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Nardi M, Catalini A, Galiano A, Santangelo OE, Pinto E, Feltrin A, Nucci D, Gianfredi V. Association between malnutrition and anxiety in cancer patients-a retrospective study. Support Care Cancer 2024; 32:152. [PMID: 38334802 DOI: 10.1007/s00520-024-08350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION The total number of cancer-related deaths and new cancer cases in 2020 was 19.3 billion and 10.8 billion, respectively. Therefore, prevention, diagnosis, and treatment of neoplastic disease, as well as management of comorbidities, are of paramount importance. In this regards, poor nutritional status and mental disorders are comorbidity conditions frequently observed in cancer patients. The aim of this study was to assess the association between malnutrition and anxiety in hospitalized adult cancer patients. METHODS This is a retrospective study. Nutrition Risk Screening (NRS) 2002, body mass index (BMI), daily calorie intake, and weight difference between admission and discharge were used to evaluate nutritional status. Anxiety was assessed with the Hospital Anxiety and Depression Scale (HADS-A). Ordered logistic and linear logistic regressions adjusted for sex and age were used to estimate the association between malnutrition and anxiety in cancer patients. RESULTS A total of 90 patients were included. Higher NRS risk [aβ = 0.85; 95% CI (0.28-1.42); p = 0.004], disease stage [aβ = 0.77; 95% CI (0.08-1.47); p = 0.029], and cachexia [aβ = 2.20; 95% CI (0.75-3.65); p = 0.003] were significantly associated with anxiety symptoms. Moreover, cancer site different than gastrointestinal cancers was associated with a lower risk of anxiety symptoms [aβ = - 2.11; 95% CI (- 3.55/ - 0.66); p = 0.005]. CONCLUSION In the current study, we found a relatively high rate of malnourished patients, indicating the importance of routinely assessing nutritional status and screening cancer patients for mental health issues. This approach could help physicians to treat both in a timely manner, thereby significantly reducing the burden of the disease and improving the quality of life of patients.
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Affiliation(s)
- Mariateresa Nardi
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, 35128, Padua, Italy
| | - Alessandro Catalini
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, 60100, Ancona, Italy
| | - Antonella Galiano
- Oncology Unit 1, Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, 35128, Padua, Italy
| | | | - Eleonora Pinto
- Hospital Psychology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128, Padua, Italy.
| | - Alessandra Feltrin
- Hospital Psychology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128, Padua, Italy
| | - Daniele Nucci
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, 35128, Padua, Italy
| | - Vincenza Gianfredi
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
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Powers-James C, Morse M, Narayanan S, Ramondetta L, Lopez G, Wagner R, Cohen L. Integrative Oncology Approaches to Reduce Recurrence of Disease and Improve Survival. Curr Oncol Rep 2024; 26:147-163. [PMID: 38180690 DOI: 10.1007/s11912-023-01467-5] [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] [Accepted: 10/10/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW After a cancer diagnosis, patients ask what they can do in addition to the recommended treatments to increase their survival. Many turn to integrative medicine modalities and lifestyle changes to improve their chances of survival. Numerous studies have demonstrated that lifestyle changes can significantly improve survival rates for cancer patients. Less support exists for the use of natural products or supplements to improve cancer survival. In this manuscript, we review key findings and evidence in the areas of healthy eating habits, physical activity, stress management and social support, and sleep quality, as well as natural products and supplements as they relate to the cancer recurrence and survival. RECENT FINDINGS While more research is needed to fully understand the mechanisms underlying the associations between lifestyle changes and cancer survival, findings suggest that lifestyle modifications in the areas of diet, physical activity, stress management and social support, and sleep quality improve clinical cancer outcomes. This is especially true for programs that modify more than one lifestyle habit. To date, outside of supplementing with vitamin D to maintain adequate levels, conflicting conclusion within the research remain regarding the efficacy of using natural products or supplement to improve cancer recurrence of disease or cancer survival. A call for further research is warranted. Lifestyle screening and counseling should be incorporated into cancer treatment plans to help improve patient outcomes. While the scientific community strives for the pursuit of high-quality research on natural products to enhance cancer survival, transparency, dialogue, and psychological safety between patients and clinicians must continue to be emphasized. Proactive inquiry by clinicians regarding patients' supplement use will allow for an informed discussion of the benefits and risks of natural products and supplements, as well as a re-emphasis of the evidence supporting diet and other lifestyle habits to increase survival.
