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Doppenberg-Smit GE, Lamers F, van Linde ME, Braamse AMJ, Sprangers MAG, Beekman ATF, Verheul HMW, Dekker J. Network analysis used to investigate the interplay among somatic and psychological symptoms in patients with cancer and cancer survivors: a scoping review. J Cancer Surviv 2024:10.1007/s11764-024-01543-0. [PMID: 38530627 DOI: 10.1007/s11764-024-01543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/22/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Patients with cancer often experience multiple somatic and psychological symptoms. Somatic and psychological symptoms are thought to be connected and may reinforce each other. Network analysis allows examination of the interconnectedness of individual symptoms. The aim of this scoping review was to examine the current state of knowledge about the associations between somatic and psychological symptoms in patients with cancer and cancer survivors, based on network analysis. METHODS This scoping review followed the five-stage framework of Arksey and O'Malley. The literature search was conducted in May, 2023 in PubMed, APA PsycINFO, Embase Cochrane central, and CINAHL databases. RESULTS Thirty-two studies were included, with eleven using longitudinal data. Seventeen studies reported on the strength of the associations: somatic and psychological symptoms were associated, although associations among somatic as well as among psychological symptoms were stronger. Other findings were the association between somatic and psychological symptoms was stronger in patients experiencing more severe symptoms; associations between symptoms over time remained rather stable; and different symptoms were central in the networks, with fatigue being among the most central in half of the studies. IMPLICATIONS FOR CANCER SURVIVORS Although the associations among somatic symptoms and among psychological symptoms were stronger, somatic and psychological symptoms were associated, especially in patients experiencing more severe symptoms. Fatigue was among the most central symptoms, bridging the somatic and psychological domain. These findings as well as future research based on network analysis may help to untangle the complex interplay of somatic and psychological symptoms in patients with cancer.
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Affiliation(s)
- G Elise Doppenberg-Smit
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands.
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands.
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Myra E van Linde
- Department of Medical Oncology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam A G Sprangers
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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Asakitogum DA, Nutor JJ, Pozzar R, Hammer M, Miaskowski C. Systematic Review of the Literature on Multiple Co-occurring Symptoms in Patients Receiving Treatment for Gynecologic Cancers. Semin Oncol Nurs 2024; 40:151572. [PMID: 38246840 DOI: 10.1016/j.soncn.2023.151572] [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: 09/09/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Patients with gynecologic cancers experience a very high symptom burden that has a negative impact on their quality of life. This systematic review aims to identify the common co-occurring symptoms, the prevalence of common symptoms, common instruments used to measure symptoms, associated risk factors, and the symptom burden in patients with gynecologic cancers. DATA SOURCES A search of four databases (ie, PubMed, Embase, Web of Science, and CINAHL) was done from January 1, 2012, through September 5, 2022. A qualitative synthesis of the extant literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA 2020). CONCLUSION A total of 118 studies met the prespecified inclusion criteria. Ninety-six symptoms were assessed across these studies. The top six symptoms and their grand mean prevalence rates were lack of energy (64.4%), fatigue (62.1%), abdominal pain (53.3%), depression (52.6%), concentration dysfunction (52.0%), and drowsiness (51.9%). Numerous methodologic challenges were evident across studies. Future research needs to develop a disease-specific symptom assessment measure, evaluate for risk factors associated with a higher symptom burden, and determine the impact of multiple symptoms on patient outcomes. IMPLICATION FOR NURSING PRACTICE The results are relevant for oncology clinicians to assess patients with gynecologic cancers for the presence of common symptoms and risk factors for higher symptom burden in the patients and to offer effective management interventions.
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Affiliation(s)
- David Ayangba Asakitogum
- Doctoral student, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA.
| | - Jerry John Nutor
- Assistant Professor, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA
| | - Rachel Pozzar
- Nurse Scientist and Instructor, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Marilyn Hammer
- Nurse Scientist and Instructor, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA; Director, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Christine Miaskowski
- Professor, Departments of Physiological Nursing and Anesthesia, School of Nursing and Medicine, University of California, San Francisco, CA
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Lam WWT, Ng DWL, Fielding R, Sin V, Tsang C, Chan WWL, Foo CC, Kwong A, Chan KKL. Implementing a nurse-led screening clinic for symptom distress with community-based referral for cancer survivors: A feasibility study. Psychooncology 2024; 33:e6261. [PMID: 38047720 DOI: 10.1002/pon.6261] [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: 08/17/2023] [Revised: 10/12/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION This prospective, single-arm, pragmatic implementation study evaluated the feasibility of a nurse-led symptom-screening program embedded in routine oncology post-treatment outpatient clinics by assessing (1) the acceptance rate for symptom distress screening (SDS), (2) the prevalence of SDS cases, (3) the acceptance rate for community-based psychosocial support services, and (4) the effect of referred psychosocial support services on reducing symptom distress. METHODS Using the modified Edmonton Symptom Assessment System (ESAS-r), we screened patients who recently completed cancer treatment. Patients screening positive for moderate-to-severe symptom distress were referred to a nurse-led community-based symptom-management program involving stepped-care symptom/psychosocial management interventions using a pre-defined triage system. Reassessments were conducted at 3-months and 9-months thereafter. The primary outcomes included SDS acceptance rate, SDS case prevalence, intervention acceptance rate, and ESAS-r score change over time. RESULTS Overall, 2988/3742(80%) eligible patients consented to SDS, with 970(32%) reporting ≥1 ESAS-r symptom as moderate-to-severe (caseness). All cases received psychoeducational material, 673/970(69%) accepted psychosocial support service referrals. Among 328 patients completing both reassessments, ESAS-r scores improved significantly over time (p < 0.0001); 101(30.8%) of patients remained ESAS cases throughout the study, 112(34.1%) recovered at 3-month post-baseline, an additional 72(22%) recovered at 9-month post-baseline, while 43(12.2%) had resumed ESAS caseness at 9-month post-baseline. CONCLUSION Nurse-led SDS programs with well-structured referral pathways to community-based services and continued monitoring are feasible and acceptable in cancer patients and may help in reducing symptom distress. We intend next to develop optimal strategies for SDS implementation and referral within routine cancer care services.
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Affiliation(s)
- Wendy Wing Tak Lam
- Centre for Psycho-Oncology Research and Trainig, Division of Behavioural Sciences, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
- LKS Faculty of Medicine Jockey Club Institute of Cancer Care, The University of Hong Kong, Hong Kong, SAR, China
| | - Danielle W L Ng
- Centre for Psycho-Oncology Research and Trainig, Division of Behavioural Sciences, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
- LKS Faculty of Medicine Jockey Club Institute of Cancer Care, The University of Hong Kong, Hong Kong, SAR, China
| | - Richard Fielding
- Centre for Psycho-Oncology Research and Trainig, Division of Behavioural Sciences, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
- LKS Faculty of Medicine Jockey Club Institute of Cancer Care, The University of Hong Kong, Hong Kong, SAR, China
| | - Vivian Sin
- LKS Faculty of Medicine Jockey Club Institute of Cancer Care, The University of Hong Kong, Hong Kong, SAR, China
| | - Catherine Tsang
- LKS Faculty of Medicine Jockey Club Institute of Cancer Care, The University of Hong Kong, Hong Kong, SAR, China
| | - Wendy W L Chan
- Department of Clinical Oncology, LKS Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Chi Chung Foo
- Department of Surgery, LKS Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Ava Kwong
- Department of Surgery, LKS Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Karen K L Chan
- Department of Obstetrics and Gynaecology, LKS Faculty of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, SAR, China
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Luo F, Lu Y, Chen C, Chang D, Jiang W, Yin R. Analysis of the Risk Factors for Negative Emotions in Patients with Esophageal Cancer During the Peri-Radiotherapy Period and Their Effects on Malnutrition. Int J Gen Med 2023; 16:6137-6150. [PMID: 38162686 PMCID: PMC10757788 DOI: 10.2147/ijgm.s444255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024] Open
Abstract
Background Esophageal cancer has a high incidence in China. Many patients also have a heavy psychological burden due to clinical features such as wasting and choking on food. This study analyzed the risk factors of negative emotions in esophageal cancer patients during the peri-radiotherapy period and its effects on malnutrition. Methods We retrospectively analyzed 339 patients with esophageal cancer during the peri-radiotherapy who received treatment at our hospital from April 2017 to April 2020, and followed up for 3 years. t test and Chi-square test were used to analyze the relationship between patients' negative emotions and clinical data. Binary logistics regression was performed to analyze the independent risk factors for the occurrence of negative mood and malnutrition in the patients. Kaplan-Meier survival curves were used to analyze survival rates. Results Our results showed that 18.3% of patients undergoing radiotherapy for esophageal cancer had negative emotions, and 41.9% suffered from malnutrition. The results of the binary logistic regression analysis showed that monthly household income (OR = 0.470, P = 0.022), the TNM stage (OR = 2.030, P = 0.044), concomitant gastrointestinal symptoms (OR = 2.071, P = 0.024), sleep status (OR = 2.540, P = 0.003), swallowing disorders (OR = 1.919, P = 0.048), and post-radiotherapy complications were independent risk factors for the development of negative emotions in patients. Negative emotions (OR = 2.547, P = 0.038) were also a risk factor for malnutrition in patients with esophageal cancer. Conclusion Many patients with esophageal cancer suffer from anxiety and depression in the peri-radiotherapy period, which might lead to complications such as malnutrition or aggravate and affect the prognosis of patients. Therefore, psychological care should be provided based on conventional care to effectively relieve their psychological pressure, and improve their prognosis and quality of life.
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Affiliation(s)
- Feng Luo
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Yingying Lu
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Chen Chen
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Dongdong Chang
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Wei Jiang
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Ronghua Yin
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
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Wang Y, Du X, Gong Y, Jiang Y, Zheng Y. Influencing factors of cancer-related fatigue in acute leukemia patients: A cross-sectional study. Heliyon 2023; 9:e22813. [PMID: 38144341 PMCID: PMC10746407 DOI: 10.1016/j.heliyon.2023.e22813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose To investigate influencing factors of cancer-related fatigue (CRF) in adult patients with acute leukemia (AL). Methods A total of 288 adult patients diagnosed with acute leukemia in West China Hospital were included in this study. A cross-sectional survey, including the Clinical Information Questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HAD), was provided to the patients. Hierarchical multiple linear regression analyses were conducted to evaluate the associations of the variable factors and the AL patients' CRF. Results The CRF score of AL patients was 33.25 ± 10.35. Gender, age, albumin level, depression, anxiety status of the patients and treatment cycles were identified as influencing factors of CRF in AL patients (P < 0.05). The CRF level of acute leukemia patients in the complete remission group was lower than that of patients who were not achieving complete remission. Depression, anxiety, age, employment, albumin, and sleep disturbance were independent influencing factors for CRF in patients who were not achieving complete remission. Conclusions Acute leukemia patients who are female, older, hypoalbuminemia,or in the induction therapy have a higher risk of developing a high degree of CRF. Clinical staff should pay more attention to the CRF of patients who were not achieving complete remission. Early screening and aggressive intervention could be adopted in caring for these patients.
