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Shin J, Hammer MJ, Paul SM, Conley YP, Harris C, Oppegaard K, Morse L, Cooper BA, Levine JD, Miaskowski C. Associations Between Preoperative Shortness of Breath and Potassium Channels Gene Variations in Women With Breast Cancer. Biol Res Nurs 2024:10998004241268088. [PMID: 39137431 DOI: 10.1177/10998004241268088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES Shortness of breath is a common symptom in patients with cancer. However, the mechanisms that underlie this troublesome symptom are poorly understood. Therefore, this study aimed to determine the prevalence of and associated risk factors for shortness of breath in women prior to breast cancer surgery and identify associations between shortness of breath and polymorphisms for potassium channel genes. METHODS Patients were recruited prior to breast cancer surgery and completed a self-report questionnaire on the occurrence of shortness of breath. Genotyping of single nucleotides polymorphism (SNPs) in potassium channel genes was performed using a custom array. Multiple logistic regression analyses were done to identify associations between the occurrence of shortness of breath and SNPs in ten candidate genes. RESULTS Of the 398 patients, 11.1% reported shortness of breath. These patients had a lower annual household income, a higher comorbidity burden, and a lower functional status. After controlling for functional status, comorbidity burden, genomic estimates of ancestry and self-reported race and ethnicity, the genetic associations that remained significant in the multiple regression analyses were for potassium voltage-gated channel subfamily D (KCND2) rs12673992, potassium voltage-gated channel modifier subfamily S (KCNS1) rs4499491, and potassium two pore channel subfamily K (KCNK2) rs4411107. CONCLUSIONS While these findings warrant replication, they suggest that alterations in potassium channel function may contribute to the occurrence of shortness of breath in women prior to breast cancer surgery.
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Affiliation(s)
- Joosun Shin
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Steven M Paul
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn Harris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lisa Morse
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Jon D Levine
- VA Portland Health Care System, Portland, OR, USA
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
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2
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Rönningås U, Fransson P, Holm M, Beckman L, Wennman-Larsen A. Symptom burden among men treated for castration-resistant prostate cancer: a longitudinal study. BMJ Support Palliat Care 2024:spcare-2024-005054. [PMID: 39122263 DOI: 10.1136/spcare-2024-005054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES Despite rapid expansion of treatments for metastatic castration-resistant prostate cancer (mCRPC) and the importance of symptom management for enhancing quality of life, few studies have focused on men's experiences of symptom burden over time when receiving one or more lines of treatment in a real-world situation in this phase. The aim was to investigate changes in the multidimensional symptom burden during the first year of life-prolonging treatment of mCRPC. METHODS Longitudinal data from the first year of life-prolonging treatment for 134 men with mCRPC were used. Symptoms were measured with the multidimensional Memorial Symptom Assessment Scale. Data are presented with descriptive statistics, and changes in symptom burden (physical, psychological and number of symptoms) were analysed using linear mixed modelling. RESULTS On average, the men had approximately 10 (0-31) symptoms at inclusion and 12 (0-33) at the last time point. Lack of energy and sweats were the two most reported symptoms at every time point. Sexual problems had the highest scores in all dimensions (frequency, severity, distress). Regarding pain, the distress score was higher than the scores for frequency and severity at t1-t4. Physical symptom burden and the number of symptoms changed significantly over time, towards a higher symptom burden. Psychological symptom burden did not change significantly over time. CONCLUSION The different dimensions of physical symptoms in men treated for mCRPC need to be more acknowledged. Early integration of a palliative care approach could possibly help in enhancing symptom management and quality of life for these men.
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Affiliation(s)
| | - Per Fransson
- Department of Nursing, Umeå University, Umea, Sweden
| | - Maja Holm
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Department of Health Care Sciences, Marie Cederschiold hogskola - Campus Ersta, Stockholm, Sweden
| | - Lars Beckman
- Department of Radiation Sciences, Umea Universitet, Umea, Sweden
| | - Agneta Wennman-Larsen
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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3
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Anandavadivelan P, Mijwel S, Wiklander M, Kjoe PLM, Luijendijk M, Bergh J, Rundqvist H, Wengstrom Y. Five-year follow-up of the OptiTrain trial on concurrent resistance and high-intensity interval training during chemotherapy for patients with breast cancer. Sci Rep 2024; 14:15333. [PMID: 38961182 PMCID: PMC11222517 DOI: 10.1038/s41598-024-65436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024] Open
Abstract
The protocol predefined aim of this study is to assess sustained effects of the OptiTrain trial on several health outcomes, 5 years after the baseline assessment. The OptiTrain study was a prospective, randomised controlled trial with 240 patients with breast cancer undergoing adjuvant chemotherapy that compared the effects of 16 weeks of two exercise programs, RT-HIIT and AT-HIIT, with usual care (UC). After a 5-year follow-up, eligible participants were evaluated for the primary outcome of cancer-related fatigue (CRF) and secondary outcomes including quality of life, symptoms, muscle strength, cardiorespiratory fitness, body mass, physical activity, and sedentary behavior. Statistical analysis was conducted using linear mixed models adjusted for baseline values. Tumour profile and menopausal status were additionally adjusted for CRF. Mean differences (MD), 95% confidence intervals (CIs), and standardized effect sizes (ES) were reported. At the 5-year follow-up, there were no statistically significant differences in total CRF between the intervention groups and the UC group. RT-HIIT reported significantly reduced pain sensitivity at the gluteus MD = 79.00 (95% CI 10.17, 147.83, ES = 0.55) compared to UC. Clinically meaningful differences for an increase in cognitive CRF and cardiorespiratory fitness were observed for the AT-HIIT versus UC group, and for lower limb strength for the RT-HIIT versus UC group, albeit without statistical significance. Engaging in targeted exercise during adjuvant chemotherapy for breast cancer provides short-term benefits in reducing fatigue and maintaining physical function. However, our 5-year follow-up indicates that these effects are limited in the long term. This underscores the need to support breast cancer survivors maintain their PA levels throughout their survivorship journey.
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Affiliation(s)
- Poorna Anandavadivelan
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
| | - Sara Mijwel
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Maria Wiklander
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
| | - Philippe Lee Meeuw Kjoe
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Maryse Luijendijk
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Center, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Helene Rundqvist
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Wengstrom
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
- Breast Center, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
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Hammarström M, Gabrielson M, Crippa A, Discacciati A, Eklund M, Lundholm C, Bäcklund M, Wengström Y, Borgquist S, Bergqvist J, Eriksson M, Tapia J, Czene K, Hall P. Side effects of low-dose tamoxifen: results from a six-armed randomised controlled trial in healthy women. Br J Cancer 2023:10.1038/s41416-023-02293-z. [PMID: 37149701 DOI: 10.1038/s41416-023-02293-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Adherence to adjuvant tamoxifen therapy is suboptimal, and acceptance of tamoxifen for primary prevention is poor. Published results indicate effect of low-dose tamoxifen therapy. Using questionnaire data from a randomised controlled trial, we describe side effects of standard and low-dose tamoxifen in healthy women. METHODS In the KARISMA trial, 1440 healthy women were randomised to 6 months of daily intake of 20, 10, 5, 2.5, 1 mg of tamoxifen or placebo. Participants completed a 48-item, five-graded Likert score symptom questionnaire at baseline and follow-up. Linear regression models were used to identify significant changes in severity levels across doses and by menopausal status. RESULTS Out of 48 predefined symptoms, five were associated with tamoxifen exposure (hot flashes, night sweats, cold sweats, vaginal discharge and muscle cramps). When comparing these side effects in premenopausal women randomised to low doses (2.5, 5 mg) versus high doses (10, 20 mg), the mean change was 34% lower in the low-dose group. No dose-dependent difference was seen in postmenopausal women. CONCLUSIONS Symptoms related to tamoxifen therapy are influenced by menopausal status. Low-dose tamoxifen, in contrast to high-dose, was associated with less pronounced side effects, a finding restricted to premenopausal women. Our findings give new insights which may influence future dosing strategies of tamoxifen in both the adjuvant and preventive settings. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03346200.
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Affiliation(s)
- Mattias Hammarström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Marike Gabrielson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Discacciati
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Bäcklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Science and Society, Division of Nursing and Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Signe Borgquist
- Department of Oncology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Clinical Sciences Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Jenny Bergqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Capio St Görans Hospital, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - José Tapia
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
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Kotte M, Bolam KA, Mijwel S, Altena R, Cormie P, Wengström Y. Distance-based delivery of exercise for people treated for breast, prostate or colorectal cancer: a study protocol for a randomised controlled trial of EX-MED Cancer Sweden. Trials 2023; 24:116. [PMID: 36800978 PMCID: PMC9936694 DOI: 10.1186/s13063-023-07152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/10/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Regular exercise has been shown to have beneficial health effects in cancer survivors, including improving quality of life and other important health outcomes. However, providing people with cancer with easily accessible, high-quality exercise support and programs is a challenge. Therefore, there is a need to develop easily accessible exercise programs that draw upon the current evidence. Supervised, distance-based exercise programs have the benefit of reaching out to many people whilst providing the support of an exercise professional. The aim of the EX-MED Cancer Sweden trial is to examine the effectiveness of a supervised, distance-based exercise program, in people previously treated for breast, prostate, or colorectal cancer, on health-related quality of life (HRQoL), as well as other physiological and patient-reported health outcomes. METHODS The EX-MED Cancer Sweden trial is a prospective randomised controlled trial including 200 people that have completed curative treatment for breast, prostate, or colorectal cancer. Participants are randomly allocated to an exercise group or a routine care control group. The exercise group will participate in a supervised, distanced-based exercise program delivered by a personal trainer who has undertaken specialised exercise oncology education modules. The intervention consists of a combination of resistance and aerobic exercises with participants completing two 60-min sessions per week for 12 weeks. The primary outcome is HRQoL (EORTC QLQ-C30) assessed at baseline, 3- (end of intervention and primary endpoint) and 6-months post-baseline. Secondary outcomes are physiological (cardiorespiratory fitness, muscle strength, physical function, body composition) and patient-reported outcomes (cancer-related symptoms, fatigue, self-reported physical activity), and self-efficacy of exercise. Furthermore, the trial will explore and describe the experiences of participation in the exercise intervention. DISCUSSION The EX-MED Cancer Sweden trial will provide evidence regarding the effectiveness of a supervised, distance-based exercise program for survivors of breast, prostate, and colorectal cancer. If successful, it will contribute to the implementation of flexible and effective exercise programs as part of the standard of care for people following cancer treatment, which is likely to contribute to a reduction in the burden of cancer on the individual, health care system and society. TRIAL REGISTRATION www. CLINICALTRIALS gov NCT05064670. Registered on October 1, 2021.
