1
|
Wu JR, Chen VCH, Fang YH, Hsieh CC, Wu SI. The associates of anxiety among lung cancer patients: Dehydroepiandrosterone (DHEA) as a potential biomarker. BMC Cancer 2024; 24:476. [PMID: 38622547 PMCID: PMC11021003 DOI: 10.1186/s12885-024-12195-9] [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: 12/27/2023] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE Anxiety is a prevalent comorbidity in lung cancer (LC) patients associated with a decline in quality of life. Dehydroepiandrosterone (DHEA), a neuroactive steroid, levels rise in response to stress. Prior research on the association between DHEA and anxiety has yielded contradictory results and no study has investigated this association in LC patients. METHODS A total of 213 patients with LC were recruited from a general hospital. Data on demographic and cancer-related variables were collected. Using the Chinese version of the Hospital Anxiety and Depression Scale (HADS), the degree of anxiety was determined. Cortisol, DHEA, and Dehydroepiandrosterone sulfate (DHEA-S) levels in saliva were measured. Adjusting for confounding variables, a multivariate regression analysis was conducted. RESULTS 147 men and 66 women comprised our group with an average age of 63.75 years. After accounting for demographic and treatment-related factors, anxiety levels were significantly correlated with, post-traumatic stress symptoms (PTSSs) (β = 0.332, p < 0.001) and fatigue (β = 0.247, p = 0.02). Association between anxiety and three factors, including DHEA, PTSSs, and fatigue, was observed in patients with advanced cancer stages (III and IV) (DHEA β = 0.319, p = 0.004; PTSS β = 0.396, p = 0.001; fatigue β = 0.289, p = 0.027) and those undergoing chemotherapy (DHEA β = 0.346, p = 0.001; PTSS β = 0.407, p = 0.001; fatigue β = 0.326, p = 0.011). CONCLUSIONS The association between anxiety and DHEA remained positive in advanced cancer stages and chemotherapy patients. Further study is necessary to determine whether DHEA is a potential biomarker of anxiety in LC patients.
Collapse
Affiliation(s)
- Jia-Rong Wu
- Department of Psychiatry, Chang Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
- School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, Taiwan
| | - Yu-Hung Fang
- Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
| | - Ching-Chuan Hsieh
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, Taiwan
- Department of Surgery, Chang-Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, No.46, Sec.3, Zhongzheng Rd., Sanzhi Dist, 25245, New Taipei City, Taiwan.
- Department of Psychiatry, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., 104, Taipei City, Taiwan.
| |
Collapse
|
2
|
Chen J, Mark S, Mackin L, Paul SM, Cooper BA, Hammer MJ, Conley YP, Levine JD, Miaskowski C. Increased Stress Is Associated With Severe Pain and Decrements in Cognitive Function in Patients Receiving Chemotherapy. Semin Oncol Nurs 2024; 40:151577. [PMID: 38245388 DOI: 10.1016/j.soncn.2023.151577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/18/2023] [Accepted: 12/20/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVES Purposes were to identify subgroups of adult oncology patients (n = 1342) with distinct joint profiles of worst pain and cognitive function (CF) and evaluate for differences in demographic and clinical characteristics, as well as the severity of three distinct types of stress, resilience, and coping. DATA SOURCES Measures of pain and CF were evaluated six times over two cycles of chemotherapy. The other measures of demographic and clinical characteristics, stress, resilience, and coping were completed at enrollment (ie, prior to the second or third cycle of chemotherapy). RESULTS Using latent profile analysis, four distinct profiles were identified (ie, no pain + moderate CF [27.6%], moderate pain + high CF [22.4%] moderate pain and moderate CF [32.4%, both moderate], severe pain and low CF [17.5%, both severe]). Both moderate and both severe classes reported higher global, cancer-specific, and cumulative life stress, lower levels of resilience, and greater use of disengagement coping strategies. The Both severe class had higher occurrence rates for a number of adverse childhood experiences (ie, family violence in childhood, physical abuse at <16 years, forced sex at <16 years). Risk factors associated with membership in the two worst profiles included: being female, having a lower annual income, having a higher comorbidity burden, and having a poorer functional status. CONCLUSION Findings suggest that 72.4% of the patients reported pain scores in the moderate to severe range and 77.6% reported low to moderate levels of CF. Clinicians need to assess for both symptoms and various types of stress on a routine basis.
Collapse
Affiliation(s)
- Jacqueline Chen
- School of Nursing, University of California, San Francisco, CA
| | - Sueann Mark
- School of Nursing, University of California, San Francisco, CA
| | - Lynda Mackin
- School of Nursing, University of California, San Francisco, CA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA
| | | | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA; School of Medicine, University of California, San Francisco, CA.
| |
Collapse
|
3
|
Calvo-Schimmel A, Paul SM, Cooper BA, Shin J, Harris C, Oppegaard K, Hammer MJ, Cartwright F, Conley YP, Kober KM, Levine JD, Miaskowski C. Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life. Cancer Nurs 2023; 46:417-431. [PMID: 35688433 PMCID: PMC9729413 DOI: 10.1097/ncc.0000000000001139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anxiety and sleep disturbance are frequent symptoms during chemotherapy. OBJECTIVES Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups. METHODS Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles. RESULTS Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life. CONCLUSIONS More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms. IMPLICATIONS FOR PRACTICE Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.
