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Chan A, Ng DQ, Arcos D, Heshmatipour M, Lee BJ, Chen A, Duong L, Van L, Nguyen T, Green V, Hoang D. Electronic Patient-Reported Outcome-Driven Symptom Management by Oncology Pharmacists in a Majority-Minority Population: An Implementation Study. JCO Oncol Pract 2024:OP2400050. [PMID: 39008806 DOI: 10.1200/op.24.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/02/2024] [Accepted: 05/23/2024] [Indexed: 07/17/2024] Open
Abstract
PURPOSE There is a lack of systematic solutions to manage supportive care issues in racial/ethnic minorities (REM) receiving treatment for cancer. We developed and implemented an electronic patient-reported outcome (ePRO)-driven symptom management tool led by oncology pharmacists in a majority-minority cancer center located in Southern California. This study was designed to evaluate the implementation outcomes of our multilevel intervention. METHODS This was a prospective, pragmatic, implementation study conducted between July 2021 and June 2023. Newly diagnosed adult patients with cancer receiving intravenous anticancer therapies completed symptom screening using ePRO that consists of the Patient-Reported Outcomes Measurement Information System measures at each infusion visit during the study. ePRO results were presented to an oncologist pharmacist for personalized symptom management and treatment counseling. The RE-AIM framework was used to guide implementation outcomes. Differences in symptom trajectories and clinical outcomes between groups were tested using generalized estimating equations. RESULTS We screened 388 patients of whom 250 were enrolled (acceptance rate: 64.4%), with 564 assessments being completed. The sample consisted of non-Hispanic White (NHW, 42.4%), Hispanic/Latinx (H/L, 30.8%), and non-Hispanic Asian (20.4%), with one (21.6%) of five participants preferring speaking Spanish. Compared with NHW, H/L participants had greater odds of reporting mild to severe pain interference (odds ratio [OR], 1.91 [95% CI, 1.18 to 3.08]; P = .008) and nausea and vomiting (OR, 2.08 [95% CI, 1.21 to 3.58]; P = .008), and higher rates of urgent care utilization (OR, 1.92 [95% CI, 1.04 to 3.61]; P = .04) within 30 days. Nausea and vomiting (n = 131, 23.2%), pain (n = 91, 16.1%), and fatigue (n = 72, 12.8%) were most likely to be intervened, with 90% of the participants expressing satisfaction across all visits. CONCLUSION Our multilevel ePRO-driven intervention led by oncology pharmacists helps facilitate symptom assessments and management and potentially reduce health disparities among REM.
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Affiliation(s)
- Alexandre Chan
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Ding Quan Ng
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
| | - Daniela Arcos
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
| | - Matthew Heshmatipour
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
| | - Benjamin J Lee
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Alison Chen
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Lan Duong
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Linda Van
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Thomas Nguyen
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Vuong Green
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
| | - Daniel Hoang
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, Irvine, CA
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, Orange, CA
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Youn N, Sorensen J, Howland C, Gilbertson-White S. Social Determinants of Health and Cancer Pain in the US: Scoping Review. Clin Nurs Res 2024; 33:416-428. [PMID: 38375791 DOI: 10.1177/10547738241232018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Social determinants of health (SDOH) are structural factors that yield health inequities. Within the context of cancer, these inequities include screening rates and survival rates, as well as higher symptom burden during and after treatment. While pain is one of the most frequently reported symptoms, the relationship between SDOHs and cancer pain is not well understood. The purpose of this study is to describe and synthesize the published research that has evaluated the relationships between SDOH and cancer pain. A systematic search of PubMed, CINAHL, and Embase was conducted to identify studies in which cancer pain and SDOH were described. In all, 20 studies met the inclusion criteria. In total, 14 studies reported a primary aim related to SDOH and cancer pain. Demographic variables including education or income were used most frequently. Six specific measurements were utilized to measure SDOH, such as the acculturation scale, the composite measure of zip codes for poverty level and blight prevalence, or the segregation index. Among the five domains of SDOH based on Healthy People 2030, social and community was the most studied, followed by economic stability, and education access and quality. The neighborhood and built environment domain was the least studied. Despite increasing attention to SDOH, the majority of published studies use single-dimension variables derived from demographic data to evaluate the relationships between SDOH and cancer pain. Future research is needed to explore the intersectionality of SDOH domains and their impact on cancer pain. Additionally, intervention studies should be conducted to address existing disparities and to reduce the incidence and impact of cancer pain.
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Affiliation(s)
- Nayung Youn
- Univeristy of Iowa, College of Nursing, IA, USA
| | - Jamie Sorensen
- Department of Epidemiology, University of Iowa College of Public Health, IA, USA
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Chang P, Amaral LJ, Asher A, Clauw D, Jones B, Thompson P, Warner AS. A perspective on a precision approach to pain in cancer; moving beyond opioid therapy. Disabil Rehabil 2024; 46:2174-2183. [PMID: 37194659 DOI: 10.1080/09638288.2023.2212916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/07/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Cancer-related pain is primarily treated with opioids which while effective can add significant patient burden due to side effects, associated stigma, and timely access. The purpose of this perspective discussion is to argue for a precision approach to pain in cancer based on a biopsychosocial and spiritual model which we argue can offer a higher quality of life while limiting opioid use. CONCLUSIONS Pain in cancer represents a heterogenous process with multiple contributing and modulating factors. Specific characterization of pain as either nociceptive, neuropathic, nociplastic, or mixed can allow for targeted treatments. Additional assessment of biopsychosocial and spiritual issues can elucidate further points of targeted intervention which can lead to overall greater pain control.
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Affiliation(s)
- Philip Chang
- Philip Chang - Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Arash Asher
- Arash Asher - Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Bronwen Jones
- Bronwen Jones - Cedars Sinai Medical Center, Los Angeles, CA
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Fereydooni S, Lorenz K, Azarfar A, Luckett T, Phillips JL, Becker W, Giannitrapani K. Identifying provider, patient and practice factors that shape long-term opioid prescribing for cancer pain: a qualitative study of American and Australian providers. BMJ Open 2024; 14:e082033. [PMID: 38514141 PMCID: PMC10961503 DOI: 10.1136/bmjopen-2023-082033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Prescribing long-term opioid therapy is a nuanced clinical decision requiring careful consideration of risks versus benefits. Our goal is to understand patient, provider and context factors that impact the decision to prescribe opioids in patients with cancer. METHODS We conducted a secondary analysis of the raw semistructured interview data gathered from 42 prescribers who participated in one of two aligned concurrent qualitative studies in the USA and Australia. We conducted a two-part analysis of the interview: first identifying all factors influencing long-term prescribing and second open coding-related content for themes. RESULTS Factors that influence long-term opioid prescribing for cancer-related pain clustered under three key domains (patient-related, provider-related and practice-related factors) each with several themes. Domain 1: Patient factors related to provider-patient continuity, patient personality, the patient's social context and patient characteristics including racial/ethnic identity, housing and socioeconomic status. Domain 2: Provider-related factors centred around provider 'personal experience and expertise', training and time availability. Domain 3: Practice-related factors included healthcare interventions to promote safer opioid practices and accessibility of quality alternative pain therapies. CONCLUSION Despite the differences in the contexts of the two countries, providers consider similar patient, provider and practice-related factors when long-term prescribing opioids for patients with cancer. Some of these factors may be categorised as cognitive biases that may intersect in an already disadvantaged patient and exacerbate disparities in the treatment of their pain. A more systematic understanding of these factors and how they impact the quality of care can inform appropriate interventions.
