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Xu W, Zhao N, Li W, Qiu L, Luo X, Lin Y, Wang W, Garg S, Sun H, Yang Y. Effects of repetitive transcranial magnetic stimulation on fear of cancer recurrence and its underlying neuromechanism. Contemp Clin Trials Commun 2024; 39:101299. [PMID: 38720913 PMCID: PMC11076408 DOI: 10.1016/j.conctc.2024.101299] [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: 01/16/2024] [Revised: 04/07/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Many breast cancer patients suffer from fear of cancer recurrence (FCR). However, effective physical intervention for FCR has been scarce. Previous studies have confirmed that repetitive transcranial magnetic stimulation (rTMS) can help improve patients' anxiety, depression, fear, and stress level. Therefore, this study aims to assess the efficacy of rTMS in the treatment of FCR in breast cancer patients and explore its underlying neural mechanism. Methods and analysis and analysis: Fifty breast cancer patients with high FCR (FCR total score >27), and fifty age- and gender-matched patients with low FCR (FCR total score <7) will be recruited to participate in this study. Patients in the high FCR group will be randomly assigned to receive 4-week low-frequency rTMS targeting the right dorsolateral prefrontal cortex (rDLPFC) + treatment as usual (TAU) (n = 25), or to receive sham stimulation + TAU (n = 25). Patients in the low FCR group will only receive TAU. All participants will take a baseline fMRI scan to examine the local activities and interactions of brain activity between the prefrontal cortex (DLPFC), amygdala and hippocampus. Fear of Cancer Recurrence Questionnaire (FCRQ7), Patient Health Questionnaire (PHQ9), Generalize Anxiety Disorder (GAD7), Numeric Rating Scale (NRS), and Insomnia Severity Index (ISI7) will be used to measure an individual's FCR, depression, anxiety, pain, and insomnia symptoms at week 0 (baseline), week 4 (the end of intervention), week 5 (1 week post-treatment), week 8 (1 month post-treatment), and week 16 (3 months post-treatment). Participants in the high FCR group will receive a post-treatment fMRI scan within 24 h after intervention to explore the neural mechanisms of rTMS treatment. The primary outcome of the study, whether the rTMS intervention is sufficient in relieving FCR in breast cancer patients, is measured by FCRQ7. Additionally, task activation, local activity and functional connectivity of the DLPFC, amygdala and hippocampus will be compared, between high and low FCR group, and before and after treatment. Discussion Studies have shown that low-frequency rTMS can be used to treat patient's FCR. However, there is a lack of relevant evidence to support the efficacy of rTMS on FCR in cancer patients, and the neural mechanisms underlying the effects of rTMS on FCR need to be further investigated. Ethics and dissemination Ethical approval for the study has been obtained from the Ethics Committee of Guangdong Provincial People's Hospital (reference number: KY-N-2022-136-01). The results of the investigation will be published in scientific papers. The data from the investigation will be made available online if necessary. Trial registration NCT05881889 (ClinicalTrials.gov). Date of registration: May 31, 2023.
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Affiliation(s)
- Wenjing Xu
- Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Na Zhao
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, 311121, China
| | - Wengao Li
- Department of Psychiatry, General Hospital of Southern Theatre Command, Guangzhou, 510515, China
| | - Lirong Qiu
- Mental Health Education Center, University of Electronic Science and Technology of China, Chengdu, 611701, China
| | - Xian Luo
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, 510515, China
| | - Yuanyuan Lin
- Department of Medical Treatment, Mental Hospital of Guangzhou Civil Affairs Bureau, Guangzhou, 510000, China
| | - Wenjing Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Samradhvi Garg
- School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9BL, UK
| | - Hengwen Sun
- Department of Radiotherapy, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Yuan Yang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
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Nightingale CL, Snavely AC, McLouth LE, Dressler EV, Kent EE, Adonizio CS, Danhauer SC, Cannady R, Hopkins JO, Kehn H, Weaver KE, Sterba KR. Processes for identifying caregivers and screening for caregiver and patient distress in community oncology: results from WF-1803CD. J Natl Cancer Inst 2024; 116:324-333. [PMID: 37738445 PMCID: PMC10852602 DOI: 10.1093/jnci/djad198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Despite their vital roles, informal caregivers of adult cancer patients are commonly overlooked in cancer care. This study describes processes for identifying cancer caregivers and processes for distress screening and management among caregivers and patients in the understudied community oncology setting. METHODS Supportive care leaders from the National Cancer Institute Community Oncology Research Program practices completed online survey questions regarding caregiver identification, caregiver and patient distress screening, and distress management strategies. We described practice group characteristics and prevalence of study outcomes. Multivariable logistic regression explored associations between practice group characteristics and caregiver identification in the electronic health record (EHR). RESULTS Most (64.9%, 72 of 111) supportive care leaders reported routine identification and documentation of informal caregivers; 63.8% record this information in the EHR. Only 16% routinely screen caregivers for distress, though 92.5% screen patients. Distress management strategies for caregivers and patients are widely available, yet only 12.6% are routinely identified and screened and had at least 1 referral strategy for caregivers with distress; 90.6% are routinely screened and had at least 1 referral strategy for patients. Practices with a free-standing outpatient clinic (odds ratio [OR] = 0.29, P = .0106) and academic affiliation (OR = 0.01, P = .04) were less likely to identify and document caregivers in the EHR. However, higher oncologist volume was associated with an increased likelihood of recording caregiver information in the EHR (OR = 1.04, P = .02). CONCLUSIONS Despite high levels of patient distress screening and management, few practices provide comprehensive caregiver engagement practices. Existing patient engagement protocols may provide a promising platform to build capacity to better address caregiver needs.
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Affiliation(s)
- Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Laurie E McLouth
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Christian S Adonizio
- Center for Oncology Research and Innovation, Geisinger Health, Danville, PA, USA
| | - Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel Cannady
- Cancer Caregiver Support, American Cancer Society, Atlanta, GA, USA
| | - Judith O Hopkins
- Hematology and Oncology, Novant Health Cancer Institute, Southeast Clinical Oncology Research Consortium National Cancer Institute Community Oncology Research Program, Winston-Salem, NC, USA
| | - Heather Kehn
- Metro Minnesota Community Oncology Research Consortium, Minneapolis, MN, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina College of Medicine, Charleston, SC, USA
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Kesireddy M, Tenner L. Colon Cancer Survivorship in Patients Who Have Received Adjuvant Chemotherapy. Clin Colorectal Cancer 2023; 22:361-374. [PMID: 37574392 DOI: 10.1016/j.clcc.2023.07.001] [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: 06/11/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023]
Abstract
The number of colon cancer survivors in the United States is increasing due to improved early detection, better treatments that extend survival, and the growing aging population who are at high risk for cancer. Following initial active treatment, colon cancer survivors experience a wide range of long-term physical, psychological, and socio-economic effects that impact their overall well-being. Healthcare providers caring for survivors need to prioritize not only monitoring for cancer recurrence but also optimizing their overall health through addressing these long-term effects; managing their comorbidities; promoting healthy behaviors (like exercise, nutrition, and weight loss); and screening for a second primary cancer depending on their risk. Personalized survivorship care plans should be formulated clearly outlining the roles of various healthcare providers involved in their care. Our review article focuses on these various aspects of colon cancer survivorship, including surveillance for cancer recurrence specific to those who received adjuvant chemotherapy with curative intent.
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Affiliation(s)
- Meghana Kesireddy
- Division of Hematology-Oncology, University of Nebraska Medical Center- Fred & Pamela Buffett Cancer Center, Omaha, NE
| | - Laura Tenner
- Division of Hematology-Oncology, University of Nebraska Medical Center- Fred & Pamela Buffett Cancer Center, Omaha, NE.
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Chen P, Zhao YJ, An FR, Li XH, Lam MI, Lok KI, Wang YY, Li JX, Su Z, Cheung T, Ungvari GS, Ng CH, Zhang Q, Xiang YT. Prevalence of insomnia and its association with quality of life in caregivers of psychiatric inpatients during the COVID-19 pandemic: a network analysis. BMC Psychiatry 2023; 23:837. [PMID: 37964197 PMCID: PMC10644468 DOI: 10.1186/s12888-023-05194-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/14/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Studies on sleep problems among caregivers of psychiatric patients, especially during the COVID-19 pandemic, are limited. This study examined the prevalence and correlates of insomnia symptoms (insomnia hereafter) among caregivers of psychiatric inpatients during the COVID-19 pandemic as well as the association with quality of life (QoL) from a network analysis perspective. METHODS A multi-center cross-sectional study was conducted on caregivers of inpatients across seven tertiary psychiatric hospitals and psychiatric units of general hospitals. Network analysis explored the structure of insomnia using the R program. The centrality index of "Expected influence" was used to identify central symptoms in the network, and the "flow" function was adopted to identify specific symptoms that were directly associated with QoL. RESULTS A total of 1,101 caregivers were included. The overall prevalence of insomnia was 18.9% (n = 208; 95% CI = 16.7-21.3%). Severe depressive (OR = 1.185; P < 0.001) and anxiety symptoms (OR = 1.099; P = 0.003), and severe fatigue (OR = 1.320; P < 0.001) were associated with more severe insomnia. The most central nodes included ISI2 ("Sleep maintenance"), ISI7 ("Distress caused by the sleep difficulties") and ISI1 ("Severity of sleep onset"), while "Sleep dissatisfaction" (ISI4), "Distress caused by the sleep difficulties" (ISI7) and "Interference with daytime functioning" (ISI5) had the strongest negative associations with QoL. CONCLUSION The insomnia prevalence was high among caregivers of psychiatric inpatients during the COVID-19 pandemic, particularly in those with depression, anxiety and fatigue. Considering the negative impact of insomnia on QoL, effective interventions that address insomnia and alteration of sleep dissatisfaction should be developed.
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Affiliation(s)
- Pan Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Yan-Jie Zhao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Feng-Rong An
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiao-Hong Li
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Mei Ieng Lam
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Ka-In Lok
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao SAR, China
| | - Yue-Ying Wang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Jia-Xin Li
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia.
| | - Qinge Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
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Rogers AH, Gallagher MW, Zvolensky MJ. Intraindividual change in pain tolerance and negative affect over 20 years: findings from the MIDUS study. PSYCHOL HEALTH MED 2023; 28:1950-1962. [PMID: 36882375 DOI: 10.1080/13548506.2023.2188229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
Pain tolerance, defined as the ability to withstand physical pain states, is a clinically important psychobiological process associated with several deleterious outcomes, including increased pain experience, mental health problems, physical health problems, and substance use. A significant body of experimental work indicates that negative affect is associated with pain tolerance, such that increased negative affect is associated with decreased pain tolerance. Although research has documented the associations between pain tolerance and negative affect, little work has examined these associations over time, and how change in pain tolerance is related to changes in negative affect. Therefore, the current study examined the relationship between intraindividual change in self-reported pain tolerance and intraindividual change in negative affect over 20 years in a large, longitudinal, observation-based national sample of adults (n = 4,665, Mage = 46.78, SD =12.50, 53.8% female). Results from parallel process latent growth curve models indicated that slope of pain tolerance and negative affect were associated with each other over time (r = .272, 95% CI [.08, .46] p = .006). Cohen's d effect size estimates provide initial, correlational evidence that changes in pain tolerance may precede changes in negative affect. Given the relevance of pain tolerance to deleterious health outcomes, better understanding how individual difference factors, including negative affect, influence pain tolerance over time, are clinically important to reduce disease-related burden.
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Affiliation(s)
- Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Matthew W Gallagher
- Department of Psychology, University of Houston, Houston, TX, USA
- Evaluation, and Statistics, University of Houston, Texas Institute for Measurement, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
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Lee YJ, Kim JS, Jo JC, Kim Y, Im HS, Kim H, Koh S, Min YJ, Park SH, Ahn JW, Choi Y. Risk factors of menopause after allogeneic hematopoietic cell transplantation in premenopausal adult women. Eur J Haematol 2023. [PMID: 37308461 DOI: 10.1111/ejh.14027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Allogeneic hematopoietic stem-cell transplantation (HCT) is the only curative option for most hematologic malignancies. However, HSCT can cause early menopause and various complications in premenopausal women. Therefore, we aimed to investigate risk factors predicting early menopause and its clinical implications among survivors post HCT. METHODS We retrospectively analyzed 30 adult women who had received HCT at premenopausal status between 2015 and 2018. We excluded patients who had received autologous stem cell transplantation, had relapsed, or died of any cause within 2 years of HCT. RESULTS The median age at HCT was 41.6 years (range, 22-53). Post-HCT menopause was identified in 90% of myeloablative conditioning (MAC) HCT and 55% of reduced-intensity conditioning (RIC) HCT (p = .101). In the multivariate analysis, the post-HCT menopausal risk was 21 times higher in a MAC regimen containing 4 days of busulfan (p = .016) and 9.3 times higher in RIC regimens containing 2-3 days of busulfan (p = .033) than that of non-busulfan-based conditioning regimens. CONCLUSIONS Higher busulfan dose in conditioning regimens is the most significant risk factor affecting post-HCT early menopause. Considering our data, we need to decide on conditioning regimens and individualized fertility counseling before HCT for premenopausal women.
