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Liang M, Zhong T, Knobf MT, Chen L, Xu M, Cheng B, Pan Y, Zhou J, Ye Z. Sentinel and networked symptoms in patients with breast cancer undergoing chemotherapy. Eur J Oncol Nurs 2024; 70:102566. [PMID: 38513452 DOI: 10.1016/j.ejon.2024.102566] [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: 02/08/2024] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE It was designed to identify the symptom clusters and sentinel symptoms among patients with breast cancer receiving chemotherapy at the community level, and to explore core and bridge symptoms at the global level. METHODS A cross-sectional survey was conducted using the MD Anderson Symptom Inventory. Patients with breast cancer receiving chemotherapy, recruited from the "Be Resilient to Breast Cancer" project between January 2023 and December 2023, were included in the study. Symptom clusters and their sentinel symptoms were identified using exploratory factor analysis and Apriori algorithm. Core and bridge symptoms were identified using network analysis. RESULTS A total of 468 patients with breast cancer participated in the current study. At the community level, three symptom clusters and their corresponding sentinel symptoms were identified: a gastrointestinal symptom cluster (with nausea as the sentinel symptom), a psycho-sleep-related symptom cluster (with distress as the sentinel symptom), and a neurocognition symptom cluster (with dry mouth as the sentinel symptom). At the global level, fatigue emerged as the core symptom, while disturbed sleep and lack of appetite as bridge symptoms. CONCLUSION Addressing nausea, distress, and dry mouth are imperative for alleviating specific symptom clusters at the community level. Furthermore, targeting fatigue, disturbed sleep, and lack of appetite are crucial to break the interactions among diverse symptoms at the global level.
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Affiliation(s)
- Minyu Liang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Tong Zhong
- Tumor Radiotherapy Department, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, China
| | - M Tish Knobf
- School of Nursing, Yale University, Orange, CT, United States
| | - Lisi Chen
- Department of Medical Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, China
| | - Min Xu
- Galactophore Department, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, China
| | - Beibei Cheng
- Thyroid and Breast Department, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, China
| | - Yichao Pan
- Department of Cardiology, Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Jian Zhou
- Galactophore Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
| | - Zengjie Ye
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong Province, China.
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Hu Y, Xie YD, Xu X, Liu Y, Zhang C, Wang H. Facilitators and barriers of attending BaDuanJin experienced by breast cancer survivors during chemotherapy. Physiother Theory Pract 2024; 40:528-543. [PMID: 36259288 DOI: 10.1080/09593985.2022.2135977] [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: 05/09/2021] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to identify facilitators and barriers to adherence to a Baduanjin program experienced by breast cancer survivors (BCSs) during chemotherapy. METHODS Semi-structured interviews with 10 BCSs in an interprofessional BaDuanJin program were conducted to understand their experiences, including the facilitators and barriers concerning exercise. Content analysis was performed following the behaviour change wheel (BCW). RESULTS The following five domains emerged from the analysis: 1) Capacity: Recovery of upper limb function, symptom relief, and emotional release are facilitators; periodic treatment and related symptoms and negative emotions are barriers; 2) Motivation: Reflection on health, positive belief, and weight control are facilitators; a doubtful attitude is a barrier; 3) Opportunity: Recuperating at home is a facilitator; 4) Intervention: Facilitators include simple and gentle exercise at home, comprehensive tutoring by an interprofessional team, treating exercise as a task occurring at a fixed time, and peer support. The hindrances are work and home duties prior to exercise and a lack of group activities; and 5) Policy: Social media promotion and less support from physicians are facilitators and barriers, respectively. CONCLUSION Identifying facilitators and barriers leads to improved support from health professionals, which is required to provide effective strategies to increase adherence to BaDuanJin exercise.
