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McDaniels-Davidson C, Parada Jr H, Kasiri N, Patel SP, Strong D, Doran N. The association of perceived cannabis risks and benefits with cannabis use since cancer diagnosis. J Natl Cancer Inst Monogr 2024; 2024:244-251. [PMID: 39108239 PMCID: PMC11303868 DOI: 10.1093/jncimonographs/lgad024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/13/2023] [Accepted: 08/13/2023] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Many patients with cancer use cannabis to help alleviate untreated cancer symptoms and side effects. METHODS We examined associations of perceived benefits and risks and postdiagnosis cannabis use in a weighted sample of adult cancer survivors through a 1-time survey. Fifteen perceived cannabis use benefits and 19 perceived risks were operationalized as both summary scores and report of any benefits or risks. Survey-weighted logistic regression provided covariate-adjusted odds of postdiagnosis cannabis use for each benefit-risk measure. RESULTS Among the weighted population of 3785 survivors (mean [SD] age = 62.2 [13.5] years), one-third used cannabis after diagnosis. Perceiving any benefits increased the odds of postdiagnosis cannabis use more than 500%, and perceiving any risks lowered the odds by 59%. Each SD increase in endorsed benefits doubled the odds of postdiagnosis cannabis use, while each SD increase in endorsed risks reduced the odds by 36%. CONCLUSION An accurate understanding of benefits and risks is critical for informed decision making.
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Affiliation(s)
- Corinne McDaniels-Davidson
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA, USA
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
| | - Humberto Parada Jr
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Nasim Kasiri
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Sandip P Patel
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
| | - David Strong
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego,La Jolla, CA, USA
| | - Neal Doran
- Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Psychology Service, Jennifer Moreno Department of Veterans Affairs Medical Center, San Diego, CA, USA
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Rönningås U, Fransson P, Holm M, Beckman L, Wennman-Larsen A. Symptom burden among men treated for castration-resistant prostate cancer: a longitudinal study. BMJ Support Palliat Care 2024:spcare-2024-005054. [PMID: 39122263 DOI: 10.1136/spcare-2024-005054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES Despite rapid expansion of treatments for metastatic castration-resistant prostate cancer (mCRPC) and the importance of symptom management for enhancing quality of life, few studies have focused on men's experiences of symptom burden over time when receiving one or more lines of treatment in a real-world situation in this phase. The aim was to investigate changes in the multidimensional symptom burden during the first year of life-prolonging treatment of mCRPC. METHODS Longitudinal data from the first year of life-prolonging treatment for 134 men with mCRPC were used. Symptoms were measured with the multidimensional Memorial Symptom Assessment Scale. Data are presented with descriptive statistics, and changes in symptom burden (physical, psychological and number of symptoms) were analysed using linear mixed modelling. RESULTS On average, the men had approximately 10 (0-31) symptoms at inclusion and 12 (0-33) at the last time point. Lack of energy and sweats were the two most reported symptoms at every time point. Sexual problems had the highest scores in all dimensions (frequency, severity, distress). Regarding pain, the distress score was higher than the scores for frequency and severity at t1-t4. Physical symptom burden and the number of symptoms changed significantly over time, towards a higher symptom burden. Psychological symptom burden did not change significantly over time. CONCLUSION The different dimensions of physical symptoms in men treated for mCRPC need to be more acknowledged. Early integration of a palliative care approach could possibly help in enhancing symptom management and quality of life for these men.