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Affiliation(s)
| | - Karl Lorenz
- Stanford University, Stanford, California, USA
| | - Azin Azarfar
- University of Florida, Gainesville, Florida, USA
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology, Sydney, New South Wales, Australia
| | - William Becker
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Karleen Giannitrapani
- VA Center for Innovation to Implementation, Menlo Park, California, USA
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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Brady K, Cohen AL. Differences in Symptom Burden in Primary Brain Tumor Patients Based on Sex, Race, and Ethnicity: a Single-Center Retrospective Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01761-9. [PMID: 37783921 DOI: 10.1007/s40615-023-01761-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Symptom burden affects quality of life and prognosis in primary brain tumor (PBT) patients. Knowing whether symptom burden varies based on sex, race, or ethnicity may affect the interpretation of the relationship between symptoms and survival may reveal issues with applying the tools to measure symptom burden to different groups and may identify inequities in symptom management that need to be addressed at a system level. To determine whether symptoms in PBT patients vary across demographic groups, we conducted a retrospective chart review of symptom burden collected as part of routine care in a diverse population. METHODS Patient demographics and scores on the MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT) module were extracted from the electronic medical record for patients seen in the Inova Neuro-oncology Clinic between March 2021 and June 2022. MDASI-BT scores were compared based on side of tumor, sex, race, and ethnicity for the entire population and for the subset with gliomas. RESULTS We included 125 people, of whom 85 had gliomas. For both the entire group and the subgroup with gliomas, about 40% were female and about 40% were non-White race. No differences in symptom burden were seen between males and females. Pain and numbness/tingling symptom burden were higher in both the entire population and the glioma subgroup for people of Hispanic/Latino/Spanish ethnicity and for people of races other than White or Middle Eastern self-identification. CONCLUSIONS Pain, weakness, and numbness/tingling varied significantly across racial and ethnic groups. Further research is needed to validate this finding in other populations and determine its cause.
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Affiliation(s)
- Kendall Brady
- National Cathedral School, Woodley Road NW, 20016, Washington, DC, USA
| | - Adam L Cohen
- Inova Schar Cancer Institute, 8081 Innovation Park Dr., VA, 22031, Fairfax, USA.
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Salomon RE, Dobbins S, Harris C, Haeusslein L, Lin CX, Reeves K, Richoux S, Roussett G, Shin J, Dawson-Rose C. Antiracist symptom science: A call to action and path forward. Nurs Outlook 2022; 70:794-806. [PMID: 36400578 PMCID: PMC10916506 DOI: 10.1016/j.outlook.2022.07.014] [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: 04/06/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022]
Abstract
Nurse scientists recognize the experience of racism as a driving force behind health. However, symptom science, a pillar of nursing, has rarely considered contributions of racism. Our objective is to describe findings within symptom science research related to racial disparities and/or experiences of racism and to promote antiracist symptom science within nursing research. In this manuscript, we use an antiracist lens to review a predominant symptom science theory and literature in three areas of symptom science research-oncology, mental health, and perinatal health. Finally, we make recommendations for increasing antiracist research in symptom science by altering (a) research questions, (b) recruitment methods, (c) study design, (d) data analysis, and (e) dissemination of findings. Traditionally, symptom science focuses on individual level factors rather than broader contexts driving symptom experience and management. We urge symptom science researchers to embrace antiracism by designing research with the specific intent of dismantling racism at multiple levels.
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Affiliation(s)
- Rebecca E Salomon
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Sarah Dobbins
- San Francisco Department of Public Health, San Francisco, California
| | | | | | - Chen-Xi Lin
- University of California, San Francisco, San Francisco, California
| | - Katie Reeves
- University of California, San Francisco, San Francisco, California
| | - Sarah Richoux
- University of California, San Francisco, San Francisco, California
| | - Greg Roussett
- University of California, San Francisco, San Francisco, California
| | - Joosun Shin
- University of California, San Francisco, San Francisco, California
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Sociodemographic and Clinical Characteristics Associated With Worst Pain Intensity Among Cancer Patients. Pain Manag Nurs 2022; 23:424-429. [PMID: 35227646 PMCID: PMC9308655 DOI: 10.1016/j.pmn.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 10/17/2021] [Accepted: 11/19/2021] [Indexed: 02/02/2023]
Abstract
AIMS Patients with cancer have pain due to their cancer, the cancer treatment and other causes, and the pain intensity varies considerably between individuals. Additional research is needed to understand the factors associated with worst pain intensity. Our study aim was to determine the association between worst pain intensity and sociodemographics and cancerspecific factors among patients with cancer. DESIGN A total of 1,280 patients with cancer recruited from multiple cancer centers over 25 years in the United States were asked to complete a questionnaire that collected respondents' demographic, chronic pain, and cancer-specific information. SETTINGS Worst, least, and current pain intensities were captured using a modified McGill Pain Questionnaire (pain intensity measured on 0-10 scale). A generalized linear regression analysis was utilized to assess the associations between significant bivariate predictors and worst pain intensity scores.Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (β = 0.6859), previous toothache pain (β = 0.0960), headache pain (β = 0.0549), and stomachache pain (β = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. CONCLUSIONS Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (β = 0.6859), previous toothache pain (β = 0.0960), headache pain (β = 0.0549), and stomachache pain (β = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. Findings identified being Hispanic and having previous severe toothache, stomachache, and headache pain as significant predictors of worst pain intensity among patients with cancer. After controlling for selected covariates, we did not note statistical differences in worst pain during a 25-year period. Therefore,studies focused on improving the management of pain among patients with cancer should target interventions for those with Hispanic heritage and those with past history of severe common pain.
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Marcewicz L, Kunihiro SK, Curseen KA, Johnson K, Kavalieratos D. Application of Critical Race Theory in Palliative Care Research: A Scoping Review. J Pain Symptom Manage 2022; 63:e667-e684. [PMID: 35231591 DOI: 10.1016/j.jpainsymman.2022.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/13/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
CONTEXT Structural racism negatively impacts individuals and populations. In the medical literature, including that of palliative care, structural racism's influence on interracial differences in outcomes remains poorly examined. Examining the contribution of structural racism to outcomes is paramount to promoting equity. OBJECTIVES We examined portrayals of race and racial differences in outcomes in the palliative care literature and created a framework using critical race theory (CRT) to aid in this examination. METHODS We reviewed the CRT literature and iteratively developed a rubric to examine when and how differences between races are described. Research articles published in The Journal of Pain and Symptom Management presenting empiric data specifically including findings about racial differences were examined independently by three reviewers using the rubric. RESULTS Fifty-seven articles met inclusion criteria. Articles that specifically described racial differences were common in the topic areas of quality (75% of articles), hospice (53%), palliative care services (40%) and spirituality/religion (40%). The top three reasons posited for racial differences were patient preference (26%), physician bias (23%), and cultural barriers (21%). Using the CRT rubric we found that 65% of articles posited that a racial difference was something that needed to be rectified, while articles rarely provided narrative (5%) or other data on perspectives of people of color (11%) to explain assumptions about differences. CONCLUSION Palliative care research frequently highlights racial differences in outcomes. Articles that examine racial differences often assume that differences need to be fixed but posit reasons for differences without the narratives of those most affected by them.
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Affiliation(s)
- Lawson Marcewicz
- Division of Palliative Medicine (L.M., S.K.K., K.A.C., D.K.), Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA; Atlanta VA Health Care System (L.M.), Decatur, Georgia, USA.
| | - Susan K Kunihiro
- Division of Palliative Medicine (L.M., S.K.K., K.A.C., D.K.), Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kimberly A Curseen
- Division of Palliative Medicine (L.M., S.K.K., K.A.C., D.K.), Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Khaliah Johnson
- Division of Pediatric Palliative Medicine (K.J.), Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine (L.M., S.K.K., K.A.C., D.K.), Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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Friedman DR, Patil V, Li C, Rassmussen KM, Burningham Z, Hamilton-Hill S, Kelley MJ, Halwani AS. Integration of Patient-Reported Outcome Measures in the Electronic Health Record: The Veterans Affairs Experience. JCO Clin Cancer Inform 2022; 6:e2100086. [PMID: 35290072 PMCID: PMC8932492 DOI: 10.1200/cci.21.00086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE There are growing efforts to integrate patient-reported outcome (PRO) data into electronic health records (EHRs) to bring together disparate sources of patient information and improve medical care. PRO measures can be used to assess cancer symptom presence and severity. Integrating PRO tools in EHRs can alert providers to address symptoms, which is an essential component of comprehensive oncology care. METHODS We modified a PRO used to measure cancer and end-of-life symptoms, the Edmonton Symptom Assessment System to create the Veteran Symptom Assessment System (VSAS). VSAS was implemented as an integrated PRO as part of the Veterans Administration EHR system and was used at hematology-oncology clinics in Veteran Administration (VA) medical centers in the Southeast. RESULTS From 2013 to 2014, VSAS was introduced, underwent usability testing and modifications, and was finally implemented in the EHR. Between 2015 and 2019, VSAS was administered 43,883 times in 9,058 patients. Eighty-nine percent of Veterans were male, 11% were female, 52% identified as non-Hispanic White, and 43% identified as African American. Fatigue, shortness of breath with exertion, and pain were most frequently reported initially (68%, 48%, and 45%, respectively) and were most frequently rated as severe (27%, 16%, and 17%, respectively). In patients diagnosed with stage IV cancer, higher symptom burden was significantly associated with shorter overall survival. The majority of Veterans with longitudinal measurements experienced improvement in symptoms, most frequently in severe symptoms. CONCLUSION To our knowledge, this is the first large-scale implementation of a PRO system, integrated in the VA EHR, in ambulatory patients with cancer and blood disorders. The integration of VSAS within the VA EHR is a significant demonstration and a necessary requirement for current and future systemic initiatives in cancer symptom management.