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Affiliation(s)
- Yoo Jin Lee
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Jeong Sook Kim
- Department of Obstetrics, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Youjin Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Hyeon-Soo Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Hyeyeong Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - SuJin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Young Joo Min
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Sang-Hyuk Park
- Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Jun Woo Ahn
- Department of Obstetrics, Ulsan University Hospital, University of Ulsan College of Medicine, Korea
| | - Yunsuk Choi
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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LeBaron V, Homdee N, Ogunjirin E, Patel N, Blackhall L, Lach J. Describing and visualizing the patient and caregiver experience of cancer pain in the home context using ecological momentary assessments. Digit Health 2023; 9:20552076231194936. [PMID: 37654707 PMCID: PMC10467200 DOI: 10.1177/20552076231194936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Background Pain continues to be a difficult and pervasive problem for patients with cancer, and those who care for them. Remote health monitoring systems (RHMS), such as the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C), can utilize Ecological Momentary Assessments (EMAs) to provide a more holistic understanding of the patient and family experience of cancer pain within the home context. Methods Participants used the BESI-C system for 2-weeks which collected data via EMAs deployed on wearable devices (smartwatches) worn by both patients with cancer and their primary family caregiver. We developed three unique EMA schemas that allowed patients and caregivers to describe patient pain events and perceived impact on quality of life from their own perspective. EMA data were analyzed to provide a descriptive summary of pain events and explore different types of data visualizations. Results Data were collected from five (n = 5) patient-caregiver dyads (total 10 individual participants, 5 patients, 5 caregivers). A total of 283 user-initiated pain event EMAs were recorded (198 by patients; 85 by caregivers) over all 5 deployments with an average severity score of 5.4/10 for patients and 4.6/10 for caregivers' assessments of patient pain. Average self-reported overall distress and pain interference levels (1 = least distress; 4 = most distress) were higher for caregivers (x ¯ 3.02, x ¯ 2.60 , respectively ) compared to patients (x ¯ 2.82, x ¯ 2.25, respectively) while perceived burden of partner distress was higher for patients (i.e., patients perceived caregivers to be more distressed, x ¯ 3.21, than caregivers perceived patients to be distressed, x ¯ 2.55 ). Data visualizations were created using time wheels, bubble charts, box plots and line graphs to graphically represent EMA findings. Conclusion Collecting data via EMAs is a viable RHMS strategy to capture longitudinal cancer pain event data from patients and caregivers that can inform personalized pain management and distress-alleviating interventions.
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Affiliation(s)
- Virginia LeBaron
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Nutta Homdee
- Center for Research Innovation and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Emmanuel Ogunjirin
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, USA
| | - Nyota Patel
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, USA
| | - Leslie Blackhall
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - John Lach
- The George Washington University School of Engineering & Applied Science, Washington, DC, USA
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McGarrah P, Hubbard J, Novotny PJ, Branda ME, Sargent DS, Morton RF, Fuchs CS, Benson AB, Williamson SK, Findlay BP, Alberts SR, Goldberg RM, Sloan JA. Baseline Quality of Life is a Strong and Independent Prognostic Factor for Overall Survival in Metastatic Colorectal Cancer. Cancer Control 2023; 30:10732748231185047. [PMID: 37339926 PMCID: PMC10286175 DOI: 10.1177/10732748231185047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Previous studies have established that higher baseline quality of life (QOL) scores are associated with improved survival in patients with metastatic colorectal cancer (mCRC). We examined the relationship between overall survival (OS) and baseline QOL. PATIENTS AND METHODS A total of 1 247 patients with mCRC participating in N9741 (comparing bolus 5-FU/LV, irinotecan [IFL] vs infusional 5-FU/leucovorin [LV]/oxaliplatin [FOLFOX] vs. irinotecan/oxaliplatin [IROX]) provided data at baseline on overall QOL using a single-item linear analogue self-assessment (LASA) 0-100 point scale. The association of OS according to clinically deficient (defined as CD-QOL, score 0-50) vs not clinically deficient (nCD-QOL, score 51-100) baseline QOL scores was tested. A multivariable analysis using Cox proportional hazards modeling was performed to adjust for the effects of multiple baseline factors. An exploratory analysis was performed evaluating OS according to baseline QOL status among patients who did or did not receive second-line therapy. RESULTS Baseline QOL was a strong predictor of OS for the whole cohort (CD-QOL vs nCD-QOL: 11.2 months vs 18.4 months, P < .0001), and in each arm IFL 12.4 vs 15.1 months, FOLFOX 11.1 months vs 20.6 months, and IROX 8.9 months vs 18.1 months. Baseline QOL was associated with baseline performance status (PS) (P < .0001). After adjusting for PS and treatment arm, baseline QOL was still associated with OS (P = .017). CONCLUSIONS Baseline QOL is an independent prognostic factor for OS in patients with mCRC. The demonstration that patient-assessed QOL and PS are independent prognostic indicators suggests that these assessments provide important complementary prognostic information.
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Affiliation(s)
| | - Joleen Hubbard
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Paul J. Novotny
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Megan E. Branda
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Daniel S. Sargent
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Roscoe F. Morton
- North Central Cancer Treatment Group, Iowa Oncology Research Association, Des Moines, IA, USA
| | | | - Al B. Benson
- Division of Hematology and Medical Oncology, Northwestern University, Chicago, IL, USA; and ECOG-ACRIN Cancer Research Group, Philadelphia, PA, USA
| | - Stephen K. Williamson
- SWOG Cancer Research Network, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | - Jeff A. Sloan
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
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Do JH, Gelvosa MN, Choi KY, Kim H, Kim JY, Stout NL, Cho YK, Kim HR, Kim YH, Kim SA, Jeon JY. Effects of Multimodal Inpatient Rehabilitation vs Conventional Pulmonary Rehabilitation on Physical Recovery After Esophageal Cancer Surgery. Arch Phys Med Rehabil 2022; 103:2391-2397. [PMID: 35760108 DOI: 10.1016/j.apmr.2022.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the effects of multimodal rehabilitation initiated immediately after esophageal cancer surgery on physical recovery compared with conventional pulmonary rehabilitation. DESIGN Retrospective study. SETTING Private quaternary care hospital. PARTICIPANTS Fifty-nine inpatients (N=59) who participated in either conventional pulmonary rehabilitation (n=30) or in multimodal rehabilitation (n=29) after esophageal cancer surgery were included. INTERVENTIONS Both groups performed pulmonary exercises, including deep breathing, chest expansion, inspiratory muscle training, coughing, and manual vibration. In the conventional pulmonary rehabilitation group, light-intensity mat exercise, stretching, and walking were performed. The multimodal rehabilitation group performed resistance exercises and moderate- to high-intensity aerobic interval exercises using a bicycle. MAIN OUTCOME MEASURES The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30), pain, 6-minute walk test (6MWT), 30-second chair stand test, and grip strengths were assessed before and after the rehabilitation programs. RESULTS Symptom scales of pain, dyspnea, and insomnia in the EORTC QLQ-C30 as well as 6MWT improved significantly after each program (P<.05). 6MWT (73.1±52.6 vs 28.4±14.3, P<.001, d=1.15), 30-second chair stand test (3.5±3.9 vs 0.35±2.0, P<.001, d=1.06), and left grip strength (1.2±1.3 vs 0.0±1.5, P=.002, d=0.42) improved significantly in the multimodal rehabilitation group compared with the pulmonary rehabilitation group. While right grip strength also showed more improvement for those undergoing the multimodal program, the mean strength difference was not clinically meaningful. CONCLUSIONS A multimodal inpatient rehabilitation program instituted early after esophageal cancer surgery improved endurance for walking more than conventional pulmonary rehabilitation as measured by the 6MWT and the 30-second chair stand test.
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Affiliation(s)
- Jung Hwa Do
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ma Nessa Gelvosa
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Yong Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hwal Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ja Young Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Nicole L Stout
- West Virginia University School of Public Health, West Virginia University Cancer Institute, Morgantown, West Virginia, United States
| | - Young Ki Cho
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Ah Kim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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10
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Xia L, Yang C, Wang J, Liu L, Tian Y, Tang YL, Jiang F, Liu H. Posttraumatic Stress Symptoms and Attitudes toward the China Eastern Airlines Plane Crash in Transportation Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11400. [PMID: 36141672 PMCID: PMC9517083 DOI: 10.3390/ijerph191811400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
On 21 March 2022, a China Eastern Airlines plane with 132 people on board crashed and all people are presumed dead. This study aimed to explore mental health symptoms and attitudes toward the plane crash among flight and train attendant students and the general public. A cross-sectional online survey was conducted two weeks after the plane crash. Mental health symptoms, including posttraumatic stress symptoms (PTSS), depressive, anxiety, and insomnia symptoms were assessed. A total of 494 participants were included, of which 183 were flight (n = 140) and train (n = 43) attendant students (aged 17.3 ± 1.7 years, 80.9% were female), and 311 were sampled from the general population (aged 26.7 ± 7.8 years, 62.1% were female). The prevalence of depressive, anxiety, and insomnia symptoms, and PTSS was 51.9%, 40.4%, 25.1%, and 12.6% in the transportation students, and 45.3%, 36.0%, 17.4%, and 4.2% in the general public sample, respectively. The students reported more frequent insomnia symptoms and PTSS than the general public sample. In the student group, compared with those without PTSS, those with PTSS reported significantly higher rates of depressive, anxiety, and insomnia symptoms. Two weeks after a plane crash, mental health symptoms are common in the general public and transportation students, with the latter being more likely to have PTSS symptoms. Our findings suggest the importance to identify risk groups when developing interventions after indirect exposure to traumatic events.
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Affiliation(s)
- Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei 230032, China
| | - Cheng Yang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei 230032, China
| | - Jiawei Wang
- Department of Psychiatry, Bozhou People’s Hospital, Bozhou 236800, China
| | - Lewei Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei 230032, China
| | - Yinghan Tian
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei 230032, China
| | - Yi-lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA 30322, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, USA
| | - Feng Jiang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200030, China
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei 238000, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei 230032, China
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11
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Yang Y, Zhang SF, Yang BX, Li W, Sha S, Jia FJ, Cheung T, Zhang DX, Ng CH, Xiang YT. Mapping Network Connectivity Among Symptoms of Depression and Pain in Wuhan Residents During the Late-Stage of the COVID-19 Pandemic. Front Psychiatry 2022; 13:814790. [PMID: 35370830 PMCID: PMC8968182 DOI: 10.3389/fpsyt.2022.814790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Symptoms of depression and pain often overlap, and they negatively influence the prognosis and treatment outcome of both conditions. However, the comorbidity of depression and pain has not been examined using network analysis, especially in the context of a pandemic. Thus, we mapped out the network connectivity among the symptoms of depression and pain in Wuhan residents in China during the late stage of the COVID-19 pandemic. Methods This cross-sectional study was conducted from May 25, 2020 to June 18, 2020 in Wuhan, China. Participants' depressive and pain symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ9) and a pain numeric rating scale (NRS), respectively. Network analyses were performed. Results In total, 2,598 participants completed all assessments. PHQ4 (fatigue) in the depression community showed the highest strength value, followed by PHQ6 (worthlessness) and PHQ2 (depressed or sad mood). PHQ4 (fatigue) was also the most key bridge symptom liking depression and pain, followed by PHQ3 (sleep difficulties). There were no significant differences in network global strength (females: 4.36 vs. males: 4.29; S = 0.075, P = 0.427), network structure-distribution of edge weights (M = 0.12, P = 0.541), and individual edge weights between male and female participants. Conclusion Depressive and pain symptoms showed strong cross-association with each other. "Fatigue" was the strongest central and bridge symptom in the network model, while "sleep difficulties" was the second strongest bridge symptom. Targeting treatment of both fatigue and sleep problems may help improve depressive and pain symptoms in those affected.
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Affiliation(s)
- Yuan Yang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shu-Fang Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | | | - Wen Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - De-Xing Zhang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chee H. Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VA, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macau, Macao SAR, China
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12
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Liu ZH, Cai H, Bai W, Liu S, Liu H, Chen X, Qi H, Cheung T, Jackson T, Liu R, Xiang YT. Gender Differences in Body Appreciation and Its Associations With Psychiatric Symptoms Among Chinese College Students: A Nationwide Survey. Front Psychiatry 2022; 13:771398. [PMID: 35250658 PMCID: PMC8892204 DOI: 10.3389/fpsyt.2022.771398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Body appreciation (BA hereafter), which reflects approval, acceptance, and respect for one's body while also rejecting media-promoted appearance ideals as the only form of human beauty, is an important aspect of positive body image. Much of the BA literature has been conducted on samples from Western nations but less is known about BA or its correlates in Asian cultural contexts wherein concerns with body image are also common. Toward addressing this gap, we examined gender differences in BA and its associations with common psychiatric symptoms (i.e., depressive symptoms, anxiety symptoms, and suicidality) within a national college student sample from China. METHOD This cross-sectional, nationwide study was conducted between December 27, 2020, and January 18, 2021, based on snowball sampling. Aside from measures of demographics and background factors, Chinese versions of the Body Appreciation Scale-2 (BAS-2), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and a standard item on suicidal ideation and planning were administered to assess BA, depressive and anxiety symptoms, and suicidality, respectively. RESULTS In total, 2,058 college students (665 men, 1,393 women) in China were assessed. An analysis of covariance revealed that the men had a significantly higher average BA level than did women [F (1,2058) = 13.244, P < 0.001, Cohen's d = 0.193]. Hierarchical multiple regression analyses revealed BA was negatively associated with symptoms of depression, anxiety, and suicidality within the entire sample (depressive symptoms, β = -0.129, P < 0.001; anxiety symptoms, β = -0.101, P < 0.001; suicidality, OR = 0.788 P = 0.020) and among women (depressive symptoms, β = -0.172, P < 0.001; anxiety symptoms, β = -0.131, P < 0.001; suicidality, OR = 0.639 P = 0.001) but not men. CONCLUSION Chinese college women reported lower BA than their male peers did. Furthermore, among women but not men, elevations in BA corresponded with protective mental health experiences including lower levels of depressive symptoms, anxiety symptoms and suicidality. Findings underscore the potential utility of including BA in mental health assessments of Chinese college students, especially women. Findings also provide foundations for continued research on interventions to increase BA among at-risk young women in China.