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Affiliation(s)
- Yingli Wang
- Department of Hematology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China
| | - Xinwen Du
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Yuping Gong
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China
| | - Yuhuan Zheng
- Department of Hematology, West China Hospital, Sichuan University, China
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Li H, Ng MSN, Jin X, Wong CL. 'Life became slow down': A descriptive qualitative study of the experiences of cancer-related fatigue amongst people with advanced lung cancer. Palliat Med 2023; 37:1168-1182. [PMID: 37395316 DOI: 10.1177/02692163231184926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND Cancer-related fatigue is a complex multidimensional concept. However, little is known about the experience of cancer-related fatigue in people with advanced lung cancer. How they emotionally react to and cope with the experience of cancer-related fatigue according to cultural influences has not been extensively explored. AIM To explore the experience of cancer-related fatigue, its impacts and emotional reactions to and coping strategies for cancer-related fatigue amongst people with advanced lung cancer in China. DESIGN This was a cross-sectional, descriptive qualitative study with face-to-face semi-structured interviews. Data were analysed using content analysis. SETTING/PARTICIPANTS Twenty-one people with advanced lung cancer who experienced cancer-related fatigue were recruited in a hospital setting. RESULTS Four themes were identified: multifaceted experiences of cancer-related fatigue, impacts of cancer-related fatigue, negative perceptions of cancer-related fatigue and avoiding cancer-related fatigue. The multifaceted experience of cancer-related fatigue had physical, psychological and social impacts along the cancer trajectory. Informants regarded it as a sign of a 'bad ending', searched for root causes and had negative attitudes towards role changes. Avoiding coping strategies included not discussing cancer-related fatigue, refusing encouragement and support, hiding feelings, withdrawing from social life and attempting to control cancer-related fatigue. CONCLUSION The findings provide insights into the lack of flexibility of people with advanced lung cancer to adapt to the multidimensional experience of cancer-related fatigue. The reactions and coping towards cancer-related fatigue are profoundly influenced by Chinese culture. Developing psychological interventions based on the cultural background are highly recommended to cultivate the ability to cope flexibly with stressful events and live a meaningful cancer life.
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Affiliation(s)
- Huiyuan Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Marques Shek Nam Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaohuan Jin
- The School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Hoogland AI, Small BJ, Oswald LB, Bryant C, Rodriguez Y, Gonzalez BD, Li X, Janelsins MC, Bulls HW, James BW, Arboleda B, Colon-Echevarria C, Townsend MK, Tworoger SS, Rodriguez PC, Bower JE, Apte SM, Wenham RM, Jim HSL. Relationships among Inflammatory Biomarkers and Self-Reported Treatment-Related Symptoms in Patients Treated with Chemotherapy for Gynecologic Cancer: A Controlled Comparison. Cancers (Basel) 2023; 15:3407. [PMID: 37444517 PMCID: PMC10340589 DOI: 10.3390/cancers15133407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Previous research suggests that inflammation triggers cancer-treatment-related symptoms (i.e., fatigue, depression, and disruptions in sleep and physical activity), but evidence is mixed. This study examined relationships between inflammatory biomarkers and symptoms in patients with gynecologic cancer compared to age-matched women with no cancer history (i.e., controls). Patients (n = 121) completed assessments before chemotherapy cycles 1, 3, and 6, and 6 and 12 months later. Controls (n = 105) completed assessments at similar timepoints. Changes in inflammation and symptomatology were evaluated using random-effects mixed models, and cross-sectional differences between patients and controls in inflammatory biomarkers and symptoms were evaluated using least squares means. Associations among inflammatory biomarkers and symptoms were evaluated using random-effects fluctuation mixed models. The results indicated that compared to controls, patients typically have higher inflammatory biomarkers (i.e., TNF-alpha, TNFR1, TNFR2, CRP, IL-1ra) and worse fatigue, depression, and sleep (ps < 0.05). Patients reported lower levels of baseline physical activity (p = 0.02) that became more similar to controls over time. Significant associations were observed between CRP, depression, and physical activity (ps < 0.05), but not between inflammation and other symptoms. The results suggest that inflammation may not play a significant role in fatigue or sleep disturbance among gynecologic cancer patients but may contribute to depression and physical inactivity.
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Affiliation(s)
- Aasha I. Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa, FL 33612, USA
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Crystal Bryant
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Yvelise Rodriguez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Xiaoyin Li
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Michelle C. Janelsins
- Department of Surgery and Neuroscience, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Hailey W. Bulls
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Brian W. James
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Bianca Arboleda
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | | | - Mary K. Townsend
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Shelley S. Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Julienne E. Bower
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Sachin M. Apte
- Department of Obstetrics and Gynecology, Huntsman Cancer Institute, Salt Lake City, UT 84132, USA
| | - Robert M. Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
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Li S, Gao Y, Lin Y, Wu W, Fang Q, Ni X, Zhou Y, Hong M, Zhang R, Lou Y. Development and preliminary testing of the cancer-related fatigue comprehensive assessment scale in cancer survivors. J Clin Nurs 2023; 32:1186-1217. [PMID: 35285109 DOI: 10.1111/jocn.16272] [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: 09/07/2021] [Revised: 01/19/2022] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tailored management of cancer-related fatigue (CRF) is important for effective coping; however, it has been hindered by the lack of a comprehensive tool that assesses both symptoms and treatable influencing factors. AIMS AND OBJECTIVES The aim was to develop a cancer-related fatigue comprehensive assessment scale (CRF-CAS) and assess its psychometric properties. DESIGN This was a mixed-method study. METHODS The study included two phases which were conducted in Zhejiang Province, China. In phase one, a literature search, brainstorming sessions, Delphi studies, cognitive interviews and a pilot study were conducted to construct and revise CRF-CAS indicators. In phase two, a questionnaire-based survey was conducted among cancer survivors. Item analysis was used to select and optimize indicators. Cronbach's α was calculated for reliability analysis. Validity analysis included concurrent validity and structural validity. RESULTS A 93-item tool was initially constructed. Phase one ended with revision and optimization. The preliminary scale included five dimensions (CRF symptoms, physical activity, cognitive-emotional status, sleep status, nutritional status) and 30 items. The mean item-content validity index (I-CVI) and scale-level CVI universal agreement (S-CVI/UA) were .98, and the adjusted mean values of Kappa for indicators ranged from .91-1, as evaluated by the expert group. The Pearson correlation coefficient between the CRF-CAS and criterion scales ranged from .337-.862. Cronbach's α coefficient ranged from .624-.728. Respondents agreed that the scale was acceptable for administration and that it contributed to decision-making in fatigue management. Confirmatory factor analysis (CFA) indicated that the CRF-CAS fit well. CONCLUSIONS The construction process of the CRF-CAS, involving panel discussion and expert and participant evaluations, was shown to be scientific and feasible. The CRF-CAS had relatively good validity and reliability in version 5 of its preliminary scale, which requires further improvement in future studies.
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Affiliation(s)
- Shuaini Li
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China.,The Children's Hospital Zhejiang University School of Medicine (National Clinical Research Center for Child Health), Hangzhou, Zhejiang Province, China
| | - Yating Gao
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Ying Lin
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Wanying Wu
- Zhejiang Cancer Hospital (Cancer Hospital of the University of Chinese Academy of Sciences), Hangzhou, Zhejiang Province, China
| | - Qunying Fang
- Zhejiang Cancer Hospital (Cancer Hospital of the University of Chinese Academy of Sciences), Hangzhou, Zhejiang Province, China
| | - Xiaosha Ni
- Hangzhou Ninth People's Hospital, Hangzhou, Zheijiang province, China
| | - Yao Zhou
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Meirong Hong
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Ruolin Zhang
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Yan Lou
- Hangzhou Normal University, Hangzhou, Zhejiang Province, China
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Jordan DG, Slavish DC, Dietch J, Messman B, Ruggero C, Kelly K, Taylor DJ. Investigating sleep, stress, and mood dynamics via temporal network analysis. Sleep Med 2023; 103:1-11. [PMID: 36709723 PMCID: PMC10006381 DOI: 10.1016/j.sleep.2023.01.007] [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: 08/19/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVE/BACKGROUND Prior research has emphasized the bidirectional relationships between sleep, stress, and affective states, such as depression. Given the inherent variability and fluctuations associated with sleep, assessing how sleep and affective variables function within a dynamic system may help further uncover possible causes and consequences of sleep disturbances, as well as find candidate targets for intervention. To this end, we examined dynamic relationships between self-reported stress, depressed mood, and clinically-relevant sleep parameters via temporal network analysis. METHODS Participants were 401 nurses (92% female, 78% White, Mage = 39.47 years) who completed 14 days of sleep diaries incorporating self-reported stress and depression, as well as total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset. RESULTS AND CONCLUSIONS Overall, total sleep time emerged as a highly influential variable in the context of "outstrength centrality," meaning total sleep time had numerous outward connections with other variables (e.g., stress and sleep efficiency). The high outstrength centrality of total sleep time suggests this variable is a source of activation within this dynamic system. Conversely, stress showed high "instrength centrality," suggesting this variable was highly impacted by other variables in the system, such as depressed mood and sleep efficiency. These findings emphasize the importance of assessing unfolding sleep processes within a naturalistic setting, and implicate the role of total sleep time in fueling depressed mood and stress. Discussion emphasizes implications of these results for understanding the connections between sleep, stress, and depression as well as clinical relevance of these findings.
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Ju X, Bai J, She Y, Zheng R, Xu X, Wang W, Hong J. Symptom cluster trajectories and sentinel symptoms during the first cycle of chemotherapy in patients with lung cancer. Eur J Oncol Nurs 2023; 63:102282. [PMID: 36889243 DOI: 10.1016/j.ejon.2023.102282] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To investigate symptom severity, symptom cluster trajectories and sentinel symptoms during chemotherapy cycle 1 in patients with lung cancer. METHODS Patients with lung cancer were recruited to complete the MD Anderson Symptom Inventory (MDASI) and First Appearance of Symptoms Time Sheet daily during the first week of chemotherapy cycle 1. Latent class growth analysis was performed to examine symptom cluster trajectories. The Apriori algorithm combined with the time of the first appearance of symptoms after chemotherapy was used to determine the sentinel symptoms of each symptom cluster. RESULTS A total of 175 lung cancer patients participated in the study. Five symptom clusters were identified: class 1 (difficulty remembering-numbness-hemoptysis-weight loss), class 2 (cough-expectoration-chest tightness-shortness of breath), class 3 (nausea-sleep disturbance-drowsiness-constipation), class 4 (pain-distress-dry mouth-sadness-vomiting), class 5 (fatigue-lack of appetite). Sentinel symptoms were found to be cough (class 2) and fatigue (class 5), while none were found for other symptom clusters. CONCLUSION The trajectories of five symptom clusters were observed during the first week of chemotherapy cycle 1 and the sentinel symptoms of each cluster were explored. The study has important significance for the effective management of symptoms and the quality of nursing care for patients. At the same time, alleviating sentinel symptoms may reduce the severity of the whole symptom cluster, reducing medical resources and improving quality of life for lung cancer patients.