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Affiliation(s)
- Daphne R Friedman
- Division of Medical Oncology, Duke University School of Medicine, Durham, NC.,Durham Veterans Administration Health Care System, Durham, NC
| | - Vikas Patil
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT.,Division of Epidemiology, VERITAS, University of Utah, Salt Lake City, UT
| | - Chunyang Li
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT.,Division of Epidemiology, VERITAS, University of Utah, Salt Lake City, UT
| | - Kelli M Rassmussen
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT.,Division of Epidemiology, VERITAS, University of Utah, Salt Lake City, UT
| | - Zachary Burningham
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT.,Division of Epidemiology, VERITAS, University of Utah, Salt Lake City, UT
| | - Susan Hamilton-Hill
- National Oncology Program Office, Department of Veterans Administration, Durham, NC
| | - Michael J Kelley
- Division of Medical Oncology, Duke University School of Medicine, Durham, NC.,Durham Veterans Administration Health Care System, Durham, NC.,National Oncology Program Office, Department of Veterans Administration, Durham, NC
| | - Ahmad S Halwani
- George E. Wahlen Veterans Health Administration, Salt Lake City, UT.,Division of Epidemiology, VERITAS, University of Utah, Salt Lake City, UT.,Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, Salt Lake City, UT
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Sreedhar J. Symptom Occurrence, Severity, and Self-Care Methods by Ethnicity and Age Group Among Adults With Cancer. Oncol Nurs Forum 2021; 48:522-534. [PMID: 34411086 DOI: 10.1188/21.onf.522-534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine the relationships among cancer therapy-related symptom occurrence and severity, selected cancer-related variables, and demographic variables. Secondary purposes were to examine participants' reported symptom occurrence and severity by ethnicity and by age group and to identify self-care methods. SAMPLE & SETTING Convenience sampling was used and included 110 adults receiving cancer treatment from a major hospital in the northeast region of the United States. METHODS & VARIABLES A descriptive correlational design was used. Study variables were symptom occurrence and severity and selected demographic and cancer-related variables. The Therapy-Related Symptom Checklist was used to measure symptom occurrence and severity, and the Symptom Alleviation. RESULTS Significant relationships were found between symptom occurrence and severity and gender, economic status, and disease stage. Feeling sluggish was the most frequently reported symptom. IMPLICATIONS FOR NURSING Oncology nurses are in an influential position to educate and manage participants' cancer therapy-related symptoms.
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Treasure M, Daly B, Cao S, Fu P, Hong A, Weinstein E, Surdam J, Meropol NJ, Dowlati A. A randomized controlled trial of structured palliative care versus standard supportive care for patients enrolled in phase 1 clinical trials. Cancer Med 2021; 10:4312-4321. [PMID: 34033228 PMCID: PMC8267138 DOI: 10.1002/cam4.3971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/13/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Patients enrolled in Phase 1 clinical trials have typically exhausted standard therapies and often are choosing between a clinical trial and hospice care. Significant symptom burden can result in early trial discontinuation and confound trial outcomes. This study aimed to examine differences in study duration, symptom burden, adverse events (AE), and quality of life (QOL) between those receiving structured palliative care versus usual supportive care. Patients and methods Sixty‐eight patients enrolled in phase 1 clinical trials and 39 of their CGs were randomly assigned to receive structured palliative care or usual supportive care. Patient QOL was measured monthly using the Functional Assessment of Cancer Therapy and Memorial Symptom Assessment Scale. The Quality of Life in Life‐Threatening Illness–Family Care Version and Caregiver Reaction Assessment were used for CGs. AEs and use of palliative care resources were compared between arms. Results Mean duration of the phase 1 study was 142 days in the palliative care arm versus 116 days in the usual care arm (p = 0.55). Although not statistically significant, patients in the palliative care arm experienced fewer AEs and better QOL, as did their CGs, compared to those receiving usual care. Conclusions Phase 1 patients and their CGs have physical and psychosocial needs warranting palliative care services. Results suggest that structured palliative care is associated with the increased duration of the study and improved patient and CG QOL. Phase 1 patients and their caregivers have physical and psychosocial needs warranting palliative care services. Providing structured palliative care servies to this population was associated with increased duration on phase 1 study and improved patient and caregiver QOL.
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Affiliation(s)
- Michelle Treasure
- Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Daly
- Frances Payne School of Nursing, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Shufen Cao
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Augustine Hong
- Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
| | - Elizabeth Weinstein
- Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
| | - Jessica Surdam
- University Hospitals Cleveland Medical Center, Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Neal J Meropol
- Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
| | - Afshin Dowlati
- Department of Medicine, University Hospitals Cleveland Medical Center, Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA
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Hodges TR, Labak CM, Mahajan UV, Wright CH, Wright J, Cioffi G, Gittleman H, Herring EZ, Zhou X, Duncan K, Kruchko C, Sloan AE, Barnholtz-Sloan JS. Impact of race on care, readmissions, and survival for patients with glioblastoma: an analysis of the National Cancer Database. Neurooncol Adv 2021; 3:vdab040. [PMID: 33959715 PMCID: PMC8086235 DOI: 10.1093/noajnl/vdab040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The objective of this study was to explore racial/ethnic factors that may be associated with survival in patients with glioblastoma by querying the National Cancer Database (NCDB). Methods The NCDB was queried for patients diagnosed with glioblastoma between 2004 and 2014. Patient demographic variables included age at diagnosis, sex, race, ethnicity, Charlson-Deyo score, insurance status, and rural/urban/metropolitan location of zip code. Treatment variables included surgical treatment, extent of resection, chemotherapy, radiation therapy, type of radiation, and treatment facility type. Outcomes included 30-day readmission, 30- and 90-day mortality, and overall survival. Multivariable Cox regression analyses were performed to evaluate variables associated with race and overall survival. Results A total of 103 652 glioblastoma patients were identified. There was a difference in the proportion of patients for whom surgery was performed, as well as the proportion receiving radiation, when stratified by race (P < .001). Black non-Hispanics had the highest rates of unplanned readmission (7.6%) within 30 days (odds ratio [OR]: 1.39 compared to White non-Hispanics, P < .001). Asian non-Hispanics had the lowest 30- (3.2%) and 90-day mortality (9.8%) when compared to other races (OR: 0.52 compared to White non-Hispanics, P = .031). Compared to White non-Hispanics, we found Black non-Hispanics (hazard ratio [HR]: 0.88, P < .001), Asian non-Hispanics (HR: 0.72, P < .001), and Hispanics (HR: 0.69, P < .001) had longer overall survival. Conclusions Differences in treatment and outcomes exist between races. Further studies are needed to elucidate the etiology of these race-related disparities and to improve outcomes for all patients.