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Affiliation(s)
- Melissa Kotte
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Kate A. Bolam
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden ,grid.416784.80000 0001 0694 3737 Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Sara Mijwel
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden ,grid.412285.80000 0000 8567 2092Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Renske Altena
- grid.24381.3c0000 0000 9241 5705Medical Unit Breast, Endocrine Tumors and Sarcoma, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Prue Cormie
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC Australia ,EX-MED Cancer, Melbourne, VIC Australia
| | - Yvonne Wengström
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Medical Unit Breast, Endocrine Tumors and Sarcoma, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Tödt K, Engström M, Ekström M, Efverman A. Fatigue During Cancer-Related Radiotherapy and Associations with Activities, Work Ability and Quality of Life: Paying Attention to Subgroups more Likely to Experience Fatigue. Integr Cancer Ther 2022; 21:15347354221138576. [PMID: 36444775 PMCID: PMC9716605 DOI: 10.1177/15347354221138576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Having knowledge of which patients are more likely to experience fatigue during radiotherapy and the relationship between fatigue and health-related quality of life (HRQL) is important to improve identification and care of patients experiencing burdensome fatigue. OBJECTIVE To identify subgroups of patients, varying in situational, physiological, and psychological factors, who are more likely to experience fatigue an ordinary week of radiotherapy, and to compare patients experiencing and not experiencing fatigue regarding perceived HRQL and functional performance, that is, daily and physical activity and work ability. METHODS Cross-sectional study of 457 patients (52% women) undergoing radiotherapy (38% breast, 32% prostate cancer), using self-reported questionnaire data on fatigue, HRQL and functional performance analyzed using multivariable regression models. RESULTS Of the 448 patients who answered the fatigue question, 321 (72%) experienced fatigue. Patients reporting any comorbidity or depressed mood were more likely to experience fatigue, relative risk (RR) 1.56 ([95% confidence interval (CI)] 1.13-2.16) and RR 2.57 (CI 1.73-3.83), respectively. Patients with fatigue reported worse HRQL and performed less physical activity, including daily (P = .003), vigorous (P = .003) and moderate (P = .002) activity. Patients with and without fatigue reported 60% versus 40% sickness absence. CONCLUSION Patients with depressed mood or comorbidity were more likely to experience fatigue an ordinary week of radiotherapy than other patients were. Patients experiencing fatigue perceived worse HRQL and performed less daily and physical activity compared to patients not experiencing fatigue. Cancer care practitioners may consider paying extra attention to these subgroups of patients.
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Affiliation(s)
- Kristina Tödt
- University of Gävle, Gävle, Sweden,Skåne University Hospital, Lund, Sweden,Kristina Tödt, Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle 801 76, Sweden.
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Stake-Nilsson K, Gustafsson S, Tödt K, Fransson P, Efverman A. A Study of Self-Care Practice in Routine Radiotherapy Care: Identifying Differences Between Practitioners and Non-Practitioners in Sociodemographic, Clinical, Functional, and Quality-of-Life-Related Characteristics. Integr Cancer Ther 2022; 21:15347354221130301. [PMID: 36245274 PMCID: PMC9575442 DOI: 10.1177/15347354221130301] [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] [Indexed: 11/05/2022] Open
Abstract
Objectives: The objective of this study was to describe self-care practice during
radiotherapy for cancer and to identify potential differences between
practitioners and non-practitioners of self-care regarding sociodemographic,
clinical, functional, and quality-of-life-related characteristics. Methods: In this descriptive study, 439 patients (87% response rate) undergoing
radiotherapy responded to a study questionnaire regarding self-care,
sociodemographic, clinical (eg, experienced symptoms), functional, and
quality-of-life-related characteristics. Results: Of the 439 patients, 189 (43%) practiced at least one self-care strategy,
while 250 (57%) did not. In total, the patients described 332 self-care
practices, resulting in 14 different categories of self-care strategies. The
5 most common indicators of practicing self-care were fatigue, general
wellbeing, psychological symptoms, nausea, vomiting and improving physical
condition. The 5 most common self-care strategies were physical activity,
increased recovery, healthy eating, distraction, and skincare. Patients who
were married, were older than 69, patients with less education than
university education, patients undergoing a combination of internal and
external radiotherapy, patients experiencing fewer than 8 symptoms, and
better quality of life, practiced self-care to a lower extent than did other
patients. Functional capacity did not differ between self-care practitioners
and non-practitioners. Conclusion and Implications for Practice: Of the patients undergoing radiotherapy, slightly less than half practiced
self-care during an ordinary week of radiotherapy. Because older and
less-educated patients were less likely to practice self-care, cancer care
practitioners should consider paying particular attention to helping such
patients with their self-care practice.
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Affiliation(s)
- Kerstin Stake-Nilsson
- University of Gävle, Gävle,
Sweden,Kerstin Stake-Nilsson, Department of Caring
Science, Faculty of Health and Occupational Studies, University of Gävle,
kungsbäcksvägen 3, Gävle 801 76, Sweden.
| | | | - Kristina Tödt
- University of Gävle, Gävle,
Sweden,Skåne University Hospital, Sweden
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Ahlstedt Karlsson S, Henoch I, Olofsson Bagge R, Wallengren C. Person-centred support programme (RESPECT intervention) for women with breast cancer treated with endocrine therapy: a feasibility study. BMJ Open 2022; 12:e060946. [PMID: 36198470 PMCID: PMC9535178 DOI: 10.1136/bmjopen-2022-060946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The peRson-cEntred Support Programme EndoCrine Therapy intervention is a complex intervention encompassing a person-centred support programme for patients with breast cancer being treated with endocrine therapy (ET). The aim of this study was to explore the feasibility of the trial design and patient acceptability of the intervention and outcome measures and to provide data to estimate the parameters required to design the final intervention. DESIGN A controlled before-and-after design following the Consolidated Standards of Reporting Trials 2010 statement for feasibility trials. SETTING A surgical outpatient clinic in Sweden. PARTICIPANTS Forty-one patients (aged 47-85) with breast cancer who were treated with ET. INTERVENTIONS Eligible patients were assigned to the control group or intervention group, which included individual education material, an individualised learning plan and a personalised reminder letter using a person-centred approach. The intervention could be delivered as a telephone or digital follow-up during a 12-week follow-up. OUTCOME MEASURES The aims were to determine the recruitment rate, assess the rate of retention, explore whether the intervention was delivered according to the protocol, assess the preferred form of educational support, rate of education sessions, length per education session and length between each education session, determine the distribution of education materials and assess completion rates of patient-reported instruments, including the General Self-efficacy Scale, the Quality of Care from the Patient's Perspective Questionnaire and the Memorial Symptom Assessment Scale. RESULTS Eighty-six per cent of the patients in the intervention group completed the intervention and questionnaires 3 months after their inclusion. The call attendance was 90%. During the intervention, the contact nurse complied with the intervention protocol. For self-efficacy, symptoms and quality of care, there were no differences in effect size between the control and intervention groups. CONCLUSIONS This intervention seems to be feasible and acceptable among patients.
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Affiliation(s)
| | - Ingela Henoch
- Institute of Health and Care Sciences, Gothenburg University, Gothenburg, Sweden
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Hayase T, Mieno MN, Kobayashi K, Mori N, Lebowitz AJ, Kato Y, Saito Y, Yuza Y, Sano H, Osone S, Hori T, Shinkoda Y, Yamamoto N, Hasegawa D, Yano M, Ashiarai M, Hasegawa D, Sawada A, Yamaguchi T, Morimoto A, Fukushima K. Reliability and Validity of the Japanese Pediatric Version of Memorial Symptom Assessment Scale. J Pain Symptom Manage 2022; 63:e495-e504. [PMID: 35031501 DOI: 10.1016/j.jpainsymman.2021.12.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Few instruments in Japanese assess health-related quality of life in pediatric cancer patients. OBJECTIVES To translate the Memorial Symptom Assessment Scale (MSAS) into Japanese pediatric and proxy versions (MSAS-J 7-12, MSAS-J 13-18, and MSAS-J-Proxy) and assess validity and reliability. METHODS Phase I comprised forward-backward translation and pilot testing in 13 children and 16 guardians. Phase II consisted of psychometric testing of the three MSAS-J versions in 162 children and 238 guardians. Internal consistency, test-retest reliability, and construct and known-group validity of the MSAS-J were assessed. RESULTS Cronbach's alpha coefficients for the total and subscale scores were over 0.70, excluding the psychological symptom (PSYCH) subscale score of the MSAS-J 7-12. Most MSAS-J scores significantly inversely correlated with two versions of the Pediatric Quality of Life Inventory. A strong child-guardian correlation was shown in the total and subscale scores (ICC range 0.66-0.83). Kappa estimates showed acceptable child-guardian symptom agreement. MSAS-J 7-12 and proxy differentiated patients according to clinical status. CONCLUSION MSAS-J is a reliable and valid instrument to assess symptoms among Japanese children with cancer.
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Affiliation(s)
- Tomomi Hayase
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan.
| | - Makiko N Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Shimotsuke, Japan
| | - Kyoko Kobayashi
- Department of Child Health Nursing, St. Luke's International University Graduate School of Nursing Science, Tokyo, Japan
| | - Naoko Mori
- Department of Pediatrics, Akabane Zaitaku Clinic, Tokyo, Japan; Departments of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Adam Jon Lebowitz
- Department of General Education, Jichi Medical University, Shimotsuke, Japan
| | - Yoko Kato
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuya Saito
- Departments of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuki Yuza
- Departments of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hirozumi Sano
- Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Shinya Osone
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University, Sapporo, Japan
| | - Yuichi Shinkoda
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Nobuyuki Yamamoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daiichiro Hasegawa
- Department of Hematology and Oncology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Michihiro Yano
- Department of Pediatrics, Akita University School of Medicine, Akita, Japan
| | - Miho Ashiarai
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Akihisa Sawada
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Keitaro Fukushima
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Japan
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10
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Johansson YA, Gillsjö C, Kenne Sarenmalm E. Symptoms and Well-Being in Older Hospitalized Patients with Cognitive Impairment, As Self-Reported and Reported in Patient Records: A Quantitative Exploratory Subgroup Analysis. Dement Geriatr Cogn Dis Extra 2021; 11:71-77. [PMID: 34178010 PMCID: PMC8215956 DOI: 10.1159/000515822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Given the aging population and the high prevalence of cognitive impairment in older hospitalized patients, it is essential to provide good fundamental care to these vulnerable patients, who easily might be affected by poor outcomes as delirium. Risk factors for delirium are, for example, cognitive impairment, old age, pain, and sleep deprivation. Different symptoms are often unidentified in hospitals, and associated with poor well-being, but this is rarely studied in older patients with cognitive impairment. The study aim was to examine symptoms and sense of well-being in older hospitalized patients with cognitive impairment, as self-reported and reported in patient records. Methods Exploratory quantitative subgroup (n = 25) analysis of a point-prevalence study (n = 210). Inclusion criteria were age ≥65, and cognitive impairment. Data were collected through structured interviews, validated instruments, and patient records. Associations between well-being and symptoms, and concordance between the occurrence of self-reported symptoms and symptoms reported in patient records were analyzed. Results The patients reported severe and distressing symptoms that were sparsely reported (14%) in their records. As well were cognitive impairment, and the patients' own descriptions of their well-being. Some symptoms and the total symptom burden were associated with poor well-being. Discussion/Conclusion To our knowledge, this hypothesis-generating study is one of few studies that describe both symptoms and well-being as self-reported and reported in patient records, in vulnerable patients due to old age, cognitive impairment, and hospitalization. Despite the limited sample size, the results indicate that symptoms were more insufficient alleviated in these patients compared to patients with normal cognitive function in other studies. To our knowledge, this has not been shown previously. Additionally, patients' own experiences were sparsely reported in their records. A larger sample size and longitudinal design has the potential to determine if symptom alleviation differs between patients with and without cognitive impairment, and if a total symptom burden increases the risk of poor outcomes as delirium in vulnerable patients.