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Affiliation(s)
- Xiaodi Ju
- School of Nursing, Anhui Medical University, PR China.
| | - Jiayuan Bai
- School of Nursing, Anhui Medical University, PR China.
| | - Yiwei She
- School of Nursing, Anhui Medical University, PR China.
| | - Rong Zheng
- School of Nursing, Anhui Medical University, PR China.
| | - Xiuzhi Xu
- School of Nursing, Anhui Medical University, PR China.
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Jingfang Hong
- School of Nursing, Anhui Medical University, PR China.
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11
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An Investigation of Symptom Clusters and Sentinel Symptoms During the First 2 Cycles of Postoperative Chemotherapy in Patients With Lung Cancer. Cancer Nurs 2022; 45:488-496. [PMID: 35089876 DOI: 10.1097/ncc.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lung cancer has the highest incidence and mortality of all cancers in China. Patients after a lobectomy experience serious physical and psychological symptoms during chemotherapy. Studies are lacking about symptom clusters (SCs) and sentinel symptoms during the postoperative chemotherapy period in lung cancer patients. OBJECTIVE The aim of this study was to explore SCs and sentinel symptoms during cycles 1 and 2 of postoperative chemotherapy in patients with lung cancer. METHODS Using a longitudinal study design, patients in treatment for lung cancer were measured at 2 separate points following a lobectomy: chemotherapy cycle 1 and chemotherapy cycle 2. The MD Anderson Symptom Inventory lung cancer-specific module and First Appearance of Symptoms Time Sheet were completed. RESULTS A total of 180 postoperative patients with lung cancer participated in the study. Four SCs were identified at chemotherapy cycle 1: gastrointestinal SC, respiratory tract SC, psychological SC, and somatic SC. The sentinel symptoms were nausea, cough, sadness, and fatigue. At chemotherapy cycle 2, similar SCs were identified, with the exception of merging the psychological SC and somatic SC, resulting in 3 clusters: gastrointestinal SC, respiratory tract SC, and psychological-somatic SC. The sentinel symptoms were nausea, cough, and fatigue. CONCLUSIONS Symptom clusters and sentinel symptoms were stable during the first 2 cycles of postoperative chemotherapy in patients with lung cancer. IMPLICATIONS FOR PRACTICE The understanding of SCs and sentinel symptoms could be beneficial to assess and manage both in postoperative patients with lung cancer during chemotherapy. Nurses should pay close attention to sentinel symptoms and develop effective interventions.
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12
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Crowder SL, Hoogland AI, Small BJ, Carpenter KM, Fischer SM, Li D, Kinney AY, Welniak TL, Brownstein N, Reich RR, Hembree T, Extermann M, Kim R, Afiat TP, Berry DL, Turner K, Jim HSL. Associations among frailty and quality of life in older patients with cancer treated with chemotherapy. J Geriatr Oncol 2022; 13:1149-1155. [PMID: 36008271 PMCID: PMC9871794 DOI: 10.1016/j.jgo.2022.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Previous studies have suggested that frailty among older adults with cancer is associated with a variety of negative outcomes, including greater chemotherapy toxicity and worse survival. However, results often do not include patient-reported outcomes, such as quality of life (QOL). The objective of this study was to evaluate frailty prior to receipt of moderately- or highly-emetogenic chemotherapy and acute changes in QOL in patients at least 65 years of age. It was hypothesized that frail patients would report greater declines in QOL. MATERIALS AND METHODS Participants completed questionnaires before receiving their first infusion and again five days later. A 59-item deficit accumulation index score was created at baseline using a modified Rockwood frailty index. QOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The relationship between baseline frailty and QOL was evaluated using a dichotomized deficit accumulation index (frail vs. robust) in repeated measures ANOVA. RESULTS Study participants (n = 151) had a mean age of 72 (SD = 4.5) and 62% were female. Nearly half (42%) were frail at baseline. Frail participants reported worse QOL at baseline compared to robust participants. Frail patients reported smaller declines in overall and physical (p < 0.0001) and emotional (p = 0.006) QOL from baseline to five days after receiving chemotherapy. At five days, frail participants reported better emotional and physical QOL compared to robust participants. DISCUSSION Contrary to expectations, frail patients reported smaller declines in QOL compared to robust patients using a deficit accumulation index. These results can be used to help educate frail patients on what to expect during treatment.
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Affiliation(s)
- Sylvia L Crowder
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Aasha I Hoogland
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Brent J Small
- University of South Florida, School of Aging Studies, United States of America
| | - Kristen M Carpenter
- The Ohio State University, Department of Psychiatry, United States of America
| | - Stacy M Fischer
- University of Colorado Denver, Department of General Internal Medicine, United States of America
| | - Daneng Li
- City of Hope Comprehensive Cancer Center, Department of Medical Oncology and Therapeutics Research, United States of America
| | - Anita Y Kinney
- Rutgers University, Department of Biostatistics and Epidemiology, School of Public Health, United States of America
| | - Taylor L Welniak
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Naomi Brownstein
- Moffitt Cancer Center, Biostatistics and Bioinformatics Shared Resource, United States of America
| | - Richard R Reich
- Moffitt Cancer Center, Biostatistics and Bioinformatics Shared Resource, United States of America
| | - Tim Hembree
- Moffitt Cancer Center, Department of Internal and Hospital Medicine, United States of America
| | - Martine Extermann
- Moffitt Cancer Center, Department of Senior Adult Oncology, United States of America
| | - Richard Kim
- Moffitt Cancer Center, Department of Gastrointestinal Oncology, United States of America
| | - Thanh-Phuong Afiat
- Moffitt Cancer Center, Department of Internal and Hospital Medicine, United States of America
| | - Donna L Berry
- University of Washington, Biobehavioral Nursing and Health Informatics, United States of America
| | - Kea Turner
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Heather S L Jim
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America.
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13
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Oswald LB, Eisel SL, Tometich DB, Bryant C, Hoogland AI, Small BJ, Apte SM, Chon HS, Shahzad MM, Gonzalez BD, Jim HS. Cumulative burden of symptomatology in patients with gynecologic malignancies undergoing chemotherapy. Health Psychol 2022; 41:864-873. [PMID: 35901399 PMCID: PMC9588549 DOI: 10.1037/hea0001190] [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: 11/08/2022]
Abstract
OBJECTIVE Patients with gynecologic malignancies commonly experience distressing symptoms during chemotherapy. This study sought to evaluate whether symptoms accumulated over the course of several chemotherapy cycles, which could provide essential information for planning supportive interventions. METHOD Patients with gynecologic malignancies completed questionnaires about fatigue, depressive symptoms, sleep, and physical activity 1 week before and after chemotherapy cycles 1, 3, and 6. Multilevel models examined the effects of time (pre- and postchemotherapy), treatment cycle (1, 3, 6), and their interaction on symptoms. Logistic regression models examined the effects of time, treatment cycle, and their interaction on the proportion of participants exceeding thresholds for clinically meaningful symptomatology. RESULTS Most participants (N = 140; Mage = 60.8 years, SD = 10.4) had ovarian cancer (49%) and Stage III disease (55%). Participants reported worse fatigue, depressive symptoms, sleep disturbance, and sleep efficiency from pre- to posttreatment at each cycle (ps < .001). With each successive cycle, participants reported worse pretreatment fatigue (p < .001) and depressive symptoms (p < .01) but better sleep efficiency (p = .02). Fatigue increases attenuated across cycles (p = .04). There were no changes in physical activity. Across time points, at least half of participants met clinical thresholds for fatigue, sleep disturbance, and low sleep efficiency and were minimally physically active. Postchemotherapy cycle 6, 23% of participants reported clinically meaningful depressive symptoms. CONCLUSIONS Patients with gynecologic malignancies have high rates of clinically meaningful symptomatology during chemotherapy. Patients may experience a cumulative burden of symptomatology as treatment progresses, which could have therapeutic implications. Early implementation of supportive interventions should be considered to prevent or mitigate cumulative treatment burden. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Sarah L. Eisel
- Dept of Health Outcomes and Behavior, Moffitt Cancer Center
| | | | - Crystal Bryant
- Dept of Health Outcomes and Behavior, Moffitt Cancer Center
| | | | | | - Sachin M. Apte
- Dept of Obstetrics and Gynecology, University of Utah Health and Huntsman Cancer Institute
| | | | - Mian M. Shahzad
- Dept of Gynecologic Oncology, Moffitt Cancer Center
- Dept of Oncologic Sciences, University of South Florida
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14
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Kirvin-Quamme A, Rumble ME, Cadmus-Bertram L, Juckett MB, Rathouz PJ, Schell G, Callander NS, Hematti P, Costanzo ES. A biobehavioral intervention to enhance recovery following hematopoietic cell transplantation: Protocol for a feasibility and acceptability randomized control trial. Contemp Clin Trials Commun 2022; 28:100938. [PMID: 35664502 PMCID: PMC9160488 DOI: 10.1016/j.conctc.2022.100938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 04/14/2022] [Accepted: 05/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Insomnia, fatigue, and depression are among the most persistent and distressing concerns for hematologic cancer patients recovering from hematopoietic cell transplantation (HCT). This study will evaluate a novel behavioral intervention, Restoring Sleep and Energy after Transplant (ReSET), designed to alleviate insomnia, fatigue, and depression by improving rest-activity patterns. Evidence-based behavioral strategies to improve nighttime sleep and increase non-sedentary daytime activity will be combined to optimize 24-h rest-activity patterns. Methods The protocol herein evaluates the feasibility and acceptability of ReSET by conducting a pilot randomized controlled trial to compare the intervention with usual care. Adults undergoing HCT will be randomly assigned to ReSET or usual care. The ReSET arm will receive 3 face-to-face sessions and telephone coaching delivered in an individual format tailored to each patient. Patient-reported insomnia, fatigue, and depression will be the primary outcome measures. Actigraphy will be used to objectively quantify rest-activity patterns. Semi-structured interviews will evaluate participant satisfaction with ReSET. The goals are to determine: (1) participant satisfaction with and acceptability of the behavioral techniques; (2) facilitator fidelity and participant uptake of key intervention components; (3) ability to recruit, retain, and collect complete data from participants; (4) participant willingness to be randomized and acceptability of the control condition; and (5) validity and acceptability of the assessment strategy. Conclusion The overarching goal is to optimize recovery following HCT with a brief, non-invasive intervention that can be implemented as a part of routine clinical care. First intervention for cancer patients to optimize 24-h rest-activity rhythms. Non-invasive intervention designed for implementation in routine clinical care. Restoration of normal circadian rhythm targets insomnia, fatigue, and depression. Addresses the high need for efficacious, brief interventions for cancer patients. Innovative behavioral intervention approach applicable to a wide variety of cancers.