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Affiliation(s)
- Yun Hu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Dan Xie
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaozhen Xu
- School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanyan Liu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Chengrui Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Huiru Wang
- Department of Physical Education; Institution of Health Yangtze River Delta, Shanghai Jiaotong University, Shanghai, China
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Silva RJG, Grippa WR, Neto LCBS, Enriquez-Martinez OG, Marcarini JAC, Pessanha RM, Haraguchi FK, Lopes-Júnior LC. Factors Associated with the Nutritional Status of Women with Non-Metastatic Breast Cancer in a Brazilian High Complexity Oncology Center. Nutrients 2023; 15:4961. [PMID: 38068818 PMCID: PMC10707825 DOI: 10.3390/nu15234961] [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: 07/29/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Breast cancer poses a significant public health concern owing to its high prevalence and the risk of mortality associated with delayed diagnosis and treatment. The aim of this study was to assess the nutritional status of women with non-metastatic breast cancer and to identify factors associated with it. METHODS A cross-sectional observational study was conducted at a High Complexity Oncology Assistance Center in the southeast region of Brazil, with the aim of assessing the nutritional status in women undergoing treatment for stage I, II, or III breast cancer. Patients in palliative care or undergoing reconstructive surgery were excluded. Data collection took place between June 2022 and March 2023 and included questionnaires, physical examinations, laboratory tests, and anthropometric assessments. Nutritional status was assessed using measures such as BMI and skinfold thickness, while nutritional risk was assessed using the Nutritional Risk Screening (NRS-2002) tool. RESULTS Significant associations were found between nutritional risk and educational level (p = 0.03) and BMI (p = 0.01). Binary logistic regression analysis revealed a significant association between educational level and nutritional risk, indicating that lower educational level was associated with higher odds of nutritional risk (OR = 4.59; 95% CI = 1.01-21.04; p = 0.049). In addition, regarding BMI, it was observed that a BMI above 20.5 kg/m2 was associated with a higher likelihood of nutritional risk (OR = 0.09; 95% CI = 0.01-0.89; p = 0.039). CONCLUSIONS It is crucial to consider the nutritional status of breast cancer patients, alongside clinical factors, to offer comprehensive and personalized care. Gaining insight into the sociodemographic variables linked to nutritional risk can significantly contribute to our understanding of breast cancer. This knowledge, in turn, can aid in identifying effective strategies for public policy, health promotion, and prevention efforts aimed at tackling this condition.
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Affiliation(s)
- Roberto Júnio Gomes Silva
- Graduate Program in Nutrition and Health, Universidade Federal do Espírito Santo, Vitória 29500-000, ES, Brazil (F.K.H.)
| | - Wesley Rocha Grippa
- Graduate Program in Public Health, Universidade Federal do Espírito Santo, Vitória 29500-000, ES, Brazil; (W.R.G.); (R.M.P.)
| | | | | | | | - Raphael Manhães Pessanha
- Graduate Program in Public Health, Universidade Federal do Espírito Santo, Vitória 29500-000, ES, Brazil; (W.R.G.); (R.M.P.)
| | - Fabiano Kenji Haraguchi
- Graduate Program in Nutrition and Health, Universidade Federal do Espírito Santo, Vitória 29500-000, ES, Brazil (F.K.H.)
| | - Luís Carlos Lopes-Júnior
- Graduate Program in Nutrition and Health, Universidade Federal do Espírito Santo, Vitória 29500-000, ES, Brazil (F.K.H.)
- Graduate Program in Public Health, Universidade Federal do Espírito Santo, Vitória 29500-000, ES, Brazil; (W.R.G.); (R.M.P.)
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Li H, Shi X, Li J, Zhang X, Li F. Psychoneurological symptoms and inflammatory markers in patients with glioma in China: a network analysis. Support Care Cancer 2023; 31:435. [PMID: 37395813 DOI: 10.1007/s00520-023-07873-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/09/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Anxiety, depression, sleep disorder, fatigue, and pain develop as common psychoneurological symptoms in patients with glioma, and their occurrence and development are potentially related to inflammatory factors. However, this theory has not been proven within the context of glioma. This study aimed to estimate interconnections among psychoneurological symptoms and inflammatory biomarkers by a network analysis. PATIENTS AND METHODS We selected 203 patients with stage I-IV glioma from a tertiary hospital in China using convenient sampling method. Patients completed the self-made questionnaires, Hamilton Anxiety Scale-14 (HAMA-14), Hamilton Depression Scale-24 (HAMD-24), Pittsburgh Sleep Quality Index (PSQI), Multidimensional Fatigue Inventory-20 (MFI-20), and pain Numerical Rating Scale (NRS). The plasma inflammatory cytokines were examined. Partial correlation network analysis was performed to illustrate interactions of symptoms and inflammatory biomarkers. RESULTS Among the 203 included patients, all psychoneurological symptoms, except for depression and pain, exhibited significant connections with each other. Depression, anxiety, fatigue, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) with higher strength centrality indices were identified as the most central node within the symptom-biomarker network. CONCLUSIONS Depression, anxiety, fatigue, IL-6, and TNF-α play a significant role in the symptom-biomarker network in patients with glioma. Medical staff should strengthen the dynamic evaluation of the involved symptoms and inflammatory cytokines and take effective measures to alleviate the burden of symptoms and improve the quality of life of patients.