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Affiliation(s)
- Catherine Powers-James
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Meroë Morse
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Santhosshi Narayanan
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lois Ramondetta
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Gabriel Lopez
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Richard Wagner
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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He C, He Y, Yang T, Wu C, Lin Y, Yan J, Chang W, Chang F, Wang Y, Wu S, Cao B. Relationship of sleep-quality and social-anxiety in patients with breast cancer: a network analysis. BMC Psychiatry 2023; 23:887. [PMID: 38017507 PMCID: PMC10683122 DOI: 10.1186/s12888-023-05262-1] [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: 05/17/2023] [Accepted: 10/08/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND There is a complex relationship between social anxiety and sleep quality. However, network analysis studies of associations between social anxiety and sleep quality are lacking, particularly among patients with breast cancer. The current study aimed to extend this research to a sample of patients with breast cancer and to examine symptom-level associations between social anxiety and sleep quality using network analysis. METHODS Network analysis was conducted to explore their associations and identify bridge items of social anxiety and sleep quality. RESULTS The network structure revealed 9 important edges between social anxiety and sleep quality. "Subjective sleep quality" had the highest EI value in the network. "Working difficulty under watching" and "Sleep disorders" had the highest BEI values in their own communities. CONCLUSION There are complex pathological correlation pathways between social anxiety and sleep quality in breast cancer patients. "Subjective sleep quality", "Working difficulty under watching" and "Sleep disorders" have the potential to be intervention targets for sleep disorder-social anxiety comorbidity. Medical staff can take corresponding interventions according to the the centrality indices and bridge centrality indicators identified in this study, which is likely to effectively reduce the comorbidity of sleep disorders and social anxiety.
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Affiliation(s)
- Chunyan He
- Department of Nursing, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yang He
- Department of Psychology, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Tianqi Yang
- Department of Psychology, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Chao Wu
- Department of Nursing, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yawei Lin
- Department of Nursing, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Jiaran Yan
- Department of Nursing, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Wei Chang
- Center for Aerospace Clinical Medicine, Department of Aerospace Medicine, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Fenxia Chang
- Department of Obstetrics and Gynecology, Xi 'an Daxing Hospital, Xi'an, 710000, Shaanxi, China
| | - Yameng Wang
- School of Clinical Medicine, Anhui Medical University, Hefei, 230000, Anhui, China
| | - Shengjun Wu
- Department of Psychology, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
| | - Baohua Cao
- Department of Nursing, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
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DSilva F, Singh P, Javeth A. Determinants of Cancer-Related Fatigue among Cancer Patients: A Systematic Review. J Palliat Care 2023; 38:432-455. [PMID: 36245333 DOI: 10.1177/08258597221131133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: This systematic review aims to assess and explore various determinants of cancer- related fatigue. Methods: A systematic search of various determinants of Cancer-related fatigue (CRF) was performed in different databases like PubMed, Google Scholar, Science Direct and Clinical Key dating from 1990 to September 2020. Results: A total of 6115 studies were screened and 95 articles related to determinants of fatigue were retained. Various modifiable and non-modifiable determinants including socio-demographic, clinical, treatment related, plasma biomarker related, genetic, behavioural, concurrent symptoms related and psychological determinants were identified. Depression was one of the significant factors reported in 28% of studies, followed by pain, (17%), performance status (16%), chemotherapy and anxiety (15%). Conclusion: It is recommended that nurses and clinicians should anticipate, identify and take appropriate interventions to manage those modifiable factors. Ultimately, managing the modifiable factors helps in the comprehensive care of cancer patients.