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Affiliation(s)
- Zi-Han Liu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Taipa, Macao SAR, China
| | - Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Taipa, Macao SAR, China
| | - Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Taipa, Macao SAR, China
| | - Shou Liu
- Department of Public Health, Medical College, Qinghai University, Xining, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Xu Chen
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Han Qi
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Taipa, Macao SAR, China
| | - Rui Liu
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Taipa, Macao SAR, China
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13
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Zhao YJ, Zhang SF, Li W, Zhang L, Cheung T, Tang YL, Ng CH, Yang BX, Xiang YT. Mental health status and quality of life in close contacts of COVID-19 patients in the post-COVID-19 era: a comparative study. Transl Psychiatry 2021; 11:505. [PMID: 34601497 PMCID: PMC8487227 DOI: 10.1038/s41398-021-01623-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 01/19/2023] Open
Abstract
Close contacts of those with COVID-19 (CC) may experience distress and long-lasting mental health effects. However, the mental health status and quality of life (QOL) in CC have not been adequately examined. This study examined the mental health status and QOL in CC during the post-COVID-19 period. This cross-sectional study comprised 1169 CC and 1290 who were non-close contacts (non-CC). Demographic data were collected; depression, fatigue, post-traumatic stress symptoms (PTSS) and QOL were assessed using the Patient Health Questionnaire - 9 items (PHQ-9), fatigue numeric rating scale, Post-Traumatic Stress Disorder Checklist - 17 items (PCL-17), and the World Health Organization Quality of Life Questionnaire - brief version (WHOQOL-BREF), respectively. Analysis of covariance was used to compare depressive symptoms, QOL, fatigue, and PTSS between the CC and non-CC groups. Multiple logistic regression analyses were performed to determine the independent correlates for depression, fatigue, PTSS, and QOL in the CC group. Compared to the non-CC group, the CC group reported significantly more severe depression (F(1, 2458) = 5.58, p = 0.018) and fatigue (F(1, 2458) = 9.22, p = 0.002) in the post-COVID-19 period. No significant differences in PTSS and QOL between the CC and non-CC groups were found (F(1, 2458) = 2.93, p = 0.087 for PTSS; F(1, 2458) = 3.45, p = 0.064 for QOL). In the CC group, younger age, financial loss due to COVID-19, and perception of poor or fair health status were significantly associated with depression and fatigue, while frequent use of mass media was significantly associated with fatigue. In conclusion, close contacts of COVID-19 patients experienced high levels of depression and fatigue in the post-COVID-19 period. Due to the negative effects of depression and fatigue on daily functioning, early detection and timely interventions should be provided to this neglected population.
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Affiliation(s)
- Yan-Jie Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Shu-Fang Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei Province, China
| | - Wen Li
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, USA
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Bing-Xiang Yang
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China.
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14
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Zimmermann C, Pope A, Hannon B, Krzyzanowska MK, Rodin G, Li M, Howell D, Knox JJ, Leighl NB, Sridhar S, Oza AM, Prince R, Lheureux S, Hansen AR, Rydall A, Chow B, Herx L, Booth CM, Dudgeon D, Dhani N, Liu G, Bedard PL, Mathews J, Swami N, Le LW. Phase II Trial of Symptom Screening With Targeted Early Palliative Care for Patients With Advanced Cancer. J Natl Compr Canc Netw 2021; 20:361-370.e3. [PMID: 34492632 DOI: 10.6004/jnccn.2020.7803] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Routine early palliative care (EPC) improves quality of life (QoL) for patients with advanced cancer, but it may not be necessary for all patients. We assessed the feasibility of Symptom screening with Targeted Early Palliative care (STEP) in a phase II trial. METHODS Patients with advanced cancer were recruited from medical oncology clinics. Symptoms were screened at each visit using the Edmonton Symptom Assessment System-revised (ESAS-r); moderate to severe scores (screen-positive) triggered an email to a palliative care nurse, who called the patient and offered EPC. Patient-reported outcomes of QoL, depression, symptom control, and satisfaction with care were measured at baseline and at 2, 4, and 6 months. The primary aim was to determine feasibility, according to predefined criteria. Secondary aims were to assess whether STEP identified patients with worse patient-reported outcomes and whether screen-positive patients who accepted and received EPC had better outcomes over time than those who did not receive EPC. RESULTS In total, 116 patients were enrolled, of which 89 (77%) completed screening for ≥70% of visits. Of the 70 screen-positive patients, 39 (56%) received EPC during the 6-month study and 4 (6%) received EPC after the study end. Measure completion was 76% at 2 months, 68% at 4 months, and 63% at 6 months. Among screen-negative patients, QoL, depression, and symptom control were substantially better than for screen-positive patients at baseline (all P<.0001) and remained stable over time. Among screen-positive patients, mood and symptom control improved over time for those who accepted and received EPC and worsened for those who did not receive EPC (P<.01 for trend over time), with no difference in QoL or satisfaction with care. CONCLUSIONS STEP is feasible in ambulatory patients with advanced cancer and distinguishes between patients who remain stable without EPC and those who benefit from targeted EPC. Acceptance of the triggered EPC visit should be encouraged. ClinicalTrials.gov identifier: NCT04044040.
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Affiliation(s)
- Camilla Zimmermann
- 1Department of Supportive Care, and.,2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,4Division of Palliative Medicine, Department of Medicine, and.,5Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto
| | | | - Breffni Hannon
- 1Department of Supportive Care, and.,2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,4Division of Palliative Medicine, Department of Medicine, and
| | - Monika K Krzyzanowska
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | - Gary Rodin
- 1Department of Supportive Care, and.,2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,5Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto
| | - Madeline Li
- 1Department of Supportive Care, and.,2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,5Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto
| | - Doris Howell
- 1Department of Supportive Care, and.,2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,7Faculty of Nursing, University of Toronto, Toronto
| | - Jennifer J Knox
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | - Natasha B Leighl
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | - Srikala Sridhar
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | - Amit M Oza
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | - Rebecca Prince
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | - Stephanie Lheureux
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | - Aaron R Hansen
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | | | | | - Leonie Herx
- 8Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston
| | - Christopher M Booth
- 9Division of Medical Oncology, Kingston Health Sciences Centre, Kingston.,10Department of Oncology, Queen's University, Kingston.,11Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston; and
| | - Deborah Dudgeon
- 9Division of Medical Oncology, Kingston Health Sciences Centre, Kingston
| | - Neesha Dhani
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | - Geoffrey Liu
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | - Philippe L Bedard
- 2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.,3Division of Medical Oncology.,6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto
| | - Jean Mathews
- 1Department of Supportive Care, and.,4Division of Palliative Medicine, Department of Medicine, and
| | | | - Lisa W Le
- 12Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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15
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Mlakar I, Lin S, Aleksandraviča I, Arcimoviča K, Eglītis J, Leja M, Salgado Barreira Á, Gómez JG, Salgado M, Mata JG, Batorek D, Horvat M, Molan M, Ravnik M, Kaux JF, Bleret V, Loly C, Maquet D, Sartini E, Smrke U. Patients-centered SurvivorShIp care plan after Cancer treatments based on Big Data and Artificial Intelligence technologies (PERSIST): a multicenter study protocol to evaluate efficacy of digital tools supporting cancer survivors. BMC Med Inform Decis Mak 2021. [PMID: 34391413 DOI: 10.1186/isrctn97617326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is encouraging to see a substantial increase in individuals surviving cancer. Even more so since most of them will have a positive effect on society by returning to work. However, many cancer survivors have unmet needs, especially when it comes to improving their quality of life (QoL). Only few survivors are able to meet all of the recommendations regarding well-being and there is a body of evidence that cancer survivors' needs often remain neglected from health policy and national cancer control plans. This increases the impact of inequalities in cancer care and adds a dangerous component to it. The inequalities affect the individual survivor, their career, along with their relatives and society as a whole. The current study will evaluate the impact of the use of big data analytics and artificial intelligence on the self-efficacy of participants following intervention supported by digital tools. The secondary endpoints include evaluation of the impact of patient trajectories (from retrospective data) and patient gathered health data on prediction and improved intervention against possible secondary disease or negative outcomes (e.g. late toxicities, fatal events). METHODS/DESIGN The study is designed as a single-case experimental prospective study where each individual serves as its own control group with basal measurements obtained at the recruitment and subsequent measurements performed every 6 months during follow ups. The measurement will involve CASE-cancer, Patient Activation Measure and System Usability Scale. The study will involve 160 survivors (80 survivors of Breast Cancer and 80 survivors of Colorectal Cancer) from four countries, Belgium, Latvia, Slovenia, and Spain. The intervention will be implemented via a digital tool (mHealthApplication), collecting objective biomarkers (vital signs) and subjective biomarkers (PROs) with the support of a (embodied) conversational agent. Additionally, the Clinical Decision Support system (CDSS), including visualization of cohorts and trajectories will enable oncologists to personalize treatment for an efficient care plan and follow-up management. DISCUSSION We expect that cancer survivors will significantly increase their self-efficacy following the personalized intervention supported by the m-HealthApplication compared to control measurements at recruitment. We expect to observe improvement in healthy habits, disease self-management and self-perceived QoL. Trial registration ISRCTN97617326. https://doi.org/10.1186/ISRCTN97617326 . Original Registration Date: 26/03/2021.
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Affiliation(s)
- Izidor Mlakar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000, Maribor, Slovenia.
| | - Simon Lin
- Data Science Department, Symptoma, Vienna, Austria.,Department of Internal Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Ilona Aleksandraviča
- Institute of Clinical and Preventive Medicine of the University of Latvia, Riga, Latvia
| | | | - Jānis Eglītis
- Riga East Clinical University Hospital, Riga, Latvia
| | - Mārcis Leja
- Institute of Clinical and Preventive Medicine of the University of Latvia, Riga, Latvia
| | | | - Jesús G Gómez
- SERGAS - Galician Healthcare Service, Galicia, Spain
| | | | - Jesús G Mata
- SERGAS - Galician Healthcare Service, Galicia, Spain
| | | | - Matej Horvat
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Maja Molan
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Maja Ravnik
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, Centre Hospitalier Universitaire de Liège, Université de Liège, Liege, Belgium
| | - Valérie Bleret
- Service of Sénologie, Centre Hospitalier Universitaire de Liège, Liege, Belgium
| | - Catherine Loly
- Department of Gastroenterology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Didier Maquet
- Physical and Rehabilitation Medicine Department, Centre Hospitalier Universitaire de Liège, Université de Liège, Liege, Belgium
| | | | - Urška Smrke
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000, Maribor, Slovenia
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16
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Mlakar I, Lin S, Aleksandraviča I, Arcimoviča K, Eglītis J, Leja M, Salgado Barreira Á, Gómez JG, Salgado M, Mata JG, Batorek D, Horvat M, Molan M, Ravnik M, Kaux JF, Bleret V, Loly C, Maquet D, Sartini E, Smrke U. Patients-centered SurvivorShIp care plan after Cancer treatments based on Big Data and Artificial Intelligence technologies (PERSIST): a multicenter study protocol to evaluate efficacy of digital tools supporting cancer survivors. BMC Med Inform Decis Mak 2021; 21:243. [PMID: 34391413 PMCID: PMC8364016 DOI: 10.1186/s12911-021-01603-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/05/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND It is encouraging to see a substantial increase in individuals surviving cancer. Even more so since most of them will have a positive effect on society by returning to work. However, many cancer survivors have unmet needs, especially when it comes to improving their quality of life (QoL). Only few survivors are able to meet all of the recommendations regarding well-being and there is a body of evidence that cancer survivors' needs often remain neglected from health policy and national cancer control plans. This increases the impact of inequalities in cancer care and adds a dangerous component to it. The inequalities affect the individual survivor, their career, along with their relatives and society as a whole. The current study will evaluate the impact of the use of big data analytics and artificial intelligence on the self-efficacy of participants following intervention supported by digital tools. The secondary endpoints include evaluation of the impact of patient trajectories (from retrospective data) and patient gathered health data on prediction and improved intervention against possible secondary disease or negative outcomes (e.g. late toxicities, fatal events). METHODS/DESIGN The study is designed as a single-case experimental prospective study where each individual serves as its own control group with basal measurements obtained at the recruitment and subsequent measurements performed every 6 months during follow ups. The measurement will involve CASE-cancer, Patient Activation Measure and System Usability Scale. The study will involve 160 survivors (80 survivors of Breast Cancer and 80 survivors of Colorectal Cancer) from four countries, Belgium, Latvia, Slovenia, and Spain. The intervention will be implemented via a digital tool (mHealthApplication), collecting objective biomarkers (vital signs) and subjective biomarkers (PROs) with the support of a (embodied) conversational agent. Additionally, the Clinical Decision Support system (CDSS), including visualization of cohorts and trajectories will enable oncologists to personalize treatment for an efficient care plan and follow-up management. DISCUSSION We expect that cancer survivors will significantly increase their self-efficacy following the personalized intervention supported by the m-HealthApplication compared to control measurements at recruitment. We expect to observe improvement in healthy habits, disease self-management and self-perceived QoL. Trial registration ISRCTN97617326. https://doi.org/10.1186/ISRCTN97617326 . Original Registration Date: 26/03/2021.