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Affiliation(s)
| | - Per Fransson
- Department of Nursing, Umeå University, Umea, Sweden
| | - Maja Holm
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Department of Health Care Sciences, Marie Cederschiold hogskola - Campus Ersta, Stockholm, Sweden
| | - Lars Beckman
- Department of Radiation Sciences, Umea Universitet, Umea, Sweden
| | - Agneta Wennman-Larsen
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Albashayreh A, Bandyopadhyay A, Zeinali N, Zhang M, Fan W, Gilbertson White S. Natural Language Processing Accurately Differentiates Cancer Symptom Information in Electronic Health Record Narratives. JCO Clin Cancer Inform 2024; 8:e2300235. [PMID: 39116379 DOI: 10.1200/cci.23.00235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/29/2024] [Accepted: 05/30/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE Identifying cancer symptoms in electronic health record (EHR) narratives is feasible with natural language processing (NLP). However, more efficient NLP systems are needed to detect various symptoms and distinguish observed symptoms from negated symptoms and medication-related side effects. We evaluated the accuracy of NLP in (1) detecting 14 symptom groups (ie, pain, fatigue, swelling, depressed mood, anxiety, nausea/vomiting, pruritus, headache, shortness of breath, constipation, numbness/tingling, decreased appetite, impaired memory, disturbed sleep) and (2) distinguishing observed symptoms in EHR narratives among patients with cancer. METHODS We extracted 902,508 notes for 11,784 unique patients diagnosed with cancer and developed a gold standard corpus of 1,112 notes labeled for presence or absence of 14 symptom groups. We trained an embeddings-augmented NLP system integrating human and machine intelligence and conventional machine learning algorithms. NLP metrics were calculated on a gold standard corpus subset for testing. RESULTS The interannotator agreement for labeling the gold standard corpus was excellent at 92%. The embeddings-augmented NLP model achieved the best performance (F1 score = 0.877). The highest NLP accuracy was observed in pruritus (F1 score = 0.937) while the lowest accuracy was in swelling (F1 score = 0.787). After classifying the entire data set with embeddings-augmented NLP, we found that 41% of the notes included symptom documentation. Pain was the most documented symptom (29% of all notes) while impaired memory was the least documented (0.7% of all notes). CONCLUSION We illustrated the feasibility of detecting 14 symptom groups in EHR narratives and showed that an embeddings-augmented NLP system outperforms conventional machine learning algorithms in detecting symptom information and differentiating observed symptoms from negated symptoms and medication-related side effects.
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Affiliation(s)
| | | | | | - Min Zhang
- School of Economics and Management, Communication University of China, Beijing, China
| | - Weiguo Fan
- Tippie College of Business, University of Iowa, Iowa City, IA
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Van Cleave JH, Concert C, Kamberi M, Zahriah E, Most A, Mojica J, Riccobene A, Russo N, Liang E, Hu KS, Jacobson AS, Li Z, Moses LE, Persky MJ, Persky MS, Tran T, Brody AA, Kim A, Egleston BL. A Preliminary Validation of an Optimal Cutpoint in Total Number of Patient-Reported Symptoms in Head and Neck Cancer for Effective Alignment of Clinical Resources with Patients' Symptom Burden. CANCER CARE RESEARCH ONLINE 2024; 4:e051. [PMID: 38586274 PMCID: PMC10993689 DOI: 10.1097/cr9.0000000000000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Patients with head and neck cancer (HNC) often experience high symptom burden leading to lower quality of life (QoL). Objective This study aims to conceptually model optimal cutpoint by examining where total number of patient-reported symptoms exceeds patients' coping capacity, leading to a decline in QoL in patients with HNC. Methods Secondary data analysis of 105 individuals with HNC enrolled in a clinical usefulness study of the NYU Electronic Patient Visit Assessment (ePVA)©, a digital patient-reported symptom measure. Patients completed ePVA and European Organization for Research and Treatment of Cancer (EORTC©) QLQ-C30 v3.0. The total number of patient-reported symptoms was the sum of symptoms as identified by the ePVA questionnaire. Analysis of variance (ANOVA) was used to define optimal cutpoint. Results Study participants had a mean age of 61.5, were primarily male (67.6%), and had Stage IV HNC (53.3%). The cutpoint of 10 symptoms was associated with significant decline of QoL (F= 44.8, P<.0001), dividing the population into categories of low symptom burden (< 10 symptoms) and high symptom burden (≥ 10 symptoms). Analyses of EORTC© function subscales supported the validity of 10 symptoms as the optimal cutpoint (Physical: F=28.3, P<.0001; Role: F=21.6, P<.0001; Emotional: F=9.5, P=.003; Social: F=33.1, P<.0001). Conclusions In HNC, defining optimal cutpoints in the total number of patient-reported symptoms is feasible. Implications for Practice Cutpoints in the total number of patient-reported symptoms may identify patients experiencing a high symptom burden from HNC. Foundational Using optimal cutpoints of the total number of patient-reported symptoms may help effectively align clinical resources with patients' symptom burden.