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Affiliation(s)
- Yvonne A Johansson
- Skaraborg Hospital, Skövde, Sweden.,Jönköping University, The Research School of Health and Welfare, Aging Research Network-Jönköping (ARN-J), Jönköping, Sweden
| | - Catharina Gillsjö
- University of Skövde, Skövde, Sweden.,College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA
| | - Elisabeth Kenne Sarenmalm
- Skaraborg Hospital, Skövde, Sweden.,University of Skövde, Skövde, Sweden.,Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Wiggenraad F, Bolam KA, Mijwel S, van der Wall E, Wengström Y, Altena R. Long-Term Favorable Effects of Physical Exercise on Burdensome Symptoms in the OptiTrain Breast Cancer Randomized Controlled Trial. Integr Cancer Ther 2021; 19:1534735420905003. [PMID: 32090630 PMCID: PMC7040931 DOI: 10.1177/1534735420905003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: We evaluate longitudinal changes in symptom clusters and core burdensome symptoms in breast cancer patients who participated in the OptiTrain trial. Methods: 240 women were randomized to 16 weeks of supervised exercise (RT-HIIT or AT-HIIT) or usual care (UC) during adjuvant chemotherapy. Symptom clusters were composed using the Memorial Symptom Assessment Scale (MSAS), assessed at baseline, 16 weeks and 12 months later. Three symptom clusters were formed. Results: Three symptom clusters were identified: "emotional," "treatment-related toxicity," and "physical," with core burdensome symptoms present over time. At 16 weeks, the reported burdens of "feeling sad" (RT-HIIT vs UC: effect size [ES] = -0.69; AT-HIIT vs UC: ES = -0.56) and "feeling irritable" (ES = -0.41 RT-HIIT; ES = -0.31 AT-HIIT) were significantly lower in both intervention groups compared with UC. At 12 months, the AT-HIIT group continued to have significantly lower scores for the core burdensome symptoms "feeling sad" (ES = -0.44), "feeling irritable" (ES = -0.44), and "changes in the way food tastes" (ES = -0.53) compared with UC. No between-group differences were found for physical symptoms. Conclusion: We identified 3 symptom clusters in breast cancer patients during and after adjuvant chemotherapy, composed of "emotional," "treatment-related toxicity," and "physical" symptoms. After treatment completion up to 12 months post-baseline, patients in the physical exercise groups reported lower symptom burden scores for emotional symptoms, compared with UC. Our findings indicate a preserved and long-term beneficial effect of physical exercise on self-reported emotional well-being in chemotherapy-treated breast cancer patients.
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Affiliation(s)
| | | | | | | | - Yvonne Wengström
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Renske Altena
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
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12
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Mao T, Cheng Q, Liu X, Chen Y. Effect of Electrical Stimulation on Gastrointestinal Symptoms in Lung Cancer Patients during Chemotherapy: A Randomized Controlled Trial. Asia Pac J Oncol Nurs 2021; 8:246-254. [PMID: 33850958 PMCID: PMC8030592 DOI: 10.4103/apjon.apjon_61_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/13/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: The objective was to evaluate the effects of transcutaneous acupoint electric stimulation (TAES) and gastric electrical stimulation (GES) on cancer patients with chemotherapy-induced gastrointestinal (GI) symptoms. Methods: A total of 122 lung cancer patients receiving chemotherapy were assigned randomly to the following two groups: control group (usual care group, n = 61) and intervention group (TAES plus GES, n = 61). TAES involved two acupoints such as Neiguan (PC6) and Zusanli (ST36). GES was performed at gastric pacing sites on the body surface such as the places of projection of gastric antrum and corpus on the body surface. GES was performed on these sites for 14 days continuously (25 min every time, once daily). The effects of TAES and GES on GI symptoms were assessed using the Memorial Symptom Assessment Scale on the day prior to chemotherapy (time point 1) and days 14 (time point 2) and 28 (time point 3) after chemotherapy. Results: No significant differences in the demographic and disease-related variables were detected between the two groups. Differences in symptom occurrence and severity at time point 1 were not statistically significant between the two groups (both P > 0.05). At time points 2 and 3, GI symptoms such as loss of appetite, nausea, vomiting, diarrhea, and constipation in the stimulation group had statistically significantly improved compared with the control group (all P < 0.05). Conclusions: TAES and GES were efficacious in relieving GI discomfort in lung cancer patients after chemotherapy. TAES combined with GES is a safe and easy-to-use tool to manage GI symptoms in practice.
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Affiliation(s)
- Ting Mao
- Department of Palliative Care, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Nursing, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Qinqin Cheng
- Department of Pain Management, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiangyu Liu
- Department of Health Service, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yongyi Chen
- Department of Hospital Office, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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13
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Chien TW, Lai CY, Huang SS, Tsai LY, Tsai MC, Tsay SL. Cancer pain and lower functional status predict poor trajectories of symptom and fatigue distress in patients with lung cancer. Eur J Cancer Care (Engl) 2021; 30:e13403. [PMID: 33484044 DOI: 10.1111/ecc.13403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/05/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To identify distinct subgroups of patients newly diagnosed with lung cancer (LC) over time and to explore the predictors of distinct trajectories of symptom and fatigue distress in LC patients. METHODS A total of 120 patients newly diagnosed with LC were recruited in this longitudinal prospective study. Our survey investigated patients' symptoms in 6 months. Latent growth curve analysis (LGCA) was conducted to identify patients with distinct trajectories of symptom and fatigue distress. The characteristics of the patients among groups were compared for statistical differences by the chi-square test or ANOVA. RESULTS The results of LGCA revealed that the linear three-trajectory model had the best model fit for symptom and fatigue distress. Patients' symptom and fatigue distress improved with time, except for patients with increasing trajectories. Patients' trajectories of symptom and fatigue distress were affected by pain, lower functional status, total symptom score and depression. Moreover, patients with increasing trajectories of symptom and fatigue distress experienced more pain, physiological symptoms and depression from 1 to 6 months. CONCLUSIONS Pain and functional status were the major factors that deteriorated the recovery of trajectory in symptom distress and fatigue distress among patients with increasing trajectories.
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Affiliation(s)
- Tsui-Wei Chien
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chung-Yu Lai
- Surgery Department, Chung-Kang Branch, Cheng-Ching General Hospital, Taichung, Taiwan.,College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Sheng-Shiung Huang
- College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Li-Yun Tsai
- College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Meng-Chuan Tsai
- Department of Sport and Health Management, Da-Yeh University, Changhua, Taiwan
| | - Shiow-Luan Tsay
- College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
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14
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Hiensch AE, Bolam KA, Mijwel S, May AM, Wengström Y. Sense of coherence and its relationship to participation, cancer-related fatigue, symptom burden, and quality of life in women with breast cancer participating in the OptiTrain exercise trial. Support Care Cancer 2020; 28:5371-5379. [PMID: 32140973 PMCID: PMC7546973 DOI: 10.1007/s00520-020-05378-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/24/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE This study examined the Sense of Coherence (SOC) of patients participating in the randomized controlled 'Optimal Training for Women with Breast Cancer' (OptiTrain) study and assessed how patient characteristics were associated with SOC. Secondary aims were to assess the association between SOC and patients' participation in this study and to determine whether SOC moderates the effect of the 16-week exercise intervention on fatigue, quality of life (QoL), and symptom burden in women with breast cancer undergoing chemotherapy. METHODS Modified Poisson regression analyses were conducted to determine the relative risk of weak-normal SOC versus strong SOC in terms of exercise session attendance, study and intervention dropout, and long absence rates. Analyses of covariance were performed to assess whether SOC moderated the effect of the exercise intervention (pinteraction ≤ 0.10). RESULTS Two hundred and forty women with early breast cancer (mean age 53 ± 10) participated in the OptiTrain study. Women with strong SOC reported less fatigue, lower symptom burden, and higher QoL. Women with weak-normal SOC were significantly more likely to drop out from the OptiTrain study and tended to have slightly poorer exercise session attendance. Women with breast cancer and weaker SOC benefitted as much from the exercise intervention, in terms of fatigue and QoL, as those with stronger SOC (pinteraction > 0.10). CONCLUSIONS Strong SOC appears to be associated with a more positive subjective state of health. Women with weak-normal SOC may need additional support to encourage participation and adherence in exercise trials. Assessing SOC may assist clinicians to identify and provide extra support for participants with weak SOC, who may be less inclined to participate in exercise programs.
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Affiliation(s)
- Anouk E Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Kate A Bolam
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sara Mijwel
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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15
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Göransson C, Wengström Y, Hälleberg-Nyman M, Langius-Eklöf A, Ziegert K, Blomberg K. An app for supporting older people receiving home care - usage, aspects of health and health literacy: a quasi-experimental study. BMC Med Inform Decis Mak 2020; 20:226. [PMID: 32933500 PMCID: PMC7493150 DOI: 10.1186/s12911-020-01246-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/03/2020] [Indexed: 01/21/2023] Open
Abstract
Background During the last decade, there has been an increase in studies describing use of mHealth, using smartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people’s usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time. Methods A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6–month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics. Results The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people’s communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time. Conclusions The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, and which aspects of health of importance to support by an app.
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Affiliation(s)
- Carina Göransson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden. .,School of Health and Welfare, Halmstad University, 302 18, Halmstad, Sweden.
| | - Yvonne Wengström
- Theme Cancer, Karolinska University Hospital, 141 86, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska, Institutet, 171 77, Stockholm, Sweden
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska, Institutet, 171 77, Stockholm, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, 302 18, Halmstad, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden
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16
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Gustavell T, Sundberg K, Langius-Eklöf A. Using an Interactive App for Symptom Reporting and Management Following Pancreatic Cancer Surgery to Facilitate Person-Centered Care: Descriptive Study. JMIR Mhealth Uhealth 2020; 8:e17855. [PMID: 32554375 PMCID: PMC7330738 DOI: 10.2196/17855] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pancreatic and periampullary cancers are rare but have high mortality rates. The only hope for cure is surgical removal of the tumor. Following pancreatic surgery, the patients have a great deal of responsibility for managing their symptoms. Patients report a lack of sufficient knowledge of self-care and unmet supportive care needs. This necessitates a health care system responsive to these needs and health care professionals who pay close attention to symptoms. Person-centered care is widely encouraged and means a shift from a model in which the patient is the passive object of care to a model involving the patient as an active participant in their own care. To address the challenges in care following pancreatic cancer surgery, an interactive app (Interaktor) was developed in which patients regularly report symptoms and receive support for self-care. The app has been shown to reduce patients' symptom burden and to increase their self-care activity levels following pancreaticoduodenectomy due to cancer. OBJECTIVE The aim of the study was to describe how patients used the Interaktor app following pancreaticoduodenectomy due to cancer and their experience with doing so. METHODS A total of 115 patients were invited to use Interaktor for 6 months following pancreaticoduodenectomy. Of those, 35 declined, 8 dropped out, and 46 did not meet the inclusion criteria after surgery, leaving 26 patients for inclusion in the analysis. The patients were instructed to report symptoms daily through the app for up to 6 months following surgery. In case of alerting symptoms, they were contacted by their nurse. Data on reported symptoms, alerts, and viewed self-care advice were logged and analyzed with descriptive statistics. Also, the patients were interviewed about their experiences, and the data were analyzed using thematic analysis. RESULTS The patients' median adherence to symptom reporting was 82%. Fatigue and pain were the most reported symptoms. Alerting symptoms were reported by 24 patients, and the most common alert was fever. There were variations in how many times the patients viewed the self-care advice (range 3-181 times). The most commonly viewed advice concerned pancreatic enzyme supplements. Through the interviews, the overarching theme was "Being seen as a person," with the following 3 sub-themes: "Getting your voice heard," "Having access to an extended arm of health care," and "Learning about own health." CONCLUSIONS Interaktor proved to be well accepted. It made patients feel reassured at home and offered support for self-care. The app facilitated person-centered care by its multiple features targeting individual supportive care needs and enabled participation in their own care. This supports our recent studies showing that patients using the app had less symptom burden and higher self-care activity levels than patients receiving only standard care.