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Affiliation(s)
- Izidor Mlakar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000, Maribor, Slovenia.
| | - Simon Lin
- Data Science Department, Symptoma, Vienna, Austria
- Department of Internal Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Ilona Aleksandraviča
- Institute of Clinical and Preventive Medicine of the University of Latvia, Riga, Latvia
| | | | - Jānis Eglītis
- Riga East Clinical University Hospital, Riga, Latvia
| | - Mārcis Leja
- Institute of Clinical and Preventive Medicine of the University of Latvia, Riga, Latvia
| | | | - Jesús G Gómez
- SERGAS - Galician Healthcare Service, Galicia, Spain
| | | | - Jesús G Mata
- SERGAS - Galician Healthcare Service, Galicia, Spain
| | | | - Matej Horvat
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Maja Molan
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Maja Ravnik
- Univerzitetni Klinicni Center Maribor, Maribor, Slovenia
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, Centre Hospitalier Universitaire de Liège, Université de Liège, Liege, Belgium
| | - Valérie Bleret
- Service of Sénologie, Centre Hospitalier Universitaire de Liège, Liege, Belgium
| | - Catherine Loly
- Department of Gastroenterology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Didier Maquet
- Physical and Rehabilitation Medicine Department, Centre Hospitalier Universitaire de Liège, Université de Liège, Liege, Belgium
| | | | - Urška Smrke
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, 2000, Maribor, Slovenia
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17
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Rapin L, Gamaoun R, El Hage C, Arboleda MF, Prosk E. Cannabidiol use and effectiveness: real-world evidence from a Canadian medical cannabis clinic. J Cannabis Res 2021; 3:19. [PMID: 34162446 PMCID: PMC8223341 DOI: 10.1186/s42238-021-00078-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/07/2021] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Cannabidiol (CBD) is a primary component in the cannabis plant; however, in recent years, interest in CBD treatments has outpaced scientific research and regulatory advancement resulting in a confusing landscape of misinformation and unsubstantiated health claims. Within the limited results from randomized controlled trials, and lack of trust in product quality and known clinical guidelines and dosages, real-world evidence (RWE) from countries with robust regulatory frameworks may fill a critical need for patients and healthcare professionals. Despite growing evidence and interest, no real-world data (RWD) studies have yet investigated patients' reports of CBD impact on symptom control in the common expression of pain, anxiety, depression, and poor wellbeing. The objective of this study is to assess the impact of CBD-rich treatment on symptom burden, as measured with a specific symptom assessment scale (ESAS-r). METHODS This retrospective observational study examined pain, anxiety, depression symptoms, and wellbeing in 279 participants over 18 years old, prescribed with CBD-rich treatment at a network of clinics dedicated to medical cannabis in Quebec, Canada. Data were collected at baseline, 3 (FUP1), and 6 (FUP2) month after treatment initiation. Groups were formed based on symptom severity (mild vs moderate/severe) and based on changes to treatment plan at FUP1 (CBD vs THC:CBD). Two-way mixed ANOVAs were used to assess ESAS-r scores differences between groups and between visits. RESULTS All average ESAS-r scores decreased between baseline and FUP1 (all ps < 0.003). The addition of delta-9-tetrahydrocannabinol (THC) during the first follow-up had no effect on symptom changes. Patients with moderate/severe symptoms experienced important improvement at FUP1 (all ps < 0.001), whereas scores on pain, anxiety, and wellbeing of those with mild symptoms actually increased. Differences in ESAS-r scores between FUP1 and FUP2 were not statistically different. CONCLUSION This retrospective observational study suggests CBD-rich treatment has a beneficial impact on pain, anxiety, and depression symptoms as well as overall wellbeing only for patients with moderate to severe symptoms; however, no observed effect on mild symptoms. The results of this study contribute to address the myths and misinformation about CBD treatment and demand further investigation.
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Affiliation(s)
- Lucile Rapin
- Research Department, Santé Cannabis, 4150 Ste-Catherine O. Bureau 225, Montréal, QC, H3Z 2Y5, Canada.
| | - Rihab Gamaoun
- Research Department, Santé Cannabis, 4150 Ste-Catherine O. Bureau 225, Montréal, QC, H3Z 2Y5, Canada
| | - Cynthia El Hage
- Research Department, Santé Cannabis, 4150 Ste-Catherine O. Bureau 225, Montréal, QC, H3Z 2Y5, Canada
| | - Maria Fernanda Arboleda
- Research Department, Santé Cannabis, 4150 Ste-Catherine O. Bureau 225, Montréal, QC, H3Z 2Y5, Canada
| | - Erin Prosk
- Research Department, Santé Cannabis, 4150 Ste-Catherine O. Bureau 225, Montréal, QC, H3Z 2Y5, Canada
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18
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Wei X, Yu H, Dai W, Mu Y, Wang Y, Liao J, Peng L, Han Y, Li Q, Shi Q. Patient-Reported Outcomes of Video-Assisted Thoracoscopic Surgery Versus Thoracotomy for Locally Advanced Lung Cancer: A Longitudinal Cohort Study. Ann Surg Oncol 2021; 28:8358-8371. [PMID: 33880671 DOI: 10.1245/s10434-021-09981-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effects of video-assisted thoracoscopic surgery (VATS) and traditional thoracotomy with respect to patient-reported outcomes (PROs) have only been assessed for early-stage lung cancer. This study was a longitudinal PRO assessment to compare the effects of these surgeries for locally advanced (stage II and III) lung cancer from the patients' perspective. METHODS We investigated lung cancer patients from a previous prospective, multicentre study. Longitudinal data of clinical characteristics and PROs were collected. PROs were obtained preoperatively, daily in the hospital postoperatively, and weekly up to 4 weeks after discharge or the beginning of postoperative adjuvant therapy. Symptoms and impact on daily functioning and quality of life (QOL) were assessed by using the MD Anderson Symptom Inventory for lung cancer and a single-item QOL scale. Trajectories of PROs over the investigation period were compared. RESULTS Overall, 117 primary lung cancer patients (stage II or III), including 63 and 54 patients who underwent VATS and traditional thoracotomy, respectively, were included. During postoperative hospitalization, VATS patients reported milder disturbed sleep (p = 0.048), drowsiness (p = 0.008), and interference with activity (p = 0.001), as well as better work ability (p < 0.0001), walking ability (p < 0.0001), and life enjoyment (p = 0.004). Post-discharge, VATS patients had less distress (p = 0.039), milder pain (p = 0.006), better work ability (p = 0.001), and better QOL (p = 0.047). CONCLUSIONS Locally advanced lung cancer patients who underwent VATS had lower postoperative symptom burden, less daily function interference, and better QOL than those who underwent thoracotomy.
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Affiliation(s)
- Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Hongfan Yu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yunfei Mu
- Department of Thoracic Surgery, Chengdu Third People's Hospital, Chengdu, Sichuan, China
| | - Yaqin Wang
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jia Liao
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lin Peng
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiuling Shi
- School of Public Health and Management, Chongqing Medical University, Chongqing, China. .,Center for Cancer Prevention Research, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
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19
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Pearson EJ, Drosdowsky A, Edbrooke L, Denehy L. Exploring the Use of Two Brief Fatigue Screening Tools in Cancer Outpatient Clinics. Integr Cancer Ther 2021; 20:1534735420983443. [PMID: 33522317 PMCID: PMC7871054 DOI: 10.1177/1534735420983443] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Cancer fatigue guidelines recommend routine fatigue screening, with further assessment for people reporting moderate to severe fatigue. There is neither a gold-standard, nor a broadly accepted screening method, and knowledge about the impact of screening on care processes is limited. This study aimed to explore the feasibility of 2 fatigue screening methods and current clinical practice in cancer outpatient clinics. METHODS Hospital outpatients attending cancer clinics during 1 week completed a five-item survey: a numeric scale for current tiredness, 2 categorical pictorial scales rating tiredness last week and the impact of fatigue (Fatigue Pictogram), screening tool preference and help needed for survey completion. Participant demographics and fatigue documentation by clinical staff for that appointment were extracted from medical records. Analyses used descriptive statistics. Groups were compared using appropriate statistical tests. RESULTS Over 75% of participants rated their fatigue consistently as mild or significant on both screening tools. Of 1709 eligible outpatients, 533 (31%) completed the survey. Records were audited for 430 (81%) identifiable participants. Over half of the participants reported moderate or severe tiredness either "now" (237, 57%) and/or "last week" (226, 53%). Clinician documentation of fatigue seldom matched self-reports. Fatigue was rated as severe by 103 participants (24%), yet was noted in only 21 (20%) of these individuals' clinical notes. Both screening tools were equally preferred. CONCLUSION The numeric rating scale and Fatigue Pictogram are equally applicable for screening fatigue in cancer outpatient care. There is a high prevalence of clinically significant fatigue in a hospital outpatient setting that is not documented. Adequate care pathways for further management should be established alongside fatigue screening.
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Affiliation(s)
- Elizabeth J Pearson
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Allison Drosdowsky
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lara Edbrooke
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Denehy
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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20
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Ji X, Li W, Zhu H, Zhang L, Cheung T, Ng CH, Xiang YT. Fatigue and Its Association With Quality of Life Among Carers of Patients Attending Psychiatric Emergency Services During the COVID-19 Pandemic. Front Psychiatry 2021; 12:681318. [PMID: 34239464 PMCID: PMC8257938 DOI: 10.3389/fpsyt.2021.681318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
Aims: Carers of psychiatric patients often suffered from mental and physical burden during the coronavirus disease 2019 (COVID-19) pandemic due to the lack of mental health services. This study investigated the pattern of fatigue and its association with quality of life (QOL) among the carers of patients attending psychiatric emergency services during the COVID-19 pandemic. Methods: In this cross-sectional study, carers of patients attending psychiatric emergency services during the COVID-19 pandemic were consecutively included. Fatigue, insomnia symptoms, depressive symptoms, and QOL were assessed with standardized instruments. Results: A total of 496 participants were included. The prevalence of fatigue was 44.0% (95% CI = 39.6-48.4%). Multivariate logistic regression analysis revealed that fatigue was positively associated with higher education level (OR = 1.92, P < 0.01) and more severe depressive (OR = 1.18, P < 0.01) and insomnia symptoms (OR = 1.11, P < 0.01). ANCOVA analysis revealed that the QOL was significantly lower in carers with fatigue compared with those without (P = 0.03). Conclusions: Fatigue was common among carers of patients attending psychiatric emergency services during the COVID-19 pandemic. Considering the adverse impact of fatigue on QOL and other health outcomes, routine screening and appropriate intervention for fatigue are warranted for this subpopulation.
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Affiliation(s)
- Xiao Ji
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Wen Li
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
| | - Hui Zhu
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ling Zhang
- Beijing Key Laboratory of Mental Disorders, The National Clinical Research Center for Mental Disorders, The Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic, St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
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21
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Yuan Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, Cheung T, Jackson T, Jiang GQ, Xiang YT. Prevalence of Post-traumatic Stress Symptoms and Its Associations With Quality of Life, Demographic and Clinical Characteristics in COVID-19 Survivors During the Post-COVID-19 Era. Front Psychiatry 2021; 12:665507. [PMID: 34093279 PMCID: PMC8176302 DOI: 10.3389/fpsyt.2021.665507] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The prevalence of post-traumatic stress symptoms (PTSS) in COVID-19 survivors is unclear. This study examined the prevalence of PTSS and its association with quality of life (QOL) among COVID-19 survivors during the post-COVID-19 era in China. Methods: This was a comparative, cross-sectional study. PTSS, depressive symptoms, and QOL were assessed with standardized instruments. Results: A total of 134 COVID-19 survivors and 214 non-infected controls (healthy controls hereafter) were recruited. Among COVID-19 survivors, the PTSS prevalence was 18.66% (95%CI: 11.98-25.34%), which was significantly higher than that (5.61%, 95%CI: 2.50-8.71%) of healthy controls (P < 0.001). After controlling for covariates, an analysis of covariance (ANCOVA) showed that COVID-19 survivors had a higher PTSS total score than did healthy controls [F (1,348) = 4.664, P = 0.032]. A separate ANCOVA revealed there were no significant differences in overall QOL between COVID-19 survivors with and without PTSS [F (1,348) = 1.067, P = 0.304]. A multiple logistic regression analysis showed that more severe depressive symptoms were significantly associated with PTSS in COVID-19 survivors (OR = 1.425, P < 0.001). Conclusions: PTSS were more severe in COVID-19 survivors compared to healthy controls in the post-COVID-19 era. Considering their negative impact on daily life and functional outcomes, regular assessment and appropriate treatments of PTSS should be conducted in COVID-19 survivors.