Collapse
Affiliation(s)
- Alejandra Calvo-Schimmel
- Author affiliations: School of Nursing, University of California, San Francisco (Drs Calvo-Schimmel, Paul, Cooper, Kober, and Miaskowski and Mss Shin, Harris, and Oppegaard); Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); Department of Nursing, Mount Sinai Medical Center, New York (Dr Cartwright); School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Conley); and School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Haroen H, Harun H, Sari CWM, Witdiawati W. Uncovering Methods and Outcomes of Palliative Care for Geriatric Patients: A Scoping Review. J Multidiscip Healthc 2023; 16:2905-2920. [PMID: 37790991 PMCID: PMC10544005 DOI: 10.2147/jmdh.s429323] [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: 07/06/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
Background Palliative care is an integral part of care for patients with life-limited diseases that focuses on reducing symptoms and maintaining and increasing the quality of life (QoL) for patients and their families. Geriatric patients were more likely to receive palliative care and had unique needs compared to the general population. To improve the quality of palliative care, especially for geriatric patients, it is necessary to have a better understanding of methods and outcomes for geriatric patients when delivering palliative care. Objective This study aims to identify the methods and outcomes of palliative care in geriatric patients across the globe. Methods This scoping review was guided by Arksey and 'O Malley's framework and utilized the Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist for providing transparent reporting to the readers. EBSCO, PubMed, and Scopus databases were used to search the relevant articles with a publication range of 2013-2023. Thematic analysis was used to identify and summarize palliative care methods and outcomes for geriatric patients in this review. Results Twenty-one studies were included in this review, and it was found that there were many types of methods for delivering palliative care to geriatric patients. In both acute care settings and community settings, a wide range of methods for delivering palliative care to geriatric patients were identified. Outcomes of palliative care in geriatric patients in hospitals and community settings, were reduced pain, depressive symptoms and anxiety, edema, constipation, odds of in-hospital death, and increased spiritual well-being, QoL and well-being, being comfortable, patient readiness, place of death, sleep quality, and quality of dying. Conclusion Geriatric patients had a variety of methods and outcomes in palliative care. This study suggests that outcomes should be evaluated continuously after implementing methods for delivering palliative care to geriatric patients.
Collapse
Affiliation(s)
- Hartiah Haroen
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Hasniatisari Harun
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Citra Windani Mambang Sari
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Witdiawati Witdiawati
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| |
Collapse
|
5
|
Rolbiecki AJ, Govindarajan A, Froeliger B. Immersive virtual reality and neurofeedback for the management of cancer symptoms during treatment. Support Care Cancer 2023; 31:493. [PMID: 37493785 DOI: 10.1007/s00520-023-07957-3] [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: 12/22/2022] [Accepted: 07/19/2023] [Indexed: 07/27/2023]
Abstract
Millions of people are diagnosed with cancer each year in the USA and are living on systemic therapies designed to prolong their life. While these therapies are intended to treat the disease, most exacerbate cancer symptoms such as pain and anxiety. Oncologists and other healthcare providers are now challenged to deliver adjunctive therapies designed to improve quality of life of patients while they undergo cancer treatment, including minimizing already disruptive symptoms such as cancer pain and anxiety. Complementary and alternative medicines such as immersive virtual reality (VR) and neurofeedback (NF) are novel approaches to the management of cancer symptoms. While the evidence for combining VR and NF, specifically for management of cancer pain, while patients undergo systemic therapies, is still emerging; our preliminary findings suggest this treatment modality might offer relief of cancer symptoms. This paper briefly highlights the clinical need for supportive therapies such as VR and NF in the oncological setting and summarizes innovative research in this area.
Collapse
Affiliation(s)
- Abigail J Rolbiecki
- Department of Family and Community Medicine, University of Missouri, One Hospital Drive, MA306 Medical Science Building, DC032.00, Columbia, MO, 65212, USA.
| | - Ameish Govindarajan
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Brett Froeliger
- Department of Psychiatry, Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| |
Collapse
|
6
|
Shin J, Oppegaard K, Calvo-Schimmel A, Harris C, Cooper BA, Paul SM, Conley YP, Hammer MJ, Cartwright F, Kober KM, Levine JD, Miaskowski C. Distinct Worst Pain Profiles in Oncology Outpatients Undergoing Chemotherapy. Cancer Nurs 2023; 46:176-188. [PMID: 35439202 PMCID: PMC9554042 DOI: 10.1097/ncc.0000000000001095] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While pain is a significant problem for oncology patients, little is known about interindividual variability in pain characteristics. OBJECTIVE The aims of this study were to identify subgroups of patients with distinct worst pain severity profiles and evaluate for differences among these subgroups in demographic, clinical, and pain characteristics and stress and symptom scores. METHODS Patients (n = 934) completed questionnaires 6 times over 2 chemotherapy cycles. Worst pain intensity was assessed using a 0- to 10-point numeric rating scale. Brief Pain Inventory was used to assess various pain characteristics. Latent profile analysis was used to identify subgroups of patients with distinct pain profiles. RESULTS Three worst pain profiles were identified (low [17.5%], moderate [39.9%], severe [42.6%]). Compared with the other 2 classes, severe class was more likely to be single and unemployed and had a lower annual household income, a higher body mass index, a higher level of comorbidity, and a poorer functional status. Severe class was more likely to have both cancer and noncancer pain, a higher number of pain locations, higher frequency and duration of pain, worse pain quality scores, and higher pain interference scores. Compared with the other 2 classes, severe class reported lower satisfaction with pain management and higher global, disease-specific, and cumulative life stress, as well as higher anxiety, depression, fatigue, sleep disturbance, and cognitive dysfunction scores. CONCLUSIONS Unrelieved pain is a significant problem for more than 80% of outpatients. IMPLICATIONS FOR PRACTICE Clinicians need to perform comprehensive pain assessments; prescribe pharmacologic and nonpharmacologic interventions; and initiate referrals for pain management and psychological services.