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Affiliation(s)
- Tiffany R Hodges
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Collin M Labak
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Uma V Mahajan
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - James Wright
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gino Cioffi
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Haley Gittleman
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Eric Z Herring
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xiaofei Zhou
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kelsey Duncan
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Andrew E Sloan
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Jill S Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
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13
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Chan CWH, Law BMH, Wong MMH, Chan DNS, Ng MSN, So WKW, Wong CL, Chow KM. Oral mucositis among Chinese cancer patients receiving chemotherapy: Effects and management strategies. Asia Pac J Clin Oncol 2020; 17:e10-e17. [PMID: 32700818 DOI: 10.1111/ajco.13349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/01/2020] [Indexed: 12/22/2022]
Abstract
Oral mucositis is a painful and distressing complication of chemotherapy-induced toxicity in cancer patients that can develop early during the treatment regimen. Previous studies have demonstrated that both oxidative stress and inflammation play a role in the development of the ulceration that is a characteristic of oral mucositis. To date, a few studies have investigated the effect of this complication on the well-being of patients, demonstrating its negative impact on patients' functional ability and quality of life. This effect may entail chemotherapeutic drug dose reduction among patients, in turn reducing their cancer survival rates. Therefore, interventions to address the detrimental effects of oral mucositis on the well-being of cancer patients are required. This review provides an overview of the studies that have examined the negative effects of oral mucositis on Chinese cancer patients undergoing chemotherapy, as well as the interventions shown to be effective in treating this complication, with a focus on interventions utilizing traditional Chinese medicine. Overall, both traditional Chinese medicine-based interventions and interventions involving patient education about effective oral care led by trained nurses were found to be useful in reducing the incidence and severity of oral mucositis among Chinese patients undergoing chemotherapy. Future oral mucositis management plans aiming at effective oral care among cancer patients undergoing chemotherapy should incorporate these types of interventions as integral components to enhance the well-being of these patients.
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Affiliation(s)
- Carmen W H Chan
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Bernard M H Law
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin M H Wong
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Dorothy N S Chan
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Marques S N Ng
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie K W So
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Cho Lee Wong
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Ming Chow
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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14
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Booker SQ, Herr KA, Wilson Garvan C. Racial Differences in Pain Management for Patients Receiving Hospice Care. Oncol Nurs Forum 2020; 47:228-240. [PMID: 32078609 DOI: 10.1188/20.onf.228-240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate racial differences in implementation of 11 evidence-based cancer pain management strategies in a matched sample of patients in hospice. SAMPLE & SETTING 32 African American and 32 Caucasian American older adults (aged 65 years or older) with cancer pain receiving hospice care in the midwestern United States. METHODS & VARIABLES Matched cohort secondary data analysis of postintervention data in a cluster randomized controlled trial was used. Main outcomes are the summative and individual Cancer Pain Practice Index scores. RESULTS There were few statistically significant or clinically meaningful differences in implementation of individual best practices for pain management by race. Assessment of primary pain characteristics and management of opioid-induced constipation with a bowel regimen was significantly lower in African Americans than in Caucasian Americans. IMPLICATIONS FOR NURSING African American older adults receiving hospice care at the end of life received pain management that was, overall, comparable to matched Caucasian American older adults. Hospice and oncology nurses play a critical role in effective pain management and should continue to implement evidence-based guidelines for pain management into daily practice. Diffusing the hospice model and principles of pain and symptom management into other settings and specialty care areas may reduce widespread pain disparities.
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15
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Rosa WE, Riegel B, Ulrich CM, Meghani SH. A concept analysis of analgesic nonadherence for cancer pain in a time of opioid crisis. Nurs Outlook 2020; 68:83-93. [DOI: 10.1016/j.outlook.2019.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 11/25/2022]
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16
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Nwosu AG, Anikwe I, Eze B, Ossai E, Onyekwulu F. Amputation-related phantom limb pain in Nigeria: A prospective cohort study. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_11_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Begic D, Janda-Martinac C, Vrdoljak M, Puljak L. Reporting and analyses of sex/gender and race/ethnicity in randomized controlled trials of interventions published in the highest-ranking anesthesiology journals. J Comp Eff Res 2019; 8:1417-1423. [PMID: 31789050 DOI: 10.2217/cer-2019-0071] [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] [Indexed: 02/04/2023] Open
Abstract
Aim: We assessed reporting of data on sex/gender and race/ethnicity in randomized controlled trials of interventions published in the highest-ranking anesthesiology journals from 2014 to 2017. Methods: We extracted data regarding terminology for sex/gender, proportion of participants according to the race/gender and race/ethnicity, and results shown for the race/gender and race/ethnicity. Results: Among the analyzed 732 trials, few stratified allocation of participants on the basis of sex/gender and race/ethnicity, few reported results for sex/gender or race/ethnicity and the outcomes reported may be influenced by one or both. Conclusion: In conclusion, outcomes of anesthesiology trials could be vulnerable to an important and avoidable source of bias; trialists need to pay more attention to sex and race/ethnicity when designing and reporting their studies.
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Affiliation(s)
- Dinka Begic
- Department of Endocrinology, University Clinical Center Tuzla, Tuzla, Bosnia & Hercegovina
| | | | | | - Livia Puljak
- Center for Evidence-Based Medicine & Health Care, Catholic University of Croatia, Zagreb, Croatia
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18
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Clinical and Demographic Predictors of Interdisciplinary Chronic Pain Rehabilitation Program Treatment Response. THE JOURNAL OF PAIN 2019; 20:1470-1485. [DOI: 10.1016/j.jpain.2019.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/24/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
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19
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Vogel J, Wang X, Troxel AB, Simone CB, Rengan R, Lin LL. Prospective assessment of demographic characteristics associated with worse health related quality of life measures following definitive chemoradiation in patients with locally advanced non-small cell lung cancer. Transl Lung Cancer Res 2019; 8:332-339. [PMID: 31555509 DOI: 10.21037/tlcr.2019.08.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to evaluate baseline demographic characteristics which may be associated with worse health related quality of life (HRQOL) for patients with locally advanced non-small cell lung cancer (NSCLC) receiving definitive chemoradiation (CRT). Materials Patients with NSCLC were prospectively enrolled on an Institutional Review Board-approved clinical trial between 2009 and 2012. HRQOL assessments were collected pre-radiation therapy (RT), during RT, and within 3 months post-RT using Euroqol (EQ-5D), MD Anderson Symptom Inventory (MDASI), and Functional Assessment of Cancer Therapy General (FACT-G). HRQOL correlation was assessed with categorical variables by Wilcoxon rank sum tests and with continuous variables by Pearson correlation. P<0.05 was defined as statistically significant. Results Forty-three consecutive patients received definitive concurrent CRT and completed assessments at one or more time-points. Patients most commonly had stage IIIB disease (72%), were married or with a partner (70%) and Caucasian (91%). Median patient age was 65 (range: 39-79) years and Charlson comorbidity index (CCI) was 0 (range: 0-5). Female gender, African-American ethnicity, age, chemotherapy type, baseline hemoglobin, and CCI were associated with worse post-treatment HRQOL measures. Conclusions We have identified novel characteristics associated with worse quality of life following definitive CRT for lung cancer. Patients at risk for worse post-treatment quality of life may benefit from earlier follow-up and greater supportive measures following treatment.
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Affiliation(s)
- Jennifer Vogel
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Xingmei Wang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea B Troxel
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles B Simone
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ramesh Rengan
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lilie L Lin
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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20
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Lee E, Nelson OL, Puyana C, Takita C, Wright JL, Zhao W, Reis IM, Lin RY, Hlaing WM, Bakalar JL, Yang GR, Hu JJ. Association between C-reactive protein and radiotherapy-related pain in a tri-racial/ethnic population of breast cancer patients: a prospective cohort study. Breast Cancer Res 2019; 21:70. [PMID: 31138314 PMCID: PMC6537305 DOI: 10.1186/s13058-019-1151-y] [Citation(s) in RCA: 10] [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: 12/18/2018] [Accepted: 05/06/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Post-surgery adjuvant radiotherapy (RT) significantly improves clinical outcomes in breast cancer patients; however, some patients develop cancer or treatment-related pain that negatively impacts quality of life. This study examined an inflammatory biomarker, C-reactive protein (CRP), in RT-related pain in breast cancer. METHODS During 2008 and 2014, breast cancer patients who underwent RT were prospectively evaluated for pre- and post-RT pain. Pre- and post-RT plasma CRP levels were measured using a highly sensitive CRP ELISA kit. Pain score was assessed as the mean of four pain severity items (i.e., pain at its worst, least, average, and now) from the Brief Pain Inventory. Pain scores of 4-10 were classified as clinically relevant pain. Multivariable logistic regression analyses were applied to ascertain the associations between CRP and RT-related pain. RESULTS In 366 breast cancer patients (235 Hispanic whites, 73 black/African Americans, and 58 non-Hispanic whites), 17% and 30% of patients reported pre- and post-RT pain, while 23% of patients had RT-related pain. Both pre- and post-RT pain scores differed significantly by race/ethnicity. In multivariable logistic regression analysis, RT-related pain was significantly associated with elevated pre-RT CRP (≥ 10 mg/L) alone (odds ratio (OR) = 2.44; 95% confidence interval (CI) = 1.02, 5.85); or combined with obesity (OR = 4.73; 95% CI = 1.41, 15.81) after adjustment for age and race/ethnicity. CONCLUSIONS This is the first pilot study of CRP in RT-related pain, particularly in obese breast cancer patients. Future larger studies are warranted to validate our findings and help guide RT decision-making processes and targeted interventions.