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Affiliation(s)
- Janet H Van Cleave
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Catherine Concert
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Maria Kamberi
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Elise Zahriah
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Allison Most
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Jacqueline Mojica
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Ann Riccobene
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Nora Russo
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Eva Liang
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Kenneth S Hu
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Adam S Jacobson
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Zujun Li
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Lindsey E Moses
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Michael J Persky
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Mark S Persky
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Theresa Tran
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Abraham A Brody
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Arum Kim
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
| | - Brian L Egleston
- NYU Meyers College of Nursing (JH Van Cleave, E Liang, AA Brody); NYU Langone Perlmutter Cancer Center, Department of Radiation Oncology (C Concert); NYU Langone Perlmutter Cancer Center, Department of Head and Neck Surgical Oncology (M Kamberi, A Most, J Mojica, N Russo); NYU Langone Perlmutter Cancer Center, Department of Medical Oncology (E Zahriah, A Riccobene); NYU Grossman School of Medicine, Department of Radiation Oncology (KS Hu); NYU Grossman School of Medicine, Department of Otolaryngology - Head and Neck Surgery (AS Jacobson, LE Moses, MJ Persky, MS Persky, T Tran); NYU Grossman School of Medicine, Department of Medicine (AA Brody, Z Li, A Kim)
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Sugar D, Patel R, Comella C, González DA, Gray G, Stebbins GT, Mahajan A. The effect of botulinum toxin on anxiety in cervical dystonia: A prospective, observational study. Parkinsonism Relat Disord 2023; 114:105792. [PMID: 37540934 DOI: 10.1016/j.parkreldis.2023.105792] [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] [Received: 06/01/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Anxiety is present in 30-40% of patients with cervical dystonia (CD). It has been ascribed to a direct effect of the state of motor symptoms on related pain, disability, and disfigurement. Accordingly, any reported benefit of botulinum toxin (BoNT) on anxiety is thought to be secondary to its effect on the same. We sought to evaluate the distinctive impact of botulinum toxin (BoNT) on anxiety in cervical dystonia (CD). METHODS In this prospective observational study, 60 participants with idiopathic isolated CD were recruited from clinic. We assessed motor and anxiety burden using Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) parts I-III and State-Trait Anxiety Inventory (STAI). Assessments were done at time of BoNT (baseline) and at 6 weeks post-injection. RESULTS STAI and motor severity TWSTRS scores poorly correlated at the baseline visit (rho = -0.30, p = 0.411). Both, motor TWSTRS (Mdifference = -1.46, p < 0.024) and STAI (Mdifference = -10.37, p = 0.007) improved from baseline to 6 weeks (peak effect). The change in motor TWSTRS poorly correlated with change in anxiety scores from baseline visit to 6 weeks (rho = -0.14, p > 0.999). Of these measures of anxiety, improvement in STAI-T had the largest effect size (rank biserial = 0.52). CONCLUSION BoNT improves both motor severity and anxiety in CD. Poor correlation between motor severity and anxiety at both the time of injection and during the time of peak effect, and improvement in trait anxiety suggests that BoNT has a direct beneficial effect on anxiety.
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Affiliation(s)
- Dana Sugar
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Roshni Patel
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Cynthia Comella
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - David A González
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Gabrielle Gray
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Glenn T Stebbins
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA
| | - Abhimanyu Mahajan
- Rush Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, Chicago, IL, USA.