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Affiliation(s)
- Tina Gustavell
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.,Karolinska University Hospital, Theme Cancer, Department of Upper Abdominal Diseases, Stockholm, Sweden
| | - Kay Sundberg
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden
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17
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Fjell M, Langius-Eklöf A, Nilsson M, Wengström Y, Sundberg K. Reduced symptom burden with the support of an interactive app during neoadjuvant chemotherapy for breast cancer - A randomized controlled trial. Breast 2020; 51:85-93. [PMID: 32247251 PMCID: PMC7375618 DOI: 10.1016/j.breast.2020.03.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/12/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023] Open
Abstract
Objectives Neoadjuvant chemotherapy causes distressing symptoms, which have to be managed by patients at home. Assessing and acting upon relevant patient-reported symptoms regularly with the support of mHealth such as apps, has shown to decrease symptom burden and improve health-related quality of life (HRQoL). There is a lack of apps for patients with breast cancer which are tested in rigorous trials and only a few include interactive components for immediate clinical management. The aim of this study was to evaluate whether the use of the interactive app Interaktor improves patients’ levels of symptom burden and HRQoL during neoadjuvant chemotherapy for breast cancer. Materials and methods This randomized controlled trial included patients in an intervention group (n = 74) and a control group (n = 75), recruited at two university hospitals in Stockholm, Sweden. The intervention group used Interaktor for symptom reporting, self-care advice and support from health-care professionals during treatment, and the control group received standard care alone. Self-reported symptoms and HRQoL were assessed at two time points to determine differences between the groups. Results The intervention group rated statistically significant less symptom prevalence in nausea, vomiting, feeling sad, appetite loss and constipation. Overall symptom distress and physical symptom distress were rated statistically significant lower in the intervention group. Further, emotional functioning was rated statistically significant higher in the intervention group. Conclusions By using the Interaktor app in clinical practice, patients get individual support when managing treatment-related symptoms during neoadjuvant chemotherapy for breast cancer, leading to decreased symptom burden and improved emotional functioning. Using the app Interaktor reduced symptom burden in patients with breast cancer. The use of Interaktor enhanced emotional functioning during treatment. Interaktor provided individual support during neoadjuvant chemotherapy. Use of Interaktor allowed breast cancer patients for daily reflection over symptoms.
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Affiliation(s)
- Maria Fjell
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden.
| | - Ann Langius-Eklöf
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden
| | - Marie Nilsson
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden; Karolinska University Hospital, Function Area Social Work in Health Care, Stockholm, Sweden; Stockholm County Council, Academic Primary Health Care Center, Stockholm, Sweden
| | - Yvonne Wengström
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden; Karolinska University Hospital, Cancer Theme, Stockholm, Sweden
| | - Kay Sundberg
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Stockholm, Sweden
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18
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Development and Feasibility of an Interactive Smartphone App for Early Assessment and Management of Symptoms Following Pancreaticoduodenectomy. Cancer Nurs 2020; 42:E1-E10. [PMID: 29596113 DOI: 10.1097/ncc.0000000000000584] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients who have undergone pancreaticoduodenectomy because of pancreatic cancer experience distressing symptoms and unmet supportive care needs after discharge. To meet these needs, we have developed a mobile health app (Interaktor) for daily assessment of symptoms and access to self-care advice that includes a risk assessment model for alerts with real-time interactions with professionals. OBJECTIVE The study aim was to develop and test a version of the Interaktor app adapted for patients who have undergone pancreaticoduodenectomy. METHODS The app was developed and tested for feasibility in 6 patients during 4 weeks. One nurse monitored and responded to alerts. Logged data from the app were collected, and all participants were interviewed about their experiences. RESULTS Adherence to reporting daily was 84%. Alerts were generated in 41% of the reports. The patients felt reassured and cared for and received support for symptom management. The app was easy to use, had relevant content, and had few technical problems, although suggestions for improvement were given. CONCLUSIONS The daily reporting of symptoms and having access to a nurse in real time in the case of an alarming symptom seem to enhance symptom management and render a feeling of security in patients. Some modifications of the app are needed before use in a larger sample. IMPLICATIONS FOR PRACTICE Daily reporting of symptoms after pancreaticoduodenectomy enhances symptom management, self-care, and participation without being a burden to patients, indicating that mobile health can be used in clinical practice by patients with poor prognosis who experience severe symptoms.
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19
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Göransson C, Wengström Y, Ziegert K, Langius-Eklöf A, Blomberg K. Self-care ability and sense of security among older persons when using an app as a tool for support. Scand J Caring Sci 2019; 34:772-781. [PMID: 31769888 DOI: 10.1111/scs.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/02/2019] [Indexed: 01/01/2023]
Abstract
THE STUDY'S RATIONALE The need for home care among older persons is increasing, and mHealth is evolving to help meet the challenge. When developing an app to help maintain their health, it is essential to incorporate older persons' preferences. AIMS AND OBJECTIVES To describe and evaluate the experiences of self-care support and sense of security among older persons using an interactive app to report health concerns. METHODOLOGICAL DESIGN AND JUSTIFICATION The study had a descriptive and evaluative design. Qualitative and quantitative methods were applied to achieve a broader understanding. ETHICAL ISSUES AND APPROVAL Ethical approval was obtained from the Regional Ethical Review Board. The older persons received verbal and oral information about the study and gave written informed consent. RESEARCH METHODS Questionnaires (n = 17 older persons) answered at baseline, end of the intervention and at a 6-month follow-up were analysed with statistical analysis. Interviews (n = 17 older persons) conducted at the end of the intervention were analysed using a qualitative directed approach. MEASUREMENTS AND INTERVENTION The questionnaire included the Appraisal of Self-care Agency Scale and a question concerning sense of security. For 3 months, the older persons used an app for regular reporting of health concerns. The app included self-care advice, graphs and a risk assessment model that generated alerts directly to the nurses. RESULTS The older persons described how self-care and sense of security increased at the end of intervention, but statistically, it was shown to decrease afterwards. STUDY LIMITATIONS The small sample size for statistical analysis. CONCLUSIONS This study shows that an app can be a complementary tool to conventional home care that can increase older persons' sense of security and self-care ability. The results mirror the older persons' awareness that the support they received with the app was only temporary. Larger studies are needed for generalisation.
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Affiliation(s)
- Carina Göransson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.,School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Yvonne Wengström
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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20
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Klompstra L, Ekdahl AW, Krevers B, Milberg A, Eckerblad J. Factors related to health-related quality of life in older people with multimorbidity and high health care consumption over a two-year period. BMC Geriatr 2019; 19:187. [PMID: 31277674 PMCID: PMC6612189 DOI: 10.1186/s12877-019-1194-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of multimorbidity is increasing worldwide, and older people with multimorbidity are frequent users of health care services. Since multimorbidity has a significant negative impact on Health-related Quality of Life (HrQoL) and is more common in older age it would be expected that factors related to HrQoL in this group might have been thoroughly researched, but this is not the case. Furthermore, it is important to look at old people living at home, considering the shift from residential to home-based care. Therefore, we aim to investigate factors that are related to HrQoL in older people with multimorbidity and high health care consumption, living at home. METHODS This is a secondary analysis of a RCT study conducted in a municipality in south-eastern Sweden. The study had a longitudinal design with a two-year follow-up period assessing HrQoL, symptom burden, activities of daily living, physical activity and depression. RESULTS In total, 238 older people with multimorbidity and high health care consumption, living at home were included (mean age 82, 52% female). A multiple linear regression model including symptom burden, activities of daily living and depression as independent variables explained 64% of the HrQoL. Higher symptom burden, lower ability in activities of daily living and a higher degree of depression were negatively related to HrQoL. Depression at baseline and a change in symptom burden over a two-year period explained 28% of the change in HrQoL over a two-year period variability. A higher degree of depression at baseline and negative change in higher symptom burden were related to a decrease in HrQoL over a two-year period. CONCLUSION In order to facilitate better delivery of appropriate health care to older people with high health care consumption living at home it is important to assess HrQoL, and HrQoL over time. Symptom burden, activities of daily living, depression and change in symptom burden over time are important indicators for HrQoL. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01446757 , the trial was registered prospectively with the date of trial registration October 5th, 2011.
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Affiliation(s)
- Leonie Klompstra
- Department of Social and Welfare Studies, Division of Nursing, Linköping University, Linköping, Sweden. .,Department of Social and Welfare Studies, Linköping University, SE 601 74, Norrköping, Sweden.
| | - Anne W Ekdahl
- Section of Geriatric Medicine and Institution of Clinical Research, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Barbro Krevers
- Department of Medicine and Health Sciences, Division of Health Care Analysis, Linköping University, Linkoping, Sweden
| | - Anna Milberg
- Department of Advanced Home Care, Linköping University, Norrköping, Sweden.,Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Jeanette Eckerblad
- Department on Neurobiology and Care Science and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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Bolam KA, Mijwel S, Rundqvist H, Wengström Y. Two-year follow-up of the OptiTrain randomised controlled exercise trial. Breast Cancer Res Treat 2019; 175:637-648. [PMID: 30915663 PMCID: PMC6534518 DOI: 10.1007/s10549-019-05204-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 12/24/2022]
Abstract
Purpose The aim of this study was to determine if there were any differences in health-related outcomes and physical activity (PA) between the two OptiTrain exercise groups and usual care (UC), 2 years post-baseline. Methods The OptiTrain study was a three-arm randomised controlled trial comparing 16 weeks of concurrent aerobic high-intensity interval training (HIIT) and progressive resistance exercise (RT-HIIT) or concurrent HIIT and continuous moderate-intensity aerobic exercise (AT-HIIT) to UC in 206 patients with breast cancer undergoing chemotherapy. Eligible participants were approached 2 years following baseline to assess cancer-related fatigue, quality of life, symptoms, muscle strength, cardiorespiratory fitness, body mass, PA, sedentary behaviour, and sick leave. Results The RT-HIIT group reported lower total cancer-related fatigue, (− 1.37, 95% CI − 2.70, − 0.04, ES = − 0.06) and cognitive cancer-related fatigue (− 1.47, 95% CI − 2.75, − 0.18, ES = − 0.28), and had higher lower limb muscle strength (12.09, 95% CI 3.77, 20.40, ES = 0.52) than UC at 2 years. The AT-HIIT group reported lower total symptoms (− 0.23, 95% CI − 0.42, − 0.03, ES = − 0.15), symptom burden (− 0.30, 95% CI − 0.60, − 0.01, ES = − 0.19), and body mass − 2.15 (− 3.71, − 0.60, ES = − 0.28) than UC at 2 years. Conclusion At 2 years, the exercise groups were generally experiencing positive differences in cancer-related fatigue (RT-HIIT), symptoms (AT-HIIT), and muscle strength (RT-HIIT) to UC. The findings provide novel evidence that being involved in an exercise program during chemotherapy can have long-term benefits for women with breast cancer, but that strategies are needed to create better pathways to support patients to maintain physical activity levels. Trial registration Clinicaltrials.gov registration number: NCT02522260. Trial registered on 9 June 2015. https://clinicaltrials.gov/ct2/show/NCT02522260. Retrospectively registered.