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Affiliation(s)
- Eunkyung Lee
- Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, Orlando, FL, 32816, USA.
| | - Omar L Nelson
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - Carolina Puyana
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - Cristiane Takita
- Department of Radiation Oncology, University of Miami School of Medicine, Miami, FL, USA
| | - Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, USA
| | - Isildinha M Reis
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, USA
| | - Rick Y Lin
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - WayWay M Hlaing
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - Johnna L Bakalar
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - George R Yang
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - Jennifer J Hu
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, USA.
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21
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Racial/Ethnic Disparities in Pain Burden and Pain Management in the Context of Opioid Overdose Risk. CURR EPIDEMIOL REP 2019. [DOI: 10.1007/s40471-019-00202-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Social disparities and symptom burden in populations with advanced cancer: specialist palliative care providers' perspectives. Support Care Cancer 2019; 27:4733-4744. [PMID: 30972644 DOI: 10.1007/s00520-019-04726-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
Disparities in access to palliative care services for populations with social disparities have been reported in Western countries. Studies indicate that these populations tend to report higher symptom distress than other population groups. We need to further investigate how social disparities influence symptom burden to improve symptom relief in these populations. PURPOSE To examine the perspectives of specialist palliative care providers concerning the relationship between social disparities and symptom burden in populations with advanced cancer. METHODS Two sequential qualitative studies that followed a combination of interpretive and critical methodologies. The interpretive approach was outlined by van Manen's hermeneutic phenomenology while the critical component was informed by the works of Paulo Freire. Participants involved two specialist palliative care teams from a large acute care hospital and a large cancer center in Western Canada. Participants included 11 palliative care providers including registered nurses, nurse practitioners, physicians, and pharmacists. RESULTS Participants perceived that social conditions that might aggravate symptom burden included low income, low education, lack of social support, language barriers, and rurality. The relationship between income and symptom burden reflected diverse views. Participants identified populations prone to complex symptom burden including homeless individuals, Indigenous people, people with a history of addictions, and people with mental health or psychosocial issues. CONCLUSION Participants perceived that social disparities may increase symptom complexity in populations with advanced cancer. Participants did not identify ethnicity and gender as influencing symptom burden. Further research is needed to examine the interactions of social disparities, patient individuality, and symptom burden.
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23
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Mahar AL, Davis LE, Bubis LD, Li Q, Sutradhar R, Coburn NG, Barbera L. Factors associated with receipt of symptom screening in the year after cancer diagnosis in a universal health care system: a retrospective cohort study. ACTA ACUST UNITED AC 2019; 26:e8-e16. [PMID: 30853804 DOI: 10.3747/co.26.4160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose Patient-reported symptom data are collected prospectively by a provincial cancer agency to mitigate the significant symptom burden that patients with cancer experience. However, an assessment of whether such symptom screening occurs uniformly for those patients has yet to be performed. In the present study, we investigated patient, disease, and health system factors associated with receipt of symptom screening in the year after a cancer diagnosis. Methods Patients diagnosed with cancer between 2007 and 2014 were identified. We measured whether 1 or more symptom screenings were recorded in the year after diagnosis. A multivariable modified Poisson regression with robust error variance was used to identify predictors [age, comorbidity, rurality, socioeconomic status, immigration status, cancer site, registration at a regional cancer centre (cc), and year of diagnosis] of being screened for symptoms. Results Of 425,905 patients diagnosed with cancer, 163,610 (38%) had 1 or more symptom screening records in the year after diagnosis, and 75% survived at least 1 year. We identified variability in symptom screening by primary cancer site, regional cc, age, sex, comorbidity, material deprivation, rurality of residence, and immigration status. Patients who had been diagnosed with melanoma or endocrine cancers, who were not registered at a regional cc, who lived in the most urban areas, who were elderly, and who were immigrants were least likely to undergo symptom screening after diagnosis. Conclusions Our evaluation of the implementation of a population-based symptom screening program in a universal health care system identified populations who are at risk for not receiving screening and who are therefore future targets for improvements in population symptom screening and better management of cancer-related symptoms at diagnosis.
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Affiliation(s)
- A L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
| | - L E Davis
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON
| | - L D Bubis
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON
| | | | - R Sutradhar
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON.,ICES, Toronto, ON
| | - N G Coburn
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON.,ICES, Toronto, ON.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON
| | - L Barbera
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON.,ICES, Toronto, ON.,Department of Radiation Oncology, University of Toronto, Toronto, ON
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24
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Shields CG, Griggs JJ, Fiscella K, Elias CM, Christ SL, Colbert J, Henry SG, Hoh BG, Hunte HER, Marshall M, Mohile SG, Plumb S, Tejani MA, Venuti A, Epstein RM. The Influence of Patient Race and Activation on Pain Management in Advanced Lung Cancer: a Randomized Field Experiment. J Gen Intern Med 2019; 34:435-442. [PMID: 30632104 PMCID: PMC6420510 DOI: 10.1007/s11606-018-4785-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/30/2018] [Accepted: 11/19/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pain management racial disparities exist, yet it is unclear whether disparities exist in pain management in advanced cancer. OBJECTIVE To examine the effect of race on physicians' pain assessment and treatment in advanced lung cancer and the moderating effect of patient activation. DESIGN Randomized field experiment. Physicians consented to see two unannounced standardized patients (SPs) over 18 months. SPs portrayed 4 identical roles-a 62-year-old man with advanced lung cancer and uncontrolled pain-differing by race (black or white) and role (activated or typical). Activated SPs asked questions, interrupted when necessary, made requests, and expressed opinions. PARTICIPANTS Ninety-six primary care physicians (PCPs) and oncologists from small cities, and suburban and rural areas of New York, Indiana, and Michigan. Physicians' mean age was 52 years (SD = 27.17), 59% male, and 64% white. MAIN MEASURES Opioids prescribed (or not), total daily opioid doses (in oral morphine equivalents), guideline-concordant pain management, and pain assessment. KEY RESULTS SPs completed 181 covertly audio-recorded visits that had complete data for the model covariates. Physicians detected SPs in 15% of visits. Physicians prescribed opioids in 71% of visits; 38% received guideline-concordant doses. Neither race nor activation was associated with total opioid dose or guideline-concordant pain management, and there were no interaction effects (p > 0.05). Activation, but not race, was associated with improved pain assessment (ẞ, 0.46, 95% CI 0.18, 0.74). In post hoc analyses, oncologists (but not PCPs) were less likely to prescribe opioids to black SPs (OR 0.24, 95% CI 0.07, 0.81). CONCLUSIONS Neither race nor activation was associated with opioid prescribing; activation was associated with better pain assessment. In post hoc analyses, oncologists were less likely to prescribe opioids to black male SPs than white male SPs; PCPs had no racial disparities. In general, physicians may be under-prescribing opioids for cancer pain. TRIAL REGISTRATION NCT01501006.
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Affiliation(s)
- Cleveland G Shields
- Center for Cancer Research, Purdue University, West Lafayette, IN, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
- Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
| | - Jennifer J Griggs
- Department of Internal Medicine, Hematology/ Oncology Division, and Health Management and Policy, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Department of Health Management & Policy, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Kevin Fiscella
- Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY, USA
| | - Cezanne M Elias
- Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
| | - Sharon L Christ
- Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Joseph Colbert
- Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Stephen G Henry
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Beth G Hoh
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA
| | - Haslyn E R Hunte
- School of Public Health, Department of Social and Behavioral Sciences, West Virginia University, Morgantown, WV, USA
| | - Mary Marshall
- Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
| | - Supriya Gupta Mohile
- James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA
| | - Sandy Plumb
- Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
- James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA
| | - Mohamedtaki A Tejani
- James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA
| | - Alison Venuti
- Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA
| | - Ronald M Epstein
- Center for Communication and Disparities Research, University of Rochester School of Medicine, Rochester, NY, USA.