Collapse
Affiliation(s)
- Joosun Shin
- Author Affiliations: School of Nursing, University of California, San Francisco (Mss Shin, Oppegaard, and Harris and Drs Calvo-Schimmel, Cooper, Paul, Kober, and Miaskowski); School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley); Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); Mount Sinai Medical Center, New York (Dr Cartwright); and School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Koca GY, Aylaz R. The effect of music on pain and anxiety in patients receiving chemotherapy during COVID-19. Eur J Cancer Care (Engl) 2022; 31:e13715. [PMID: 36168097 DOI: 10.1111/ecc.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This research has been conducted to determine the effect of music on pain and anxiety levels of patients receiving chemotherapy during COVID-19. METHODS The research has been carried out in a real trial model with 92 adult patients (45 in the experimental group who received chemotherapy and 47 in the control group). The data have been collected by the researcher with Google Forms (using State and Trait Anxiety Inventory [STAI] and visual analogue scale [VAS]) through the links sent to the phones of participants on the day they received chemotherapy, between March 2020 and July 2020. RESULTS The mean scores obtained from the post-test STAI (53.11 ± 4.77) and VAS (3.44 ± 2.53) in the experimental group have been determined to statistically significantly decrease when compared to the pre-test measurement data (STAI: 54.26 ± 4.26; VAS: 4.22 ± 2.41) (p < 0.05). No statistically significant difference has been determined between pre-test and post-test mean scores of the patients in the control group. CONCLUSION It has been observed that music applications reduce the pain and anxiety levels of patients receiving chemotherapy during the COVID-19 process. It can be recommended to use music applications in the management of pain and anxiety symptoms.
Collapse
Affiliation(s)
- Gülsüm Yetiş Koca
- Department of Public Health Nursing, Faculty of Nursing, İnönü University, Malatya, Turkey.,Home Care Program, Health Services Vocational School, İnönü University, Malatya, Turkey
| | - Rukuye Aylaz
- Department of Public Health Nursing, Faculty of Nursing, İnönü University, Malatya, Turkey
| |
Collapse
|
8
|
Lobefaro R, Rota S, Porcu L, Brunelli C, Alfieri S, Zito E, Taglialatela I, Ambrosini M, Spagnoletti A, Zimatore M, Fatuzzo G, Lavecchia F, Borreani C, Apolone G, De Braud F, Platania M. Cancer-related fatigue and depression: a monocentric, prospective, cross-sectional study in advanced solid tumors. ESMO Open 2022; 7:100457. [PMID: 35366489 PMCID: PMC9058920 DOI: 10.1016/j.esmoop.2022.100457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 12/28/2022] Open
Abstract
Background Cancer-related fatigue (CRF) is common in patients with advanced solid tumors and several risk factors are described. The possible role of depression is reported by clinicians despite the association with CRF being unclear. Material and methods In this monocentric, cross-sectional, prospective study we recruited patients with advanced solid tumors who were hospitalized at Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. The primary objective was to assess the correlation between CRF and depression. Secondary objectives were the estimation of CRF and depression prevalence and the identification of associated clinical risk factors. CRF and depression were evaluated through the Functional Assessment of Cancer Therapy-Fatigue subscale and the Zung Self Depression Scale (ZSDS) questionnaires. The Cochran-Armitage trend test was used to demonstrate the primary hypothesis. Univariate and multivariate logistic regression models were used to investigate the impact of clinical variables. Results A total of 136 patients were enrolled. The primary analysis found a linear correlation (P < 0.0001) between CRF and depression. The prevalence of CRF and of moderate to severe depressive symptoms was 43.5% and 29.2%, respectively. In univariate analysis, patients with poor Eastern Cooperative Oncology Group performance status (ECOG PS), anemia, distress, pain, and receiving oncological treatment were at a significantly higher risk for CRF, whereas poor ECOG PS, pain, and distress were risk factors for depression. In multivariate analysis, high levels of ZSDS were confirmed to be correlated to CRF: odds ratio of 3.86 [95% confidence interval (CI) 0.98-15.20) and 11.20 (95% CI 2.35-53.36) for ZSDS of 50-59 and 60-100, respectively (P value for trend 0.002). Moreover, the ECOG PS score was confirmed to be significantly associated with CRF (OR 7.20; 95% CI 1.73-29.96; P = 0.007). Conclusions Our data suggest a strong correlation between CRF and depression in patients with advanced solid tumors. Further investigations are needed to better understand this relationship and if depressive disorder therapeutic strategies could also impact on CRF. Validated patient-reported outcome measures were used for screening CRF and depression in advanced cancer patients. A direct strong correlation between CRF and depression was found in these patients, often unconsidered by clinicians. Other different clinical risk factors for the onset and worsening of CRF were identified. A comprehensive evaluation of cancer patients, that should also consider mood disorders, could improve CRF management.