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Affiliation(s)
- Yuan Yuan
- Chongqing Mental Health Center, Chongqing, China
| | - Zi-Han Liu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
| | - Yan-Jie Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders, School of Mental Health, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China.,The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders, School of Mental Health, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China.,The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Macau, China
| | | | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
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22
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Zou S, Liu ZH, Yan X, Wang H, Li Y, Xu X, Du X, Zhang L, Zhang Q, Jackson T, Ungvari GS, Xiang YT. Prevalence and correlates of fatigue and its association with quality of life among clinically stable older psychiatric patients during the COVID-19 outbreak: a cross-sectional study. Global Health 2020; 16:119. [PMID: 33339523 PMCID: PMC7748982 DOI: 10.1186/s12992-020-00644-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background The pattern of fatigue in older psychiatric patients during the COVID-19 outbreak was unknown. This study examined the prevalence of fatigue and its association with overall quality of life (overall QOL) in clinically stable older patients with psychiatric disorders during the COVID-19 outbreak. Methods This was a multicenter, cross-sectional study. Fatigue, depressive symptoms, pain, insomnia symptoms, and overall QOL were assessed with standardized instruments. Results A total of 1063 patients were recruited. The prevalence of fatigue was 47.1% (95%CI: 44.1–50.1%). An analysis of covariance revealed that overall QOL was significantly lower in patients with fatigue compared to those without (P = 0.011). A multiple logistic regression analysis revealed that more severe depressive symptoms (OR = 1.15, P < 0.001), insomnia symptoms (OR = 1.08, P < 0.001) and pain (OR = 1.43, P < 0.001) were significantly associated with fatigue. Conclusions Fatigue is common among clinically stable older patients with psychiatric disorders during the COVID-19 outbreak. Considering its negative impact on overall QOL, regular assessment of fatigue and appropriate treatment warrant attention in this subpopulation.
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Affiliation(s)
- Siyun Zou
- Medical College of Soochow University, Suzhou, Jiangsu Province, China.,Guangji Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Zi-Han Liu
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Building E12, Avenida da Universidade, Taipa, Macau SAR, China.,Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Xiaona Yan
- Department of Psychiatry, Xiamen Xianyue Hospital, Xiamen, China
| | - Huan Wang
- Department of Psychiatry, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Yulong Li
- Department of Psychiatry, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Xiuying Xu
- Department of Psychiatry, Xiamen Xianyue Hospital, Xiamen, China
| | - Xiangdong Du
- Medical College of Soochow University, Suzhou, Jiangsu Province, China.,Guangji Hospital Affiliated to Soochow University, Suzhou, Jiangsu Province, China
| | - Lan Zhang
- Department of Psychiatry, Lanzhou University Second Hospital, Lanzhou, Gansu Province, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China.
| | - Todd Jackson
- Department of Psychology, University of Macau, Macau SAR, China
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia.,University of Notre Dame Australia, Fremantle, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Building E12, Avenida da Universidade, Taipa, Macau SAR, China. .,Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China. .,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China.
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23
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Lee MK, Schalet BD, Cella D, Yost KJ, Dueck AC, Novotny PJ, Sloan JA. Establishing a common metric for patient-reported outcomes in cancer patients: linking patient reported outcomes measurement information system (PROMIS), numerical rating scale, and patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Patient Rep Outcomes 2020; 4:106. [PMID: 33305344 PMCID: PMC7728866 DOI: 10.1186/s41687-020-00271-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Researchers and clinicians studying symptoms experienced by people with cancer must choose from various scales. It would be useful to know how the scores on one measure translate to another. METHODS Using item response theory (IRT) with the single-group design, in which the same sample answers all measures, we produced crosswalk tables linking five 0-10 numeric rating scale (NRS) and 15 items from Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE, scored on a 1-5 scale) to the T-Score metric of six different scales from the NIH Patient reported Outcomes Measurement Information System (PROMIS®). The constructs, for which we conducted linking, include emotional distress-anxiety, emotional distress-depression, fatigue, sleep disturbance, pain intensity, and pain interference. We tested the IRT linking assumption of construct similarity between measures by comparing item content and testing unidimensionality of item sets comprising each construct. We also investigated the correlation of the measures to be linked and, by inspecting standardized mean differences, whether the linkage is invariant across age and gender subgroups. For measures that satisfied the assumptions, we conducted linking. RESULTS In general, an NRS score of 0 corresponded to about 38.2 on the PROMIS T-Score scale (mean = 50; SD = 10); whereas an NRS score of 10 corresponded to a PROMIS T-Score of approximately 72.7. Similarly, the lowest/best score of 1 on PRO-CTCAE corresponded to 39.8 on T-score scale and the highest/worst score of 5 corresponded to 72.0. CONCLUSION We produced robust linking between single item symptom measures and PROMIS short forms.
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Affiliation(s)
- Minji K Lee
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN, 55906, USA.
| | - Benjamin D Schalet
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 27th Floor, Chical, IL, 60611, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 27th Floor, Chical, IL, 60611, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Amylou C Dueck
- Department of Health Sciences Research, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Paul J Novotny
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jeff A Sloan
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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24
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Keijsers NLW, Ter Stal M, Jonkergouw N, Helmhout PH. Musculoskeletal complaints in military recruits during their basic training. BMJ Mil Health 2020; 168:260-265. [PMID: 33122401 DOI: 10.1136/bmjmilitary-2020-001461] [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: 03/16/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Overuse injuries often start with a musculoskeletal complaint, which can progress over time to an injury. Little or no information is known about the development and severity of overuse injuries in military recruits. This study describes the musculoskeletal complaints in Dutch military recruits during their basic training and examines potential predictive factors for dropout due to injury. METHODS In this prospective cohort study, Dutch military recruits reported complaints of the lower body weekly using a Numeric Rating Scale (NRS) pain score chart during their basic training. Number, location and severity of complaints during each of the first 12 weeks of basic training were analysed. RESULTS Of the 930 recruits, 61% reported an NRS pain score of 3 or higher and 34% reported an NRS pain score of 5 or higher at least once. Complaints were mostly reported in the foot and ankle region and least reported in the upper leg region. Injury dropouts (11%) showed significantly higher proportions of complaints and higher maximal pain scores throughout most weeks of basic training. The maximal NRS pain score of the first two weeks was the strongest predictor of dropping out due to injury. CONCLUSIONS Recruits who drop out due to injury report more severe complaints throughout basic training. Focusing on musculoskeletal complaints in the first phase of training seems helpful to identify recruits who are at risk of developing an injury.
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Affiliation(s)
- Noel L W Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - M Ter Stal
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - N Jonkergouw
- Department of research and development, Military Rehabilitation Center Aardenburg, Doorn, The Netherlands
| | - P H Helmhout
- Department of Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, The Netherlands
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25
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Lee G, Kim HS, Lee SW, Park YR, Kim EH, Lee B, Hu YJ, Kim KA, Kim D, Cho HY, Kang B, Choi HJ. Pre-screening of patient-reported symptoms using the Edmonton Symptom Assessment System in outpatient palliative cancer care. Eur J Cancer Care (Engl) 2020; 29:e13305. [PMID: 33016473 DOI: 10.1111/ecc.13305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/24/2020] [Accepted: 08/07/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Although early palliative care is associated with a better quality of life and improved outcomes in end-of-life cancer care, the criteria of palliative care referral are still elusive. METHODS We collected patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS) at the baseline, first and second follow-up visits. A total of 71 patients were evaluable, with a median age of 65 years, male (62%) and Eastern Cooperative Oncology Group (ECOG) performance status distribution of 1/2/3 (28%/39%/33%) respectively. RESULTS Twenty (28%) patients had moderate/severe symptom burden with the mean ESAS ≥ 5. Interestingly, most of the patients with moderate/severe symptom burdens (ESAS ≥ 5) had globally elevated symptom expression. While the mean ESAS score was maintained in patients with mild symptom burden (ESAS < 5; 2.7 at the baseline; 3.4 at the first follow-up; 3.0 at the second follow-up; p = .117), there was significant symptom improvement in patients with moderate/severe symptom burden (ESAS ≥ 5; 6.5 at the baseline; 4.5 at the first follow-up; 3.6 at the second follow-up; p < .001). CONCLUSIONS In conclusion, advanced cancer patients with ESAS ≥ 5 may benefit from outpatient palliative cancer care. Pre-screening of patient-reported symptoms using ESAS can be useful for identifying unmet palliative care needs in advanced cancer patients.
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Affiliation(s)
- Garden Lee
- Division of Hematology Oncology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Han Sang Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.,Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Korea
| | - Si Won Lee
- Palliative Care Center, Yonsei Cancer Center, Seoul, South Korea
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Hwa Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Bori Lee
- Palliative Care Center, Yonsei Cancer Center, Seoul, South Korea
| | - Youn Jung Hu
- Palliative Care Center, Yonsei Cancer Center, Seoul, South Korea
| | - Kyung-A Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - DooA Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.,Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Yeon Cho
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.,Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Korea
| | - Beodeul Kang
- Medical Oncology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Hye Jin Choi
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.,Palliative Care Center, Yonsei Cancer Center, Seoul, South Korea
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Cheon J, Lee YJ, Jo JC, Kweon K, Koh S, Min YJ, Park SH, Lee SH, Kim HJ, Choi Y. Late complications and quality of life assessment for survivors receiving allogeneic hematopoietic stem cell transplantation. Support Care Cancer 2020; 29:975-986. [PMID: 32556712 DOI: 10.1007/s00520-020-05572-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/11/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE The survival rates of patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) have improved. However, HSCT can induce significant long-term complications. Therefore, we investigated the late complications and risk factors for quality of life (QOL) post-HSCT. METHODS We retrospectively analyzed 67 adult survivors over 2 years after HSCT between 2015 and 2018 at Ulsan University Hospital, Ulsan, Korea. The survey data including FACT-BMT, Hospital Anxiety and Depression Scale, and NCCN Distress Thermometer were collected as patient-reported outcomes using a tablet PC during a routine practice of survivorship clinic. RESULTS The median age was 46 years. The most common symptom was fatigue (80.6%). Younger age (< 60 years), acute lymphoblastic leukemia (ALL), chronic graft-versus-host disease (GVHD), and immunosuppressant use were significantly associated with worse QOL and depression. Additionally, younger survivors (< 60 years) showed significantly more fatigue and anxiety compared with elderly survivors (≥ 60 years). Female sex was significantly associated with lower physical well-being and higher distress than male sex. CONCLUSION Younger patients (< 60 years), female, ALL, chronic GVHD, and continuous immunosuppressant use were significant risk factors for worse QOL and depression. Hence, creating a more active survivorship care plan after HSCT, specifically for these patients, is required.
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Affiliation(s)
- Jaekyung Cheon
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwandoro, Dong-gu, Ulsan, 44033, South Korea
| | - Yoo Jin Lee
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwandoro, Dong-gu, Ulsan, 44033, South Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwandoro, Dong-gu, Ulsan, 44033, South Korea
| | - Kukju Kweon
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwandoro, Dong-gu, Ulsan, 44033, South Korea
| | - SuJin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwandoro, Dong-gu, Ulsan, 44033, South Korea
| | - Young Ju Min
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwandoro, Dong-gu, Ulsan, 44033, South Korea
| | - Sang-Hyuk Park
- Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwandoro, Dong-gu, Ulsan, 44033, South Korea
| | - Sin-Hye Lee
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwandoro, Dong-gu, Ulsan, 44033, South Korea
| | - Hyo-Jin Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwandoro, Dong-gu, Ulsan, 44033, South Korea
| | - Yunsuk Choi
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwandoro, Dong-gu, Ulsan, 44033, South Korea.
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Guillaume E, Daguenet E, Lahmamssi C, Ben Mrad M, Jmour O, Langrand-Escure J, Rehailia-Blanchard A, Vial N, Pigné G, Bard-Reboul S, Maison M, Tinquaut F, Vallard A, Magné N. [Predictors of asthenia in breast and prostate cancer patients undergoing curative radiotherapy]. Cancer Radiother 2020; 24:15-20. [PMID: 31983629 DOI: 10.1016/j.canrad.2019.09.005] [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: 08/20/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients frequently report asthenia during radiation. The present study aimed at identifying the correlation between numerous clinical and tumoral factors and asthenia in breast and prostate cancer patients treated by curative radiotherapy. MATERIALS AND METHODS A retrospective study was conducted at the Lucien Neuwirth Cancer Institute (France). All breast and prostate cancer patients undergoing curative radiotherapy during 2015 were screened (n=806). Patient's self-evaluation of asthenia and radiotherapy tolerance was assessed through verbal analogic scale (0/10 to 10/10). Data about toxicities, travel distance and travel time, tumor's characteristics, radiotherapy treatment planning, previous cancer therapies, were collected from medical records. RESULTS 500 patients were included (350 in the breast cancer group and 150 in the prostate cancer group). In all, 86% of patients in the breast cancer group reported asthenia, with a 5/10 median score. In all, 54% of patients in the prostate cancer group reported asthenia, with a 2/10 median score. Univariate analysis showed correlation between asthenia and radiotherapy tolerance as well as tumor staging, in the prostate cancer group. No other correlation was evidenced. CONCLUSION Radiotherapy-related fatigue is a common side effect. This study showed that most of the factors related to patients or disease that are commonly used to explain fatigue during curative treatments, seem finally to be not correlated with asthenia.