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA.
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA.
- James P Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY, USA.
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA.
- Family Medicine Research Programs, University of Rochester, Rochester, NY, USA.
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25
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Lor M, Koleck TA, Bakken S. Information visualizations of symptom information for patients and providers: a systematic review. J Am Med Inform Assoc 2019; 26:162-171. [PMID: 30535152 PMCID: PMC6657383 DOI: 10.1093/jamia/ocy152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/09/2018] [Accepted: 10/24/2018] [Indexed: 12/25/2022] Open
Abstract
Objective To systematically synthesize the literature on information visualizations of symptoms included as National Institute of Nursing Research common data elements and designed for use by patients and/or healthcare providers. Methods We searched CINAHL, Engineering Village, PsycINFO, PubMed, ACM Digital Library, and IEEE Explore Digital Library to identify peer-reviewed studies published between 2007 and 2017. We evaluated the studies using the Mixed Methods Appraisal Tool (MMAT) and a visualization quality score, and organized evaluation findings according to the Health Information Technology Usability Evaluation Model. Results Eighteen studies met inclusion criteria. Ten of these addressed all MMAT items; 13 addressed all visualization quality items. Symptom visualizations focused on pain, fatigue, and sleep and were represented as graphs (n = 14), icons (n = 4), and virtual body maps (n = 2). Studies evaluated perceived ease of use (n = 13), perceived usefulness (n = 12), efficiency (n = 9), effectiveness (n = 5), preference (n = 6), and intent to use (n = 3). Few studies reported race/ethnicity or education level. Conclusion The small number of studies for each type of information visualization limit generalizable conclusions about optimal visualization approaches. User-centered participatory approaches for information visualization design and more sophisticated evaluation designs are needed to assess which visualization elements work best for which populations in which contexts.
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Affiliation(s)
- Maichou Lor
- School of Nursing, Columbia University, New York City, New York USA
| | - Theresa A Koleck
- School of Nursing, Columbia University, New York City, New York USA
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York City, New York USA
- Department of Biomedical Informatics, Columbia University, New York City, New York USA
- Data Science Institute, Columbia University, New York City, New York, USA
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Zhong HY, Deng XB, Wang Z. Effects of fascia iliaca compartment block combined with general laryngeal mask airway anesthesia in children undergoing femoral fracture surgery: a randomized trial. J Pain Res 2018; 11:2821-2826. [PMID: 30519084 PMCID: PMC6235337 DOI: 10.2147/jpr.s177122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Postoperative agitation after general anesthesia is a common complication in children; however, pain or uncomfortable feeling is the main reason of emergence agitation. Here, we have investigated the effects of fascia iliaca compartment block (FICB) combined with general laryngeal mask airway (LMA) anesthesia in children undergoing femoral surgery. Methods Eighty children undergoing femoral surgery were randomly divided into two groups: FICB + LMA group and control group (n=40). The FICB + LMA group received FICB combined with general LMA anesthesia, and the control group received tracheal intubation general anesthesia alone. Anesthesia was maintained with nitrous oxide and sevoflurane. Hemodynamic parameters were monitored, and pain was assessed by verbal numeric score within 24 hours postoperatively. Time to extubation, time to discharge from the postanesthesia care unit and postoperative complications were recorded. Results Hemodynamic parameters were more stable in the FICB + LMA group than in the control group during anesthesia induction (P<0.05). Verbal numeric score values were lower in the FICB + LMA group than in the control group at 2–8 hours postoperatively (P>0.05). Compared with the control group, the time to extubation and time to discharge from postanesthesia care unit were shorter in the FICB + LMA group (P<0.05). Additionally, postoperative complications were less in the FICB + LMA group. Conclusion The FICB combined with general LMA anesthesia may provide intra- and postoperative analgesia, shorten emergence time and reduce postoperative agitation in children undergoing femoral surgery. Trial registration This study is registered at http://www.chictr.org.cn (registration number: ChiCTR-IOR-17012725).
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Affiliation(s)
- H Y Zhong
- Department of Anesthesiology, Huadu District People's Hospital, Southern Medical University, Guangzhou 510800, Guangdong China
| | - X B Deng
- Department of General Surgery, The People's Hospital of Xiaochang, Xiaogan 432900, Hubei, China
| | - Z Wang
- School of Medicine, Jiaxing University, Jiaxing 314000, Zhejiang, China,
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Ethnic Differences Identified by Pain Sensitivity Questionnaire Correlate With Clinical Pain Responses. Reg Anesth Pain Med 2018; 43:200-204. [PMID: 29278602 DOI: 10.1097/aap.0000000000000689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The Pain Sensitivity Questionnaire, English version (PSQ-E), is predictive of pain-related responses to experimental stimuli. Ethnic differences have been noted in experimental measures of pain sensation using quantitative sensory testing. The present study sought to determine if the PSQ-E also identified similar ethnic differences. METHODS Fifty-seven subjects who self-identified as African Americans (AAs) and who were scheduled to undergo a low-back interventional procedure completed the PSQ-E and other questionnaires. Their data were compared with an age-, sex-, and opioid usage-matched sample of 57 self-identified non-Hispanic white (NHW) subjects. Pain ratings on a visual analog scale (VAS) were obtained following 2 standardized injections of subcutaneous lidocaine (VAS1-infiltration in hand, VAS2-infiltration of procedural site). Correlations between PSQ-E scores, VAS measures, and other inventories were tested. RESULTS The PSQ-E scores and clinical and experimental pain scores were all significantly elevated in AA compared with NHW patients (P < 0.05 for experimental pain scores, P < 0.001 for PSQ and clinical pain scores). Measures of pain interference, depression, anxiety, and pain catastrophizing were not different between groups. Similar to our previous study, PSQ-E scores significantly correlated with both experimental and clinical pain scores (eg, PSQ-E with Brief Pain Inventory pain score: r = 0.39, P < 0.001). CONCLUSIONS The study demonstrated significantly elevated pain sensitivity in AA compared with NHW patients as measured by the PSQ-E and experimental and clinical pain intensity scores. This shows that the PSQ reflects the known elevation of pain sensitivity in AA subjects and suggests that it may be useful in assessing pain treatment disparities by identifying and standardizing differences in pain sensitivity.
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Check DK, Chawla N, Kwan ML, Pinheiro L, Roh JM, Ergas IJ, Stewart AL, Kolevska T, Ambrosone C, Kushi LH. Understanding racial/ethnic differences in breast cancer-related physical well-being: the role of patient-provider interactions. Breast Cancer Res Treat 2018; 170:593-603. [PMID: 29623576 PMCID: PMC6528788 DOI: 10.1007/s10549-018-4776-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Racial/ethnic differences in cancer symptom burden are well documented, but limited research has evaluated modifiable factors underlying these differences. Our objective was to examine the role of patient-provider interactions to help explain the relationship between race/ethnicity and cancer-specific physical well-being (PWB) among women with breast cancer. METHODS The Pathways Study is a prospective cohort study of 4505 women diagnosed with breast cancer at Kaiser Permanente Northern California between 2006 and 2013. Our analysis included white, black, Hispanic, and Asian participants who completed baseline assessments of PWB, measured using the Functional Assessment of Cancer Therapy for Breast Cancer, and patient-provider interactions, measured by the Interpersonal Processes of Care Survey (IPC) (N = 4002). Using step-wise linear regression, we examined associations of race/ethnicity with PWB, and changes in associations when IPC domains were added. RESULTS We observed racial/ethnic differences in PWB, with minorities reporting lower scores than whites (beta, black: - 1.79; beta, Hispanic: - 1.92; beta, Asian: - 1.68; p < 0.0001 for all comparisons). With the addition of health and demographic covariates to the model, associations between race/ethnicity and PWB score became attenuated for blacks and Asians (beta: - 0.63, p = 0.06; beta: - 0.68, p = 0.02, respectively) and, to a lesser extent, for Hispanic women (beta: - 1.06, p = 0.0003). Adjusting for IPC domains did not affect Hispanic-white differences (beta: - 1.08, p = 0.0002), and slightly attenuated black-white differences (beta: - 0.51, p = 0.14). Asian-white differences narrowed substantially (beta: - 0.31, p = 0.28). CONCLUSIONS IPC domains, including those capturing perceived discrimination, respect, and clarity of communication, appeared to partly explain PWB differences for black and Asian women. Results highlight opportunities to improve providers' interactions with minority patients, and communication with minority patients about their supportive care needs.