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Nugent SM, Golden SE, Sullivan DR, Thomas CR, Wisnivesky J, Saha S, Slatore CG. Patient-clinician communication and patient-centered outcomes among patients with suspected stage I non-small cell lung cancer: a prospective cohort study. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2022; 39:203. [PMID: 36175802 DOI: 10.1007/s12032-022-01776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/15/2022] [Indexed: 10/14/2022]
Abstract
Among patients with suspected early-stage non-small cell lung cancer (NSCLC), we sought to evaluate the association of patient-clinician communication (PCC) with patient-centered outcomes (PCOs). We conducted a multicenter, prospective cohort study examining PCOs at five time points, up to 12-months post-treatment. We used generalized estimating equation (GEE) models adjusted for sociodemographic and clinical variables to examine the relationship between PCC (dichotomized as high- or low-quality) and decisional conflict, treatment self-efficacy, and anxiety. The cohort included 165 patients who were 62% male with a mean age of 70.7 ± SD 8.1 years. Adjusted GEE analysis including 810 observations revealed high-quality PCC was associated with no decisional conflict (adjusted odds ratio [aOR] = 0.14, 95% CI = 0.07 to 0.27) and higher self-efficacy (β = -0.26, 95% CI = -0.37 to -0.14). High-quality PCC was not associated with moderately severe anxiety (aOR = 0.68, 95% CI = 0.41 to 1.09), though was associated with decreased anxiety scores (β = -3.91, 95% CI = -6.48 to -1.35). Among individuals with suspected early-stage NSCLC, high-quality PCC is associated with less decisional conflict and higher self-efficacy; the relationship with anxiety is unclear. Clinicians should prioritize enhanced treatment-related communication at critical and vulnerable periods in the cancer care trajectory to improve PCOs.
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Affiliation(s)
- Shannon M Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA. .,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA. .,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth University, Lebanon, NH, USA
| | - Juan Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth University, Lebanon, NH, USA.,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, USA
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7
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Miaskowski C, Paul SM, Harris CS, Shin J, Oppegaard K, Conley YP, Hammer M, Kober KM, Levine JD. Determination of Cutpoints for Symptom Burden in Oncology Patients Receiving Chemotherapy. J Pain Symptom Manage 2022; 63:42-51. [PMID: 34333099 PMCID: PMC10791137 DOI: 10.1016/j.jpainsymman.2021.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
CONTEXT Cutpoints can be used as a threshold for screening symptom(s) that warrant intervention(s) and for monitoring patients' responses to these interventions. OBJECTIVES In a sample of oncology patients undergoing chemotherapy, study purposes were to determine the optimal cutpoints for low, moderate, and high symptom burden and determine if these cutpoints distinguished among the symptom groups in any demographic, clinical, and stress characteristics, as well as QOL outcomes. METHODS Total of 1329 patients completed a modified version of the Memorial Symptom Assessment Scale (38 symptoms). Using the methodology of Serlin and colleagues, cutpoints were created using symptom occurrence rates and cancer-specific quality of life (QOL) scores. Cutpoints were validated using measures of stress and resilience and a generic measure of QOL (i.e., Medical Outcomes Study Short Form 12 (SF-12)). RESULTS Of the 25 possible cutpoints evaluated, the optimal cutpoint, with the largest between category F statistic, was CP8,15 (Low = 0-8, Moderate = 9-15, High = 16-38 symptoms). Percentage of patients in the Low, Moderate, and High cutpoint groups were 25.3%, 36.3%, and 38.4%, respectively. Significant differences were found among the symptom burden groups in global, cancer-specific, and cumulative life stress (i.e., Low < Moderate < High) and resilience and SF-12 (i.e., Low > Moderate > High) scores. CONCLUSION Our findings provide evidence for clinically meaningful cutpoints that can be used to guide symptom assessment and management. These cutpoints may be used to establish alert thresholds for electronic monitoring of symptoms in oncology patients.