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Affiliation(s)
- Kate A Bolam
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, 14183, Stockholm, Sweden.
| | - Sara Mijwel
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, 14183, Stockholm, Sweden
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Helene Rundqvist
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, 14183, Stockholm, Sweden
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
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High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship. J Cancer Surviv 2019; 13:244-256. [PMID: 30912010 PMCID: PMC6482129 DOI: 10.1007/s11764-019-00747-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/27/2019] [Indexed: 12/12/2022]
Abstract
Purpose Whether the benefits of exercise during chemotherapy continue into survivorship is not well-known. Here, the aim was to examine the effects of two exercise interventions on self-reported health-related and objectively measured physiological outcomes 12 months following commencement of chemotherapy. Methods Two hundred and forty women with breast cancer stage I–IIIa were randomized to 16 weeks of high-intensity aerobic interval training combined with either resistance training (RT-HIIT), or moderate-intensity aerobic training (AT-HIIT), or to usual care (UC). Primary outcome: cancer-related fatigue (CRF); secondary outcomes: quality of life (QoL), symptom burden, muscle strength, cardiorespiratory-fitness, body mass, and return to work. Results Compared to UC, both RT-HIIT and AT-HIIT significantly counteracted increases in total CRF (ES = − 0.34; ES = − 0.10), daily life CRF (ES=-0.76; ES=-0.50, and affective CRF (ES=-0.60; ES=-0.39). Both RT-HIIT and AT-HIIT reported significantly lower total symptoms (ES = − 0.46, ES = − 0.46), and displayed gains in lower limb (ES = 0.73; ES = 1.03) and handgrip muscle strength (surgery side ES = 0.70, ES = 0.71; non-surgery side ES = 0.57, ES = 0.59). AT-HIIT displayed significant reductions in body mass (ES = − 0.24), improved QoL: role (ES = 0.33) and emotional functioning (ES = 0.40), and a larger proportion had returned to work (p = 0.02) vs UC. Conclusion These findings emphasize the beneficial effects of supervised high-intensity exercise during chemotherapy to improve the health and to reduce societal costs associated with prolonged sick leave for patients with breast cancer several months following chemotherapy. Implications for Cancer Survivors These findings provide important information with substantial positive consequences for breast cancer survivorship. High-intensity exercise programs during chemotherapy and support to maintain physical activity can be a powerful strategy to manage or prevent many of the short- and long-term adverse effects of treatment for the increasing cohort of cancer survivors.
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Haryani H, Hsu YY, Warsini S, Wang ST. Measuring the Symptom Experience of Patients With Cancer in Indonesia: Cross-Cultural Adaptation and Validation of the Memorial Symptom Assessment Scale-Indonesian Version. J Pain Symptom Manage 2018; 56:920-927. [PMID: 30176284 DOI: 10.1016/j.jpainsymman.2018.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022]
Abstract
CONTEXT Little is known about cancer-related symptoms in terms of prevalence, severity, and distress among patients with cancer in Indonesia because of a lack of a valid and reliable scale. OBJECTIVES To translate and validate the Memorial Symptom Assessment Scale (MSAS) among cancer patients in Indonesia. METHODS Two procedures consisting of forward-backward translation and validation were conducted. The validation process including pretesting involved 34 cancer patients, and the psychometric testing of the Indonesian version of MSAS (MSAS-I) involved 207 cancer patients. Internal consistency, test-retest reliability, construct, and concurrent validity of the MSAS-I were established. RESULTS Cronbach's alpha coefficients for the total scale and subscales of the MSAS-I ranged from 0.75 to 0.87. The interclass correlations for test-retest reliability ranged from 0.80 to 0.89. A two-factor structure in the MSAS-I was produced by exploratory factor analysis, and the two factors accounted for 28.34% of the cumulative variance. In addition, the concurrent validity was demonstrated by the significant associations between the subscales of the MSAS-I and their corresponding subscales in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, with r = -0.25 to -0.65 (all P < 0.001). CONCLUSION The MSAS-I presents a valid and reliable scale for assessing symptom frequency, severity, and distress among patients with cancer in Indonesia. IMPLICATION FOR NURSING The MSAS-I can assess physical and psychological symptoms during cancer treatment. In addition, the MSAS-I may facilitate in measuring the effectiveness of symptom management strategies.
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Affiliation(s)
- Haryani Haryani
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Yu-Yun Hsu
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan.
| | - Sri Warsini
- Department of Mental Health Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Shan-Tair Wang
- Department of Gerontology, College of Medicine, National Cheng Kung University, Taiwan
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Saraev AV, Kornilov NN, Kulyaba TA. [Efficiency of the multimodal approach to analgesia in total knee arthroplasty]. Khirurgiia (Mosk) 2018:83-90. [PMID: 29953105 DOI: 10.17116/hirurgia2018683-90] [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] [Indexed: 01/13/2023]
Abstract
MATERIAL AND METHODS The study included 160 patients with end stage knee osteoarthritis hospitalized for primary uncomplicated TKA. There were 142 women and 18 men (mean age 66.5 and 65.4 years respectively). In the control group (n=100) standard protocol of perioperative pain management was applied, in the main group (n=60) - original multimodal approach including patient's education in order to increase his awareness and to reduce anxiety on the preoperative stage, modified surgical technique (optimization of incision length, 'sliding window' principle, tourniquet during the whole procedure until applying of compressive dressing, no drains and local infiltration analgesia) and double-level postoperative analgesia. Different factors of pain syndrome were assessed before surgery by using of specialized tests, while the dynamics of early postoperative pain characteristics were evaluated by individual diaries. RESULTS Despite decrease of pain syndrome in both groups within 3 days after TKA in the main group these changes were significantly better (p<0.05). On the first postoperative day 42 (70%) patients in the main group had not pain at rest, while in the control group such cases were absent (р<0.001). There was 2-fold increase of hours of moderate/severe pain per day in the control group compared with the main group (р<0.001). No specific complications were identified in both groups during follow-up. CONCLUSION Original multimodal perioperative approach to analgesia proved its efficiency in patients undergoing primary TKA compared with conventional one and may be safely used in clinical practice.
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Affiliation(s)
- A V Saraev
- Knee Surgery Department #17, Vreden Russian Research Institute for Traumatology and Orthopaedics, Saint Petersburg, Russia
| | - N N Kornilov
- Knee Surgery Department #17, Vreden Russian Research Institute for Traumatology and Orthopaedics, Saint Petersburg, Russia; Mechnikov North-Western State Medical University, Saint-Petersburg, Russia
| | - T A Kulyaba
- Knee Surgery Department #10, Vreden Russian Research Institute for Traumatology and Orthopaedics, Saint-Petersburg, Russia
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Henoch I, Olsson C, Larsson M, Ahlberg K. Symptom Dimensions as Outcomes in Interventions for Patients With Cancer: A Systematic Review. Oncol Nurs Forum 2018; 45:237-249. [DOI: 10.1188/18.onf.237-249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tantoy IY, Cooper BA, Dhruva A, Cataldo J, Paul SM, Conley YP, Hammer M, Wright F, Dunn LB, Levine JD, Miaskowski C. Changes in the Occurrence, Severity, and Distress of Symptoms in Patients With Gastrointestinal Cancers Receiving Chemotherapy. J Pain Symptom Manage 2018; 55:808-834. [PMID: 29051114 PMCID: PMC5834370 DOI: 10.1016/j.jpainsymman.2017.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 01/02/2023]
Abstract
CONTEXT Studies on multiple dimensions of the symptom experience of patients with gastrointestinal cancers are extremely limited. OBJECTIVE Purpose was to evaluate for changes over time in the occurrence, severity, and distress of seven common symptoms in these patients. METHODS Patients completed Memorial Symptom Assessment Scale, six times over two cycles of chemotherapy (CTX). Changes over time in occurrence, severity, and distress of pain, lack of energy, nausea, feeling drowsy, difficulty sleeping, and change in the way food tastes were evaluated using multilevel regression analyses. In the conditional models, effects of treatment group (i.e., with or without targeted therapy), age, number of metastatic sites, time from cancer diagnosis, number of prior cancer treatments, cancer diagnosis, and CTX regimen on enrollment levels, as well as the trajectories of symptom occurrence, severity, and distress were evaluated. RESULTS Although the occurrence rates for pain, lack of energy, feeling drowsy, difficulty sleeping, and change in the way food tastes declined over the two cycles of CTX, nausea and numbness/tingling in hands/feet had more complex patterns of occurrence. Severity and distress ratings for the seven symptoms varied across the two cycles of CTX. CONCLUSIONS Demographic and clinical characteristics associated with differences in enrollment levels as well as changes over time in occurrence, severity, and distress of these seven common symptoms were highly variable. These findings can be used to identify patients who are at higher risk for more severe and distressing symptoms during CTX and to enable the initiation of preemptive symptom management interventions.
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Affiliation(s)
- Ilufredo Y Tantoy
- School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, California, USA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Fay Wright
- School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Palo Alto, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Göransson C, Eriksson I, Ziegert K, Wengström Y, Langius-Eklöf A, Brovall M, Kihlgren A, Blomberg K. Testing an app for reporting health concerns-Experiences from older people and home care nurses. Int J Older People Nurs 2017; 13:e12181. [PMID: 29210218 DOI: 10.1111/opn.12181] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of using an app among older people with home-based health care and their nurses. BACKGROUND Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. DESIGN Explorative qualitative design. METHODS For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. RESULTS The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. CONCLUSIONS The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. IMPLICATIONS FOR PRACTICE The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care.
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Affiliation(s)
- Carina Göransson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Irene Eriksson
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Yvonne Wengström
- Cancer Theme, Karolinska University Hospital, Stockholm, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ann Langius-Eklöf
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Brovall
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Annica Kihlgren
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Validation of the Symptom Status Questionnaire-Heart Failure in Korean patients. Appl Nurs Res 2017; 38:141-146. [DOI: 10.1016/j.apnr.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 10/05/2017] [Accepted: 10/15/2017] [Indexed: 01/06/2023]
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Mijwel S, Backman M, Bolam KA, Jervaeus A, Sundberg CJ, Margolin S, Browall M, Rundqvist H, Wengström Y. Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial. Breast Cancer Res Treat 2017; 168:79-93. [PMID: 29139007 PMCID: PMC5847033 DOI: 10.1007/s10549-017-4571-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/04/2017] [Indexed: 01/06/2023]
Abstract
Purpose Exercise training is an effective and safe way to counteract cancer-related fatigue (CRF) and to improve health-related quality of life (HRQoL). High-intensity interval training has proven beneficial for the health of clinical populations. The aim of this randomized controlled trial was to compare the effects of resistance and high-intensity interval training (RT–HIIT), and moderate-intensity aerobic and high-intensity interval training (AT–HIIT) to usual care (UC) in women with breast cancer undergoing chemotherapy. The primary endpoint was CRF and the secondary endpoints were HRQoL and cancer treatment-related symptoms. Methods Two hundred and forty women planned to undergo chemotherapy were randomized to supervised RT–HIIT, AT–HIIT, or UC. Measurements were performed at baseline and at 16 weeks. Questionnaires included Piper Fatigue Scale, EORTC-QLQ-C30, and Memorial Symptom Assessment Scale. Results The RT–HIIT group was superior to UC for CRF: total CRF (p = 0.02), behavior/daily life (p = 0.01), and sensory/physical (p = 0.03) CRF. Role functioning significantly improved while cognitive functioning was unchanged for RT–HIIT compared to declines shown in the UC group (p = 0.04). AT–HIIT significantly improved emotional functioning versus UC (p = 0.01) and was superior to UC for pain symptoms (p = 0.03). RT–HIIT reported a reduced symptom burden, while AT–HIIT remained stable compared to deteriorations shown by UC (p < 0.01). Only RT–HIIT was superior to UC for total symptoms (p < 0.01). Conclusions 16 weeks of resistance and HIIT was effective in preventing increases in CRF and in reducing symptom burden for patients during chemotherapy for breast cancer. These findings add to a growing body of evidence supporting the inclusion of structured exercise prescriptions, including HIIT, as a vital component of cancer rehabilitation. Trial registration Clinicaltrials.gov Registration Number: NCT02522260.