Collapse
Affiliation(s)
- R Lobefaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - S Rota
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Porcu
- Methodology for Clinical Research Laboratory, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - C Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Zito
- Information and Communication Technology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - I Taglialatela
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Ambrosini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Spagnoletti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Zimatore
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Fatuzzo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Lavecchia
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F De Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - M Platania
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
9
|
Shi J, Li T, Chang P, Wang Z, Hu L. Education curriculum for surgical interns that improves stress management and grit levels. MEDICAL TEACHER 2022; 44:263-266. [PMID: 34608836 DOI: 10.1080/0142159x.2021.1984407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Overwhelming stress or burnout has been observed in medical students, including 69% of surgical interns. This study aimed to assess the stress levels of fifth-year medical students during surgical training. An education curriculum with both clinical and research sessions was evaluated for its effect on the interns' stress and grit levels. METHOD A blinded, prospective study was conducted to evaluate the efficacy of an educational program on the recognition and management of stress. The State-Trait Anxiety Inventory (STAI) was used to assess anxiety. The Grit Scale was used to quantify the interns' grit, conscientiousness, and self-control. RESULTS The STAI survey results showed that the STAI state scores but not the trait scores were significantly lower in the intervention group than in the control group (p < 0.05). Additionally, the postintervention STAI score and the change in the STAI score were both lower in the intervention group (p < 0.05). There was a significant increase in grit among the medical students in the intervention group from baseline to post-intervention (p < 0.001). The scores of the consistency and perseverance subscales of the Grit Scale also increased significantly from baseline to post-intervention (both p < 0.001). CONCLUSION The education curriculum can improve interns' stress management and grit levels. We believe this curriculum needs to be implemented in medical education, and we plan to continue the program.
Collapse
Affiliation(s)
- Jianhua Shi
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tao Li
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pengkang Chang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zheng Wang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liangshuo Hu
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
10
|
Sathe H, Thakre M, Talapalliwar M. Psychometric properties of Kessler's Psychological Distress Scale (K10) in cancer patients. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_104_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
11
|
Mendonça AB, Pereira ER, Magnago C, da Silva PG, Morett Leão DC, Costa Rosa Andrade Silva RM, Meira KC. Distress and Spiritual Well-Being in Brazilian Patients Initiating Chemotherapy during the COVID-19 Pandemic-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13200. [PMID: 34948809 PMCID: PMC8702099 DOI: 10.3390/ijerph182413200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 12/27/2022]
Abstract
Social distancing and the priority given to COVID-19 patients in health services, which caused postponement of appointments and cancer treatment, may have triggered unprecedented levels of distress in cancer patients. The aim of this study was to analyze the prevalence of distress and the levels of spiritual well-being of people initiating chemotherapy during the COVID-19 pandemic, identifying the factors associated with distress, and determining if there is a relationship between distress and spiritual well-being. A cross-sectional study was conducted with 91 Brazilians. Data were collected by applying the Spiritual Well-Being Scale (SWBS) and the Distress Thermometer and Problem List for Patients. The prevalence of distress was 59.5%, and the average score of spiritual well-being was 106.54 (±9.06). Emotional issues were the most reported by patients with distress. The Poisson regression showed that male sex (PR = 0.588; 95% CI 0.392-0.881), age (PR = 0.985; 95% CI 0.973-0.996), and spiritual well-being score were predictors of distress (PR = 0.971; 95% CI 0.946-0.996). These findings indicate that distress relief involves implementation of public health programs capable of integrating spiritual interventions into cancer care.
Collapse
Affiliation(s)
- Angelo Braga Mendonça
- Nursing School, Fluminense Federal University, Niterói 24020-091, Brazil; (E.R.P.); (D.C.M.L.); (R.M.C.R.A.S.)
| | - Eliane Ramos Pereira
- Nursing School, Fluminense Federal University, Niterói 24020-091, Brazil; (E.R.P.); (D.C.M.L.); (R.M.C.R.A.S.)
| | - Carinne Magnago
- School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil;
| | - Pedro Gilson da Silva
- School of Health, Federal University of Rio Grande do Norte, Natal 59075-000, Brazil; (P.G.d.S.); (K.C.M.)
| | - Diva Cristina Morett Leão
- Nursing School, Fluminense Federal University, Niterói 24020-091, Brazil; (E.R.P.); (D.C.M.L.); (R.M.C.R.A.S.)
| | | | - Karina Cardoso Meira
- School of Health, Federal University of Rio Grande do Norte, Natal 59075-000, Brazil; (P.G.d.S.); (K.C.M.)
| |
Collapse
|
12
|
Hatano Y, Morita T, Mori M, Maeda I, Oyamada S, Naito AS, Oya K, Sakashita A, Ito S, Hiratsuka Y, Tsuneto S. Complexity of desire for hastened death in terminally ill cancer patients: A cluster analysis. Palliat Support Care 2021; 19:646-655. [PMID: 33641697 DOI: 10.1017/s1478951521000080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The present study aims were (1) to identify the proportion of terminally ill cancer patients with desire for hastened death (DHD) receiving specialized palliative care, (2) to identify the reasons for DHD, and (3) to classify patients with DHD into some interpretable subgroups. METHODS Advanced cancer patients admitted to 23 inpatients hospices/palliative care units in 2017 were enrolled. Data were prospectively obtained by the primarily responsible physicians. The presence/absence of DHD and reasons for DHD were recorded. A cluster analysis was performed to identify patterns of subgroups in patients with DHD. RESULTS Data from 971 patients, whose Richmond Agitation-Sedation Scale score at admission was zero and who died in palliative care units, were analyzed. The average age was 72 years, common primary cancer sites were the gastrointestinal tract (31%) and the liver/biliary ducts/pancreas (19%). A total of 174 patients (18%: 95% confidence interval, 16-20) expressed DHD. Common reasons for DHD were dependency (45%), burden to others (28%), meaninglessness (24%), and inability to engage in pleasant activities (24%). We identified five clusters of patients with DHD: cluster 1 (35%, 61/173): "physical distress," cluster 2 (21%, 37/173): "dependent and burdensome," cluster 3 (19%, 33/173): "hopelessness," cluster 4 (17%, 30/173): "profound fatigue," and cluster 5 (7%, 12/173): "extensive existential suffering." CONCLUSIONS A considerable number of patients expressed DHD and could be categorized into five subgroups. These findings may contribute to the development of therapeutic strategies.