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Affiliation(s)
- Christine Miaskowski
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA; School of Medicine (C.M., J.D.L.), University of California, San Francisco, California, USA.
| | - Steven M Paul
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA
| | - Carolyn S Harris
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA
| | - Joosun Shin
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA
| | - Kate Oppegaard
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing (Y.P.C.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Dana Farber Cancer Institute (M.H.), Boston, Massachusetts, USA
| | - Kord M Kober
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine (C.M., J.D.L.), University of California, San Francisco, California, USA
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The efficacy of web or mobile-based interventions to alleviate emotional symptoms in people with advanced cancer: a systematic review and meta-analysis. Support Care Cancer 2021; 30:3029-3042. [PMID: 34735601 DOI: 10.1007/s00520-021-06496-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This review aims to critically evaluate the efficacy of web or mobile-based (WMB) interventions impacting emotional symptoms in patients with advanced cancer. METHOD Articles published from 1991 to 2019 were identified using PubMed, PsycINFO, CINAHL, and Scopus. Only interventions involving adults with advanced cancer using a WMB intervention to manage emotional symptoms were included. Risk of bias was assessed using ROBINS-I and ROB2 tools. Studies that reported mean symptom scores were pooled using a random-effects model, and standardized mean difference (SMD) and 95% CIs were calculated. RESULTS Twenty-three of the 1177 screened studies met the inclusion criteria, and a total sample of 2558 patients were included. The sample was 57% female, and 33% had advanced cancer with mean age of 57.15 years. Thirteen studies evaluated anxiety, nineteen evaluated depression, and eleven evaluated distress. Intervention components included general information, tracking, communication, multimedia choice, interactive online activities, tailoring/feedback, symptom management support content, and self-monitoring. Overall pooled results showed that WMB interventions' effects on decreasing anxiety (SMD - 0.20, - 0.45 to 0.05, I2 = 72%), depression (SMD - 0.10, - 0.30 to 0.11, I2 = 73%), and distress (SMD - 0.20, - 0.47 to 0.06, I2 = 60%) were not significant for randomized controlled trials (RCTs). In contrast, WMB interventions significantly decreased symptoms of anxiety (p = .002) in a sub-group analysis of non-RCTs. CONCLUSION This meta-analysis demonstrated that WMB interventions were not efficacious in alleviating emotional symptoms in adults with advanced cancer. Considering the diversity of interventions, the efficacy of WMB interventions and its impacts on emotional symptoms should be further explored.
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Silva ACAE, Santos IC, Carmo CND, Mattos IE. Symptoms and factors associated with symptom clusters among older adults with oral and oropharyngeal cancers at diagnosis. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: Describe differences in pretreatment symptoms and the composition of symptom clusters in older patients with oral and oropharyngeal cancer.
METHODS: In this cross-sectional study, quality of life (QoL) assessments for cancer patients (EORCT QLQ-C30 and QLQ-H & N35) were applied to 161 cases of oral and oropharyngeal cancer at the time of enrollment in an outpatient clinic. They were used to evaluate QoL-related symptoms reported by patients, according to their occurrence. To identify symptom clusters, an exploratory factor analysis (EFA) was performed, and the relationships between these clusters and independent variables were assessed with linear regression models. RESULTS: The most prevalent symptoms were pain (52%), worry (48%), and weight loss (44%). Five factors were extracted from the EFA, of which 3 were noteworthy. The dysphagia cluster was common to both cancer sites, although more frequent in oropharyngeal cancer patients, and included symptoms such as difficulty swallowing, pain, and weight loss. The psychological cluster included symptoms related to feeling worried, nervous, and depressed. The asthenia cluster, in addition to being age-related, may represent the advanced stage or progression of the disease. CONCLUSION: The dysphagia cluster loaded the most symptoms and was common to both cancers. In addition to pain (one of the main symptoms of the dysphagia cluster), psychological symptoms were also important in both groups of patients. Adequate and early control of these symptom clusters at diagnosis could favor better management of symptoms during treatment.