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Affiliation(s)
- Fatima DSilva
- Nitte Usha Institute of Nursing Sciences, Nitte University, Mangalore, Karnataka, India
| | - Pritanjali Singh
- Department of Radiation Oncology, All India Institute of Medical Science (AIIMS), Patna, Bihar, India
| | - Athar Javeth
- College of Nursing, All India Institute of Medical Science (AIIMS), Patna, Bihar, India
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Kos M, Brouwer CG, van Laarhoven HW, Hopman MT, van Oijen MG, Buffart LM. The association between wearable device metrics and clinical outcomes in oncology: a systematic review with evidence synthesis and meta-analysis. Crit Rev Oncol Hematol 2023; 185:103979. [PMID: 37001837 DOI: 10.1016/j.critrevonc.2023.103979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The emerging study of wearable devices (WDs) in patients with cancer provides opportunities to harness real-time patient data for predicting clinical outcomes. We conducted a systematic review with best evidence synthesis to examine the association between WD metrics and clinical outcomes in patients with cancer. METHODS MEDLINE and Embase were searched from inception until June 2022. Risk of bias assessment and best evidence synthesis were performed and, If possible, meta-analysis was conducted. RESULTS A total of 34 studies was included. We found moderate-to-strong evidence for associations between circadian rest-activity metrics and OS. Disrupted I<O was associated with increased hazard for death (HR 2.08; 95 %CI: 1.50-2.88). For most associations there was insufficient evidence due to lack of studies (n = 32) or inconsistent results (n = 14). CONCLUSION Meta-analysis was greatly hampered due to heterogeneity and different methodology used between studies. Studies primarily designed to investigate the association between WD metrics and clinical outcomes are warranted.
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Abebe E, Giru BW, Boka A. Sleep Quality and Associated Factors Among Adult Cancer Patients on Treatments at Tikur Anbessa Specialized Hospital Oncology Unit, Addis Ababa, Ethiopia, 2021. Cancer Control 2023; 30:10732748231160129. [PMID: 36812068 PMCID: PMC9950603 DOI: 10.1177/10732748231160129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Patients with cancer frequently reported sleep problems during their treatments which can affect their sleep quality have an impact on patients' quality of life (QOL). OBJECTIVE to assess the prevalence of sleep quality and associated factors in adult cancer patients on treatment in the Oncology unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2021. METHODS institutional-based cross-sectional study design was used and data was collected by using face-to-face structured interview questionnaires from March 1 to April 1, 2021. Sleep Quality Index (PSQI) consisted of 19 items, the social support scale (OSS-3) consisted of 3 items, and the Hospital Anxiety and Depression Scale (HADS) consisted of 14 items were applied. Logistic regression including bivariate and multivariate analysis was done to examine the association between dependent and independent variables, and P< 0.05 was considered the level of significance for associations. RESULTS A total of 264 sampled adult cancer patients on treatments were included in this study, with a response rate of 93.61%. About 26.5% of the participants' age distribution was between 40 to 49 years, and 68.6% were female. 59.8% of the study participants were married. Concerning education, about 48.9% of participants attended primary and secondary school and 45% of participants were unemployed. Overall, 53.79% of individuals had poor sleep quality. Low income ((AOR=5.36 CI 95% (2.23, 12.90), fatigue (AOR=2.89 CI 95(1.32, 6.33), pain (AOR 3.82 C I95 % (1.84, 7.93), poor of social support (AOR =3.20 CI 95% (1.43, 6.74), anxiety (AOR=3.48 CI 95% (1.44, 8.38) and depression (AOR 2.87 CI 95 % (1.05-7.391) were all associated with poor sleep quality. CONCLUSION This study revealed a high prevalence of poor sleep quality, which was significantly associated with factors like low income, fatigue, pain, poor social support, anxiety, and depression among cancer patients on treatments.
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Affiliation(s)
- Eshetu Abebe
- Jimma University Medical
Center, Jimma, Ethiopia
| | - Berhanu Wordofa Giru
- School of Nursing and Midwifery
College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abdissa Boka
- School of Nursing and Midwifery
College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia,Abdissa Boka, School of Nursing and
Midwifery, College of Health Science, Addis Ababa University, Addis Ababa 1000,
Ethiopia.