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Affiliation(s)
- Huayu Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Xiaohan Shi
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Jing Li
- Department of Neurosurgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xinrui Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Feng Li
- Department of Neurosurgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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Ebbestad FE, Ammitzbøll G, Horsbøll TA, Andersen I, Johansen C, Zehran B, Dalton SO. The long-term burden of a symptom cluster and association with longitudinal physical and emotional functioning in breast cancer survivors. Acta Oncol 2023; 62:706-713. [PMID: 36912039 DOI: 10.1080/0284186x.2023.2185909] [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: 10/23/2022] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Fatigue, insomnia and pain are some of the most common and distressing symptoms experienced during breast cancer (BC) treatment and survivorship. The symptoms have been found to impact one another and to form a symptom cluster, and greater severity of the symptoms may be negatively associated with physical and emotional functioning in survivorship. In exploratory analyses from a randomized controlled trial examining the effect of progressive resistance training on the development of lymphedema after BC, we aimed to examine the burden of the symptom cluster fatigue-pain-insomnia, and its prognostic value for long-term symptom severity as well as emotional and physical functioning. MATERIAL AND METHODS Latent profile analysis was used to identify groups with similar severity of pain, fatigue and insomnia among 158 patients with BC two weeks after surgery. Mixed effects Tobit regression models were used to estimate fatigue, pain, insomnia, and physical and emotional functioning 20 weeks, 1 year and 3.5 years after surgery. RESULTS Two symptom burden groups were identified: 80% of women had a low severity while 20% of women had a high severity of the three symptoms after BC surgery. 3.5 years later, the women with high symptom burden post-surgery still had higher pain, insomnia and fatigue scores than women with low symptom burden. High symptom burden post-surgery was associated with worse physical functioning 3.5 years later, while emotional functioning was only negatively impacted during the first year. DISCUSSION These findings warrant larger studies investigating if symptom burden early in BC trajectory can be used for risk stratification for persistent symptoms and diminished physical functioning with the purpose of developing and implementing targeted interventions.
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Affiliation(s)
- Freja Ejlebæk Ebbestad
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Gunn Ammitzbøll
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- COMPAS, Danish Research Center for Equality in Cancer, Zealand University Hospital, Næstved, Denmark
| | | | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE), Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Denmark
| | - Bo Zehran
- Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- COMPAS, Danish Research Center for Equality in Cancer, Zealand University Hospital, Næstved, Denmark
- Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Denmark
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6
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Wright F, Cooper BA, Paul SM, Hammer MJ, Conley YP, Levine JD, Miaskowski C, Kober KM. Distinct Profiles of Morning and Evening Fatigue Co-Occurrence in Patients During Chemotherapy. Nurs Res 2023; 72:259-271. [PMID: 37084242 PMCID: PMC10330127 DOI: 10.1097/nnr.0000000000000661] [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] [Indexed: 04/22/2023]
Abstract
BACKGROUND Morning and evening fatigue are distinct and distressing symptoms experienced during chemotherapy that demonstrate a large amount of interindividual variability. OBJECTIVES The objectives of this study were to identify subgroups of patients with distinct morning and evening fatigue co-occurrence profiles and evaluate for differences among these subgroups in demographic, clinical, and symptom characteristics and quality of life. METHODS Oncology patients ( n = 1,334) completed the Lee Fatigue Scale to self-report morning and evening fatigue, six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct morning and evening physical fatigue profiles. RESULTS Four distinct morning and evening fatigue profiles were identified (i.e., Both Low, Low Morning + Moderate Evening, Both Moderate, and Both High). Compared to the Both Low profile, the Both High profile was significantly younger, less likely to be married or partnered, more likely to live alone, had a higher comorbidity burden, and lower functional status. The Both High profile had higher levels of anxiety, depressive symptoms, sleep disturbance, and pain and lower levels of quality of life. DISCUSSION The variability in the morning and evening severity scores among the four profiles supports the hypothesis that morning and evening fatigue are distinct but related symptoms. Clinically meaningful levels of both morning and evening fatigue were reported by 50.4% of our sample, which suggests that the co-occurrence of these two symptoms is relatively common. Patients in Both Moderate and Both High profiles experienced an extremely high symptom burden that warrants ongoing assessments and aggressive symptom management interventions.