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Affiliation(s)
- Andrew Kirvin-Quamme
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Paul P. Carbone Cancer Center, Madison, WI, United States
| | - Meredith E. Rumble
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Center for Sleep Medicine & Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Lisa Cadmus-Bertram
- Paul P. Carbone Cancer Center, Madison, WI, United States
- Department of Kinesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Mark B. Juckett
- Division of Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Paul J. Rathouz
- Department of Population Heath, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Gwynneth Schell
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Natalie S. Callander
- Paul P. Carbone Cancer Center, Madison, WI, United States
- Division of Hematology and Oncology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Peiman Hematti
- Paul P. Carbone Cancer Center, Madison, WI, United States
- Division of Hematology and Oncology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Erin S. Costanzo
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Paul P. Carbone Cancer Center, Madison, WI, United States
- Corresponding author. Department of Psychiatry, University of Wisconsin- Madison, 6001 Research Park Blvd, Madison, WI, 53719, United States.
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15
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Health-related quality of life of breast and colorectal cancer patients undergoing active chemotherapy treatment: Patient-reported outcomes. Qual Life Res 2022; 31:2673-2680. [DOI: 10.1007/s11136-022-03145-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
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16
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Sleight AG, Crowder SL, Skarbinski J, Coen P, Parker NH, Hoogland AI, Gonzalez BD, Playdon MC, Cole S, Ose J, Murayama Y, Siegel EM, Figueiredo JC, Jim HSL. A New Approach to Understanding Cancer-Related Fatigue: Leveraging the 3P Model to Facilitate Risk Prediction and Clinical Care. Cancers (Basel) 2022; 14:cancers14081982. [PMID: 35454890 PMCID: PMC9027717 DOI: 10.3390/cancers14081982] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 01/02/2023] Open
Abstract
Simple Summary For the growing number of cancer survivors worldwide, fatigue presents a major hurdle to function and quality of life. Treatment options for cancer-related fatigue are still emerging, and our current understanding of its etiology is limited. In this paper, we describe a new application of a comprehensive model for cancer-related fatigue: the predisposing, precipitating, and perpetuating (3P) factors model. We propose that the 3P model may be leveraged—particularly using metabolomics, the microbiome, and inflammation in conjunction with behavioral science—to better understand the pathophysiology of cancer-related fatigue. Abstract A major gap impeding development of new treatments for cancer-related fatigue is an inadequate understanding of the complex biological, clinical, demographic, and lifestyle mechanisms underlying fatigue. In this paper, we describe a new application of a comprehensive model for cancer-related fatigue: the predisposing, precipitating, and perpetuating (3P) factors model. This model framework outlined herein, which incorporates the emerging field of metabolomics, may help to frame a more in-depth analysis of the etiology of cancer-related fatigue as well as a broader and more personalized set of approaches to the clinical treatment of fatigue in oncology care. Included within this review paper is an in-depth description of the proposed biological mechanisms of cancer-related fatigue, as well as a presentation of the 3P model’s application to this phenomenon. We conclude that a clinical focus on organization risk stratification and treatment around the 3P model may be warranted, and future research may benefit from expanding the 3P model to understand fatigue not only in oncology, but also across a variety of chronic conditions.
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Affiliation(s)
- Alix G. Sleight
- Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sylvia L. Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94501, USA;
- Department of Infectious Diseases, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA 94501, USA
- Physician Researcher Program, Kaiser Permanente Northern California, Oakland, CA 94501, USA
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA 94501, USA
| | - Paul Coen
- AdventHealth Orlando, Translational Research Institute, Orlando, FL 32804, USA;
| | - Nathan H. Parker
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Aasha I. Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
| | - Mary C. Playdon
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84044, USA;
- Department of Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84044, USA
| | - Steven Cole
- Department of Psychiatry & Biobehavioral Sciences and Medicine, University of California, Los Angeles, CA 90001, USA;
| | - Jennifer Ose
- Department of Population Sciences, University of Utah, Salt Lake City, UT 84044, USA;
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84044, USA
| | - Yuichi Murayama
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (Y.M.); (J.C.F.)
| | - Erin M. Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33601, USA;
| | - Jane C. Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (Y.M.); (J.C.F.)
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33601, USA; (S.L.C.); (N.H.P.); (A.I.H.); (B.D.G.)
- Correspondence:
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17
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Shim EJ, Jeong D, Jung D, Kim TY, Lee KH, Im SA, Hahm BJ. Do posttraumatic stress symptoms predict trajectories of sleep disturbance and fatigue in patients with breast cancer? A parallel-process latent growth model. Psychooncology 2022; 31:1286-1293. [PMID: 35301799 DOI: 10.1002/pon.5923] [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: 08/31/2021] [Revised: 02/28/2022] [Accepted: 03/13/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Using a parallel-process latent growth model (LGM), this study examined whether posttraumatic stress symptoms (PTSS) are associated with the trajectory of sleep disturbance (SD) and fatigue and whether the SD trajectory mediates the PTSS-fatigue relationship. METHODS Data were from 215 patients with breast cancer recruited from a tertiary hospital in South Korea. A self-report survey was administered at four time points during the course of adjuvant chemotherapy. RESULTS The mean age of the participants was 46.69 (SD = 9.08) and the majority was at stage I and the average months since diagnosis was 1.33 (SD=1.43). Unconditional parallel-process LGM indicated that SD and fatigue were positively associated with each other, both in terms of initial status and growth rate. Then, the conditional parallel-process LGM with baseline PTSS (i.e., avoidance, intrusion, and hyperarousal) as predictors were examined and anxiety, depressive symptoms and chronotype were entered as covariates in the model. Results indicated that a higher initial status and faster growth of SD were associated with a faster increase in fatigue. Greater baseline hyperarousal was directly related to a higher initial status and a slower increase in SD, and higher initial fatigue. Furthermore, a higher hyperarousal was associated with a greater initial SD, which was related to a faster increase in fatigue. Additionally, the late chronotype was related to a faster increase in fatigue through its impact on the initial SD. CONCLUSIONS The detrimental impact of hyperarousal on the SD trajectory and fatigue suggests the need to intervene in PTSS and SD early and throughout the course of cancer treatments to prevent fatigue. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Donghee Jeong
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Dooyoung Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea.,Healthcare Center, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
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18
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Nelson AM, Hyland KA, Small B, Kennedy B, Mishra A, Hoogland AI, Bulls HW, Jim HSL, Jacobsen PB. Contribution of Sleep Disruption and Sedentary Behavior to Fatigue in Survivors of Allogeneic Hematopoietic Cell Transplant. Ann Behav Med 2021; 55:870-878. [PMID: 33410478 DOI: 10.1093/abm/kaaa110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fatigue is a prominent quality of life concern among recipients of hematopoietic cell transplantation (HCT). PURPOSE The present study investigated whether objectively measured sleep efficiency and sedentary behavior are related to greater reports of fatigue. METHODS Eighty-two allogeneic HCT recipients who were 1-5 years post-transplant and returning for a follow-up visit participated (age M = 56, 52% female, 56% leukemia). They wore an actigraph assessing sleep efficiency and sedentary behavior for one week and completed an electronic log assessing fatigue each evening during the same period. RESULTS Twenty-six percent of patients reported clinically meaningful fatigue. On average, fatigue was mild (M = 2.5 on 0-10 scale, SD = 2.0), sleep was disturbed (sleep efficiency M = 78.9%, SD = 8.9), and patients spent the majority of time in sedentary (M = 55.4%, SD = 10.2) or light (M = 35.9%, SD = 8.6) activity. Multilevel model analysis of between-person differences indicated that patients who experienced less efficient sleep the previous evening provided greater evening reports of average fatigue, b = -0.06, 95% CI (-0.11, -0.01). Similarly, within-person analyses indicated that when patients experienced less efficient sleep the previous evening or were more sedentary as compared to their average, they provided greater evening reports of average fatigue, b = -0.02, 95% CI (-0.05, -0.004); b = 4.46, 95% CI (1.95, 6.97), respectively. CONCLUSIONS Findings demonstrate that poor sleep and daily sedentary behavior are related to evening reports of fatigue and should be considered modifiable targets for intervention.
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Affiliation(s)
- Ashley M Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, MA, USA
| | - Kelly A Hyland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Brent Small
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Brittany Kennedy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Asmita Mishra
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Hailey W Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
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Radin A, Ganz PA, Van Dyk K, Stanton AL, Bower JE. Executive Functioning and Depressive Symptoms After Cancer: The Mediating Role of Coping. Psychosom Med 2021; 83:291-299. [PMID: 33657085 PMCID: PMC8691137 DOI: 10.1097/psy.0000000000000926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cognitive difficulties are a common complaint among patients with breast cancer and may adversely affect psychological well-being. In particular, problems with executive functioning (EF) may interfere with coping, which is known to influence depressive symptoms. The current study was designed to examine correlations between EF, coping, and depressive symptoms in breast cancer survivors and to longitudinally test the hypothesis that coping mediates the relationship between EF and depressive symptoms. METHODS Participants included 171 women with early-stage breast cancer assessed at the end of primary treatment with surgery, radiation, and/or chemotherapy and at 6 months, 1 year, and 2 years after treatment follow-ups as part of the Mind-Body Study. Participants completed questionnaires to assess subjective EF, approach and avoidant coping, and depressive symptoms, and neuropsychological testing was conducted to assess objective EF. Bivariate correlations were used to examine associations between EF, coping, and depressive symptoms. Mediation analyses were conducted using a bootstrapping approach (PROCESS). RESULTS At 1 year after treatment, objective and subjective EFs were correlated with avoidant coping (r = -0.172 [p = .024] and r = 0.297 [p < .001], respectively). In longitudinal analyses, use of the avoidant strategy behavioral disengagement at 1 year mediated the association between objective (95% bootstrap confidence interval = -0.282 to -0.042) and subjective (95% bootstrap confidence interval = 0.020 to 0.254) EFs at 6 months and depressive symptoms at 2 years. CONCLUSIONS This study highlights how problems with EF during survivorship are associated with avoidant coping and depressive symptoms. Thus, these findings identify potential cognitive and affective targets for depression intervention in this population.