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Baussard L, Cousson-Gélie F, Jarlier M, Charbonnier E, Le Vigouroux S, Montalescot L, Janiszewski C, Fourchon M, Coutant L, Guerdoux E, Portales F. Hypnosis and cognitive behavioral therapy with online sessions to reduce fatigue in patients undergoing chemotherapy for a metastatic colorectal cancer: Rational and study protocol for a feasibility study. Front Psychol 2022; 13:953711. [PMID: 35967617 PMCID: PMC9363840 DOI: 10.3389/fpsyg.2022.953711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background In metastatic colorectal cancer (CRCm), fatigue is pervasive, reduces quality of life, and is negatively associated with survival. Its course is explained in part by psychosocial variables such as emotional distress, coping strategies, or perceived control. Thus, to reduce fatigue, psychosocial interventions appear to be relevant. In some cancers, Cognitive Behavioral Therapies (CBT) reduce fatigue. Hypnosis is also used as a complementary therapy to reduce the side effects of cancer. While CBT requires specific training often reserved for psychologists, hypnosis has the advantage of being increasingly practiced by caregivers and is therefore less expensive (Montgomery et al., 2007). On the other hand, CBT and hypnosis remain understudied in the CRC, do not focus on the symptom of fatigue and in Europe such programs have never been evaluated. Objectives Implementing an intervention in a healthcare setting is complex (e.g., economic and practical aspects) and recruiting participants can be challenging. The primary objective will therefore be to study the feasibility of two standardized interventions (hypnosis and CBT) that aim to reduce fatigue in patients with CRCm treated in a French cancer center. Methods and design A prospective, single-center, randomized interventional feasibility study, using mixed methods (both quantitative and qualitative). A total of 60 patients will be allocated to each intervention group [Hypnosis (n = 30) and CBT (n = 30)]. Participants will be randomized into two parallel groups (ratio 1:1). Both programs will consist of 6 weekly sessions focusing on the CRF management over a period of 6 weeks. Trained therapists will conduct the program combining 3 face-to-face sessions and 3 online sessions. The feasibility and experience of interventions will be evaluated by the outcome variables, including the adhesion rate, the reasons for acceptability, relevance or non-adherence, the satisfaction, the fatigue evolution (with ecological momentary assessments), and the quality of life. All questionnaires will be self-assessment using an online application from the cancer center. Discussion Results will highlight the barriers/facilitators to the implementation of the program and the relevance of the program to the patients, and will be used to generate hypotheses for a randomized control trial. Clinical trial registration ClinicalTrials.gov Identifier: NCT04999306; https://clinicaltrials.gov/ct2/show/NCT04999306.
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Affiliation(s)
- Louise Baussard
- UNIV. NIMES, APSY-V, F-30021 Nîmes Cedex 1, Languedoc-Roussillon, France
- *Correspondence: Louise Baussard
| | - Florence Cousson-Gélie
- Université Paul Valéry Montpellier 3, Laboratoire Epsylon EA4556, Languedoc-Roussillon, France
| | - Marta Jarlier
- Institut du Cancer de Montpellier – Université de Montpellier, Languedoc-Roussillon, France
| | - Elodie Charbonnier
- UNIV. NIMES, APSY-V, F-30021 Nîmes Cedex 1, Languedoc-Roussillon, France
| | - Sarah Le Vigouroux
- UNIV. NIMES, APSY-V, F-30021 Nîmes Cedex 1, Languedoc-Roussillon, France
| | - Lucile Montalescot
- UNIV. NIMES, APSY-V, F-30021 Nîmes Cedex 1, Languedoc-Roussillon, France
| | - Chloé Janiszewski
- Institut du Cancer de Montpellier – Université de Montpellier, Languedoc-Roussillon, France
| | - Michele Fourchon
- UNIV. NIMES, APSY-V, F-30021 Nîmes Cedex 1, Languedoc-Roussillon, France
| | - Louise Coutant
- Institut du Cancer de Montpellier – Université de Montpellier, Languedoc-Roussillon, France
| | - Estelle Guerdoux
- Institut du Cancer de Montpellier – Université de Montpellier, Languedoc-Roussillon, France
- Institut Desbrest d'Epidémiologie et de Santé Publique, INSERM, Université de Montpellier, Languedoc-Roussillon, France
| | - Fabienne Portales
- Institut du Cancer de Montpellier – Université de Montpellier, Languedoc-Roussillon, France
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He X, Ng M, Choi K, Li L, Zhao W, Zhang M, So W. Synergistic Interactions Among Fatigue, Sleep Disturbance, and Depression in Women With Breast Cancer: A Cross-Sectional Study. Oncol Nurs Forum 2022; 49:243-254. [PMID: 35446832 DOI: 10.1188/22.onf.243-254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the symptom cluster of fatigue, sleep disturbance, and depression among female patients with breast cancer receiving chemotherapy, and to evaluate its impact on quality of life (QOL) and symptom severity. SAMPLE & SETTING 372 patients receiving adjuvant chemotherapy recruited from two tertiary hospitals in China. METHODS & VARIABLES Symptom severity and QOL were evaluated using the Brief Fatigue Inventory, Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, and Functional Assessment of Cancer Therapy-Breast on the eighth day after receiving chemotherapy. RESULTS All symptoms positively correlated with each other. Although the symptom cluster was significantly associated with decreased QOL, individualized symptom severity worsened as the number of symptoms increased. IMPLICATIONS FOR NURSING The prevalence of and interactions among fatigue, sleep disturbance, and depression negatively affect symptom severity and patients' QOL. Conducting early assessment followed by effective cluster-based interventions is needed to manage this symptom cluster.
