12/2022]
Abstract
Purpose Personality traits, particularly neuroticism, have an impact on people’s health and lifestyle. Due to lack of previous studies, we examined old cancer survivors (OCSs) versus cancer-free age-matched controls aged ≥ 70 years, regarding prevalence of high neuroticism, health problems in those with high and low neuroticism, and sociodemographic and clinical variables that were significantly associated with high neuroticism. Methods We merged data from a Norwegian population–based health study (the HUNT-3) and from the Cancer Registry of Norway identifying OCSs. Three cancer-free controls were drawn at random for each OCS. Neuroticism was self-rated on a brief version of Eysenck Personality Questionnaire. Between-group statistical comparisons were made between OCS and controls, and among their subgroups with high and low neuroticism. Logistic regression analyses were used to investigate independent variables significantly associated with high neuroticism. Results Twenty-nine percent of OCSs reported high neuroticism while controls reported 30%. OCSs showed significantly lower rate of good life satisfaction than controls. All other between-group comparisons were nonsignificant. Being OCSs was not significantly related to high neuroticism in the regression analyses. Sociodemographic, general health, and lifestyle issues, lack of energy, and low life satisfaction remained significantly associated with high neuroticism in the multivariable analysis. Conclusions The prevalence of high neuroticism was similar in OCSs and controls. High neuroticism was associated with negative health and lifestyle issues in both groups. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-020-05870-7.
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Affiliation(s)
- Ellen Karine Grov
- Department of Health Sciences, Oslo Metropolitan University, POBox 4, St.Olavs plass, 0130, Oslo, Norway.
| | - Alv A Dahl
- National Advisory Unit for Late Effects after Cancer Therapy, Oslo University Hospital, Radiumhospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Utne I, Cooper BA, Ritchie C, Wong M, Dunn LB, Loyland B, Grov EK, Hammer MJ, Paul SM, Levine JD, Conley YP, Kober KM, Miaskowski C. Co-occurrence of decrements in physical and cognitive function is common in older oncology patients receiving chemotherapy. Eur J Oncol Nurs 2020; 48:101823. [PMID: 32835999 DOI: 10.1016/j.ejon.2020.101823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Older adults receiving cancer chemotherapy are at increased risk for decrements in physical (PF) and cognitive (CF) function. OBJECTIVES Study identified subgroups of patients with distinct PF and CF profiles; risk factors associated with subgroup membership; and impact of subgroup membership on quality of life (QOL). METHODS In 366 older oncology patients, PF and CF were assessed using the Physical Component Summary (PCS) of the SF-12 and Attentional Function Index, respectively. Latent profile analysis was used to identify subgroups of older patients with distinct PF/CF profiles. RESULTS Three distinct PF/CF profiles were identified (i.e., Very Low PF + Moderate CF (15.6%); Low PF + Low CF (39.3%), Normal PF + Normal CF (45.1%)). Compared to the both Normal class, patients in the other two classes had a lower functional status, a worse comorbidity profile, and were less likely to exercise on a regular basis. Compared to the Both Normal class, patients in the Both Low class were less likely to be married/partnered, more likely to live alone, less likely to be employed, and more likely to report depression and back pain. Compared to the other two classes, patients in the Both Low class had a lower annual household income and were receiving chemotherapy with a worse toxicity profile. CONCLUSION First study to use a person-centered analytic approach to identify subgroups of older adults with distinct PF/CF profiles. Fifty-five percent of the older adults had statistically significant and clinically meaningful decrements in both PF AND CF that had negative effects on all aspects of QOL.
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Affiliation(s)
- Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christine Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital Morgan Institute, Boston, MA, USA
| | - Melisa Wong
- School of Medicine, University of California, San Francisco, CA, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Borghild Loyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Marilyn J Hammer
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, MA, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
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Kohler C, Chang M, Allemann-Su YY, Vetter M, Jung M, Jung M, Conley Y, Paul S, Kober KM, Cooper BA, Smoot B, Levine JD, Miaskowski C, Katapodi MC. Changes in Attentional Function in Patients From Before Through 12 Months After Breast Cancer Surgery. J Pain Symptom Manage 2020; 59:1172-1185. [PMID: 31953207 PMCID: PMC7239765 DOI: 10.1016/j.jpainsymman.2020.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Although approximately 75% of patients with breast cancer report changes in attentional function, little is known about how demographic, clinical, symptom, and psychosocial adjustment (e.g., coping) characteristics influence changes in the trajectories of attentional function over time. OBJECTIVES This study evaluated interindividual variability in the trajectories of self-reported attentional function and determined which demographic, clinical, symptom, and psychosocial adjustment characteristics were associated with initial levels and with changes in attentional function from before through 12 months after breast cancer surgery. METHODS Before surgery, 396 women were enrolled. Attentional Function Index (AFI) was completed before and nine times within the first 12 months after surgery. Hierarchical linear modeling was used to determine which characteristics were associated with initial levels and trajectories of attentional function. RESULTS Given an estimated preoperative AFI score of 6.53, for each additional month, the estimated linear rate of change in AFI score was an increase of 0.054 (P < 0.001). Higher levels of comorbidity, receipt of adjuvant chemotherapy, higher levels of trait anxiety, fatigue, and sleep disturbance, and lower levels of energy and less sense of control were associated with lower levels of attentional function before surgery. Patients who had less improvements in attentional function over time were nonwhite, did not have a lymph node biopsy, had received hormonal therapy, and had less difficulty coping with their disease. CONCLUSION Findings can be used to identify patients with breast cancer at higher risk for impaired self-reported cognitive function and to guide the prescription of more personalized interventions.
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Affiliation(s)
- Carmen Kohler
- Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Ming Chang
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland
| | - Yu-Yin Allemann-Su
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland
| | - Marcus Vetter
- Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Miyeon Jung
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Misook Jung
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven Paul
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California, USA.
| | - Maria C Katapodi
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland; School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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