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Affiliation(s)
- E Guillaume
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - E Daguenet
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France; Département universitaire de la recherche et de l'enseignement, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France; UMR CNRS5822/IN2P3, IPNL, PRISME, laboratoire de radiobiologie cellulaire et moléculaire, 69622 Villeurbanne, France
| | - C Lahmamssi
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - M Ben Mrad
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - O Jmour
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - J Langrand-Escure
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - A Rehailia-Blanchard
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - N Vial
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - G Pigné
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - S Bard-Reboul
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - M Maison
- Département universitaire de la recherche et de l'enseignement, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - F Tinquaut
- Département universitaire de la recherche et de l'enseignement, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France
| | - A Vallard
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France; UMR CNRS5822/IN2P3, IPNL, PRISME, laboratoire de radiobiologie cellulaire et moléculaire, 69622 Villeurbanne, France
| | - N Magné
- Département de radiothérapie, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France; Département universitaire de la recherche et de l'enseignement, Institut de cancérologie Lucien Neuwirth, 42270 Saint-Priest-en-Jarez, France; UMR CNRS5822/IN2P3, IPNL, PRISME, laboratoire de radiobiologie cellulaire et moléculaire, 69622 Villeurbanne, France.
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Rotgans JI, Rajalingam P, Ferenczi MA, Low-Beer N. A Students’ Model of Team-based Learning. HEALTH PROFESSIONS EDUCATION 2019. [DOI: 10.1016/j.hpe.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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29
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PROMIS 4-item measures and numeric rating scales efficiently assess SPADE symptoms compared with legacy measures. J Clin Epidemiol 2019; 115:116-124. [DOI: 10.1016/j.jclinepi.2019.06.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/17/2019] [Accepted: 06/30/2019] [Indexed: 11/24/2022]
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30
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Lee E, Takita C, Wright JL, Slifer SH, Martin ER, Urbanic JJ, Langefeld CD, Lesser GJ, Shaw EG, Hu JJ. Genome-wide enriched pathway analysis of acute post-radiotherapy pain in breast cancer patients: a prospective cohort study. Hum Genomics 2019; 13:28. [PMID: 31196165 PMCID: PMC6567461 DOI: 10.1186/s40246-019-0212-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adjuvant radiotherapy (RT) can increase the risk of developing pain; however, the molecular mechanisms of RT-related pain remain unclear. The current study aimed to identify susceptibility loci and enriched pathways for clinically relevant acute post-RT pain, defined as having moderate to severe pain (pain score ≥ 4) at the completion of RT. METHODS We conducted a genome-wide association study (GWAS) with 1,344,832 single-nucleotide polymorphisms (SNPs), a gene-based analysis using PLINK set-based tests of 19,621 genes, and a functional enrichment analysis of a gene list of 875 genes with p < 0.05 using NIH DAVID functional annotation module with KEGG pathways and GO terms (n = 380) among 1112 breast cancer patients. RESULTS About 29% of patients reported acute post-RT pain. None of SNPs nor genes reached genome-wide significant level. Four SNPs showed suggestive associations with post-RT pain; rs16970540 in RFFL or near the LIG3 gene (p = 1.7 × 10-6), rs4584690, and rs7335912 in ABCC4/MPR4 gene (p = 5.5 × 10-6 and p = 7.8 × 10-6, respectively), and rs73633565 in EGFL6 gene (p = 8.1 × 10-6). Gene-based analysis suggested the potential involvement of neurotransmitters, olfactory receptors, and cytochrome P450 in post-RT pain, whereas functional analysis showed glucuronidation (FDR-adjusted p value = 9.46 × 10-7) and olfactory receptor activities (FDR-adjusted p value = 0.032) as the most significantly enriched biological features. CONCLUSIONS This is the first GWAS suggesting that post-RT pain is a complex polygenic trait influenced by many biological processes and functions such as glucuronidation and olfactory receptor activities. If validated in larger populations, the results can provide biological targets for pain management to improve cancer patients' quality of life. Additionally, these genes can be further tested as predictive biomarkers for personalized pain management.
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Affiliation(s)
- Eunkyung Lee
- Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, Orlando, FL, 32816, USA.
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
| | - Cristiane Takita
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, 21231, USA
| | - Susan H Slifer
- The Center for Genetic Epidemiology and Statistical Genetics, Joph P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Eden R Martin
- The Center for Genetic Epidemiology and Statistical Genetics, Joph P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - James J Urbanic
- Wake Forest NCORP Research Base, Winston-Salem, NC, 27157, USA
| | | | - Glenn J Lesser
- Wake Forest NCORP Research Base, Winston-Salem, NC, 27157, USA
| | - Edward G Shaw
- Wake Forest NCORP Research Base, Winston-Salem, NC, 27157, USA
| | - Jennifer J Hu
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
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31
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Gonzalez A, Shim M, Mahaffey B, Vranceanu AM, Reffi A, Park ER. The Relaxation Response Resiliency Program (3RP) in Patients with Headache and Musculoskeletal Pain: A Retrospective Analysis of Clinical Data. Pain Manag Nurs 2019; 20:70-74. [DOI: 10.1016/j.pmn.2018.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/26/2018] [Accepted: 04/01/2018] [Indexed: 10/27/2022]
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32
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Trotter P, Hill QA. Immune thrombocytopenia: improving quality of life and patient outcomes. PATIENT-RELATED OUTCOME MEASURES 2018; 9:369-384. [PMID: 30568522 PMCID: PMC6267629 DOI: 10.2147/prom.s140932] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia (ITP) is an immune-mediated disorder characterized by a reduced platelet count and patients may develop bruising or mucosal bleeding. Since 2003, generic health-related quality of life (HRQoL) measures have been applied and ITP-specific measures developed, alongside trials of novel therapeutic agents. These have identified significant morbidity in patients with ITP, including fatigue, fear of bleeding and a negative impact on role, social and work activities. This review critically evaluates HRQoL data in adults and children with ITP. It also considers the impact of treatment and how patient-reported outcomes might be applied to care to optimize patients' quality of life.
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Affiliation(s)
- Patrick Trotter
- Department of Surgery, University of Cambridge, Cambridge, UK.,National Health Service Blood and Transplant, Organ Donation and Transplant Directorate, Bristol, UK
| | - Quentin A Hill
- Department of Haematology, St James's University Hospital, Leeds, UK,
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Do JH, Yoon IJ, Cho YK, Ahn JS, Kim JK, Jeon J. Comparison of hospital based and home based exercise on quality of life, and neck and shoulder function in patients with spinal accessary nerve injury after head and neck cancer surgery. Oral Oncol 2018; 86:100-104. [PMID: 30409289 DOI: 10.1016/j.oraloncology.2018.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/05/2018] [Accepted: 06/17/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the effects of hospital-based and home-based exercise programs on quality of life (QOL) and neck and shoulder function of patients who underwent head and neck cancer (HNC) surgery. METHODS This clinical trial included 40 patients with neck and shoulder dysfunction after HNC. The exercise program included range of motion (ROM) exercises, massage, stretching, and strengthening exercises. Twenty patients who were assigned to the hospital-based exercise group performed physical therapy for 40 min three times a week for four weeks, and the remaining 20 patients were assigned to the home-based group. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), the EORTC Head and Neck Questionnaire (EORTC QLQ-H&N), the Neck and Shoulder Disability Index (NDI), ROM, and numeric rating scale (NRS) were assessed before and after the exercise program. The program consisted of a 10-minute ROM to the neck and shoulder, a 10-minute massage, and 15 min of progressive resistance exercises, followed by a five-minute stretching exercise. RESULTS There were statistically significant differences in the changes of neck and shoulder disability index (p < .05). Additionally, there were significant differences in neck extension and rotation ROM and NRS in the hospital-based group compared with the home-based group (p < .05). QOL was not significantly different between the two groups. CONCLUSIONS Home-based exercise was effective for improving QOL, shoulder function, and pain relief. Hospital-based exercise had better effects on physical function of the neck and shoulder and reduced pain.
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Affiliation(s)
- Jung Hwa Do
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - In Jin Yoon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Young Ki Cho
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Jun Su Ahn
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Jung Kyo Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - JaeYong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
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Kerezoudis P, Yost KJ, Tombers NM, Celda MP, Carlson ML, Link MJ. Defining the Minimal Clinically Important Difference for Patients With Vestibular Schwannoma: Are all Quality-of-Life Scores Significant? Neurosurgery 2018; 85:779-785. [DOI: 10.1093/neuros/nyy467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/31/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The diagnosis of vestibular schwannomas (VS) is associated with reduced patient quality of life (QOL). Minimal clinically important difference (MCID) was introduced as the lowest improvement in a patient-reported outcome (PRO) score discerned as significant by the patient. We formerly presented an MCID for the Penn Acoustic Neuroma QOL (PANQOL) battery based on cross-sectional data from 2 tertiary referral centers.
OBJECTIVE
To validate the PANQOL MCID values using prospective data.
METHODS
A prospective registry capturing QOL was queried, comprising patients treated at the authors’ institution and Acoustic Neuroma Association members. Anchor- and distribution-based techniques were utilized to determine the MCID for domain and total scores. We only included anchors with Spearman's correlation coefficient larger than 0.3 in the MCID threshold calculations. Most domains had multiple anchors with which to estimate the MCID.
RESULTS
A total of 1254 patients (mean age: 57.4 yr, 65% females) were analyzed. Anchor-based methods produced a span of MCID values (median, 25th-75th percentile) for each PANQOL domain and the total score: hearing (13.1, 13-16 points), balance (14, 14-19 points), pain (21, 20-28 points), face (25, 16-36 points), energy (16, 15-18 points), anxiety (16 [1 estimate]), general (13 [1 estimate]), and total (12.5, 10-15 points).
CONCLUSION
Current findings corroborate our formerly shared experience using multi-institutional, cross-sectional information. These MCID thresholds can serve as a pertinent outcome when deciphering the clinical magnitude of VS QOL endpoints in cross-sectional and longitudinal studies.
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Affiliation(s)
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Nicole M Tombers
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Maria Peris Celda
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Carlson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Symptom screening for constipation in oncology: getting to the bottom of the matter. Support Care Cancer 2018; 27:2463-2470. [PMID: 30374767 DOI: 10.1007/s00520-018-4520-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE This study seeks to determine whether specific screening for constipation will increase the frequency of clinician response within the context of an established symptom screening program. METHODS A "constipation" item was added to routine Edmonton Symptom Assessment System (ESAS) screening in gynecologic oncology clinics during a 7-week trial period, without additional constipation-specific training. Chart audits were then conducted to determine documentation of assessment and intervention for constipation in three groups of patients, those who completed (1) ESAS (n = 477), (2) ESAS-C with constipation (n = 435), and (3) no ESAS (n = 511). RESULTS Among patients who were screened for constipation, 17% reported moderate to severe symptoms. Greater constipation severity increased the likelihood of documented assessment (Z = 2.37, p = .018) and intervention (Z = 1.99, p = .048). Overall rates of documented assessment were 36%, with the highest assessment rate in the no ESAS group (χ2 = 9.505, p = .006), a group with the highest proportion of late-stage disease. No difference in the rate of assessment was found between the ESAS and ESAS-C groups. Overall rates for documentation of intervention were low, and did not differ between groups. CONCLUSIONS Specific screening for constipation within an established screening program did not increase the documentation rate for constipation assessment or intervention. The inclusion of specific symptoms in multi-symptom screening initiatives should be carefully evaluated in terms of added value versus patient burden. Care pathways should include guidance on triaging results from multi-symptom screening, and clinicians should pay particular attention to patients who are missed from screening altogether, as they may be the most symptomatic group.
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Thompson CA, Yost KJ, Maurer MJ, Allmer C, Farooq U, Habermann TM, Inwards DJ, Macon WR, Link BK, Rosenthal AC, Cerhan JR. Quality of life at diagnosis predicts overall survival in patients with aggressive lymphoma. Hematol Oncol 2018; 36:749-756. [PMID: 29862550 DOI: 10.1002/hon.2522] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/02/2018] [Accepted: 04/18/2018] [Indexed: 01/06/2023]
Abstract
Our aim was to evaluate whether quality of life (QOL) scores at diagnosis predict survival among patients with aggressive lymphoma. Newly diagnosed lymphoma patients were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE and systematically followed for event-free and overall survival (OS). QOL was measured with the Functional Assessment of Cancer Treatment-General (FACT-G), which measures 4 domains: physical, social/family, emotional, and functional well-being (WB); a single item Linear Analogue Self-Assessment (LASA) measuring overall QOL; and a spiritual WB LASA. From 9/2002 to 12/2009, 701 patients with aggressive lymphoma who completed baseline QOL questionnaires were enrolled. At a median follow-up of 71 months (range 6-128), 316 patients (45%) had an event and 228 patients (33%) died. All baseline QOL measures but emotional WB were significantly associated with OS (all P < 0.04); of which all but LASA spiritual remained significant after adjusting for IPI and NHL subtype. The strongest associations were with total FACT-G (adjusted HR = 0.86, 95% CI: 0.79-0.94, P = 0.00062) and functional WB (adjusted HR = 0.88, 95% CI: 0.83-0.93, P < .0001). QOL LASA was associated with OS (adjusted HR = 0.92, 95% CI: 0.87-0.97, P = 0.0041). Patients with clinically deficient QOL (overall QOL ≤50) had a median OS of 92 months compared with 121 months for patients with QOL >50 (P = 0.0004). In this large sample of patients with aggressive lymphoma, we found that baseline QOL is independently predictive of OS. QOL should be assessed as a prognostic factor in patients with aggressive lymphoma.