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Affiliation(s)
- Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY
| | - Bruce A. Cooper
- School of Nursing, University of California, San Francisco, CA
| | - Steven M. Paul
- School of Nursing, University of California, San Francisco, CA
| | | | | | - Jon D. Levine
- School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA
- School of Medicine, University of California, San Francisco, CA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA
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7
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Davis JK, Mark S, Mackin L, Paul SM, Cooper BA, Conley YP, Hammer MJ, Levine JD, Miaskowski C. Sleep disturbance and decrements in morning energy contribute to a higher symptom burden in oncology patients. Sleep Med 2023; 108:124-136. [PMID: 37354746 DOI: 10.1016/j.sleep.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE/BACKGROUND An emerging area of research is the relationship between sleep disturbance and decrements in energy. Given the paucity of research on the co-occurrence of these two symptoms, study purposes were to identify subgroups of oncology patients with distinct joint sleep disturbance AND morning energy profiles and evaluate for differences among the subgroups in demographic, clinical, and sleep disturbance characteristics, as well as the severity of other common symptoms and QOL outcomes. PATIENTS/METHODS Patients (n = 1336) completed measures of sleep disturbance and energy 6 times over two cycles of chemotherapy. All of the other measures were completed at enrollment. Latent profile analysis was used to identify the distinct joint sleep disturbance and morning energy profiles. RESULTS Three distinct profiles were identified (i.e., Low Sleep Disturbance and High Morning Energy (Normal, 20.6%), Moderate Sleep Disturbance and Low Morning Energy (Moderately Severe, 52.1%), Very High Sleep Disturbance and Very Low Morning Energy (Very Severe, 27.3%). Compared to Normal class, other two classes were more likely to be female, less likely to be employed, and had higher comorbidity burden and poorer functional status. Symptom scores and QOL outcomes exhibited a dose response effect (i.e., as the profile worsened, symptom scores increased and QOL scores decreased). CONCLUSIONS Given the associations between sleep disturbance and decrements in energy and a higher symptom burden, poorer QOL outcomes, and increased mortality, assessment of these two symptoms needs to be a high priority for clinicians and appropriate interventions initiated.
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Affiliation(s)
| | - Sueann Mark
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Lynda Mackin
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA.
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8
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Sheng Y, Carpenter JS, Paul SM, Conley YP, Levine JD, Miaskowski C. Patients with palpitations experience a higher symptom burden prior to breast cancer surgery. Eur J Oncol Nurs 2023; 65:102341. [PMID: 37327556 DOI: 10.1016/j.ejon.2023.102341] [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: 10/05/2022] [Revised: 04/11/2023] [Accepted: 04/29/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Anxiety, depression, sleep disturbance, fatigue, cognitive dysfunction, and pain are common symptoms reported by patients with breast cancer. Recent evidence suggests that palpitations, a feeling of the heart racing or pounding, may be equally common. Study purpose was to compare the severity and clinically meaningful occurrence rates of common symptoms and quality of life (QOL) outcomes between patients with breast cancer who did and did not report palpitations prior to surgery. METHODS Patients (n = 398) were classified as having or not having palpitations using a single item from the Menopausal Symptoms Scale. Valid and reliable measures were used to assess state and trait anxiety, depression, sleep disturbance, fatigue, energy, cognitive function, breast symptoms, and QOL. Between group differences were evaluated using parametric and non-parametric tests. RESULTS Patients with palpitations (15.1%) reported significantly higher severity scores for state and trait anxiety, depression, sleep disturbance, and fatigue as well as significant decrements in energy and cognitive function (all p < .05). A higher percentage of these patients had clinically meaningful levels of state anxiety, depression, sleep disturbance and decrements in cognitive function (all p < .05). Except for spiritual well-being, QOL scores were lower in the palpitations group (all p < .001). CONCLUSION Findings support the need for routine assessment of palpitations and management of multiple symptoms in women prior to breast cancer surgery.