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Affiliation(s)
- Arielle Radin
- From the Department of Psychology (Radin, Stanton, Bower), Schools of Medicine and Public Health (Ganz), Jonsson Comprehensive Cancer Center (Ganz, Van Dyk, Stanton, Bower), Department of Psychiatry and Biobehavioral Sciences (Van Dyk, Stanton, Bower), and Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior (Stanton, Bower), University of California, Los Angeles, Los Angeles, California
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Latifah SY, Gopalsamy B, Abdul Rahim R, Manaf Ali A, Haji Lajis N. Anticancer Potential of Damnacanthal and Nordamnacanthal from Morinda elliptica Roots on T-lymphoblastic Leukemia Cells. Molecules 2021; 26:molecules26061554. [PMID: 33808969 PMCID: PMC7998966 DOI: 10.3390/molecules26061554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/24/2022] Open
Abstract
Background: This study reports on the cytotoxic properties of nordamnacanthal and damnacanthal, isolated from roots of Morinda elliptica on T-lymphoblastic leukaemia (CEM-SS) cell lines. Methods: MTT assay, DNA fragmentation, ELISA and cell cycle analysis were carried out. Results: Nordamnacanthal and damnacanthal at IC50 values of 1.7 μg/mL and10 μg/mL, respectively. At the molecular level, these compounds caused internucleosomal DNA cleavage producing multiple 180–200 bp fragments that are visible as a “ladder” on the agarose gel. This was due to the activation of the Mg2+/Ca2+-dependent endonuclease. The induction of apoptosis by nordamnacanthal was different from the one induced by damnacanthal, in a way that it occurs independently of ongoing transcription process. Nevertheless, in both cases, the process of dephosphorylation of protein phosphates 1 and 2A, the ongoing protein synthesis and the elevations of the cytosolic Ca2+ concentration were not needed for apoptosis to take place. Nordamnacanthal was found to have a cytotoxic effect by inducing apoptosis, while damnacanthal caused arrest at the G0/G1 phase of the cell cycle. Conclusion: Damnacanthal and nordamnacanthal have anticancer properties, and could act as potential treatment for T-lymphoblastic leukemia.
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Affiliation(s)
- Saiful Yazan Latifah
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400 UPM, Selangor, Malaysia;
- Correspondence: ; Tel.: +603-89472308
| | - Banulata Gopalsamy
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400 UPM, Selangor, Malaysia;
| | - Raha Abdul Rahim
- Department of Cell and Molecular Biology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400 UPM, Selangor, Malaysia;
| | - Abdul Manaf Ali
- Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin (UniSZA), Kuala 20300, Terengganu, Malaysia;
| | - Nordin Haji Lajis
- Laboratory of Natural Products, Institute of Bioscience, Universiti Putra Malaysia, Serdang 43400 UPM, Selangor, Malaysia;
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21
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Low SLK, Cheema BS, Tan HY, Birling Y, Zhu X. The Feasibility and Effects of Qigong Intervention (Mind-Body Exercise) in Cancer Patients With Insomnia: A Pilot Qualitative Study. Integr Cancer Ther 2020. [PMCID: PMC7716076 DOI: 10.1177/1534735420977671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Up to 80% of cancer patients experience insomnia that significantly affects their quality of life. This pilot qualitative study investigated the feasibility and effects of a 3-week Qigong (mind-body exercise) intervention with a 1-week follow-up in cancer patients experiencing insomnia. Methods: Cancer patients with insomnia who had completed radiotherapy or chemotherapy treatment and/or were at least 8 weeks post-cancer-related surgery were recruited. Primary outcomes were feasibility outcomes, which included recruitment, retention, attendance, completion of assessment, adverse events and participant feedback via a questionnaire and focus group/individual interview. Secondary outcomes on insomnia severity and sleep quality were measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) at baseline, mid, post-intervention and follow-up. Results: Seven participants were recruited and two withdrew from the study. The participant retention rate was 71.4% with an overall attendance rate of more than 84% and participants were able to complete all required assessments. An adverse event relating to the worsening of existing musculoskeletal condition was reported. Qualitative analysis of participant feedback identified 4 emerging themes: (1) experience from Qigong intervention; (2) class preferences; (3) barriers to participation; and (4) recommendation for improvement. Participants reported increased relaxation, improved sleep and energy level, better upper body flexibility and reduced stress. Both ISI and PSQI scores improved significantly (P < .05). Conclusion: This study demonstrated that it is feasible to employ the current clinical trial design using Qigong intervention on insomnia in cancer patients. Preliminary data suggest that the intervention may improve sleep outcomes, however, these findings need to be confirmed by future robust randomized controlled trials. Trial registration: The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001670268) http://www.ANZCTR.org.au/ACTRN12618001670268.aspxon10October2018.
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Affiliation(s)
- Sara L. K. Low
- School of Health Science, Western Sydney University, NSW, Australia
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
| | - Birinder S. Cheema
- School of Health Science, Western Sydney University, NSW, Australia
- NICM Health Research Institute, Western Sydney University, NSW, Australia
| | - Hsiewe Ying Tan
- School of Health Science, Western Sydney University, NSW, Australia
| | - Yoann Birling
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
- NICM Health Research Institute, Western Sydney University, NSW, Australia
| | - Xiaoshu Zhu
- School of Health Science, Western Sydney University, NSW, Australia
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
- NICM Health Research Institute, Western Sydney University, NSW, Australia
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Souza RCDS, dos Santos MR, das Chagas Valota IA, Sousa CS, Costa Calache ALS. Factors associated with sleep quality during chemotherapy: An integrative review. Nurs Open 2020; 7:1274-1284. [PMID: 32802348 PMCID: PMC7424431 DOI: 10.1002/nop2.516] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
Aim To identify the most important factors associated with sleep pattern changes in patients with cancer during chemotherapy treatment. Design An integrative review of the literature was performed between December 2017-August 2018. Methods Two independent reviewers searching the National Library of Medicine (PubMed/MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Latin American and Caribbean Literature in Health Sciences (LILACS), Scopus and Scielo. The process followed the recommendations of the PRISMA tool. A total of 16 articles were selected for the final study sample, including 11 cohort studies and 5 cross-sectional studies. Results The predisposing factors for the most prevalent sleep disturbances were precipitants related to the disease and the treatment, such as fatigue, pain, depression, anxiety and distress. Predisposing factors related to lifestyle and demographic characteristics have a significant correlation with sleep disturbances.
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Affiliation(s)
| | | | | | - Cristina Silva Sousa
- University of São Paulo School of NursingSao PauloBrazil
- Sirio Libanes HospitalSao PauloBrazil
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23
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Effectiveness of physical exercise toward decreased fatigue in cervical cancer. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Leysen L, Lahousse A, Nijs J, Adriaenssens N, Mairesse O, Ivakhnov S, Bilterys T, Van Looveren E, Pas R, Beckwée D. Prevalence and risk factors of sleep disturbances in breast cancersurvivors: systematic review and meta-analyses. Support Care Cancer 2019; 27:4401-4433. [DOI: 10.1007/s00520-019-04936-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 06/11/2019] [Indexed: 01/31/2023]
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Fielding R. Developing a preventive psycho-oncology for a global context. The International Psycho-Oncology Society 2018 Sutherland Award Lecture. Psychooncology 2019; 28:1595-1600. [PMID: 31222864 DOI: 10.1002/pon.5139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Growing rates of cancer and survivorship, in situations of severe resource constraints, force a rethink about managing cancer-related psychosocial distress (CRPD). Here, a prevention-oriented natural history of distress is proposed, derived from developments in our understanding of the evolution and decay of CRPD. METHODS The literature indicates that at least four classes or natural histories of CRPD are identifiable. These are described in the context of prevention-oriented activities in psycho-oncology: (1) CRPD in persons with good coping resources, resulting from reaction to the diagnosis and treatment lifestyle disruption, which is largely self-limiting and preferably self-managed; (2) CRPD arising from residual, or late effects of disease or treatment, potentially persistent and debilitating; (3) CRPD in persons with preexisting coping difficulties; and (4) CRPD arising from existential issues such as mortality and fear of recurrence. RESULTS It is hypothesized that different natural histories of CRPD display different evolution, indicating potential causal processes, treatment priorities, and preventive strategies. In particular, the effective management of residual symptoms is crucial to prevent CRPD chronicity. Optimal patient involvement in treatment decision-making is also required. CONCLUSIONS There is a need to develop methods to differentiate if, early in the illness trajectory, the distressed patient is not able to self-manage the stress of cancer diagnosis and treatment. Not all distressed patients want or need help, and addressing just the CRPD may be inadequate where unresolved residual symptoms prevent renormalization after treatment. Improved doctor-patient communication around treatment decisions is warranted.
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Affiliation(s)
- Richard Fielding
- Centre for Psycho-Oncology Research & Training and Hong Kong Jockey Club Integrated Cancer Centre, The University of Hong Kong, Pokfulam, Hong Kong
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26
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De Feudis RL, Graziano G, Lanciano T, Garofoli M, Lisi A, Marzano N. An art therapy group intervention for cancer patients to counter distress before chemotherapy. Arts Health 2019; 13:35-48. [PMID: 31044654 DOI: 10.1080/17533015.2019.1608566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: The aim of this study was to investigate the feasibility and effectiveness of a single group session based on art therapy (AT) for adult cancer patients to reduce anxiety and distress before anticancer treatment. Methods: A non-randomized pre-post study design was adopted. Sixty-two patients took part in one of twenty-seven "one-off" sessions held over a four-month period. Sixty-six patients, who simply received routine medical treatment, served as the control group (CG). Results: The intervention was appropriate to patients' needs and feasible in the context of their routine medical care. In contrast to the CG, the intervention group(IG) participants demonstrated a decrease in symptoms of anxiety, drowsiness and tiredness. Conclusions: The intervention proved suitable to the medical routine of patients' care. The clinical implications of the AT protocol and future research aimed at testing it vs. a different type of psychosocial intervention in a randomized controlled study are discussed.