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Affiliation(s)
- Carrie A Thompson
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Umar Farooq
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - Thomas M Habermann
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David J Inwards
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Brian K Link
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - Allison C Rosenthal
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Mateo-Ortega D, Gómez-Batiste X, Maté J, Beas E, Ela S, Lasmarias C, Limonero JT. Effectiveness of Psychosocial Interventions in Complex Palliative Care Patients: A Quasi-Experimental, Prospective, Multicenter Study. J Palliat Med 2018; 21:802-808. [DOI: 10.1089/jpm.2017.0355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dolors Mateo-Ortega
- The Qualy Observatory-WHO Collaborating Center for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, Barcelona, Spain
- Palliative Care Unit, Consorci Sanitari de Terrassa, Barcelona, Spain
- Research Group on Stress and Health, Faculty of Psychology, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Xavier Gómez-Batiste
- The Qualy Observatory-WHO Collaborating Center for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, Barcelona, Spain
| | - Jorge Maté
- Research Group on Stress and Health, Faculty of Psychology, Universidad Autónoma de Barcelona, Barcelona, Spain
- PsychoOncology Unit, Catalan Institute of Oncology, Barcelona, Spain
| | - Elba Beas
- The Qualy Observatory-WHO Collaborating Center for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, Barcelona, Spain
| | - Sara Ela
- The Qualy Observatory-WHO Collaborating Center for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, Barcelona, Spain
| | - Cristina Lasmarias
- The Qualy Observatory-WHO Collaborating Center for Public Health Palliative Care Programs (WHOCC-ICO), Catalan Institute of Oncology, Barcelona, Spain
| | - Joaquín T. Limonero
- Research Group on Stress and Health, Faculty of Psychology, Universidad Autónoma de Barcelona, Barcelona, Spain
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Oncology Section EDGE Task Force on Cancer: Measures of Cancer-Related Fatigue—A Systematic Review. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000124] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dirou S, Chambellan A, Chevallier P, Germaud P, Lamirault G, Gourraud PA, Perrot B, Delasalle B, Forestier B, Guillaume T, Peterlin P, Garnier A, Magnan A, Blanc FX, Lemarchand P. Deconditioning, fatigue and impaired quality of life in long-term survivors after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 53:281-290. [PMID: 29269801 DOI: 10.1038/s41409-017-0057-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/18/2017] [Accepted: 11/07/2017] [Indexed: 12/30/2022]
Abstract
Long-term survivors after allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk for treatment-related adverse events, that may worsen physical capacity and may induce fatigue and disability. The aims of this prospective study were to evaluate exercise capacity in allotransplant survivors and its relationship with fatigue and disability. Patient-reported outcomes and exercise capacity were evaluated in 71 non-relapse patients 1 year after allo-HSCT, using validated questionnaires, cardiopulmonary exercise testing (CPET) with measure of peak oxygen uptake (peakVO2) and deconditioning, pulmonary function testing, echocardiography and 6-min walk test. A high proportion (75.4%) of allo-HSCT survivors showed abnormal cardiopulmonary exercise testing parameters as compared to predicted normal values, including 49.3% patients who exhibited moderate to severe impairment in exercise capacity and 37.7% patients with physical deconditioning. PeakVO2 values were not accurately predicted by 6-min walk distances (r = 0.53). Disability and fatigue were strongly associated with decreased peakVO2 values (p = 0.002 and p = 0.008, respectively). Exercise capacity was reduced in most allo-HSCT long-term survivors. Because reduced exercise capacity was associated with fatigue, disability and a decrease in quality of life, cardiopulmonary exercise testing should be performed in every patient who reports fatigue and disability.
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Affiliation(s)
- Stéphanie Dirou
- l'institut du thorax, UNIV Nantes, CHU Nantes, Nantes, 44000, France.
| | - Arnaud Chambellan
- Laboratory "Movement, Interactions, Performance", UNIV Nantes, CHU Nantes, Nantes, 44000, France
| | - Patrice Chevallier
- Hematology, department Inserm UMR U892, CHU Nantes, Nantes, 44000, France
| | | | - Guillaume Lamirault
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, 44000, France
| | - Pierre-Antoine Gourraud
- Equipe ATIP-Avenir INSERM, UNIV Nantes, CHU Nantes, Nantes, 44000, France.,Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Bastien Perrot
- Plateforme de biométrie, CHU Nantes, Nantes, 44000, France
| | - Béatrice Delasalle
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, 44000, France
| | | | | | | | - Alice Garnier
- Hematology department, CHU Nantes, Nantes, 44000, France
| | - Antoine Magnan
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, 44000, France
| | | | - Patricia Lemarchand
- l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, 44000, France
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Kotajarvi BR, Schafer MJ, Atkinson EJ, Traynor MM, Bruce CJ, Greason KL, Suri RM, Miller JD, LeBrasseur NK. The Impact of Frailty on Patient-Centered Outcomes Following Aortic Valve Replacement. J Gerontol A Biol Sci Med Sci 2017; 72:917-921. [PMID: 28329140 DOI: 10.1093/gerona/glx038] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/22/2017] [Indexed: 11/12/2022] Open
Abstract
Background Frailty confers risk for surgical morbidity and mortality. Whether patient-reported measures of health, well-being, or quality of life respond differently to surgery in non-frail and frail individuals is unknown. Methods Older adults with severe aortic stenosis presenting for surgery were assessed for frailty using Cardiovascular Health Study Criteria. Patient-reported measures of functional capacity (Duke Activity Status Index [DASI]), physical and mental health (Medical Outcomes Study Short Form-Physical and Mental Component Scales [SF-12 PCS and SF-12 MCS, respectively]), well-being (linear analogue self-assessment [LASA]), and quality of life (LASA) were administered before and 3 months after surgery. Results Of 103 participants (mean age of 80.6 years), 54 were frail. Frail participants had lower baseline DASI, SF-12 PCS, SF-12 MCS, physical well-being, and quality of life scores than non-frail participants. At follow-up, frail participants showed significant improvement in physical function, with DASI and SF-12 PCS scores improving by 50% and 14%, respectively. Non-frail subjects did not significantly improve in these measures. SF-12 MCS scores also improved to a greater extent in frail compared to non-frail participants (3.6 vs < 1 point). Furthermore, the frail participants improved to a greater extent than non-frail participants in physical well-being (21.6 vs 7.1 points) and quality of life measures (25.1 vs 8.7 points). Conclusions Frailty is prevalent in older adults with severe aortic stenosis and is associated with poor physical and mental function, physical well-being, and quality of life. In response to surgery, frail participants exhibited greater improvement in these patient-centered outcomes than non-frail peers.
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Affiliation(s)
- Brian R Kotajarvi
- Center for Clinical and Translational Sciences, Mayo Clinic, Rochester, Minnesota
| | - Marissa J Schafer
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota
| | | | - Megan M Traynor
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Charles J Bruce
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Rakesh M Suri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jordan D Miller
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nathan K LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Distress levels in patients with oropharyngeal vs. non-oropharyngeal squamous cell carcinomas of the head and neck over 1 year after diagnosis: a retrospective cohort study. Support Care Cancer 2017; 25:3225-3233. [PMID: 28600705 DOI: 10.1007/s00520-017-3733-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Human papillomavirus (HPV)-related cancers have been associated with different demographic profiles and disease characteristics than HPV-unrelated cancers in head and neck patients, but distress and other symptoms have not been compared. The aim of this study was to assess whether distress levels, fatigue, pain, anxiety, depression, and common psychological and practical problems differ between head and neck cancer patients with HPV-related vs. HPV-unrelated carcinomas (using oropharyngeal carcinoma (OPC) and non-OPC cancers as surrogates for HPV status). METHODS Distress, depression, anxiety, fatigue, pain, and common problems were examined in 56 OPC and 90 non-OPC patients at 4 timepoints during the first year following diagnosis. Two-level hierarchical linear modeling was used to examine effects. RESULTS The HPV-related OPC group was more likely to be younger (p = 0.05), Caucasian (p = 0.001), non-smokers (p = 0.01), earn more (p = 0.04), and present with more advanced stage (p < 0.0001). At baseline, OPC patients reported only higher pain scores (p = 0.01) than non-OPC patients. Total problems decreased more in the OPC group (p = 0.08) than the non-OPC group from baseline to 12-month follow-up. In both groups, scores on distress, depression, psychosocial problems, and practical problems decreased similarly over time. CONCLUSIONS Despite a difference in the clinico-demographic characteristics of HPV-related vs. HPV-unrelated patients, only baseline pain levels and total problems over time differed between the two groups.
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Rosman L, Salmoirago-Blotcher E, Cahill J, Wuensch KL, Sears SF. Depression and health behaviors in women with Peripartum Cardiomyopathy. Heart Lung 2017; 46:363-368. [PMID: 28583376 DOI: 10.1016/j.hrtlng.2017.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Depression and health behavior engagement are a critical issue for recovery and secondary prevention in heart failure patients. No prior studies have examined these important clinical outcomes in young women diagnosed with Peripartum Cardiomyopathy (PPCM). We sought to characterize the prevalence of depression and health behaviors in PPCM patients and examine whether depression is associated with reduced engagement in health behaviors. METHODS A nation-wide, cohort of 177 PPCM patients (mean age of 34.8 ± 5.7 years; median time since diagnosis of 3.0 ± 4.3 years) from a web-based quality of life registry completed questionnaires about depression (Patient Health Questionnaire; a cutoff score ≥10 was used for depression screening) and health behaviors. T-tests, chi-square and linear regression were used to compare clinical characteristics and health behaviors among depressed and non-depressed women. RESULTS The prevalence of clinical depression at enrollment was 32.3% and was associated with use of antihypertensive medications, disability insurance status, higher BMI, history of arrhythmia and current or past use of psychotropic medication. Health behavior engagement for diet, physical activity, and tobacco cessation were low in the overall sample and depressed PPCM patients were significantly less likely to attend medical appointments than non-depressed women. CONCLUSIONS Nearly 1 in 3 PPCM survivors reported symptoms of clinical depression which was associated with worse attendance at medical follow-up visits. Further research is needed to develop risk stratification models and patient-centered interventions to improve clinical outcomes for PPCM survivors.
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Affiliation(s)
- Lindsey Rosman
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Psychology, East Carolina University, Greenville, NC, USA
| | | | - John Cahill
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Karl L Wuensch
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, NC, USA; Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
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Abstract
AIM To investigate the risk factors and predictors of falls according to the general characteristics, conscious state, physical condition and treatment of hospitalized patients with cancer. BACKGROUND Inpatients with cancer experience falls more frequently than those without cancer, and the degree of injuries is more severe among inpatients with cancer. A specific fall prevention strategy is needed for each patient. Prevention of falls in patients with cancer is very important for improving the quality of nursing care. METHODS This retrospective study included matched case-control patients. We evaluated patients between January 1, 2013, and December 31, 2014. A total of 356 patients (fall group, 178; non-fall group, 178) were included. For fall prediction, logistic regression was performed on the variables that were statistically significant in the univariate analysis. RESULTS The variables that were significant predictors of falls were the use of an assistive device, history of falls and fatigue. DISCUSSION The predictors of falls in patients with cancer include physical conditions and general characteristics. Fall prevention strategies in patients with cancer should be planned individually with multifaceted aspects, including physical symptom management. LIMITATIONS The study was conducted at a single cancer center in Korea; thus, our results cannot be generalized. Additionally, in Korea, it is common to have family members or private caregivers for patient care, and this might have influenced the results. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY The predictive factors for falls reflect the nature of the patient's environment, culture and disease. Falls have a negative effect on patient safety and can significantly influence quality of life. Policies for patient safety need more specialized and customized approaches.
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Affiliation(s)
- M D Jun
- Thyroid Cancer Center, National Cancer Center in Korea, Goyang, Korea
| | - K M Lee
- Team of Quality Management, National Cancer Center in Korea, Goyang, Korea
| | - S A Park
- Division of Nursing Science, University of Suwon, Hwaseong, Korea
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Bhavsar NA, Harrison MR, Hirsch BR, Creel P, Wolf SP, Samsa GP, Abernethy AP, Simantov R, Borham A, George DJ. Design and Rationale of the Metastatic Renal Cell Carcinoma (MaRCC) Registry: A Prospective Academic and Community-Based Study of Patients With Metastatic Renal Cell Cancer. Cancer Invest 2017; 35:333-344. [DOI: 10.1080/07357907.2017.1289215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | - Patricia Creel
- Duke University Medical Center, Durham, North Carolina, USA
| | - Steve P. Wolf
- Duke University Medical Center, Durham, North Carolina, USA
| | - Greg P. Samsa
- Duke University Medical Center, Durham, North Carolina, USA
| | - Amy P. Abernethy
- Duke University Medical Center, Durham, North Carolina, USA
- Pfizer Inc., New York, New York, USA
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In pursuit of empirically supported assessment for use in medical settings. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wang HL, Visovsky C, Ji M, Groer M. Stress-related biobehavioral responses, symptoms, and physical activity among female veterans in the community: An exploratory study. NURSE EDUCATION TODAY 2016; 47:2-9. [PMID: 27372810 DOI: 10.1016/j.nedt.2016.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 05/29/2016] [Accepted: 06/05/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Female veterans experience multiple stresses during their lifetime. Some of them seek care in the civilian community. Common physical and psychological symptoms among female veterans include pain, fatigue, sleep quality, and depression. Physical activity has the potential to improve their well-being. OBJECTIVES This study was guided by the concept of allostasis. The purpose of the study was to determine the associations among stress-related biobehavioral responses and symptoms as well as to determine if physical activity moderated these associations among female veterans. DESIGN/SETTINGS/PARTICIPANTS/METHODS A cross-sectional and exploratory design was implemented among 82 female veterans (46±10.57years old) at a community event. Self-reported questionnaires and blood and hair samples were collected. Descriptive statistics and multivariate analyses were applied in this secondary data analysis. FINDINGS Female veterans experienced moderate perceived stress and greater body mass index, C-reactive protein, and hair cortisol levels at the same time as they reported moderate levels of pain and fatigue, poor sleep quality, and considerable depressive symptoms. The findings showed that greater body mass index was significantly associated with more severe pain and poor sleep quality. Physical activity negatively moderated the relationship between perceived stress and pain. CONCLUSION Female veterans need services to manage body weight and help them engage in physical activity. Nurse educators are responsible for instructing nurses to properly identify female veterans in the civilian community facility and to provide care in a respectful manner.