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Affiliation(s)
- Ying Sheng
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | | | - Steven M Paul
- School of Nursing, University of California at San Francisco, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California at San Francisco, San Francisco, CA, USA; School of Medicine, University of California at San Francisco, San Francisco, CA, USA.
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9
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Limbacher SA, Mazanec SR, Frame JM, Connolly MC, Park S, Rosenzweig MQ. Early-stage breast cancer menopausal symptom experience and management: exploring medical oncology clinic visit conversations through qualitative analysis. Support Care Cancer 2022; 30:9901-9907. [PMID: 36434412 DOI: 10.1007/s00520-022-07446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/30/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Women being treated with chemotherapy for breast cancer experience menopausal symptoms that vary in presentation and impact on quality of life. The clinical visit before each chemotherapy cycle provides an important opportunity to allow patients to dialogue with their medical oncology healthcare providers about these symptoms and identify strategies for self-management. The objective of this study was to characterize patient and provider interactions regarding the menopausal symptom experience and management in the context of breast cancer treatment. METHODS Thematic analysis was employed to analyze 61 transcripts from clinical encounters of women receiving chemotherapy treatment for breast cancer. Transcripts were chosen based on their inclusion of menopausal symptom discussion. RESULTS Themes were separated into three distinct categories: patient, clinician, and dyadic themes. The overarching theme was goal discordance in the clinical visit, which was reflected in the following themes: unexpected and unprepared; distressed, disrupted and disturbed; clinical insensitivity; missed opportunity for management and empathy; and use of humor and colloquial language. Overall, women were unprepared for the menopausal symptom experience, and clinicians did not often provide management, interventions, or empathetic responses. CONCLUSION There is a need to develop more astute assessment and communication regarding menopausal symptoms during the clinical visit. Possible interventions include a more holistic assessment, algorithms to facilitate the clinician's attention and response to menopausal symptoms, and treatment of symptoms.
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Affiliation(s)
- Sarah A Limbacher
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
| | - Susan R Mazanec
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Jennifer M Frame
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Mary C Connolly
- School of Nursing, The University of Pittsburgh, Pittsburg, PA, USA
| | - Sumin Park
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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10
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McCall MK, Sereika SM, Snader S, Lavanchy A, Rosenzweig MQ, Conley YP, Beumer JH, Bender CM. Trajectories of neuropsychological symptom burden in postmenopausal women prescribed anastrozole for early-stage breast cancer. Support Care Cancer 2022; 30:9329-9340. [PMID: 36085422 PMCID: PMC10148985 DOI: 10.1007/s00520-022-07326-6] [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: 01/25/2022] [Accepted: 08/09/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Aromatase inhibitors (AIs) prolong survival for postmenopausal women with hormone receptor-positive breast cancer (HR + BC) but also burden patients with symptoms, a major reason for suboptimal AI adherence. This study characterizes inter-relationships among symptom measures; describes neuropsychological symptom burden trajectories; and identifies trajectory group membership predictors for postmenopausal women prescribed anastrozole for HR + BC. METHODS This study utilized prospectively collected data from a cohort study. Relationships among various self-reported symptom measures were examined followed by a factor analysis to reduce data redundancy before trajectory analysis. Four neuropsychological scales/subscales were rescaled (range 0-100) and averaged into a neuropsychological symptom burden (NSB) score, where higher scores indicated greater symptom burden. Group-based trajectory modeling characterized NSB trajectories. Trajectory group membership predictors were identified using multinomial logistic regression. RESULTS Women (N = 360) averaged 61 years old, were mostly White, and diagnosed with stage I HR + BC. Several measures were correlated temporally but four neuropsychological measures had strong correlations and dimensional loadings. These four measures, combined for the composite NSB, averaged (mean ± standard deviation) 17.4 ± 12.9, 18.0 ± 12.7, 19.5 ± 12.8, and 19.8 ± 13.0 at pre-anastrozole, 6, 12, and 18 months post-initiation, respectively. However, the analysis revealed five NSB trajectories-low-stable, low-increasing, moderate-stable, high-stable, and high-increasing. Younger age and baseline medication categories (pre-anastrozole), including anti-depressants, analgesics, anti-anxiety, and no calcium/vitamin D, predicted the higher NSB trajectories. CONCLUSION This study found relationships among neuropsychological symptom measures and distinct trajectories of self-reported NSB with pre-anastrozole predictors. Identifying symptom trajectories and their predictors at pre-anastrozole may inform supportive care strategies via symptom management interventions to optimize adherence for women with HR + BC.