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Affiliation(s)
- Devon K Check
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Neetu Chawla
- Veterans Affairs Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25, Room B111, North Hills, CA, 91343, USA
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Laura Pinheiro
- Division of General Internal Medicine, Weill Department of Medicine, 525 East 68th Street, F-2011, New York, NY, 10065, USA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Isaac J Ergas
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Anita L Stewart
- Institute for Health and Aging, University of California San Francisco, 3333 California St. Suite 340, San Francisco, CA, 94118-0646, USA
| | - Tatjana Kolevska
- Vallejo Medical Center, Kaiser Permanente Northern California, 975 Sereno Drive, Vallejo, CA, 94589, USA
| | - Christine Ambrosone
- Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
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Samuel CA, Schaal J, Robertson L, Kollie J, Baker S, Black K, Mbah O, Dixon C, Ellis K, Eng E, Guerrab F, Jones N, Kotey A, Morse C, Taylor J, Whitt V, Cykert S. Racial differences in symptom management experiences during breast cancer treatment. Support Care Cancer 2017; 26:1425-1435. [PMID: 29150730 DOI: 10.1007/s00520-017-3965-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Racial disparities in cancer treatment-related symptom burden are well documented and linked to worse treatment outcomes. Yet, little is known about racial differences in patients' treatment-related symptom management experiences. Such understanding can help identify modifiable drivers of symptom burden inequities. As part of the Cancer Health Accountability for Managing Pain and Symptoms (CHAMPS) study, we examined racial differences in symptom management experiences among Black and White breast cancer survivors (BCS). METHODS We conducted six focus groups (n = 3 Black BCS groups; n = 3 White BCS groups) with 22 stages I-IV BCS at two cancer centers. Focus groups were audio-recorded and transcribed verbatim. Based on key community-based participatory research principles, our community/academic/medical partner team facilitated focus groups and conducted qualitative analyses. RESULTS All BCS described positive symptom management experiences, including clinician attentiveness to symptom concerns and clinician recommendations for pre-emptively managing symptoms. Black BCS commonly reported having to advocate for themselves to get information about treatment-related symptoms, and indicated dissatisfaction regarding clinicians' failure to disclose potential treatment-related symptoms or provide medications to address symptoms. White BCS often described dissatisfaction regarding inadequate information on symptom origins and clinicians' failure to offer reassurance. CONCLUSIONS This study elucidates opportunities for future research aimed at improving equity for cancer treatment-related symptom management. For Black women, warnings about anticipated symptoms and treatment for ongoing symptoms were particular areas of concern. Routine symptom assessment for all women, as well as clinicians' management of symptoms for racially diverse cancer patients, need to be more thoroughly studied and addressed.
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Affiliation(s)
- Cleo A Samuel
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
| | - Jennifer Schaal
- The Partnership Project, 620 S. Elm St, Suite 381, Greensboro, NC, 27406, USA
| | - Linda Robertson
- Department of Medicine, University of Pittsburgh, 5150 Centre Avenue, POB 2 Room, 438, Pittsburgh, PA, 15232, USA
| | - Jemeia Kollie
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA
| | - Stephanie Baker
- Department of Public Health Studies, Elon University, Campus Box 2337, Elon, NC, 27224, USA
| | - Kristin Black
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Cancer Health Disparities Training Program, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7440, Chapel Hill, NC, 27599-7440, USA
| | - Olive Mbah
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA
| | - Crystal Dixon
- Department of Public Health Education, University of North Carolina at Greensboro, 437 Coleman Building, P.O. Box 26170, Greensboro, NC, 27402-6169, USA
| | - Katrina Ellis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Cancer Health Disparities Training Program, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7440, Chapel Hill, NC, 27599-7440, USA
| | - Eugenia Eng
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Cancer Health Disparities Training Program, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7440, Chapel Hill, NC, 27599-7440, USA
| | - Fatima Guerrab
- Department of Public Health Education, North Carolina Central University, 1801 Fayetteville St, Durham, NC, 27701, USA
| | - Nora Jones
- Sisters Network Greensboro, P.O. Box 20304, Greensboro, NC, 27420, USA
| | - Amanda Kotey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Claire Morse
- Guilford College, 5800 W Friendly Ave, Greensboro, NC, 27410, USA
| | - Jessica Taylor
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA
| | - Vickie Whitt
- Sisters Network Greensboro, P.O. Box 20304, Greensboro, NC, 27420, USA
| | - Samuel Cykert
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.,School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA
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Relationship between phase I study duration and symptom burden. Support Care Cancer 2017; 26:731-737. [PMID: 28980072 DOI: 10.1007/s00520-017-3879-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Phase I clinical trials are critical to development of cancer therapeutics. Adverse events (AEs) and symptom burden contribute to early treatment withdrawal, and it is often difficult to ascertain whether these events are disease- or treatment-related. Regardless, early withdrawal may delay determination of the effectiveness of potential new therapies. We sought to characterize the reasons for early treatment termination to identify potential modifiable events. METHODS A retrospective chart review was conducted on solid tumor patients enrolled in institutional phase I clinical trials from 2003 to 2013 through the Case Comprehensive Cancer Center. RESULTS Two hundred fifty-five patients were included in the analysis. The mean duration on study was 78.4 days (SD 63.4 days), and 23% of the patients were on study ≤ 30 days. Patients experienced an average of 25.1 AEs, of which 46.9% were non-laboratory. Constitutional symptoms (29.3%), gastrointestinal symptoms (24%), and pain (12.8%) were the most common non-laboratory AEs. Disease progression (57.6%) was the most common reason for study discontinuation, followed by adverse events (16.5%). Approximately 13% of the patients discontinued treatment for other reasons, of which 41.7% were identified as related to symptom burden on further review. Increased rates of AEs negatively correlated with duration on study (r = - 0.331; p < 0.01). CONCLUSIONS AEs may lead to early termination of trial participation and confound clinical assessment of investigational treatments. Designing interventions to reduce AE burden may extend duration on trial, affect the recommended phase II dose, and benefit the quality of life of participants on phase I trials.
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Characterization of risk factors for adjuvant radiotherapy-associated pain in a tri-racial/ethnic breast cancer population. Pain 2017; 157:1122-1131. [PMID: 26780493 DOI: 10.1097/j.pain.0000000000000489] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pain related to cancer or treatment is a critical quality of life issue for breast cancer survivors. In a prospective study of 375 patients with breast cancer (enrolled during 2008-2014), we characterized the risk factors for adjuvant radiotherapy (RT)-associated pain. Pain score was assessed at pre-RT and post-RT as the mean of 4 pain severity items (ie, pain at its worst, least, average, and now) from the Brief Pain Inventory with 11-point numeric rating scale (0-10). Pain scores of 4 to 10 were considered clinically relevant pain. The study consists of 58 non-Hispanic whites (15%), 78 black or African Americans (AA; 21%), and 239 Hispanic whites (HW; 64%). Overall, the prevalence of pre-RT, post-RT, and RT-associated clinically relevant pain was 16%, 31% and 20%, respectively. In univariate analysis, AA and HW had significantly higher pre-RT and post-RT pain than non-Hispanic whites. In multivariable logistic regression analysis, pre-RT pain was significantly associated with HW and obesity; post-RT pain was significantly associated with AA, HW, younger age, ≥2 comorbid conditions, above-median hotspot volume receiving >105% prescribed dose, and pre-RT pain score ≥4. Radiotherapy-associated pain was significantly associated with AA (odds ratio [OR] = 3.27; 95% confidence interval [CI] = 1.09-9.82), younger age (OR = 2.44, 95% CI = 1.24-4.79), and 2 or ≥3 comorbid conditions (OR = 3.06, 95% CI = 1.32-7.08; OR = 4.61, 95% CI = 1.49-14.25, respectively). These risk factors may help to guide RT decision-making process, such as hypofractionated RT schedule. Furthermore, effective pain management strategies are needed to improve quality of life in patients with breast cancer with clinically relevant pain.