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Affiliation(s)
- Sara Mijwel
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. .,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
| | - Malin Backman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Kate A Bolam
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Anna Jervaeus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Carl Johan Sundberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Sara Margolin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Stockholm South General Hospital, Stockholm, Sweden
| | - Maria Browall
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,School of Health and Education, University of Skövde, Skövde, Sweden
| | - Helene Rundqvist
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Menezes JRD, Luvisaro BMO, Rodrigues CF, Muzi CD, Guimarães RM. Test-retest reliability of Brazilian version of Memorial Symptom Assessment Scale for assessing symptoms in cancer patients. EINSTEIN-SAO PAULO 2017; 15:148-154. [PMID: 28767911 PMCID: PMC5609609 DOI: 10.1590/s1679-45082017ao3645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 01/10/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the test-retest reliability of the Memorial Symptom Assessment Scale translated and culturally adapted into Brazilian Portuguese. Methods The scale was applied in an interview format for 190 patients with various cancers type hospitalized in clinical and surgical sectors of the Instituto Nacional de Câncer José de Alencar Gomes da Silva and reapplied in 58 patients. Data from the test-retest were double typed into a Microsoft Excel spreadsheet and analyzed by the weighted Kappa. Results The reliability of the scale was satisfactory in test-retest. The weighted Kappa values obtained for each scale item had to be adequate, the largest item was 0.96 and the lowest was 0.69. The Kappa subscale was also evaluated and values were 0.84 for high frequency physic symptoms, 0.81 for low frequency physical symptoms, 0.81 for psychological symptoms, and 0.78 for Global Distress Index. Conclusion High level of reliability estimated suggests that the process of measurement of Memorial Symptom Assessment Scale aspects was adequate. Objetivo Avaliar a confiabilidade teste-reteste da versão traduzida e adaptada culturalmente para o português do Brasil do Memorial Symptom Assessment Scale. Métodos A escala foi aplicada em forma de entrevista em 190 pacientes com diversos tipos de câncer internados nos setores clínicos e cirúrgicos do Instituto Nacional de Câncer José de Alencar Gomes da Silva e reaplicada em 58 pacientes. Os dados dos testes-retestes foram inseridos num banco de dados por dupla digitação independente em Excel e analisados pelo Kappa ponderado. Resultados A confiabilidade da escala mostrou-se satisfatória nos testes-retestes. Os valores do Kappa ponderado obtidos para cada item da escala apresentaram-se adequados, sendo o maior item de 0,96 e o menor de 0,69. Também se avaliou o Kappa das subescalas, sendo de 0,84 para sintomas físicos de alta frequência, de 0,81 para sintomas físicos de baixa frequência, de 0,81 também para sintomas psicológicos, e de 0,78 para Índice Geral de Sofrimento. Conclusão Altos níveis de confiabilidade estimados permitem concluir que o processo de aferição dos itens do Memorial Symptom Assessment Scale foi adequado.
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Affiliation(s)
| | | | | | - Camila Drumond Muzi
- Instituto Nacional de Câncer José de Alencar Gomes da Silva, Rio de Janeiro, RJ, Brazil
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Kenne Sarenmalm E, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med 2017; 6:1108-1122. [PMID: 28421677 PMCID: PMC5430085 DOI: 10.1002/cam4.1052] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 12/26/2022] Open
Abstract
Many breast cancer survivors have to deal with a variety of psychological and physiological sequelae including impaired immune responses. The primary purpose of this randomized controlled trial was to determine the efficacy of a mindfulness‐based stress reduction (MBSR) intervention for mood disorders in women with breast cancer. Secondary outcomes were symptom experience, health status, coping capacity, mindfulness, posttraumatic growth, and immune status. This RTC assigned 166 women with breast cancer to one of three groups: MBSR (8 weekly group sessions of MBSR), active controls (self‐instructing MBSR) and non‐MBSR. The primary outcome measure was the Hospital Anxiety and Depression Scale. Secondary outcome measures were: Memorial Symptom Assessment Scale, SF‐36, Sense of Coherence, Five Facets of Mindfulness Questionnaire, and Posttraumatic Growth Index. Blood samples were analyzed using flow cytometry for NK‐cell activity (FANKIA) and lymphocyte phenotyping; concentrations of cytokines were determined in sera using commercial high sensitivity IL‐6 and IL‐8 ELISA (enzyme‐linked immunosorbent assay) kits. Results provide evidence for beneficial effects of MBSR on psychological and biological responses. Women in the MBSR group experienced significant improvements in depression scores, with a mean pre‐MBSR HAD‐score of 4.3 and post‐MBSR score of 3.3 (P = 0.001), and compared to non‐MBSR (P = 0.015). Significant improvements on scores for distress, symptom burden, and mental health were also observed. Furthermore, MBSR facilitated coping capacity as well as mindfulness and posttraumatic growth. Significant benefits in immune response within the MBSR group and between groups were observed. MBSR have potential for alleviating depression, symptom experience, and for enhancing coping capacity, mindfulness and posttraumatic growth, which may improve breast cancer survivorship. MBSR also led to beneficial effect on immune function; the clinical implications of this finding merit further research.
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Affiliation(s)
| | - Lena B Mårtensson
- School of Health and Education, University of Skövde; Skövde, Sweden
| | - Bengt A Andersson
- Department of Clinical immunology and transfusion medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Sweden University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Bergh
- School of Health and Education, University of Skövde; Skövde, Sweden
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Algilani S, Langius-Eklöf A, Kihlgren A, Blomberg K. An interactive ICT platform for early assessment and management of patient-reported concerns among older adults living in ordinary housing - development and feasibility. J Clin Nurs 2017; 26:1575-1583. [PMID: 27381423 DOI: 10.1111/jocn.13468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To develop and test feasibility and acceptability of an interactive ICT platform integrated in a tablet for collecting and managing patient-reported concerns of older adults in home care. BACKGROUND Using different ICT applications, for example interactive tablets for self-assessment of health and health issues based on health monitoring as well as other somatic and psychiatric monitoring systems may improve quality of life, staff and patient communication and feelings of being reassured. The European Commission hypothesises that introduction of ICT applications to the older population will enable improved health. However, evidence-based and user-based applications are scarce. DESIGN The design is underpinned by the Medical Research Council's complex intervention evaluation framework. A mixed-method approach was used combining interviews with older adults and healthcare professionals, and logged quantitative data. METHODS In cooperation with a health management company, a platform operated by an interactive application for reporting and managing health-related problems in real time was developed. Eight older adults receiving home care were recruited to test feasibility. They were equipped with the application and reported three times weekly over four weeks, and afterwards interviewed about their experiences. Three nurses caring for them were interviewed. The logged data were extracted as a coded file. RESULTS The older adults reported as instructed, in total 107 reports (Mean 13). The most frequent concerns were pain, fatigue and dizziness. The older adults experienced the application as meaningful with overall positive effects as well as potential benefits for the nurses involved. CONCLUSIONS The overall findings in this study indicated high feasibility among older adults using the ICT platform. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations. RELEVANCE TO CLINICAL PRACTICE An ICT platform increased the older adults' perception of involvement and facilitated communication between the patient and nurses.
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Affiliation(s)
- Samal Algilani
- Nutrition and Physical Activity Research Centre (NUPARC), Faculty of Medicine, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Annica Kihlgren
- Nutrition and Physical Activity Research Centre (NUPARC), Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Wengström Y, Bolam KA, Mijwel S, Sundberg CJ, Backman M, Browall M, Norrbom J, Rundqvist H. Optitrain: a randomised controlled exercise trial for women with breast cancer undergoing chemotherapy. BMC Cancer 2017; 17:100. [PMID: 28166765 PMCID: PMC5294772 DOI: 10.1186/s12885-017-3079-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/20/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Women with breast cancer undergoing chemotherapy suffer from a range of detrimental disease and treatment related side-effects. Exercise has shown to be able to counter some of these side-effects and improve physical function as well as quality of life. The primary aim of the study is to investigate and compare the effects of two different exercise regimens on the primary outcome cancer-related fatigue and the secondary outcomes muscle strength, function and structure, cardiovascular fitness, systemic inflammation, skeletal muscle gene activity, health related quality of life, pain, disease and treatment-related symptoms in women with breast cancer receiving chemotherapy. The second aim is to examine if any effects are sustained 1, 2, and 5 years following the completion of the intervention and to monitor return to work, recurrence and survival. The third aim of the study is to examine the effect of attendance and adherence rates on the effects of the exercise programme. METHODS This study is a randomised controlled trial including 240 women with breast cancer receiving chemotherapy in Stockholm, Sweden. The participants are randomly allocated to either: group 1: Aerobic training, group 2: Combined resistance and aerobic training, or group 3: usual care (control group). During the 5-year follow-up period, participants in the exercise groups will receive a physical activity prescription. Measurements for endpoints will take place at baseline, after 16 weeks (end of intervention) as well as after 1, 2 and 5 years. DISCUSSION This randomised controlled trial will generate substantial information regarding the effects of different types of exercise on the health of patients with breast cancer undergoing chemotherapy. We expect that dissemination of the knowledge gained from this study will contribute to developing effective long term strategies to improve the physical and psychosocial health of breast cancer survivors. TRIAL REGISTRATION OptiTrain - Optimal Training Women with Breast Cancer (OptiTrain), NCT02522260 ; Registration: June 9, 2015, Last updated version Feb 29, 2016. Retrospectively registered.
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Affiliation(s)
- Y Wengström
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Karolinska University Hospital, 141 83 Huddinge, Stockholm, Sweden. .,Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
| | - K A Bolam
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - S Mijwel
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - C J Sundberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Unit for Bioentrepreneurship, Karolinska Institutet, Solna, Sweden
| | - M Backman
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Karolinska University Hospital, 141 83 Huddinge, Stockholm, Sweden.,Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - M Browall
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - J Norrbom
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - H Rundqvist
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
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Tantoy IY, Dhruva A, Cataldo J, Venook A, Cooper BA, Paul SM, Levine JD, Conley YP, Cartwright F, Lee K, Wright F, Miaskowski C. Differences in symptom occurrence, severity, and distress ratings between patients with gastrointestinal cancers who received chemotherapy alone or chemotherapy with targeted therapy. J Gastrointest Oncol 2017; 8:109-126. [PMID: 28280616 DOI: 10.21037/jgo.2017.01.09] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Approximately 28% of patients with gastrointestinal (GI) cancers will receive targeted therapy (TT) because of the associated increases in survival. Only four studies have examined the symptom experience of these patients. To date, no studies have evaluated for differences in symptom occurrence, severity, and distress between patients who received chemotherapy (CTX) alone (n=304) or CTX with TT (n=93). METHODS Patients completed self-report questionnaires, approximately one week after they received CTX. A modified version of the Memorial Symptom Assessment Scale (MSAS) was used to obtain data on symptom occurrence, severity, and distress. Binary logistic regression analyses were used to test for differences in symptom occurrence rates between the two treatment groups. Ordinal logistic regression analyses were used to test for differences in severity and distress ratings between the two treatment groups. RESULTS Patients who received CTX with TT were significantly younger (P=0.009); were diagnosed with cancer longer (P=0.004); had a higher number of prior treatments (P=0.024); had metastatic disease, specifically to the liver (P<0.001); had a diagnosis of anal, colon, rectum, or colorectal cancer (CRC) (P<0.001); and were positive for detection of B-Raf proto-oncogene, serine/threonine kinase (BRAF) and Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations (both P<0.001). In addition, CTX treatment regimens were significantly different between the two groups (P<0.001). After controlling for significant covariates, patients who received TT reported lower occurrence rates for lack of energy, cough, feeling drowsy, and difficulty sleeping (all, P<0.05). Patients who received TT reported lower severity scores for dry mouth (P=0.034) and change in the way food tastes (P=0.035). However, they reported higher severity scores for "I don't look like myself" (P=0.026). No differences in symptom distress scores were found between the two treatment groups. CONCLUSIONS This study is the first to evaluate for differences in the symptom experience of GI cancer patients who received CTX alone or CTX with TT using a multidimensional symptom assessment scale. While between group differences in patients' symptom experiences were identified, both treatment groups warrant ongoing assessments to optimally manage their symptoms.