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Affiliation(s)
- Maura K McCall
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
- Case Western Reserve University, Cleveland, OH, USA.
| | - Susan M Sereika
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
- University of Pittsburgh Public Health, Pittsburgh, PA, USA
| | | | - Alexa Lavanchy
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Margaret Q Rosenzweig
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Yvette P Conley
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
- University of Pittsburgh Public Health, Pittsburgh, PA, USA
| | - Jan H Beumer
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Catherine M Bender
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
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11
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Cai T, Huang Y, Huang Q, Xia H, Yuan C. Symptom trajectories in patients with breast cancer: An integrative review. Int J Nurs Sci 2022; 9:120-128. [PMID: 35079613 PMCID: PMC8766784 DOI: 10.1016/j.ijnss.2021.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to synthesize the available knowledge of symptom trajectories in patients with breast cancer and identify predictors associated with these trajectories. Methods Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in four databases (PubMed, Embase, Web of Science, and CINAHL). The retrieved articles’ publication time was limited to 2010 to 2020, and only peer-reviewed English articles were included. Results Twenty-seven articles were included. The findings of the relevant studies were analyzed using thematic analysis. They were grouped into two themes: symptom trajectories of patients with breast cancer (symptom trajectories in patients with breast cancer, in patients who underwent surgery, and in patients who received cancer-related treatment) and associated factors (socioeconomic factors, health characteristics, cancer-related treatment characteristics). Newly diagnosed patients tended to report high trajectories of depression and persistent sleep disturbance. Most patients who underwent surgery reported significant sleep disturbance and anxiety shortly after surgery. For patients who received cancer-related treatment, only a small proportion had a high level of physical activity after cancer-related therapy over time. A high body mass index, a low relationship quality, parental responsibilities, insufficient social support, a low educational background, and an unhealthy lifestyle may increase the risk of negative symptom trajectories in patients with breast cancer. Additionally, old patients were more likely to report cognitive impairment after chemotherapy, while young patients tended to report trajectories of persistent sexual dysfunction. Concurring symptoms and poor health status also contributed to adverse symptom trajectories. Conclusion The findings of this review add to the body of knowledge of the interindividual variability of symptom trajectories in patients with breast cancer. Despite the overall similarity in appraisal at baseline, the patients reported varied symptom trajectories over time. It is recommended that nurses consider sociodemographic, clinical and cancer-related treatment characteristics and perform targeted early preventive interventions for patients with breast cancer.
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Affiliation(s)
- Tingting Cai
- School of Nursing, Fudan University, Shanghai, China
| | - Yueshi Huang
- School of Nursing, Fudan University, Shanghai, China
| | - Qingmei Huang
- School of Nursing, Fudan University, Shanghai, China
| | - Haozhi Xia
- School of Nursing, Fudan University, Shanghai, China
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Changrong Yuan
- School of Nursing, Fudan University, Shanghai, China
- Corresponding author.