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Affiliation(s)
- Hsiao-Lan Wang
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL 33612, United States.
| | - Constance Visovsky
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL 33612, United States
| | - Ming Ji
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL 33612, United States
| | - Maureen Groer
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL 33612, United States
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Bennett S, Pigott A, Beller EM, Haines T, Meredith P, Delaney C. Educational interventions for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2016; 11:CD008144. [PMID: 27883365 PMCID: PMC6464148 DOI: 10.1002/14651858.cd008144.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cancer-related fatigue is reported as the most common and distressing symptom experienced by patients with cancer. It can exacerbate the experience of other symptoms, negatively affect mood, interfere with the ability to carry out everyday activities, and negatively impact on quality of life. Educational interventions may help people to manage this fatigue or to cope with this symptom, and reduce its overall burden. Despite the importance of education for managing cancer-related fatigue there are currently no systematic reviews examining this approach. OBJECTIVES To determine the effectiveness of educational interventions for managing cancer-related fatigue in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, OTseeker and PEDro up to 1st November 2016. We also searched trials registries. SELECTION CRITERIA We included randomised controlled trials (RCTs) of educational interventions focused on cancer-related fatigue where fatigue was a primary outcome. Studies must have aimed to evaluate the effect of educational interventions designed specifically to manage cancer-related fatigue, or to evaluate educational interventions targeting a constellation of physical symptoms or quality of life where fatigue was the primary focus. The studies could have compared educational interventions with no intervention or wait list controls, usual care or attention controls, or an alternative intervention for cancer-related fatigue in adults with any type of cancer. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. Trial authors were contacted for additional information. A third independent person checked the data extraction. The main outcome considered in this review was cancer-related fatigue. We assessed the evidence using GRADE and created a 'Summary of Findings' table. MAIN RESULTS We included 14 RCTs with 2213 participants across different cancer diagnoses. Four studies used only 'information-giving' educational strategies, whereas the remainder used mainly information-giving strategies coupled with some problem-solving, reinforcement, or support techniques. Interventions differed in delivery including: mode of delivery (face to face, web-based, audiotape, telephone); group or individual interventions; number of sessions provided (ranging from 2 to 12 sessions); and timing of intervention in relation to completion of cancer treatment (during or after completion). Most trials compared educational interventions to usual care and meta-analyses compared educational interventions to usual care or attention controls. Methodological issues that increased the risk of bias were evident including lack of blinding of outcome assessors, unclear allocation concealment in over half of the studies, and generally small sample sizes. Using the GRADE approach, we rated the quality of evidence as very low to moderate, downgraded mainly due to high risk of bias, unexplained heterogeneity, and imprecision.There was moderate quality evidence of a small reduction in fatigue intensity from a meta-analyses of eight studies (1524 participants; standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.52 to -0.04) comparing educational interventions with usual care or attention control. We found low quality evidence from twelve studies (1711 participants) that educational interventions had a small effect on general/overall fatigue (SMD -0.27, 95% CI -0.51 to -0.04) compared to usual care or attention control. There was low quality evidence from three studies (622 participants) of a moderate size effect of educational interventions for reducing fatigue distress (SMD -0.57, 95% CI -1.09 to -0.05) compared to usual care, and this could be considered clinically significant. Pooled data from four studies (439 participants) found a small reduction in fatigue interference with daily life (SMD -0.35, 95% CI -0.54 to -0.16; moderate quality evidence). No clear effects on fatigue were found related to type of cancer treatment or timing of intervention in relation to completion of cancer treatment, and there were insufficient data available to determine the effect of educational interventions on fatigue by stage of disease, tumour type or group versus individual intervention.Three studies (571 participants) provided low quality evidence for a reduction in anxiety in favour of the intervention group (mean difference (MD) -1.47, 95% CI -2.76 to -0.18) which, for some, would be considered clinically significant. Two additional studies not included in the meta-analysis also reported statistically significant improvements in anxiety in favour of the educational intervention, whereas a third study did not. Compared with usual care or attention control, educational interventions showed no significant reduction in depressive symptoms (four studies, 881 participants, SMD -0.12, 95% CI -0.47 to 0.23; very low quality evidence). Three additional trials not included in the meta-analysis found no between-group differences in the symptoms of depression. No between-group difference was evident in the capacity for activities of daily living or physical function when comparing educational interventions with usual care (4 studies, 773 participants, SMD 0.33, 95% CI -0.10 to 0.75) and the quality of evidence was low. Pooled evidence of low quality from two of three studies examining the effect of educational interventions compared to usual care found an improvement in global quality of life on a 0-100 scale (MD 11.47, 95% CI 1.29 to 21.65), which would be considered clinically significant for some.No adverse events were reported in any of the studies. AUTHORS' CONCLUSIONS Educational interventions may have a small effect on reducing fatigue intensity, fatigue's interference with daily life, and general fatigue, and could have a moderate effect on reducing fatigue distress. Educational interventions focused on fatigue may also help reduce anxiety and improve global quality of life, but it is unclear what effect they might have on capacity for activities of daily living or depressive symptoms. Additional studies undertaken in the future are likely to impact on our confidence in the conclusions.The incorporation of education for the management of fatigue as part of routine care appears reasonable. However, given the complex nature of this symptom, educational interventions on their own are unlikely to optimally reduce fatigue or help people manage its impact, and should be considered in conjunction with other interventions. Just how educational interventions are best delivered, and their content and timing to maximise outcomes, are issues that require further research.
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Affiliation(s)
- Sally Bennett
- The University of QueenslandDivision of Occupational Therapy, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia4072
| | - Amanda Pigott
- Princess Alexandra HospitalOccupational TherapyIpswich RoadWooloongabbaBrisbaneQueenslandAustralia4102
| | - Elaine M Beller
- Bond UniversityCentre for Research in Evidence‐Based Practice (CREBP)University DriveGold CoastQueenslandAustralia4229
| | - Terry Haines
- The University of Queensland and Princess Alexandra HospitalPhysiotherapyAlexandra Hospital, Ipswich RoadWooloongabbaBrisbaneQueenslandAustralia4102
| | - Pamela Meredith
- The University of QueenslandDivision of Occupational Therapy, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia4072
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48
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Wagner LI, Pugh SL, Small W, Kirshner J, Sidhu K, Bury MJ, DeNittis AS, Alpert TE, Tran B, Bloom BF, Mai J, Yeh A, Sarma K, Becker M, James J, Bruner DW. Screening for depression in cancer patients receiving radiotherapy: Feasibility and identification of effective tools in the NRG Oncology RTOG 0841 trial. Cancer 2016; 123:485-493. [PMID: 27861753 DOI: 10.1002/cncr.29969] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Brief tools are needed to screen oncology outpatients for depressive symptoms. METHODS Patients starting radiotherapy for the first diagnosis of any tumor completed distress screening tools, including the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), and the Hopkins Symptom Checklist (HSCL) (25-item version). Patients exceeding validated cutoff scores and a systematic sample of patients whose screening was negative completed the Structured Clinical Interview for DSM-IV (SCID) mood disorder modules via telephone. RESULTS Four hundred sixty-three patients from 35 community-based radiation oncology sites and 2 academic radiation oncology sites were recruited. Sixty-six percent of the 455 eligible patients (n = 299) were women, and the eligible patients had breast (45%), gastrointestinal (11%), lung (10%), gynecologic (6%), or other cancers (27%). Seventy-five (16.5%) exceeded screening cutoffs for depressive symptoms. Forty-two of these patients completed the SCID. Another 37 patients whose screening was negative completed the SCID. Among the 79 patients completing the SCID, 8 (10.1%) met the criteria for major depression, 2 (2.5%) met the criteria for dysthymia, and 6 (7.6%) met the criteria for an adjustment disorder. The PHQ-2 demonstrated good psychometric properties for screening for mood disorders with a cutoff score of ≥3 (receiver operating characteristic area under the curve [AUC], 0.83) and was comparable to the PHQ-9 ( > 9; AUC = 0.85). The NCCN-DT did not detect depression (AUC = 0.59). CONCLUSIONS The PHQ-2 demonstrated good psychometric properties for screening for mood disorders, which were equivalent to the PHQ-9 and superior to the NCCN-DT. These findings support using the PHQ-2 to identify patients in need of further assessment for depression, which has a low prevalence but is a clinically significant comorbidity. These findings could inform the implementation of distress screening accreditation standards. Cancer 2017;123:485-493. © 2016 American Cancer Society.
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Affiliation(s)
- Lynne I Wagner
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - William Small
- Department of Radiation Oncology, Loyola University, Chicago, Illinois
| | - Jeffrey Kirshner
- Hematology-Oncology Associates of Central New York (Community Clinical Oncology Program), East Syracuse, New York
| | - Kulbir Sidhu
- Southeast Cancer Control Consortium (Community Clinical Oncology Program), Winston-Salem, North Carolina
| | - Martin J Bury
- Grand Rapids Clinical Oncology Program, Grand Rapids, Michigan
| | - Albert S DeNittis
- Main Line Health (Community Clinical Oncology Program), Philadelphia, Pennsylvania
| | - Tracy E Alpert
- Hematology-Oncology Associates of Central New York (Community Clinical Oncology Program), East Syracuse, New York
| | - Binh Tran
- Northern Indiana Cancer Research Consortium (Community Clinical Oncology Program), South Bend, Indiana
| | - Beatrice F Bloom
- North Shore University Hospital (Community Clinical Oncology Program), Manhasset, New York
| | - Julie Mai
- Mercy Hospital St. Louis, St. Louis, Missouri
| | - Alexander Yeh
- St. Vincent Anderson Regional Hospital, Anderson, Indiana
| | - Kalika Sarma
- Carle Cancer Center (Community Clinical Oncology Program), Urbana, Illinois
| | - Mark Becker
- Columbus Community Clinical Oncology Program, Columbus, Ohio
| | - Jennifer James
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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49
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Penedo FJ, Cella D. Responding to the quality imperative to embed mental health care into ambulatory oncology. Cancer 2016; 123:382-386. [PMID: 27859012 DOI: 10.1002/cncr.30402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/07/2016] [Accepted: 09/26/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Frank J Penedo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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50
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Abrahams HJG, Gielissen MFM, de Lugt M, Kleijer EFW, de Roos WK, Balk E, Verhagen CAHHVM, Knoop H. The Distress Thermometer for screening for severe fatigue in newly diagnosed breast and colorectal cancer patients. Psychooncology 2016; 26:693-697. [PMID: 27362532 DOI: 10.1002/pon.4208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Internationally, the Distress Thermometer and associated Problem List are increasingly used in oncology as screening tools for psychological distress. Cancer-related fatigue is common but often overlooked in clinical practice. We examined if severe fatigue in cancer patients can be identified with the fatigue item of the Problem List. METHODS Newly diagnosed breast (N = 334) and colorectal (N = 179) cancer patients were screened for severe fatigue, which was defined as having a positive score on the fatigue item of the Problem List. The Fatigue Severity subscale of the Checklist Individual Strength was used as gold standard measure for severe fatigue. RESULTS In total, 78% of breast cancer patients and 81% of colorectal cancer patients were correctly identified with the fatigue item. The sensitivity was 89% in breast cancer patients and 91% in colorectal cancer patients. The specificity was 75% in breast cancer patients and 77% in colorectal cancer patients. The positive predictive value was 53% in breast cancer patients and 64% in colorectal cancer patients, whereas the negative predictive value was 95% in both tumor types. CONCLUSIONS The fatigue item of the Problem List performs satisfactorily as a quick screening tool for severe fatigue. However, a positive screen should be followed up with a more thorough assessment of fatigue, ie, a questionnaire with a validated cutoff point. Given time pressure of clinicians, this already implemented and brief screening tool may prevent severe fatigue from going undetected in clinical practice.
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Affiliation(s)
- H J G Abrahams
- Expert Center for Chronic Fatigue (ECCF), Radboud University Medical Center, Nijmegen, The Netherlands
| | - M F M Gielissen
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M de Lugt
- Department of Medical Psychology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - E F W Kleijer
- Department of Education and Training, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W K de Roos
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - E Balk
- Department of Medical Oncology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - C A H H V M Verhagen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Knoop
- Expert Center for Chronic Fatigue (ECCF), Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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