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Affiliation(s)
- Rossana L De Feudis
- Departmental Unit of Medical Oncology, 'San Paolo' Hospital, ASL BA , Bari, Italy
| | - Giusi Graziano
- Scientific Direction, 'Giovanni Paolo II' Cancer Institute IRCSS , Bari, Italy
| | - Tiziana Lanciano
- Department of Education, Psychology, Communication, 'Aldo Moro' University of Bari , Bari, Italy
| | - Manuela Garofoli
- Departmental Unit of Medical Oncology, 'San Paolo' Hospital, ASL BA , Bari, Italy
| | - Andrea Lisi
- Psychological Services, 'Giovanni Paolo II' Cancer Institute IRCSS , Bari, Italy
| | - Nicola Marzano
- Departmental Unit of Medical Oncology, 'San Paolo' Hospital, ASL BA , Bari, Italy
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27
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Shyu IL, Hu LY, Chen YJ, Wang PH, Huang BS. Risk factors for developing depression in women with cervical cancer: a nationwide population-based study in Taiwan. Int J Womens Health 2019; 11:135-141. [PMID: 30804687 PMCID: PMC6371941 DOI: 10.2147/ijwh.s193003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction Depression might affect women with cervical cancer and can deteriorate their quality of life or even their compliance with cancer treatments. The aim of this study was to investigate the incidence of depression and risk factors for developing depression among women with cervical cancer in Taiwan. Patients and methods This study enrolled patients with newly diagnosed cervical cancer from the National Health Insurance Research Database in Taiwan. From a population of 21,400,826 residents, each cervical cancer patient was matched with one subject without cervical cancer according to sex, age, and comorbidities with the same diagnostic index. The International Classification of Diseases, Ninth Revision, code 180.9 was used to identify patients with cervical cancer, and 296.0X–296.1X, 296.4X–296.8X, 296.2X–296.3X, 300.4, and 311.X codes were used to identify those with depressive disorders. Results In total, 19,316 newly diagnosed cervical cancer patients were enrolled from January 2000 to December 2005, and the median follow-up period was 5.23 years (1.75–8.48 years). The prevalence of depressive disorder was 4.21% (813 of 19,316) in the cervical cancer cohort, and it was 3.85% (744 of 19,316) in the control cohort. The incidence risk ratio of depressive disorders was 1.35 (95% CI =1.22–1.49, P<0.001) among these cervical cancer patients. Cervical cancer, as an independent risk factor, was associated with developing subsequent depressive disorder. In addition, being older (≥65 years old) and the comorbidities of diabetes mellitus, ischemic heart disease, and cerebrovascular disease were also risk factors for predicting depressive disorder in cervical cancer patients. Discussion Cervical cancer is a prominent risk factor for the development of depression in women with cervical cancer in Taiwan. The patients with comorbidities, including diabetes mellitus, ischemic heart disease, and cerebrovascular disease, have higher risks of developing depression. However, there were no significant differences among the cervical cancer treatment modalities. In conclusion, these patients require early psychological support and intervention.
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Affiliation(s)
- Ing-Luen Shyu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, .,Department of Obstetrics and Gynecology, Chi-Mei Hospital, Tainan City, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, .,Department of Obstetrics and Gynecology, School of Medicine, Taipei, Taiwan, .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan,
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, .,Department of Obstetrics and Gynecology, School of Medicine, Taipei, Taiwan, .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan,
| | - Ben-Shian Huang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, .,Department of Obstetrics and Gynecology, School of Medicine, Taipei, Taiwan, .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan,
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28
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Aldaz BE, Hegarty RSM, Conner TS, Perez D, Treharne GJ. Is avoidance of illness uncertainty associated with distress during oncology treatment? A daily diary study. Psychol Health 2019; 34:422-437. [DOI: 10.1080/08870446.2018.1532511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Bruno E. Aldaz
- Department of Psychology, University of Otago, Dunedin, Aotearoa/New Zealand
| | | | - Tamlin S. Conner
- Department of Psychology, University of Otago, Dunedin, Aotearoa/New Zealand
| | - David Perez
- Oncology and Haematology Services, Dunedin Hospital, Dunedin, Aotearoa/New Zealand
| | - Gareth J. Treharne
- Department of Psychology, University of Otago, Dunedin, Aotearoa/New Zealand
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29
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Bower JE. The role of neuro-immune interactions in cancer-related fatigue: Biobehavioral risk factors and mechanisms. Cancer 2019; 125:353-364. [PMID: 30602059 DOI: 10.1002/cncr.31790] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022]
Abstract
Fatigue is a common and distressing symptom in both patients with cancer and cancer survivors. There is substantial variation in the severity and persistence of cancer-related fatigue that may be driven by individual differences in host factors, including characteristics that predate the cancer experience as well as responses to cancer and its treatment. This review examines biobehavioral risk factors linked to fatigue and the mechanisms through which they influence fatigue across the cancer continuum, with a focus on neuro-immune processes. Among psychosocial risk factors, childhood adversity is a strong and consistent predictor of cancer-related fatigue; other risk factors include history of depression, catastrophizing, lack of physical activity, and sleep disturbance, with compelling preliminary evidence for loneliness and trait anxiety. Among biologic systems, initial work suggests that alterations in immune, neuroendocrine, and neural processes are associated with fatigue. The identification of key risk factors and underlying mechanisms is critical for the development and deployment of targeted interventions to reduce the burden of fatigue in the growing population of cancer survivors. Given the multidimensional nature of fatigue, interventions that influence multiple systems may be most effective.
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Affiliation(s)
- Julienne E Bower
- Department of Psychology, Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
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30
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Zhang N, Fielding R, Soong I, Chan KK, Lee C, Ng A, Sze WK, Tsang J, Lee V, Lam WWT. Illness perceptions as predictors of psychological distress among head and neck cancer survivors: a longitudinal study. Head Neck 2018; 40:2362-2371. [PMID: 30307664 DOI: 10.1002/hed.25343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 01/21/2018] [Accepted: 05/07/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Leventhal's commonsense model implies illness perceptions influence illness outcomes. This study examined illness perceptions among head and neck cancer survivors, and whether these predicted subsequent psychological distress. METHODS A total of 124 survivors of head and neck cancer (87% nasopharyngeal carcinoma; NPC) completed measures of psychological distress (Hospital Anxiety and Depression Scale; HADS), illness perceptions (Brief Illness Perception Questionnaire; B-IPQ), dispositional optimism (revised Chinese version of the Life Orientation Test; C-LOT-R), and clinical and demographic data approximately12.9 months after diagnosis (T1). Six months later (T2) psychological distress (HADS) was again measured. Adjusted multivariate analyses tested whether illness perceptions predicted T2 HADS scores. RESULTS Illness perception dimensions were significantly intercorrelated (0.01-0.68), explaining 8.0% of anxiety and 4.8% of depression symptom variability at T2. After adjustment for T1 distress, illness identity (β = 0.270, P < .01) and sex identification as a woman (β = 0.275, P < .01) predicted T2 anxiety symptoms while illness identity (β = 0.195, P < .05), unemployment (β = 0.195, P < .05), and pessimism (β = -0.227, P < .01) predicted T2 depression symptoms. CONCLUSION Perceived illness identity predicted psychological distress, accounting for modest levels of distress variance. Unresolved symptoms may exacerbate distress.
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Affiliation(s)
- Na Zhang
- Centre for Psycho-Oncology Research & Training, School of Public Health, University of Hong Kong, Patrick Manson Building, 7, Sassoon Rd., Pokfulam, HongKong
| | - Richard Fielding
- Centre for Psycho-Oncology Research & Training, School of Public Health, University of Hong Kong, Patrick Manson Building, 7, Sassoon Rd., Pokfulam, HongKong
| | - Inda Soong
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Karen Kk Chan
- Department of Obstetrics & Gynaecology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Conrad Lee
- Department of Clinical Oncology, Princess Margaret Hospital, Kowloon, Hong Kong
| | - Alice Ng
- Department of Clinical Oncology, TuenMun Hospital, Tuen Mun, HongKong
| | - Wing Kin Sze
- Department of Clinical Oncology, TuenMun Hospital, Tuen Mun, HongKong
| | - Janice Tsang
- Department of Clinical Oncology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Victor Lee
- Department of Clinical Oncology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Wendy Wing Tak Lam
- Centre for Psycho-Oncology Research & Training, School of Public Health, University of Hong Kong, Patrick Manson Building, 7, Sassoon Rd., Pokfulam, HongKong
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31
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Vin-Raviv N, Akinyemiju TF, Galea S, Bovbjerg DH. Sleep disorder diagnoses and clinical outcomes among hospitalized breast cancer patients: a nationwide inpatient sample study. Support Care Cancer 2018; 26:1833-1840. [PMID: 29264658 DOI: 10.1007/s00520-017-4012-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/05/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Sleep disturbances are recognized as a problem for many cancer patients, but little is known about the prevalence of sleep disorders among women hospitalized with breast cancer, or their relationship to in-hospital outcomes. The present study represents a first step toward determining the clinical significance of sleep disorders for hospitalized breast cancer patients with regard to complications, length of hospital stay, and mortality. METHODS The relationships between sleep disorders and in-hospital outcomes among 84,424 hospitalized breast cancer patients were examined. This study analyzed the Nationwide Inpatient Sample (NIS) database (2007 to 2011) for all women ages 40 years and older with a primary discharge diagnosis of breast cancer and a secondary discharge diagnosis of sleep disorder. Odds ratios, estimates, and 95% confidence intervals were computed using multivariable regression adjusting for age, comorbidities, race, cancer stage, income, insurance type, residential region, year of discharge, and surgical treatment type. RESULTS Among women hospitalized with a primary diagnosis of breast cancer, 2% (n = 1807) also received a diagnosis of a sleep disorder during hospitalization, the majority of which were sleep-related breathing disorders (n = 1274). Although there was no significant association between having a diagnosis of a sleep disorder and in-hospital mortality, patients with a sleep disorder were more likely to also experience complications (OR = 1.58, 95% CI 1.29-1.34) and have longer hospital stays (mean = 0.44 days longer, 95% CI 0.25-0.63). CONCLUSION Hospitalized breast cancer patients with a sleep disorder were more likely to experience clinical complications and stay longer in the hospital. It remains an open and important question for future research whether interventions to improve sleep during hospitalization would help to improve clinical outcomes.
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Affiliation(s)
- Neomi Vin-Raviv
- School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA.
- University of Northern Colorado Cancer Rehabilitation Institute, School of Sport and Exercise Science, University of Northern Colorado, Greeley, CO, USA.
| | - T F Akinyemiju
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, AL, USA
| | - S Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - D H Bovbjerg
- University of Pittsburgh, and the UPMC-Hillman Cancer Center, Division Departments of Psychiatry, Psychology, Behavioral & Community Health Sciences, and Health & Community Systems, Pittsburgh, PA, USA
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32
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Schmidt ME, Wiskemann J, Steindorf K. Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis. Qual Life Res 2018; 27:2077-2086. [PMID: 29740782 DOI: 10.1007/s11136-018-1866-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE After cancer treatment, it is desirable to maintain or regain a high quality of life (QoL) and the ability to accomplish everyday tasks well. Therefore, we substantiated the scarce knowledge regarding long-term QoL after breast cancer, burdensome problems, and unmet needs for more support. METHODS Disease-free breast cancer survivors (n = 190) who had participated in two randomized controlled exercise trials during primary treatment were followed up to 5 years post-diagnosis. QoL-related functions and symptoms (EORTC QLQ-C30/-BR23), health problems, and support needs were assessed. EORTC-QLQ scores were compared with age-matched normative values from the general population in Germany. RESULTS QoL-related functions and symptoms in patients during cancer treatment were worse compared to healthy references, but largely improved over time. Yet, cognitive function and sleep were still significantly impaired at 5-year follow-up. Other common long-term problems included sexual issues (45% of survivors), hot flashes (38%), pain (34%), fatigue (24%), and polyneuropathy (21%). Regression analyses indicated fatigue having the strongest impact on global QoL. Support needs were expressed mainly for menopausal disorders (43%), physical performance (39%), sleep problems (38%), arthralgia (37%), cognitive problems (36%), weight problems (32%), and fatigue (31%). CONCLUSIONS While QoL in disease-free breast cancer survivors 5 years post-diagnosis was largely comparable to the general population on average, still many survivors suffered from adverse effects. There appears to be a need for ongoing screening and support regarding fatigue, sleep problems, cognitive problems, arthralgia/pain, menopausal/sexual symptoms, physical performance, and weight problems during and several years following breast cancer therapy.