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Gilbertson-White S, Yeung C, Wickersham KE. "Just Living With Them": Symptom Management Experiences of Rural Residents With Advanced Cancer. Oncol Nurs Forum 2019; 46:531-542. [PMID: 31424451 DOI: 10.1188/19.onf.531-542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To understand how rural residents with advanced cancer experience and manage their symptoms. PARTICIPANTS & SETTING 16 adult patients with a diagnosis of advanced cancer, who were receiving antineoplastic treatment and living in rural areas of southeastern Iowa, participated in the study. METHODOLOGIC APPROACH Data were collected through semistructured, audio-recorded interviews using open-ended questions. Data were analyzed using content and dimensional analyses. FINDINGS Four themes were developed from the completed interviews, including (a) barriers and challenges associated with rural cancer care, (b) physical symptoms experienced from the time of diagnosis through the cancer trajectory, (c) symptom management strategies used to control physical symptoms, and (d) perceptions of having cancer and the use of technology in managing symptoms. IMPLICATIONS FOR NURSING Rural residents with advanced cancer experience a wide range of physical symptoms that may affect their quality of life. Although residents may develop self-management strategies to cope with symptoms, additional guidance on and interventions for how best to manage physical symptoms are needed.
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Tantoy IY, Cooper BA, Dhruva A, Cataldo J, Paul SM, Conley YP, Hammer M, Wright F, Dunn LB, Levine JD, Miaskowski C. Changes in the Occurrence, Severity, and Distress of Symptoms in Patients With Gastrointestinal Cancers Receiving Chemotherapy. J Pain Symptom Manage 2018; 55:808-834. [PMID: 29051114 PMCID: PMC5834370 DOI: 10.1016/j.jpainsymman.2017.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 01/02/2023]
Abstract
CONTEXT Studies on multiple dimensions of the symptom experience of patients with gastrointestinal cancers are extremely limited. OBJECTIVE Purpose was to evaluate for changes over time in the occurrence, severity, and distress of seven common symptoms in these patients. METHODS Patients completed Memorial Symptom Assessment Scale, six times over two cycles of chemotherapy (CTX). Changes over time in occurrence, severity, and distress of pain, lack of energy, nausea, feeling drowsy, difficulty sleeping, and change in the way food tastes were evaluated using multilevel regression analyses. In the conditional models, effects of treatment group (i.e., with or without targeted therapy), age, number of metastatic sites, time from cancer diagnosis, number of prior cancer treatments, cancer diagnosis, and CTX regimen on enrollment levels, as well as the trajectories of symptom occurrence, severity, and distress were evaluated. RESULTS Although the occurrence rates for pain, lack of energy, feeling drowsy, difficulty sleeping, and change in the way food tastes declined over the two cycles of CTX, nausea and numbness/tingling in hands/feet had more complex patterns of occurrence. Severity and distress ratings for the seven symptoms varied across the two cycles of CTX. CONCLUSIONS Demographic and clinical characteristics associated with differences in enrollment levels as well as changes over time in occurrence, severity, and distress of these seven common symptoms were highly variable. These findings can be used to identify patients who are at higher risk for more severe and distressing symptoms during CTX and to enable the initiation of preemptive symptom management interventions.
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Affiliation(s)
- Ilufredo Y Tantoy
- School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, California, USA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Fay Wright
- School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Palo Alto, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Symptom Clusters and Impact of Fatigue and Sleep Disturbance on Symptom Experiences of Hepatoma Patients in Taiwan. Cancer Nurs 2017; 40:403-411. [DOI: 10.1097/ncc.0000000000000417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shinn EH, Valentine A, Baum G, Carmack C, Kilgore K, Bodurka D, Basen-Engquist K. Comparison of four brief depression screening instruments in ovarian cancer patients: Diagnostic accuracy using traditional versus alternative cutpoints. Gynecol Oncol 2017; 145:562-568. [PMID: 28400146 DOI: 10.1016/j.ygyno.2017.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We compared the diagnostic accuracy of 4 depression screening scales, using traditional and alternative scoring methods, to the gold standard Structured Clinical Interview-DSM IV major depressive episode (MDE) in ovarian cancer patients on active treatment. METHODS At the beginning of a new chemotherapy regimen, ovarian cancer patients completed the following surveys on the same day: the Center for Epidemiological Studies Depression Scale (CES-D), the Beck Depression Inventory Fast-Screen for Primary Care (BDI-FastScreen), the Patient Health Questionnaire-9 (PHQ-9), and a 1-item screener ("Are you depressed?"). Each instrument's sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated with respect to major depression. To control for antidepressant use, the analyses were re-run for a subsample of patients who were not on antidepressants. RESULTS One hundred fifty-three ovarian cancer patients were enrolled into the study. Only fourteen participants met SCID criteria for current MDE (9%). When evaluating all patients regardless of whether they were already being treated with antidepressants, the two-phase scoring approach with an alternate cutpoint of 6 on the PHQ-9 had the best positive predictive value (PPV=32%). Using a traditional cutpoint of 16 on the CES-D resulted in the lowest PPV (5%); using a more stringent cutpoint of 22 resulted in a slightly improved but still poor PPV, 7%. CONCLUSIONS Screening with a two-phase PHQ-9 proved best overall, and its accuracy was improved when used with patients who were not already being treated with antidepressants.