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12
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Liu X, Chen C, Wu Q, Ji Q, Zhu P. Dilemma: Disclosure Experience Among Young Female Breast Cancer Survivors in China. J Adolesc Young Adult Oncol 2021; 11:486-492. [PMID: 34962155 DOI: 10.1089/jayao.2021.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Culture influences whether cancer patients disclose their disease diagnosis to others. Understanding Chinese young female breast cancer survivors (BCSs)' experiences and perspectives on disclosure could play a vital role in clinical nursing. This study explores the experiences of Chinese young female BCSs with disease disclosure and describes the reasons for their choices. Methods: Using the tenets of phenomenological research and a purpose sampling method, semistructured interviews were conducted with 31 BCSs from February to April 2021. Colaizzi's analysis method was performed with NVivo software to develop common themes from the data. Results: From the analysis of the interviews of the 31 participants, three main themes were identified: (1) disclosure-to whom, including core family members, close friends, roommates, and employers; (2) disclosure to achieve positive outcomes, including: to gain social support, tell others to take precautions, obtain relevant information, and get permission to work flexibly, and (3) nondisclosure to avoid negative outcomes, including fear of discrimination and stigmatization, strengthen the role of the patient, bring excessive burden, and fear of excessive compassion. Conclusions: For young women diagnosed with breast cancer in China, it is a very complicated matter whether they choose to disclose their diagnosis to others. While disclosure can bring many benefits, it is important to look at the reasons why these women are concealing their diagnosis.
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Affiliation(s)
- Xinyi Liu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Chen Chen
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Qiwei Wu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Qiaoying Ji
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Pingting Zhu
- School of Nursing, Yangzhou University, Yangzhou, China.,Jiangsu Key Laboratory of Zoonosis, Yangzhou University, Yangzhou, China
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13
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Abstract
Delirium is a manifestation of brain injury or acute and generalized dysfunction of the upper cerebral cortical processes. In this way, it is important to analyze delirium more broadly as a symptom to understand and intervene taking into account that it is manifesting the presence of brain lesions whose consequences are deleterious to the neurological performance of patients. This article is intended to present a comprehensive approach of delirium analyzed from a symptom perspective and from theoretical and conceptual structure, such as the Dynamic Symptoms Model, specific to the nursing practice. A literature review related to delirium and components of Dynamic Symptoms Model was carried out. We searched the MEDLINE, ScienceDirect, SciELO, and Scopus databases using the terms Delirium, Intensive Care Units, Nursing, and Risk Factor. The existing literature provides evidence of the antecedents, experience, interventions, interactions, and consequences of delirium, which are components of the Model. Thus, the analysis from the Dynamic Symptoms Model perspective bears relevance and contributes to the understanding and approach of delirium.
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14
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Voute M, Morel V, Joly D, Villatte C, Martin E, Durando X, Pereira B, Pickering G. Predicting Pain Trajectories in the One Year Following Breast Cancer Diagnosis-An Observational Study. J Clin Med 2020; 9:E1907. [PMID: 32570868 PMCID: PMC7356308 DOI: 10.3390/jcm9061907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
The impact of psychosocial vulnerability on pain in the year following breast cancer diagnosis has been little studied. To identify a score of psychosocial vulnerability (cognitive, emotional, quality of life and precariousness parameters) as a predictor of a pain trajectory, we conducted an observational prospective study and included women with newly diagnosed breast cancer. One year follow-up with 3 visits (day of breast cancer diagnosis; 6 and 12 months) aimed to identify distinct pain-time trajectories. Baseline psychosocial vulnerability was characterized by z-score transformation, a higher score representing a more vulnerable patient. A total of 89 patients were included (59.3 ± 10.7 years). Two trajectories of pain were identified-"Transient Pain trajectory" (TP) (39/89 patients) and "Persistent Pain trajectory" (PP) (50/89). A significant difference of pain over time between trajectories (PP vs. TP at 6 months: 2.23 ± 0.23 vs. 0.27 ± 0.09, p < 0.001) was observed. Psychosocial vulnerability showed a large effect size (d, -0.82; 95% CI, -1.25 to -0.38; p < 0.001) and a higher score in "Persistent pain trajectory" (PP vs. TP: 0.12 ± 0.36 vs. -0.14 ± 0.26, p < 0.001). A predictive vulnerability marker of pain development is proposed and could be used at cancer diagnosis to orientate the care pathway of patients experiencing breast cancer.