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Affiliation(s)
- Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) and University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
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33
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Schmidt ME, Wiskemann J, Schneeweiss A, Potthoff K, Ulrich CM, Steindorf K. Determinants of physical, affective, and cognitive fatigue during breast cancer therapy and 12 months follow-up. Int J Cancer 2017; 142:1148-1157. [PMID: 29082588 DOI: 10.1002/ijc.31138] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 01/22/2023]
Abstract
Fatigue is common in cancer survivors but often insufficiently treated. Due to its complexity a one-size-fits-all treatment seems not appropriate. To gain more information on influencing factors and sub-dimensions of fatigue we investigated potential determinants and correlates of physical, affective, and cognitive fatigue in breast cancer survivors during and after adjuvant therapy. Within the follow-up of two randomized controlled trials physical, affective, and cognitive fatigue were repeatedly assessed during and up to 12 months after cancer therapy with the 20-item Fatigue Assessment Questionnaire in 255 breast cancer survivors. Determinants of the different fatigue dimensions over time were explored with linear mixed models. Chemotherapy appeared as significant precipitating factor for physical fatigue. However, type of cancer therapy had no impact on fatigue one year post-treatment. Obesity was significantly associated with increased physical fatigue throughout all time points (Δ=15.5 at 12 months) whereas exercise appeared to be beneficial (Δ = -6.3). In contrast, affective fatigue was significantly associated with poor social support and worries about the future. In addition, poor sleep quality and previous use of psychopharmaceuticals were significantly associated with physical, affective, as well as cognitive fatigue. Further, hot flashes were associated with increased physical and cognitive fatigue. In conclusion, the broad diagnosis 'fatigue' in cancer survivors needs to be recognized as a diversity of symptoms determined by specific characteristics and likely different etiologies. Taking potential influencing factors such as obesity, physical inactivity, sleep problems, hot flashes, lack of social support, or psychological disorders into consideration might enable a better, individually-tailored fatigue treatment.
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Affiliation(s)
- Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ); Im Neuenheimer Feld 581, Heidelberg, 69120, Germany
| | - Joachim Wiskemann
- Division of Medical Oncology, NCT, University Hospital Heidelberg, Germany
| | - Andreas Schneeweiss
- Division of Gynecologic Oncology, NCT, University Hospital Heidelberg, Germany
| | - Karin Potthoff
- Division of Medical Oncology, NCT, University Hospital Heidelberg, Germany.,Division of Radiation Oncology, NCT, University Hospital Heidelberg, Germany
| | - Cornelia M Ulrich
- Department of Population Health Sciences, Huntsman Cancer Institute and University of Utah, Salt Lake City, UT
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ); Im Neuenheimer Feld 581, Heidelberg, 69120, Germany
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Xiao C, Miller AH, Felger J, Mister D, Liu T, Torres MA. Depressive symptoms and inflammation are independent risk factors of fatigue in breast cancer survivors. Psychol Med 2017; 47:1733-1743. [PMID: 28193310 DOI: 10.1017/s0033291717000150] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Psychosocial and inflammatory factors have been associated with fatigue in breast cancer survivors. Nevertheless, the relative contribution and/or interaction of these factors with cancer-related fatigue have not been well documented. METHOD This cross-sectional study enrolled 111 stage 0-III breast cancer patients treated with breast surgery followed by whole breast radiotherapy. Fatigue was measured by the total score of the Multidimensional Fatigue Inventory-20. Potential risk factors included inflammatory markers (plasma cytokines and their receptors and C-reactive protein; CRP), depressive symptoms (as assessed by the Inventory of Depressive Symptomatology-Self Reported), sleep (as assessed by the Pittsburgh Sleep Quality Index) and perceived stress (as assessed by the Perceived Stress Scale) as well as age, race, marital status, smoking history, menopause status, endocrine treatment, chemotherapy and cancer stage. Linear regression modeling was employed to examine risk factors of fatigue. Only risk factors with a significance level <0.10 were included in the initial regression model. A post-hoc mediation model using PROCESS SPSS was conducted to examine the association among depressive symptoms, sleep problems, stress, inflammation and fatigue. RESULTS At 1 year post-radiotherapy, depressive symptoms (p<0.0001) and inflammatory markers (CRP: p = 0.015; interleukin-1 receptor antagonist: p = 0.014; soluble tumor necrosis factor receptor-2: p = 0.009 in separate models) were independent risk factors of fatigue. Mediation analysis showed that depressive symptoms also mediated the associations of fatigue with sleep and stress. CONCLUSIONS Depressive symptoms and inflammation were independent risk factors for cancer-related fatigue at 1 year post-radiotherapy, and thus represent independent treatment targets for this debilitating symptom.
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Affiliation(s)
- C Xiao
- Emory University School of Nursing,Atlanta, GA,USA
| | - A H Miller
- Emory University Department of Psychiatry and Behavioral Sciences,Atlanta, GA,USA
| | - J Felger
- Emory University Department of Psychiatry and Behavioral Sciences,Atlanta, GA,USA
| | - D Mister
- Department of Radiation Oncology,Emory University, Winship Cancer Institute,Atlanta, GA,USA
| | - T Liu
- Department of Radiation Oncology,Emory University, Winship Cancer Institute,Atlanta, GA,USA
| | - M A Torres
- Department of Radiation Oncology,Emory University, Winship Cancer Institute,Atlanta, GA,USA
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Abstract
ABSTRACTObjective:Sleep can affect quality of life (QoL) during cancer survivorship, and symptoms related to poor sleep can be exacerbated. We examined the prevalence, severity, and nature of subjective sleep complaints in women surviving stage I-III breast cancer who were 1-10 years posttreatment. We also examined the demographic, medical, physical, and psychosocial correlates of poor sleep in these women in order to identify the subgroups that may be most in need of intervention. METHOD A total of 200 patients at a comprehensive cancer center who were 1-10 years posttreatment for primary stage I-III breast cancer with no evidence of disease at the time of enrollment completed a battery of questionnaires on demographics, sleep, physical symptoms, mood, cancer-specific fears, and QoL. RESULTS The women had a mean age of 57 years (SD = 10.0), with a mean of 63.3 months (SD = 28.8) of post-cancer treatment. Some 38% of these patients were identified as having poor-quality sleep. Women with poor sleep took longer to fall asleep, had more awakenings, and acquired 2 hours less sleep per night than those with good sleep. They also had a lower QoL, greater severity of pain, more concerns about health and recurrence, and increased vasomotor symptoms (p < 0.05). Daytime sleepiness and depression were found to be not significantly correlated with sleep quality. SIGNIFICANCE OF RESULTS Many breast cancer survivors had severe subjective insomnia, and several breast cancer survivor subgroups were identified as having members who might be most in need of sleep-improvement interventions. Addressing physical symptoms (e.g., vasomotor symptoms and pain) and providing education about the behavioral, social, environmental, and medical factors that affect sleep could result in substantial improvement in the life course of breast cancer survivors.
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Zhou ES, Partridge AH, Syrjala KL, Michaud AL, Recklitis CJ. Evaluation and treatment of insomnia in adult cancer survivorship programs. J Cancer Surviv 2017; 11:74-79. [PMID: 27495283 PMCID: PMC5865603 DOI: 10.1007/s11764-016-0564-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Insomnia is commonly experienced by cancer survivors. Chronic insomnia is associated with significant physical and psychosocial consequences if not properly treated. Both the National Cancer Institute (NCI) and the National Comprehensive Cancer Network (NCCN) recommend the evaluation of sleep disturbances and evidence-based treatment of insomnia during routine survivorship care. To better understand current clinical practices, we conducted a survey of major cancer centers across the United States (US). METHODS Adult survivorship programs at the 25 US cancer centers that are both NCI-designated comprehensive cancer centers and NCCN member institutions were surveyed about the evaluation and treatment of insomnia in their hospital. RESULTS All institutions responded to the survey. Thirteen centers (56 %) reported screening <25 % of survivors for sleep disorders, and few clinicians providing survivorship care were well-prepared to conduct a proper sleep evaluation. Insomnia was most commonly treated with sleep hygiene, or pharmacotherapy, rather than cognitive-behavioral therapy. No program reported that >50 % of their survivors were receiving optimal insomnia-related care. A variety of methods to improve insomnia care were endorsed by respondents. CONCLUSIONS There is a clear need to improve the evaluation and treatment of insomnia for cancer survivors at institutions across the country. Cancer centers deemed a number of modalities relevant for improving provider confidence in addressing sleep challenges. IMPLICATIONS FOR CANCER SURVIVORS To improve the quality of insomnia care for survivors, systematic interventions to increase standardized screening for sleep disorders, providing additional sleep medicine training for survivorship clinicians, and optimizing the role of sleep medicine specialists in the oncology setting should be considered.