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Affiliation(s)
- Eileen H Shinn
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center: Cancer Prevention Building - Unit 1330, 1155 Pressler St., Houston, TX 77030, USA.
| | - Alan Valentine
- Department of Psychiatry, The University of Texas MD Anderson Cancer Center: T. Boone Pickens Academic Tower - Unit 1454, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - George Baum
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center: Cancer Prevention Building - Unit 1330, 1155 Pressler St., Houston, TX 77030, USA.
| | - Cindy Carmack
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center: T. Boone Pickens Academic Tower - Unit 1414, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Kelly Kilgore
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center: T. Boone Pickens Academic Tower - Unit 1414, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Diane Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center: Mid Campus Building 1 - Unit 1727, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center: Cancer Prevention Building - Unit 1330, 1155 Pressler St., Houston, TX 77030, USA.
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Miaskowski C, Barsevick A, Berger A, Casagrande R, Grady PA, Jacobsen P, Kutner J, Patrick D, Zimmerman L, Xiao C, Matocha M, Marden S. Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations. J Natl Cancer Inst 2017; 109:2581261. [PMID: 28119347 PMCID: PMC5939621 DOI: 10.1093/jnci/djw253] [Citation(s) in RCA: 286] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/25/2016] [Accepted: 09/28/2016] [Indexed: 12/17/2022] Open
Abstract
An overview of proceedings, findings, and recommendations from the workshop on "Advancing Symptom Science Through Symptom Cluster Research" sponsored by the National Institute of Nursing Research (NINR) and the Office of Rare Diseases Research, National Center for Advancing Translational Sciences, is presented. This workshop engaged an expert panel in an evidenced-based discussion regarding the state of the science of symptom clusters in chronic conditions including cancer and other rare diseases. An interdisciplinary working group from the extramural research community representing nursing, medicine, oncology, psychology, and bioinformatics was convened at the National Institutes of Health. Based on expertise, members were divided into teams to address key areas: defining characteristics of symptom clusters, priority symptom clusters and underlying mechanisms, measurement issues, targeted interventions, and new analytic strategies. For each area, the evidence was synthesized, limitations and gaps identified, and recommendations for future research delineated. The majority of findings in each area were from studies of oncology patients. However, increasing evidence suggests that symptom clusters occur in patients with other chronic conditions (eg, pulmonary, cardiac, and end-stage renal disease). Nonetheless, symptom cluster research is extremely limited and scientists are just beginning to understand how to investigate symptom clusters by developing frameworks and new methods and approaches. With a focus on personalized care, an understanding of individual susceptibility to symptoms and whether a "driving" symptom exists that triggers other symptoms in the cluster is needed. Also, research aimed at identifying the mechanisms that underlie symptom clusters is essential to developing targeted interventions.
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Affiliation(s)
- Christine Miaskowski
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Andrea Barsevick
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Ann Berger
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Rocco Casagrande
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Patricia A. Grady
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Paul Jacobsen
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Jean Kutner
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Donald Patrick
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Lani Zimmerman
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Canhua Xiao
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Martha Matocha
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Sue Marden
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
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Cross, Associate Editor KL. The Importance of Mortality. J Palliat Med 2012; 15:960-1. [DOI: 10.1089/jpm.2012.9565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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