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Examining racial variation in antiemetic use and post-chemotherapy health care utilization for nausea and vomiting among breast cancer patients. Support Care Cancer 2016; 24:4839-4847. [PMID: 27465051 DOI: 10.1007/s00520-016-3338-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 07/10/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Racial minority cancer patients may experience underuse of antiemetic medications to prevent chemotherapy-induced nausea and vomiting (CINV). In addition to its adverse implications for quality of life, antiemetic underuse may contribute to observed disparities in acute illness during chemotherapy. To understand the potential contribution of CINV prophylaxis to breast cancer disparities, we assessed racial variation in potent antiemetic use and post-chemotherapy utilization related to CINV and the relationship between the two. METHODS We used SEER-Medicare data to evaluate the health care utilization in the 14 days following chemotherapy initiation among black and white women receiving highly emetogenic chemotherapy for breast cancer. We used modified Poisson regression to assess the relationship between (1) race and CINV-related utilization and (2) NK1 use and CINV-related utilization, overall and stratified by race. We report adjusted risk ratios (aRR) and 95 % confidence intervals (CI). RESULTS The study included 1130 women. Black women were 11 % less likely than white women to use neurokinin-1 receptor antagonists (NK1s) for CINV prophylaxis (p = 0.02); however, they experienced fewer CINV-related encounters following chemotherapy (unadjusted RR = 0.63, 95 %CI = 0.40-0.99; p = 0.05). After adjustment for clinical covariates, estimates were similar but no longer statistically significant (p = 0.07). Among white women, NK1 use was associated with increased CINV-related utilization (aRR NK1 users vs. non-users: 1.35, 95 % CI = 1.07-1.69, p = 0.01), likely resulting from unmeasured confounders. CONCLUSION Black women were less likely to use NK1s- and CINV-related services. Racial variation in CINV-related services use may be partly explained by differential symptom reporting or access to care.
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Check DK, Samuel CA, Rosenstein DL, Dusetzina SB. Investigation of Racial Disparities in Early Supportive Medication Use and End-of-Life Care Among Medicare Beneficiaries With Stage IV Breast Cancer. J Clin Oncol 2016; 34:2265-70. [PMID: 27161968 PMCID: PMC4962709 DOI: 10.1200/jco.2015.64.8162] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Early supportive care may improve quality of life and end-of-life care among patients with cancer. We assessed racial disparities in early use of medications for common cancer symptoms (depression, anxiety, insomnia) and whether these potential disparities modify end-of-life care. METHODS We used 2007 to 2012 SEER-Medicare data to evaluate use of supportive medications (opioid pain medications and nonopioid psychotropics, including antidepressants/anxiolytics and sleep aids) in the 90 days postdiagnosis among black and white women with stage IV breast cancer who died between 2007 and 2012. We used modified Poisson regression to assess the relationship between race and supportive treatment use and end-of-life care (hospice, intensive care unit, more than one emergency department visit or hospitalization 30 days before death, in-hospital death). RESULTS The study included 752 white and 131 black women. We observed disparities in nonopioid psychotropic use between black and white women (adjusted risk ratio [aRR], 0.51; 95% CI, 0.35 to 0.74) but not in opioid pain medication use. There were also disparities in hospice use (aRR, 0.86; 95% CI, 0.74 to 0.99), intensive care unit admission or more than one emergency department visit or hospitalization 30 days before death (aRR, 1.28; 95% CI, 1.01 to 1.63), and risk of dying in the hospital (aRR, 1.59; 95% CI, 1.22 to 2.09). Supportive medication use did not attenuate end-of-life care disparities. CONCLUSION We observed racial disparities in early supportive medication use among patients with stage IV breast cancer. Although they did not clearly attenuate end-of-life care disparities, medication use disparities may be of concern if they point to disparities in adequacy of symptom management given the potential implications for quality of life.
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Affiliation(s)
- Devon K Check
- All authors: University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Cleo A Samuel
- All authors: University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Stacie B Dusetzina
- All authors: University of North Carolina at Chapel Hill, Chapel Hill, NC
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Check DK, Reeder-Hayes KE, Basch EM, Zullig LL, Weinberger M, Dusetzina SB. Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer. Breast Cancer Res Treat 2016; 156:351-9. [PMID: 26968396 PMCID: PMC4820391 DOI: 10.1007/s10549-016-3747-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, can seriously compromise quality of life (QOL) and other treatment outcomes. Because of the expense of antiemetic medications used to prevent CINV (particularly oral medications filled through Medicare Part D), disparities in their use may exist. We used 2006-2012 SEER-Medicare data to evaluate the use of neurokinin-1 receptor antagonists (NK1s), a potent class of antiemetics, among black and white women initiating highly emetogenic chemotherapy for the treatment of early-stage breast cancer. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95 % confidence intervals (CI). The study included 1130 women. We observed racial disparities in use of any NK1 (aRR: 0.68, 95 % CI 0.51-0.91) and in use of oral aprepitant specifically (aRR: 0.54, 95 % CI 0.35-0.83). We did not observe disparities in intravenous fosaprepitant use. After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. We found racial disparities in women's use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in socioeconomic status, which may translate into differential ability to afford the medication.
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Affiliation(s)
- Devon K Check
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7411, Chapel Hill, NC, 27599, USA.
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Hematology/Oncology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ethan M Basch
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7411, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Hematology/Oncology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7411, Chapel Hill, NC, 27599, USA
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Stacie B Dusetzina
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7411, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kumie FT, Gebremedhn EG, Tawuye HY. Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture. World J Emerg Med 2015; 6:142-6. [PMID: 26056546 DOI: 10.5847/wjem.j.1920-8642.2015.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 01/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fascia iliaca compartment nerve block (FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture. METHODS An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group (n=20) and a control group (n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the first 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale (VAS), total analgesic consumption, and the time for the first analgesic request. RESULTS VAS pain scores were reduced within the first 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values (IQR) 0.00 (0.00) vs.18.00 (30.00), P=0.001; at 6 hours 0.00 (0.00) vs. 34.00 (20.75), P=0.000; at 24 hours 12.50 (10.00) vs. 31.50 (20.75), P=0.004; and at 12 hours (17.80±12.45) vs. (29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the first analgesic request was significantly prolonged (417.50 vs. 139.25 minutes, P=0.000). CONCLUSIONS A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the first analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.
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Affiliation(s)
- Fentahun Tarekegn Kumie
- Department of Anaesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endale Gebreegziabher Gebremedhn
- Department of Anaesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hailu Yimer Tawuye
- Department of Anaesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Cetin AA, Bektas H, Ozdogan M. The West Haven Yale Multidimensional Pain Inventory: Reliability and validity of the Turkish version in individuals with cancer. Eur J Oncol Nurs 2015; 20:1-9. [PMID: 25937491 DOI: 10.1016/j.ejon.2015.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Pain is a complex, multidimensional and subjective phenomenon that is common in patients with cancer. The translation of existing pain measurement scales is considered important in producing internationally comparable measures for evidence based practice. In measuring the pain experience, the WHYMPI is a widely used instrument to measure assessment of clinical pain, and it has not been validated in Turkey. The present study aimed to assess the reliability and validity of the Turkish version of the West Haven Yale Multidimensional Pain Inventory (WHYMPI). METHOD In this methodological study, the scale was translated into simplified Turkish by the cross-culture translation method, and 520 participants with cancer were assessed. The internal consistency, item analysis, and test-retest methods were used to determine the reliability of the Turkish WHYMPI. Content validity, criterion validity, convergent/divergent validity, and exploratory factor analysis were used to test the construct validity of the Turkish WHYMPI. RESULTS Cronbach's alpha and item-total correlations results suggested that there was good internal reliability. The Cronbach's alpha for internal consistency of the pain experience, responses by significant others, and daily activities were 0.85, 0.60, and 0.83, respectively. The internal consistency coefficient for test-retest reliability of the pain experience, responses by significant others, and daily activities were acceptable: 0.82, 0.66, and 0.81, respectively. Factor loadings were significant, with standardised loadings ranging from 0.40 to 0.92. CONCLUSIONS WHYMPI is reliable and valid instrument for the measurement of pain in patients with cancer in Turkey. Its use is recommended for clinical and research purposes.
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Affiliation(s)
| | - Hicran Bektas
- Akdeniz University Faculty of Nursing, Department of Internal Medicine Nursing, Antalya, Turkey.
| | - Mustafa Ozdogan
- Memorial Antalya Hospital, Medical Oncology Unit, Antalya, Turkey
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