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Affiliation(s)
- Ilufredo Y Tantoy
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Anand Dhruva
- Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Janine Cataldo
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Alan Venook
- Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kathryn Lee
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Fay Wright
- Department of Nursing and Acute Care/Health Systems, School of Nursing, Yale University, New Haven, CT, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
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Browall M, Brandberg Y, Nasic S, Rydberg P, Bergh J, Rydén A, Xie H, Eriksson I, Wengström Y. A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment. Support Care Cancer 2016; 25:1423-1429. [PMID: 27981366 PMCID: PMC5378737 DOI: 10.1007/s00520-016-3527-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/05/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim was to prospectively map symptom clusters in patients with stage I-IIIa breast cancer during standard chemotherapy treatment in a randomised study. METHODS Participants completed the Memorial Symptom Assessment Scale (MSAS) at baseline, day 12 after the first and third cycle of FEC 75 or FEC 100, and day 12 after the last cycle of Taxotere. Cut-off values for symptom scores, a mean value based on each individual reporting a symptom including occurrence, frequency, severity and distress for inclusion in analysis, were determined. RESULTS The symptom burden cluster analysis was conducted in two steps and included symptoms with high frequency and high levels of distress. The factor analysis revealed three symptom clusters; physical, gastro (phys/gastro) and emotional, with core symptoms that remained stable over time. The most prevalent symptoms for the total sample during all cycles were as follows: lack of energy (range between 48 and 90%), feeling sad (48-79%), difficulty sleeping (54-78%), difficulty concentrating (53-74%), worrying (54-74%) and pain (29-67%). CONCLUSION In summary, we have prospectively established that symptom clusters remain stable over time with a basis of core symptoms. This knowledge will aid in the development of effective core symptom-focused interventions to minimise symptom burden for patients treated with chemotherapy for breast cancer.
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Affiliation(s)
- Maria Browall
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden. .,School of Health and Education, University of Skövde, Skövde, Sweden.
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Per Rydberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Rydén
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hanjing Xie
- Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Irene Eriksson
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.,Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
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Llamas Ramos I, Llamas Ramos R, Martín Nogueras AM, Alvarado Omenat JJ, Calvo Arenillas JI, Fonseca Sánchez E, Cortés Rodríguez M. Reliability and Validity of the Spanish Version of the Memorial Symptom Assessment Scale in Oncology Patients. J Pain Symptom Manage 2016; 52:884-891. [PMID: 27693903 DOI: 10.1016/j.jpainsymman.2016.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/25/2016] [Accepted: 05/20/2016] [Indexed: 11/17/2022]
Abstract
CONTEXT Memorial Symptom Assessment Scale (MSAS) is a multidimensional tool developed to evaluate frequency, severity, and distress of common symptoms present in cancer patients. OBJECTIVE To translate the original English version of MSAS and prove the reliability and validity of the Spanish version. METHODS MSAS scale was translated into Spanish and administered to 246 cancer patients aged between 18 and 85 years. They attended the Day Hospital to receive chemotherapy. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Rotterdam Symptom Checklist were used to test criterion validity. RESULTS TOTAL MSAS, Physical Symptom Subscale (PHYS), Psychological Symptom Subscale (PSYCH), and Global Distress Index (GDI) reported high internal consistency: 0.891, 0.801, 0.825, 0.813, respectively. Exploratory factor analysis identified two-factors structure and confirmatory factor analysis showed good adjustment rates. The emotional functioning subscale of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 highly correlated with PSYCH (r = -0.868; P < 0.001) and GDI (r = -0.810; P < 0.001), whereas social functioning subscale correlated with PSYCH (r = -0.704; P < 0.001) and GDI (r = -0.624; P < 0.001). The PHYS of Rotterdam Symptom Checklist correlated with PHYS (r = 0.876; P < 0.001) and the PSYCH with PSYCH (r = 0.872; P < 0.001). CONCLUSION The Spanish version of MSAS was determined to be a valid and reliable scale in cancer patients.
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Falk H, Henoch I, Ozanne A, Öhlen J, Ung EJ, Fridh I, Sarenmalm EK, Falk K. Differences in Symptom Distress Based on Gender and Palliative Care Designation Among Hospitalized Patients. J Nurs Scholarsh 2016; 48:569-576. [PMID: 27668982 DOI: 10.1111/jnu.12254] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE To explore patient-reported symptom distress in relation to documentation of symptoms and palliative care designation in hospital inpatients. DESIGN This cross-sectional study analyzed data from 710 inpatients at two large hospitals in Sweden using the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Chart reviews focused on nurses' and physicians' symptom documentation and palliative turning point. METHODS Descriptive statistics were calculated for all variables and provided summaries about the sample. Patients were grouped according to gender, age, palliative care designation, and symptom documentation. The t test and chi-square test were used to calculate whether symptom distress varied between groups. A two-way analysis of variance was conducted for multiple comparisons to explore the impact of gender and age on mean symptom distress. FINDINGS Females reported higher levels of symptom distress than did males related to pain, fatigue, and nausea. When comparing symptom distress between males and females with documentation pertaining to symptoms, there were significant differences implying that females had to report higher levels of symptom distress than males in order to have their symptoms documented. CONCLUSIONS Females need to report higher levels of symptom distress than do males for healthcare professionals to identify and document their symptoms. It can be hypothesized that females are not receiving the same attention and symptom alleviation as men. If so, this highlights a serious inequality in care that requires further exploration. CLINICAL RELEVANCE Considering that common reasons why people seek health care are troublesome symptoms of illness, and that the clinical and demographic characteristics of inpatients are changing towards more advanced ages with serious illnesses, inadequate symptom assessment and management are a serious threat to the care quality.
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Affiliation(s)
- Hanna Falk
- Assistant Professor, The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden. .,Assistant Professor, University of Gothenburg, Centre for Ageing and Health (AGECAP), Gothenburg, Sweden.
| | - Ingela Henoch
- Associate Professor, University of Gothenburg, Centre for Ageing and Health (AGECAP), Gothenburg, Sweden
| | - Anneli Ozanne
- Assistant Professor, The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
| | - Joakim Öhlen
- Professor, The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden.,Professor, Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden.,Professor, University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden
| | - Eva Jakobsson Ung
- Associate Professor, The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
| | - Isabell Fridh
- Assistant Professor, Faculty of Caring Science, Work Life and Social Welfare University of Borås, Borås, Sweden
| | | | - Kristin Falk
- Associate Professor, University of Gothenburg, Centre for Ageing and Health (AGECAP), Gothenburg, Sweden.,Associate Professor, The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
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Abu-Saad Huijer H, Sagherian K, Tamim H. Validation of the Arabic Version of the Memorial Symptom Assessment Scale Among Lebanese Cancer Patients. J Pain Symptom Manage 2015; 50:559-65. [PMID: 25242019 DOI: 10.1016/j.jpainsymman.2014.08.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 07/24/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT To our knowledge, there have been no previous attempts to translate the Memorial Symptom Assessment Scale (MSAS) into the Arabic language and validate it among the Arab cancer population. OBJECTIVES The purpose of this study was to validate the MSAS in Arabic (MSAS-Leb) among 190 Lebanese oncology outpatients. METHODS The questionnaires were the MSAS-Leb and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Data were collected between 2009 and 2010 at a major teaching hospital in Lebanon. The psychometric indices used were reliability, convergent validity, principle component analysis, and confirmatory factor analysis (CFA). RESULTS The Cronbach's alpha coefficients for the MSAS and its subscales ranged from 0.71 to 0.83. On convergent validity testing, the psychological and global distress index subscales were moderately correlated (r > -0.50; P < 0.01) with the emotional functioning subscale of the EORTC QLQ-C30. Correlation coefficients between the MSAS items and selected subscales from the EORTC QLQ-C30 met the standards of convergent validity (r = -0.55 to 0.81; P < 0.01) except for the nausea/vomiting subscale. On principal component analysis (N = 95), four meaningful clusters were recovered. The clusters represented the psychological and physical components. CFA (N = 95) showed an acceptable model and a good fit (goodness-of-fit index = 0.59, adjusted goodness-of-fit index = 0.51, root mean square residual = 0.05, root mean square error of approximation = 0.2) with our data set. CONCLUSION The MSAS-Leb has acceptable psychometric properties of reliability and validity. We recommend its use in clinical practice and outpatient settings among health care professionals to assess and follow-up on symptom burden among patients diagnosed with cancer.
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Affiliation(s)
| | - Knar Sagherian
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Hani Tamim
- Biostatistics Unit, American University of Beirut, Beirut, Lebanon
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Aktas A, Walsh D, Kirkova J. The psychometric properties of cancer multisymptom assessment instruments: a clinical review. Support Care Cancer 2015; 23:2189-202. [PMID: 25894883 DOI: 10.1007/s00520-015-2732-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/29/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE Various instruments are used to assess both individual and multiple cancer symptoms. We evaluated the psychometric properties of cancer multisymptom assessment instruments. METHODS An Ovid MEDLINE search was done. All searches were limited to adults and in English. All instruments published from 2005 to 2014 (and with at least one validity test) were included. We excluded those who only reported content validity. Instruments were categorized by the three major types of symptom measurement scales employed as follows: visual analogue (VAS), verbal rating (VRS), and numerical rating (NRS) scales. They were then examined in two areas: (1) psychometric thoroughness (number of tests) and (2) psychometric strength of evidence (validity, reliability, generalizability). We also assigned an empirical global psychometric quality score (which combined the concepts of thoroughness and strength of evidence) to rank the instruments. RESULTS We analyzed 57 instruments (17 original, 40 modifications). They varied in types of scales used, symptom dimensions measured, and time frames evaluated. Of the 57, 10 used VAS, 28 VRS, and 19 NRS. The Edmonton Symptom Assessment System (ESAS), ESAS-Spanish, Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Symptom Distress Scale (SDS), M.D. Anderson Symptom Inventory (MDASI)-Russian, and MDASI-Taiwanese were the most comprehensively tested for validity and reliability. The ESAS, ESAS-Spanish, ASDS-2, Memorial Symptom Assessment Scale (MSAS)-SF, POMS, SDS, MDASI (and some translations), and MDASI-Heart Failure all showed good validity and reliability. CONCLUSIONS The MDASI appeared to be the best overall from a psychometric perspective. This was followed by the ESAS, ESAS-Spanish, POMS, SDS, and some MDASI translations. VRS-based instruments were most common. There was a wide range of psychometric rigor in validation. Consequently, meta-analysis was not possible. Most cancer multisymptom assessment instruments need further extensive validation to establish the excellent reliability and validity required for clinical utility and meaningful research.
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Affiliation(s)
- Aynur Aktas
- Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
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Yüceege M, Sanisoğlu B, Fırat H, Ersoy Y, Sevgi E, Kurt EB. The clinical utility of Memorial Symptom Assessment-Short Form and Condensed Memorial Symptom Assessment Scale in Turkish lung cancer patients. CLINICAL RESPIRATORY JOURNAL 2015; 9:221-7. [PMID: 25849299 DOI: 10.1111/crj.12127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 02/05/2014] [Accepted: 02/17/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Symptom assessment is essential in the palliative care of patients with cancer. We studied the Memorial Assessment Scale Test-Short Form (MSAS-SF) and Condensed Memorial Assessment Test (CMSAS) in Turkish lung cancer patients. MATERIAL AND METHOD Fifty-one patients with lung cancer (47 non-small, 4 small cell) were staged according to the International Association for the Study of Lung Cancer 2007 and filled the MSAS-SF. Karnofsky performance status, TNM staging, MSAS-SF and CMSAS scores were recorded. The study was approved by the local research ethics committee. RESULTS The mean age of 51 patients was 61.7 ± 9. Fifty-one percent were staged as M1 while 49% were staged as M0. The mean values for global distress index, PHYS (physical symptom distress), PSYCH (psychological symptom score) and MSAS-SUM were 1.15 ± 0.8, 0.9 ± 0.8, 1.13 ± 1.03 and 0.82 ± 0.47 in order. The mean values for CPHYS (physical symptom distress for Condensed MSAS), CPSYCH (psychological symptom score for CMSAS) and CSUM (sum scores) were 1.2 ± 0.75, 1.22 ± 1.1 and 1.16 ± 0.69 in order. Cronbach's alpha coefficients for MSAS-SF and CMSAS were 0.861 and 0.728 in order. Summary scores for both MSAS-SF and CMSAS-SF were significantly higher in patients with M1 disease than from M0 disease. In addition, PHYS and MSAS-SUM in MSAS-SF were significantly correlated with T and N stage. The area under curve for MSAS-SF and CMSAS were 0.793 and 0.70 in order. CONCLUSION MSAS-SF and CMSAS demonstrated significantly higher scores in lung cancer patients with M1 disease than patients with M0 disease. Further studies are needed to evaluate the usefulness of MSAS-SF and CMSAS in lung cancer patients.