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Affiliation(s)
- Eric S Zhou
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Ann H Partridge
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - Alexis L Michaud
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Christopher J Recklitis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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Li CC, Tsai YF, Chang TC, Chen L. Associations among menopausal symptoms, sleep and fatigue in Taiwanese women with endometrial cancer. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12559] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Chia-Chun Li
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
| | - Yun-Fang Tsai
- School of Nursing; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology; College of Medicine; Chang Gung University; Tao-Yuan Taiwan
- Department of Obstetrics and Gynecology; Chang Gung Memorial Hospital; Tao-Yuan Taiwan
| | - Lynn Chen
- School of Nursing; University of Maryland at Baltimore; Baltimore MD USA
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Yeh ML, Chung YC. A randomized controlled trial of qigong on fatigue and sleep quality for non-Hodgkin’s lymphoma patients undergoing chemotherapy. Eur J Oncol Nurs 2016; 23:81-6. [DOI: 10.1016/j.ejon.2016.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 05/01/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
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Holliday EB, Dieckmann NF, McDonald TL, Hung AY, Thomas CR, Wood LJ. Relationship between fatigue, sleep quality and inflammatory cytokines during external beam radiation therapy for prostate cancer: A prospective study. Radiother Oncol 2015; 118:105-11. [PMID: 26743832 DOI: 10.1016/j.radonc.2015.12.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 10/22/2015] [Accepted: 12/18/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Mechanisms of fatigue reported during radiotherapy are poorly defined but may include inflammatory cytokines and/or sleep disturbances. This prospective, longitudinal, phase II study assessed fatigue, sleep, and serum cytokine levels during radiotherapy for early-stage prostate cancer (PCa). MATERIAL AND METHODS Twenty-eight men undergoing radiotherapy for early-stage PCa wore an Actiwatch Score to record fatigue level, sleep time, onset latency, efficiency and wake after sleep onset. Serum levels of IL-1α, IL-1β, TNF-α, IL-6, IL-8, IL-10 and VEGF were measured weekly during radiotherapy. Patient reported quality of life (QOL) metrics were collected before and after treatment. Linear mixed effects models examined trajectories across treatment weeks. RESULTS Fatigue increased across treatment weeks (P<.01), and fatigue was associated with decreased patient-reported QOL. Sleep efficiency increased across treatment weeks (rate of change over time=.29, P=.03), and sleep onset latency decreased (rate of change over time=.86, P=.06). IL-6 tended to increase during treatment (P=0.09), but none of the cytokine levels or sleep variables were significantly related to fatigue trajectories. CONCLUSIONS Despite increased sleep efficiency across treatment weeks, fatigue significantly increased. Although IL-6 increased during the course of radiotherapy, cytokines levels were not associated with fatigue scores or sleep disturbance. Further studies are needed to define the mechanisms for fatigue during radiotherapy.
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Affiliation(s)
- Emma B Holliday
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, United States
| | - Nathan F Dieckmann
- Oregon Health & Science University School of Nursing, Department of Public Health and Preventative Medicine & Department of Psychiatry, Portland, United States
| | - Tasha L McDonald
- Oregon Health & Science University Department of Radiation Medicine, Portland, United States
| | - Arthur Y Hung
- Oregon Health & Science University Department of Radiation Medicine, Portland, United States
| | - Charles R Thomas
- Oregon Health & Science University Department of Radiation Medicine, Portland, United States
| | - Lisa J Wood
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, United States; Massachussettes General Hospital Institute of Health Professions, Boston, United States.
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Knobf M, Cooley M, Duffy S, Doorenbos A, Eaton L, Given B, Mayer D, McCorkle R, Miaskowski C, Mitchell S, Sherwood P, Bender C, Cataldo J, Hershey D, Katapodi M, Menon U, Schumacher K, Sun V, Ah D, LoBiondo-Wood G, Mallory G. The 2014–2018 Oncology Nursing Society Research Agenda. Oncol Nurs Forum 2015; 42:450-65. [DOI: 10.1188/15.onf.450-465] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Husson O, Mols F, van de Poll-Franse L, de Vries J, Schep G, Thong MSY. Variation in fatigue among 6011 (long-term) cancer survivors and a normative population: a study from the population-based PROFILES registry. Support Care Cancer 2015; 23:2165-74. [PMID: 25556703 DOI: 10.1007/s00520-014-2577-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/18/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE Cancer survivors commonly experience fatigue, related to disease and its treatment. This study aimed to compare fatigue severity among survivors of different cancer types with a normative population and also to identify variations in fatigue among cancer survivors according to clinical and demographic variables. METHODS We used cancer survivorship data from the population-based PROFILES registry. We included survivors of endometrial (EC, n = 741) or colorectal cancer (CRC, n = 3878) (1998-2007), thyroid cancer (TC, n = 306) (1990-2008), Hodgkin (HL, n = 150) or non-Hodgkin lymphoma (NHL, n = 716), or multiple myeloma (MM, n = 120) (1999-2008). A representative Dutch normative population (n = 2040) was also assessed. Participants completed the Fatigue Assessment Scale. RESULTS Cancer survivors were more often classified as fatigued (EC/CRC 39%, HL 40%, NHL 43%, MM 51%, TC 44%) compared with the normative population (21 %; p < 0.001). MM survivors were more often classified as fatigued than all other cancer groups, except NHL (overall p = 0.02). Shorter times since diagnosis (<5 years, 41 versus 38%; p < 0.05), younger age (≤65 years, 42 versus 39%; p < 0.01), being female (43 versus 36%; p < 0.01), chemotherapy treatment (43 versus 39%; p < 0.01), comorbidity (no (27%) versus 1 (35%) versus ≥2 (52%); p < 0.01), educational level (low (44%) versus medium (41%) versus high (32%); p < 0.01), and absence of a partner (47 versus 38%; p < 0.01) were associated with fatigue. CONCLUSIONS Fatigue levels are substantial in (long-term) cancer survivors and vary depending on cancer type, time since diagnosis, age, gender, treatment with chemotherapy, number of comorbid conditions, educational level, and partnership. Since significantly more cancer survivors feel fatigued in comparison with the normative population, appropriate information, assessment, and interventions for fatigue are needed during or after oncologic treatment. Furthermore, focus on better control or management of comorbid conditions of cancer survivors is recommended.
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Affiliation(s)
- Olga Husson
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
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Incorporating measures of sleep quality into cancer studies. Support Care Cancer 2014; 23:1145-55. [PMID: 25510361 DOI: 10.1007/s00520-014-2537-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/21/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION/BACKGROUND Sleep disturbance may influence the development of cancer and responses to treatment. It is also closely tied to recovery and quality of life in cancer patients, survivors, and caregivers, and recent studies have begun to show beneficial effects of sleep-promoting interventions. Despite the importance of sleep to cancer and its treatment and the availability of numerous tools for measuring sleep quality and quantity, sleep measurements are underutilized in cancer studies. METHODS This review, written for cancer researchers interested in incorporating sleep measures into their studies, is designed to raise awareness about the importance of sleep and suggests strategies for including sleep evaluation in cancer studies. CONCLUSIONS Inclusion of readily available sleep measures may ultimately improve cancer care by facilitating studies that lead to a greater understanding of how sleep and sleep disturbance influence all aspects of cancer care and the patient experience.
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Jim HSL, Evans B, Jeong JM, Gonzalez BD, Johnston L, Nelson AM, Kesler S, Phillips KM, Barata A, Pidala J, Palesh O. Sleep disruption in hematopoietic cell transplantation recipients: prevalence, severity, and clinical management. Biol Blood Marrow Transplant 2014; 20:1465-84. [PMID: 24747335 PMCID: PMC4163090 DOI: 10.1016/j.bbmt.2014.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
Sleep disruption is common among hematopoietic cell transplant (HCT) recipients, with over 50% of recipients experiencing sleep disruption pre-transplant, with up to 82% of patients experiencing moderate to severe sleep disruption during hospitalization for transplant and up to 43% after transplant. These rates of sleep disruption are substantially higher than what we see in the general population. Although sleep disruption can be distressing to patients and contribute to diminished quality of life, it is rarely discussed during clinical visits. The goal of the current review is to draw attention to sleep disruption and disorders (ie, insomnia, obstructive sleep apnea, restless legs syndrome) as a clinical problem in HCT in order to facilitate patient education, intervention, and research. We identified 35 observational studies published in the past decade that examined sleep disruption or disorders in HCT. Most studies utilized a single item measure of sleep, had small sample size, and included heterogeneous samples of patients. Six studies of the effects of psychosocial and exercise interventions on sleep in HCT have reported no significant improvements. These results highlight the need for rigorous observational and interventional studies of sleep disruption and disorders in HCT recipients..
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Affiliation(s)
| | - Bryan Evans
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Jiyeon M Jeong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Laura Johnston
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, California
| | - Ashley M Nelson
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Shelli Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Anna Barata
- Moffitt Cancer Center, Tampa, Florida; Psychiatry and Legal Medicine PhD Program, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Abstract
Fatigue is one of the most common adverse effects of cancer that might persist for years after treatment completion in otherwise healthy survivors. Cancer-related fatigue causes disruption in all aspects of quality of life and might be a risk factor of reduced survival. The prevalence and course of fatigue in patients with cancer have been well characterized and there is growing understanding of the underlying biological mechanisms. Inflammation seems to have a key role in fatigue before, during, and after cancer-treatment. However, there is a considerable variability in the presentation of cancer-related fatigue, much of which is not explained by disease-related or treatment-related characteristics, suggesting that host factors might be important in the development and persistence of this symptom. Indeed, longitudinal studies have identified genetic, biological, psychosocial, and behavioural risk factors associated with cancer-related fatigue. Although no current gold-standard treatment for fatigue is available, a variety of intervention approaches have shown beneficial effects in randomized controlled trials, including physical activity, psychosocial, mind-body, and pharmacological treatments. This Review describes the mechanisms, risk factors, and possible interventions for cancer-related fatigue, focusing on recent longitudinal studies and randomized trials that have targeted fatigued patients.
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Affiliation(s)
- Julienne E Bower
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095-1563, USA
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Ratcliff CG, Lam CY, Arun B, Valero V, Cohen L. Ecological momentary assessment of sleep, symptoms, and mood during chemotherapy for breast cancer. Psychooncology 2014; 23:1220-8. [PMID: 24706506 DOI: 10.1002/pon.3525] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/18/2014] [Accepted: 02/28/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study examined the association of sleep before and during a chemotherapy (CT) cycle for breast cancer with symptoms and mood during a CT cycle. METHODS Twenty women undergoing CT for breast cancer completed the Pittsburgh Sleep Quality Index (PSQI) 1 h prior to a CT infusion. For 3 weeks following infusion, participants estimated sleep efficiency, minutes to sleep (sleep latency), number of nocturnal awakenings (sleep fragmentation (SF)), and sleep quality (SQ) each morning and rated symptoms (nausea, fatigue, numbness, and difficulty thinking) and mood three times daily (morning, afternoon, and evening) via ecological momentary assessments using automated handheld computers. RESULTS The results showed that disturbed sleep (PSQI score > 5) prior to CT infusion was associated with greater fatigue, and more negative and anxious mood throughout the 3-week CT cycle, and good pre-CT infusion sleep (PSQI score < 5) buffered anxious mood in the first days following infusion. Time-lagged analyses controlling for mood/symptom ratings reported the previous evening revealed that longer sleep latency and greater SF were associated with greater daytime fatigue; poorer SQ and greater SF were antecedents of worse morning negative mood, and greater SF was associated with feeling more passive and drowsy. No evening symptom or mood ratings were related to subsequent SQ. CONCLUSIONS These findings suggest that disturbed sleep before and after a CT infusion exacerbates fatigue, and negative, anxious, and drowsy mood during a CT cycle. Reducing sleep disturbance may be an important way to improve quality of life during CT.
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Affiliation(s)
- Chelsea G Ratcliff
- Department of Clinical Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, USA
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Assessing the Outcomes of a Supervised Exercise Intervention Following Recent Allogeneic Bone Marrow Transplantation: A Case Report. REHABILITATION ONCOLOGY 2014. [DOI: 10.1097/01893697-201432020-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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