Collapse
Affiliation(s)
- Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Osaka, Japan
| | | | - Akemi Shirado Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Kiyofumi Oya
- Transitional and Palliative Care, Aso Iizuka Hospital, Fukuoka, Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Satoko Ito
- Hospice, The Japan Baptist Hospital, Kyoto, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | |
Collapse
|
13
|
Abstract
BACKGROUND Cancer pain is among the most severe types of pain and is among the most common types of cancer-related problems. Yet, many ambiguities surround the concept of cancer pain and its attributes. OBJECTIVE This study aimed to analyze the concept of cancer pain. METHODS This concept analysis was conducted using the Rodgers' evolutionary method. Nursing, psychology, social sciences, and medicine literature were reviewed through searching online databases. In total, 52 articles were included and analyzed through thematic analysis. RESULTS/CONCLUSION The attributes of cancer pain are known origin, sharp, burning, piercing, or throbbing quality, varying duration (acute, chronic, or breakthrough), intolerability, and moderate to severe intensity. Its antecedents are cognitive system, pain-related beliefs, coping strategies, family and social support, financial status, and cultural, ethnic, racial, and religious values. Its consequences include physical, psychological, existential and spiritual, and social consequences, and reduced quality of life. This concept analysis concludes that cancer pain is different from other types of acute and chronic pain. Thus, specific interventions are needed for its assessment and management. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The results of this concept analysis can broaden the case manager/health care team and other health care providers' knowledge about cancer pain and help them make better decisions and take more effective interventions for its management. The information in the article can be used to inform the case manager/health care team when it may be time to consider palliative care or even hospice care. Also, the information, itself, is crucial for case managers to understand when a patient has cancer pain.
Collapse
Affiliation(s)
- Marzieh Khatooni
- Marzieh Khatooni, PhD , is an assistant professor at the Faculty of Nursing & Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| |
Collapse
|
14
|
Wang W, Zhou Y, Cai Y, Wang S, Shao F, Du J, Fang J, Liu J, Shao X, Liu B, Fang J, Liang Y. Phosphoproteomic Profiling of Rat's Dorsal Root Ganglia Reveals mTOR as a Potential Target in Bone Cancer Pain and Electro-Acupuncture's Analgesia. Front Pharmacol 2021; 12:593043. [PMID: 33995007 PMCID: PMC8117331 DOI: 10.3389/fphar.2021.593043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/08/2021] [Indexed: 01/18/2023] Open
Abstract
Bone cancer pain (BCP) is a clinical refractory mixed pain involving neuropathic and inflammatory pain, with the underlying mechanisms remaining largely unknown. Electro-acupuncture (EA) can partly alleviate BCP according to previous research. We aim to explore the proteins and major pathways involved in BCP and EA treatment through phosphoproteomic profiling. BCP rat model was built by tibial inoculation of MRMT-1 mammary gland carcinoma cells. Mechanical hyperalgesia determined by paw withdrawal thresholds (PWTs) and bone destruction manifested on the radiographs confirmed the success of modeling, which were attenuated by EA treatment. The differentially expressed phosphorylated proteins (DEPs) co-regulated by BCP modeling and EA treatment in rat dorsal root ganglions (DRGs) were analyzed through PEX100 Protein microarray. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that DEPs were significantly enriched in mammalian target of rapamycin (mTOR) signaling pathway. The phosphorylations of mTOR at Ser2448 and Thr2446 were increased in BCP and downregulated by EA. In addition, the phosphorylation of S6K and Akt, markers of the mTOR complex, were also increased in BCP and downregulated by EA. Inhibition of mTOR signaling alleviated the PWTs of BCP rats, while the mTOR agonist impaired the analgesic effect of EA. Thus, our study provided a landscape of protein phosphorylation changes in DRGs of EA-treated BCP rats and revealed that mTOR signaling can be potentially targeted to alleviate BCP by EA treatment.