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Affiliation(s)
- Melike Yüceege
- Department of Respiratory Medicine, Dışkapı Educational Hospital, Ankara, Turkey
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Pud D. The psychometric properties of the Hebrew version of the Memorial Symptom Assessment scale (MSAS-Heb) in patients with breast cancer. J Pain Symptom Manage 2015; 49:790-5. [PMID: 25261638 DOI: 10.1016/j.jpainsymman.2014.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/27/2014] [Accepted: 09/08/2014] [Indexed: 11/21/2022]
Abstract
CONTEXT To date, no report of the psychometric properties of the Hebrew version of the Memorial Symptom Assessment Scale (MSAS-Heb) has been available, which may be a barrier to comprehensively assessing symptom frequency, severity, and distress in Israeli patients with cancer. OBJECTIVES This study aimed to translate the MSAS into Hebrew and to evaluate the psychometric properties in Israeli patients with cancer. METHODS The original 32-item MSAS was translated into Hebrew using the forward and backward procedure, and administered to female patients with early stage breast cancer (stages I-IIIA) who had received adjuvant chemotherapy. In addition, patients completed a demographic questionnaire, the Lee Fatigue Scale, the Center for Epidemiological Studies-Depression Scale, the General Sleep Disturbance Scale, a numeric rating scale for pain intensity, the Multidimensional Quality of Life Scale-Cancer and the Karnofsky Performance Status Scale. RESULTS A sample of 110 patients was recruited (mean age 45.5 ± 10.1 years). The most frequent symptoms were hair loss (96.4%), lack of energy (88.2%) and "I do not look like myself" (80.9%), and the most infrequent were vomiting (7.3%), problems with urination (10.9%), and shortness of breath (20.9%). Cronbach alpha coefficients for the MSAS-Heb subscales (i.e., physical, psychological and global distress index) ranged from 0.78 to 0.90. All MSAS-Heb subscales and all the other questionnaires used in this study were significantly correlated (P < 0.0001), with expected directions. CONCLUSION The MSAS-Heb is a valid and a reliable measure and should be a useful tool in the clinical arena and in future studies for evaluation of multiple symptoms in Israeli patients with cancer.
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Affiliation(s)
- Dorit Pud
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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Sundberg K, Eklöf AL, Blomberg K, Isaksson AK, Wengström Y. Feasibility of an interactive ICT-platform for early assessment and management of patient-reported symptoms during radiotherapy for prostate cancer. Eur J Oncol Nurs 2015; 19:523-8. [PMID: 25813529 DOI: 10.1016/j.ejon.2015.02.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 02/08/2015] [Accepted: 02/23/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to test the feasibility and acceptability of an Information and Communication Technology platform for assessing and managing patient reported symptoms during radiotherapy for prostate cancer. METHODS In cooperation with a health management company, using a patient experience co-design, we developed the platform operated by an interactive application for reporting and managing symptoms in real time. Nine patients diagnosed with prostate cancer and receiving radiotherapy were recruited from two university hospitals in Sweden. Evidence-based symptoms and related self-care advice specific to prostate cancer were implemented in the application based on a literature review and interviews with patients and health care professionals. In the test of the platform the patients reported symptoms, via a mobile phone, daily for two weeks and were afterwards interviewed about their experiences. RESULTS Overall, the patients found the symptom questionnaire and the self-care advice relevant and the application user friendly. The alert system was activated on several occasions when the symptoms were severe leading to a nurse contact and support so the patients felt safe and well cared for. CONCLUSIONS The platform enabled increased patient involvement and facilitated symptom assessment and communication between the patient and the health care provider. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations.
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Affiliation(s)
- Kay Sundberg
- Department of NVS, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
| | - Ann Langius Eklöf
- Department of NVS, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Karin Blomberg
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Yvonne Wengström
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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Heo S, Moser DK, Pressler SJ, Dunbar SB, Mudd-Martin G, Lennie TA. Psychometric properties of the Symptom Status Questionnaire-Heart Failure. J Cardiovasc Nurs 2015; 30:136-44. [PMID: 24598550 PMCID: PMC4391745 DOI: 10.1097/jcn.0000000000000102] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Many patients with heart failure (HF) experience physical symptoms, poor health-related quality of life (HRQOL), and high rates of hospitalization. Physical symptoms are associated with HRQOL and are major antecedents of hospitalization. However, reliable and valid physical symptom instruments have not been established. Therefore, this study examined the psychometric properties of the Symptom Status Questionnaire-Heart Failure (SSQ-HF) in patients with HF. METHOD Data on symptoms using the SSQ-HF were collected from 249 patients (aged 61 years, 67% male, 45% in New York Heart Association functional class III/IV). Internal consistency reliability was assessed using Cronbach's α. Item homogeneity was assessed using item-total and interitem correlations. Construct validity was assessed using factor analysis and testing hypotheses on known relationships. Data on depressive symptoms (Beck Depression Inventory II), HRQOL (Minnesota Living With Heart Failure Questionnaire), and event-free survival were collected to test known relationships. RESULTS Internal consistency reliability was supported: Cronbach's α was .80. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Factor analysis supported the construct validity of the instrument. More severe symptoms were associated with more depressive symptoms, poorer HRQOL, and more risk for hospitalization, emergency department visit, or death, controlling for covariates. CONCLUSIONS The findings of this study support the reliability and validity of the SSQ-HF. Clinicians and researchers can use this instrument to assess physical symptoms in patients with HF.
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Affiliation(s)
- Seongkum Heo
- Seongkum Heo, PhD, RN Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences, Little Rock Debra K. Moser, DNSc, RN, FAAN Professor and Gill Chair of Nursing, College of Nursing, University of Kentucky, Lexington. Susan J. Pressler, PhD, RN Professor, School of Nursing, University of Michigan, Ann Arbor Sandra B. Dunbar, DSN, RN Professor, School of Nursing, Emory University, Atlanta, Georgia Gia Mudd-Martin, PhD, RN Assistant Professor, College of Nursing, University of Kentucky, Lexington Terry A. Lennie, PhD, RN Professor, University of Kentucky, College of Nursing, Lexington
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Eckerblad J, Theander K, Ekdahl A, Unosson M, Wirehn AB, Milberg A, Krevers B, Jaarsma T. Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study. BMC Geriatr 2015; 15:1. [PMID: 25559550 PMCID: PMC4292813 DOI: 10.1186/1471-2318-15-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 12/23/2014] [Indexed: 11/26/2022] Open
Abstract
Background Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden. Methods A cross-sectional study including 378 community-dwelling people ≥ 75 years, who had been hospitalized ≥ 3 times during the previous year, had ≥ 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden. Results The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score. Conclusion The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.
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Affiliation(s)
- Jeanette Eckerblad
- Department of Social and Welfare Studies, Linkoping University, Linkoping, Sweden.
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Henoch I, Sawatzky R, Falk H, Fridh I, Jakobsson Ung E, Sarenmalm EK, Ozanne A, Öhlén J, Falk K. Symptom Distress Profiles in Hospitalized Patients in Sweden: A Cross-Sectional Study. Res Nurs Health 2014; 37:512-23. [DOI: 10.1002/nur.21624] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Ingela Henoch
- Associate Professor, Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Box 457 SE-405 30 Göteborg Sweden
- Associate Professor, Centre for Person-Centred Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Richard Sawatzky
- Associate Professor, Trinity Western University School of Nursing; Vancouver Canada
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care; Vancouver Canada
| | - Hanna Falk
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Isabell Fridh
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- School of Health Sciences; University of Borås; Borås Sweden
| | - Eva Jakobsson Ung
- Associate Professor, Centre for Person-Centred Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Elisabeth Kenne Sarenmalm
- Research and Development Centre; Skaraborg Hospital; Skövde Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
| | - Anneli Ozanne
- Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Joakim Öhlén
- Associate Professor, Centre for Person-Centred Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta Hospital; Stockholm Sweden
| | - Kristin Falk
- Associate Professor, Centre for Person-Centred Care (GPCC); Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Kenne Sarenmalm E, Browall M, Gaston-Johansson F. Symptom burden clusters: a challenge for targeted symptom management. A longitudinal study examining symptom burden clusters in breast cancer. J Pain Symptom Manage 2014; 47:731-41. [PMID: 23916827 DOI: 10.1016/j.jpainsymman.2013.05.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 05/19/2013] [Accepted: 05/22/2013] [Indexed: 11/12/2022]
Abstract
CONTEXT Although there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters. OBJECTIVES To explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer. METHODS In this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups. RESULTS Three clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with "change in the way food tastes" as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden. CONCLUSION This study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients.
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Affiliation(s)
- Elisabeth Kenne Sarenmalm
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Johns Hopkins University, Baltimore, Maryland, USA.
| | - Maria Browall
- Johns Hopkins University, Baltimore, Maryland, USA; School of Life Sciences, University of Skövde, Skövde, Sweden; Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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Pud D, Har-Zahav G, Laitman Y, Rubinek T, Yeheskel A, Ben-Ami S, Kaufman B, Friedman E, Symon Z, Wolf I. Association between variants of 5-hydroxytryptamine receptor 3C (HTR3C) and chemotherapy-induced symptoms in women receiving adjuvant treatment for breast cancer. Breast Cancer Res Treat 2014; 144:123-31. [PMID: 24477975 DOI: 10.1007/s10549-014-2832-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
Administration of chemotherapy is associated with a wide array of symptoms affecting quality of life. Genetic risk factors for severity of chemotherapy-induced symptoms have not been determined. The present study aimed to explore the associations between polymorphisms in candidate genes and chemotherapy-induced symptoms. Women treated with at least two cycles of adjuvant doxorubicin and cyclophosphamide, with or without paclitaxel for early breast cancer (n = 105) completed the memorial symptom assessment scale and provided blood for genotyping. DNA was extracted from peripheral blood leukocytes and assayed for single nucleotide polymorphisms (SNPs) in GTP cyclohydrolase 1 (GCH1, rs10483639, rs3783641, and rs8007267), catecholamine-o-methyltransferase (COMT, rs4818), and 5-hydroxytryptamine (serotonin) receptor 3C (HTR3C, rs6766410, and rs6807362). Genotyping of HTR3C revealed a significant association between the presence of rs6766410 and rs6807362 SNPs (K163 and G405 variants) and increased severity of symptoms (p = 0.0001 and p = 0.007, respectively). Multiple regressions revealed that rs6766410 and rs6807362, but not age or stage at diagnosis, predicted severity of symptoms (p = 0.001 and p = 0.006, respectively) and explained 12 % of the variance in each regression model. No association was found between the genetic variants of CGH1 or COMT and symptom score. Our study indicates, for the first time, an association between variants of HTR3C and severity of chemotherapy-induced symptoms. Analyzing these genetic variants may identify patients at increased risk for the development of chemotherapy-induced symptoms and targeting the serotonin pathway may serve as a novel treatment strategy for these patients.
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Affiliation(s)
- Dorit Pud
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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