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Affiliation(s)
- Marion Voute
- CHU Clermont-Ferrand, Inserm, Centre d’Investigation Clinique, CIC Inserm 1405, F-63000 Clermont–Ferrand, France; (M.V.); (V.M.); (E.M.)
| | - Véronique Morel
- CHU Clermont-Ferrand, Inserm, Centre d’Investigation Clinique, CIC Inserm 1405, F-63000 Clermont–Ferrand, France; (M.V.); (V.M.); (E.M.)
| | - Dominique Joly
- CHU Clermont-Ferrand, Centre Jean Perrin, Centre de Lutte contre le Cancer, F-63003 Clermont-Ferrand, France; (D.J.); (C.V.)
| | - Christine Villatte
- CHU Clermont-Ferrand, Centre Jean Perrin, Centre de Lutte contre le Cancer, F-63003 Clermont-Ferrand, France; (D.J.); (C.V.)
| | - Elodie Martin
- CHU Clermont-Ferrand, Inserm, Centre d’Investigation Clinique, CIC Inserm 1405, F-63000 Clermont–Ferrand, France; (M.V.); (V.M.); (E.M.)
| | - Xavier Durando
- Division de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre de Lutte contre le Cancer, Centre Jean Perrin, F-63003 Clermont-Ferrand, France;
| | - Bruno Pereira
- CHU de Clermont-Ferrand, Délégation Recherche Clinique & Innovation, 58 Rue Montalembert, F-63003 Clermont-Ferrand, France;
| | - Gisèle Pickering
- CHU Clermont-Ferrand, Inserm, Centre d’Investigation Clinique, CIC Inserm 1405, F-63000 Clermont–Ferrand, France; (M.V.); (V.M.); (E.M.)
- Université Clermont Auvergne, Inserm, Neuro-Dol, F-63000 Clermont-Ferrand, France
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15
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Liu M, Taylor JL, Perrin NA, Szanton SL. Distinct clusters of older adults with common neuropsychological symptoms: Findings from the National Health and Aging Trends Study. Geriatr Nurs 2020; 41:222-228. [DOI: 10.1016/j.gerinurse.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 01/29/2023]
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16
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Singh K, Paul SM, Kober KM, Conley YP, Wright F, Levine JD, Joseph PV, Miaskowski C. Neuropsychological Symptoms and Intrusive Thoughts Are Associated With Worse Trajectories of Chemotherapy-Induced Nausea. J Pain Symptom Manage 2020; 59:668-678. [PMID: 31689477 PMCID: PMC7024637 DOI: 10.1016/j.jpainsymman.2019.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT Although chemotherapy-induced vomiting is well controlled with evidence-based antiemetic regimens, chemotherapy-induced nausea (CIN) remains a significant clinical problem. OBJECTIVES Study purposes, in a sample of outpatients with breast, gastrointestinal, gynecological, or lung cancer who received two cycles of chemotherapy (CTX, n = 1251), were to evaluate for interindividual differences in the severity of CIN and to determine which demographic, clinical, symptom, and stress characteristics are associated with higher initial levels as well as with the trajectories of CIN. METHODS Patients were recruited during their first or second cycle of CTX. Patients completed self-report questionnaires a total of six times over two cycles of CTX. Hierarchical linear modeling was used to evaluate for interindividual differences in and characteristics associated with the severity of CIN. RESULTS Across the two cycles of CTX, higher levels of sleep disturbance, depression, and morning fatigue, as well as higher levels of intrusive thoughts, were associated with higher initial levels of CIN. In addition, lower functional status scores and shorter cycle lengths were associated with higher initial levels of CIN, and younger age and higher emetogenicity of the CTX regimen were associated with both higher initial levels as well as worse trajectories of CIN severity. CONCLUSION These findings suggest that common symptoms associated with cancer and its treatment are associated with increased severity of CIN. Targeted interventions for these symptoms may reduce the burden of unrelieved CIN.
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Affiliation(s)
- Komal Singh
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Paule V Joseph
- Sensory Science & Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, Department of Health and Human Services, National Institutes of Health, Bethesda, Maryland, USA
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