Collapse
Affiliation(s)
- Wen Wang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.,Quzhou Municipal Hospital of Traditional Chinese Medicine, Quzhou, China
| | - You Zhou
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yangqian Cai
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Sisi Wang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fangbing Shao
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Junying Du
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Junfan Fang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinggen Liu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaomei Shao
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Boyi Liu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianqiao Fang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yi Liang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
15
|
Kwok CYL, Chan DNS, So WKW. Effect of a theory-driven educational intervention on the level of knowledge, attitudes, and assessment practices regarding breakthrough cancer pain (BTCP) management among medical nurses in Hong Kong. Eur J Oncol Nurs 2021; 52:101945. [PMID: 33813183 DOI: 10.1016/j.ejon.2021.101945] [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: 03/23/2020] [Revised: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine the effect of an educational intervention intended to improve medical nurses' adherence to breakthrough cancer pain (BTCP) assessment practices and their level of knowledge, attitudes and perceived assessment practices regarding BTCP management. METHODS Nurses working in a regional hospital were recruited to this quasi-experimental study. The intervention group received a 3-h educational workshop and one session of individual clinical instruction, whilst the control group did not receive any intervention. Chart audits were performed to examine adherence to BTCP assessment practices as the primary outcome. A self-developed questionnaire was used to measure nurses' knowledge, attitudes and perceived assessment practices regarding BTCP management as the secondary outcomes. The chi-square or Fisher's exact test was used to compare the rate of adherence to BTCP assessment practices between groups. A generalised estimating equation was used to compare changes in knowledge, attitudes, and perceived assessment practices between groups over time. RESULTS One hundred and five nurses completed the study. The chart audits revealed a significantly higher rate of adherence to BTCP assessment practices in the intervention group after the intervention (p < .05). The intervention group exhibited significant positive changes in scores for knowledge (β = 25.49, p < .001), attitude (β = 0.98 to 2.81, p < .01), and their perceived assessment practices (β = 1.33 to 3.14, p < .002) when compared with the control group. CONCLUSIONS This theory-driven educational intervention significantly improved the medical nurses' adherence to BTCP assessment practices and their level of knowledge attitudes and perceived assessment practices regarding BTCP management.
Collapse
Affiliation(s)
- Carman Y L Kwok
- Haven of Hope Sister Annie Skau Holistic Centre, Hong Kong, SAR, China
| | - Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| |
Collapse
|
16
|
Al-Ansari AM, Abd-El-Gawad WM, AboSerea SM, ElShereafy EES, Ali FAS, ElSayed MAE. The pattern of change in opioid and adjuvant prescriptions for cancer pain before and after referral to a comprehensive program in the Palliative Care Center in Kuwait. BMC Palliat Care 2021; 20:25. [PMID: 33536013 PMCID: PMC7860188 DOI: 10.1186/s12904-021-00717-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cancer-related pain is a complicated symptom that often coincides with fatigue, depression, and anxiety. Although many safe treatments are available, inadequate control of Cancer-related pain continues to lead to suffering in cancer patients. This study’s aim is to describe pain control, and the pattern of change in opioid and adjuvant medication prescriptions, before and after referral to the Palliative Care Center. Methods We conducted a prospective cohort study in adult cancer patients the Palliative Care Center between January 1, 2016 and December 30, 2017. We measured pain intensity and other associated symptoms via the Revised Edmonton Symptom Assessment System (ESAS-r) and documented detailed analgesics and adjuvant medication history before starting any palliative care and on days 0, 3, 6, and 14. Results The analysis included 240 patients whose cancer-related pain, anxiety, and depression scores meaningfully improved by day 6. The changes in the median (interquartile ranges) of Cancer-related pain, anxiety, and depression scores from day 0 to day 6 were: 6 (4–8) to 3 (1–4); 6 (4–9) to 2 (1–4); and 3 (2–6) to 2 (1–4), respectively, with p < 0.001 for all. Morphine was the most common opioid administered; the percentage using it increased from 20.4% (n = 49) before referral to 49.6% (n = 119) on day 6 (p < 0.001). The median morphine equivalent daily dose decreased from a median (interquartile ranges) of 60(31–93) mg/day before referral to 34(22–66) mg/day on day 6 (p < 0.001). There was also a statistically significant increase in the percentage of patients taking adjuvant medications, from 38.8% before referral to 84.2% on day 6 (p < 0.001). Comparing D0 to D6, the number of patients using Gabapentinoids significantly increased from 57(23.75%) to 79(32.9%) (p < 0.001), amitriptyline dramatically increased from 14 (5.8%) to 44 (18.3%) (p < 0.001), and other antidepressant drugs increased from 15 (6.2%) to 34 (14.1%) (p < 0.001). Conclusion After referral to the Palliative Care Center, patients’ pain and other symptoms scores decreased significantly, even with lower median morphine equivalent daily doses, arguably through more appropriately directed opioid use. This is evidence for the effectiveness of the comprehensive program at the Palliative Care Center in Kuwait. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00717-2.
Collapse
Affiliation(s)
| | - Wafaa Mostafa Abd-El-Gawad
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Al- Abbaseya, Cairo, Egypt.
| | | | | | | | | |
Collapse
|
17
|
Zeng J, Zhou R, Luo Z, Zhang N, Liu Z, Lin G. Clinical evidence of acupuncture and related therapy in patients with cancer-pain: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23119. [PMID: 33157988 PMCID: PMC7647583 DOI: 10.1097/md.0000000000023119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cancer pain (CP) is one of the common complications of cancer. During the treatment, oral medication, radiotherapy and chemotherapy bring certain adverse reactions to patients with CP; a safe way to treat this disease is necessary. Acupuncture and related therapies for CP with few side effects have been gradually accepted. But at present the evidence is insufficient, the related research is not thorough enough. The purpose of this study was to investigate the efficacy and safety of acupuncture and related therapies for CP. METHODS The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines were used to design this protocol. The final study will also be conducted under the PRISMA guidelines for systematic reviews and meta-analysis. An electronic search will be conducted in Medline, Embase, and the Cochrane Central Register of Controlled Trials databases through January 2020. The search will be conducted in English. Risk of bias will be assessed by the Cochrane Collaboration tool and the collected evidence will be nar-ratively synthesized. We will also perform a meta-analysis to pool estimates from studies considered to be homogenous. Subgroup analyses will be based on intervention or overall bias. The strength of evidence will be evaluated by the Grading of Recommendations, Assessment, Development and Evaluation scale. RESULTS This systematic review will summarize high quality clinical evidence to assess and appraise the effectiveness and safety of acupuncture and related therapies for CP patients. CONCLUSION The meta-analysis will assess evidence from randomized controlled trials of acupuncture and related therapies and CP types. INPLASY REGISTRATION NUMBER INPLASY202040129.
Collapse
Affiliation(s)
- Jingchun Zeng
- Department of Acupuncture, The First Affiliated Hospital, Guangzhou University of Chinese Medicine
| | - Runjin Zhou
- Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Zhenke Luo
- Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Na Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Zijun Liu
- Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Guohua Lin
- Department of Acupuncture, The First Affiliated Hospital, Guangzhou University of Chinese Medicine
| |
Collapse
|
18
|
Hoon SN, Lawrie I, Qi C, Rahman N, Maskell N, Forbes K, Gerry S, Monterosso L, Chauhan A, Brims FJH. Symptom Burden and Unmet Needs in Malignant Pleural Mesothelioma: Exploratory Analyses From the RESPECT-Meso Study. J Palliat Care 2020; 36:113-120. [PMID: 32791881 DOI: 10.1177/0825859720948975] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Malignant Pleural Mesothelioma (MPM) has a poor prognosis and high symptom burden. RESPECT-Meso was a multicenter randomized study examining the role of early specialist palliative care (SPC) on quality of life (QoL) with MPM. This is a post-hoc exploratory analysis of the symptom burden and unmet needs identified from RESPECT-Meso participants. METHODS Exploratory analysis from 174 participants using the General Health Status (GHS) measure (from the EORTC QLQ-C30 QoL questionnaire) and 87 participants using validated assessment questionnaires in those randomized to SPC. Eligibility for the study included confirmed MPM with diagnosis <6 weeks prior, performance score (PS) 0 or 1, no significant physical or psychological comorbidity. Cox proportional hazards models were derived to examine for relationships with survival. Free text was assessed using content analysis, looking for common themes and words. RESULTS Participants were predominantly male (79.9%), mean age 72.8 years, PS was 0 in 38%, 78% of MPM was epithelioid. At least 3 symptoms were reported in 69.8% of participants, including fatigue (81%), dyspnea (73.3%), pain (61.2%), weight loss (59.3%). Anxiety was reported by 54.7% of participants, 52.3% low mood and 48.8% anhedonia symptoms. After multivariable adjustment, only pain remained statistically significant with a hazard ratio (HR) 2.9 (95% CI 1.3-6.7; p = 0.01). For each 1 unit increase in GHS score, the HR for death was 0.987 (0.978-0.996; p = 0.006), indicating a worse reported QoL is related to shorter survival. Unmet needs were common: 25.9% wanted more information about their condition, 24.7% about their care and 21.2% about their treatment. 79.1% were concerned about the effect of their illness on family. CONCLUSION There is a high symptom burden in mesothelioma despite good baseline performance status. A worse QoL is associated with a worse survival. Unmet needs are common, perhaps highlighting a need for improved communication and information sharing.
Collapse
Affiliation(s)
- Siao Nge Hoon
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Curtin Medical School, 1649Curtin University, Perth, Western Australia, Australia
| | - Iain Lawrie
- Department of Palliative Medicine, North Manchester General Hospital, Manchester, United Kingdom.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Cathy Qi
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Najib Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Nick Maskell
- Department of Respiratory Medicine, University of Bristol, Bristol, United Kingdom
| | - Karen Forbes
- Department of Palliative Medicine, University of Bristol, Bristol, United Kingdom
| | - Stephen Gerry
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Leanne Monterosso
- School of Nursing and Midwifery, University of Notre Dame, Fremantle, Australia.,School of Nursing and Midwifery, Edith Cowan University.,St John of God Murdoch Hospital, Murdoch, Australia
| | - Anoop Chauhan
- Department of Respiratory Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.,Research & Innovation Department, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.,School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, United Kingdom
| | - Fraser J H Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Curtin Medical School, 1649Curtin University, Perth, Western Australia, Australia
| |
Collapse
|
19
|
Wan CF, Meng QZ, Wang YW, Qi L, Ai CL, Sui X, Song T. Patient-controlled subcutaneous analgesia using sufentainil or morphine in home care treatment in patients with stage III-IV cancer: A multi-center randomized controlled clinical trial. Cancer Med 2020; 9:5345-5352. [PMID: 32500675 PMCID: PMC7402833 DOI: 10.1002/cam4.3194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose Patient‐controlled subcutaneous analgesia (PCSA) with sufentanil is an alternative analgesia strategy in patients with stage III‐IV cancer; however, its efficacy and safety have not been fully investigated. Methods From May 10, 2017 to November 10, 2017, 120 patients with stage III‐IV cancer suffering from moderate to severe pain were prospectively enrolled from six hospitals and randomized to receive PCSA with morphine (control group) or sufentanil (intervention group). Before the PCSA and on days 1, 3, 7, 14, 28, and 56 after treatment, the numeric rating scale (NRS) and 36‐item Short Form health survey (SF‐36) were completed for each patient and the side effects were also recorded. RESULTS No significant differences (P > .05) were observed in the preoperative NRS score and the SF‐36 parameters between the two groups. Patients in the intervention group achieved better pain relief, as indicated by lower NRS scores at days 14 (P = .040), 28 (P < .001), and 56 (P < .001) after PCSA device implantation (vs control group). Furthermore, the patients in the intervention group also achieved a better life quality, as indicated by the physical role, general health, social function body pain, and mental health scores. Finally, the patients receiving sufentanil showed lower levels of nausea and somnolence than those in the control group. Conclusion PCSA with sufentanil achieves better pain control and life quality as well as fewer adverse reactions in stage III‐IV cancer patients with pain and may be a promising pain management in these patients. Trial registration This study was registered at chictr.org.cn with the trial number: ChiCTR‐IPR‐17011280.
Collapse
Affiliation(s)
- Cheng-Fu Wan
- Pain Department of the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Qing-Zhu Meng
- Pain Department of the Central Hospital of Haicheng city, Anshan, China
| | - Yan-Wei Wang
- Pain Department of the Third People's Hospital of Anshan city, Anshan, China
| | - Liang Qi
- Pain Department of the Central Hospital of Fuxin city, Fuxin, China
| | - Chang-Liang Ai
- Pain Department of the Women and Children's Hospital of Dandong city, Dandong, China
| | - Xin Sui
- Pain Department of the Central Hospital of Kuandian city, Dandong, China
| | - Tao Song
- Pain Department of the First Affiliated Hospital, China Medical University, Shenyang, China
| |
Collapse
|
20
|
Eseadi C. Rational-emotive behavioral intervention helped patients with cancer and their caregivers to manage psychological distress and anxiety symptoms. World J Clin Oncol 2019; 10:62-66. [PMID: 30815372 PMCID: PMC6390117 DOI: 10.5306/wjco.v10.i2.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/10/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023] Open
Abstract
There is a dearth of evidence-based data on how psychological distress and death anxiety symptoms experienced by cancer patients and caregivers are treated in developing regions. This article sheds light on the report of the findings from a 2016 study that revealed a rational-emotive behavioral intervention helped a select group of cancer patients and their family caregivers to manage problematic assumptions, psychological distress, and death anxiety symptoms in Nigeria. Based on my experience as a co-investigator and corresponding author of this previous study, I addressed the challenges of conducting such a study and the implications for future research in this article. This article encourages future researchers to replicate the study and endeavor to overcome the limitations of the previous study. Funders were also encouraged to ensure increased access to funds for conducting similar studies with cancer patients and their family caregivers in developing countries and other parts of the world.
Collapse
Affiliation(s)
- Chiedu Eseadi
- Department of Educational Foundations, Faculty of Education, University of Nigeria, Nsukka 410001, Nigeria
| |
Collapse
|
21
|
Abstract
Increasing numbers of those living with and beyond cancer presents a clinical challenge for pain specialists. A large proportion of these patients experience pain secondary to their disease or its treatment, impeding rehabilitation and significantly impacting upon their quality of life. The successful management of this pain presents a considerable challenge. This review aims to outline current concepts and treatment options, while considering nuances within pain assessment and the use of large-scale data to help guide further advances.
Collapse
Affiliation(s)
- David Magee
- Department of Pain Medicine, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Sabina Bachtold
- Department of Pain Medicine, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Matthew Brown
- Department of Pain Medicine, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.,Targeted Approaches to Cancer Pain Group, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK
| | - Paul Farquhar-Smith
- Department of Pain Medicine, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| |
Collapse
|
22
|
Lerman B, Harricharran T, Ogunwobi OO. Oxytocin and cancer: An emerging link. World J Clin Oncol 2018; 9:74-82. [PMID: 30254962 PMCID: PMC6153127 DOI: 10.5306/wjco.v9.i5.74] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 02/06/2023] Open
Abstract
The neuropeptide hormone oxytocin, which is released from the posterior pituitary gland, is involved in a number of physiological processes. Understanding of its effects is gradually increasing due to new research in this area. While mostly recognized as a reproductive system hormone, oxytocin also regulates other organ systems such as the brain and cardiovascular system. Recently, research has focused on unraveling its involvement in cancer, and emerging evidence suggests a potential role for oxytocin as a cancer biomarker. This review summarizes observations linking oxytocin and cancer, with a special emphasis on prostate cancer, where it may promote cell proliferation. Research suggests that oxytocin effects may depend on cell type, concentration of the hormone, its interactions with other hormones in the microenvironment, and the precise localization of its receptor on the cell membrane. Future research is needed to further elucidate the involvement of oxytocin in cancer, and whether it could be a clinical cancer biomarker or therapeutic target.
Collapse
Affiliation(s)
- Ben Lerman
- Department of Biological Sciences, Hunter College of the City University of New York, New York, NY 10065, United States
| | - Trisheena Harricharran
- Department of Biological Sciences, Hunter College of the City University of New York, New York, NY 10065, United States
- the Graduate Center Departments of Biology and Biochemistry, the City University of New York, New York, NY 10016, United States
| | - Olorunseun O Ogunwobi
- Department of Biological Sciences, Hunter College of the City University of New York, New York, NY 10065, United States
- the Graduate Center Departments of Biology and Biochemistry, the City University of New York, New York, NY 10016, United States
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY 10065, United States
| |
Collapse
|