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Affiliation(s)
| | | | | | - Lulu Li
- Fifth Affiliated Hospital of Sun Yat-Sen University
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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.
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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
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Sleep disturbance in cancer patients referred to an ambulatory integrative oncology consultation. Support Care Cancer 2021; 30:2417-2425. [PMID: 34762218 DOI: 10.1007/s00520-021-06668-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sleep disturbance (SD) is highly prevalent in oncology and negatively affects quality of life and mortality. Evidence supports the use of integrative oncology (IO) practices to treat SD, but there is limited published data on the characteristics of SD and factors associated with SD in IO. We determined the prevalence, severity, and factors associated with SD among cancer patients seen in an ambulatory IO consultation. METHODS Patients with cancer referred for initial outpatient IO consultation in 2017 were eligible. Patient demographics, clinical characteristics, and patient-reported outcomes (Edmonton Symptom Assessment Scale (ESAS), Measure Yourself Concerns and Wellbeing (MYCaW), PROMIS-10) were retrospectively reviewed. RESULTS One thousand five hundred twenty patients were included in the analysis. The majority (70%) were women with breast cancer (42%). Nine hundred seventy-one (64%) patients reported significant SD with ESAS Sleep ≥ 4, yet only 11% expressed poor sleep as their primary or secondary concern for the IO consultation. The median SD (IQR) was 5 (3,7). ESAS scores for fatigue (adjusted OR 1.16; CI 1.07-1.26, p < 0.001), pain (adjusted OR 1.07; CI 1.00-1.15, p < 0.05), hot flashes (adjusted OR 1.14; CI 1.07-1.22, p < 0.001), well-being (adjusted OR 1.33; CI 1.22-1.46, p < 0.001), and psychological distress score (anxiety and depression) (adjusted OR 1.16; CI 1.01-1.11, p < 0.01) were independently associated with SD in multivariate analysis. Acupuncture was the most frequent intervention prescribed, 175 (35%). Other modalities included oncology massage (15%), health psychology (5%), and meditation (1%). CONCLUSIONS Although 64% of patients seeking IO consultation reported clinically significant SD, only 11% were seeking integrative approaches for managing SD. ESAS fatigue, hot flashes, well-being, and psychological symptoms were significantly associated with SD.
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Li CC, Chou YJ, Shun SC. The Relationship Between Muscle Strength and Body Composition Measures and Cancer-Related Fatigue: A Systematic Review and Meta-Analysis. Oncol Nurs Forum 2021; 48:558-576. [PMID: 34411084 DOI: 10.1188/21.onf.558-576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Cancer-related fatigue (CRF) substantially affects daily living and quality of life, but objective CRF measures remain limited. This review aimed to identify the correlation between muscle strength and body composition measures and CRF, as well as potential objective indicators for assessing CRF. LITERATURE SEARCH PubMed®, MEDLINE®, CINAHL®/PsycINFO®, and Embase® were searched for studies published from January 2000 to January 2021. DATA EVALUATION Study selection and quality assessment were conducted using the Critical Appraisals Skills Programme checklist and the Strengthening the Reporting of Observational Studies in Epidemiology statement. Comprehensive Meta-Analysis software was used to perform meta-analysis. SYNTHESIS 25 studies were selected, and 19 measures were analyzed. CRF negatively correlated with hand grip strength, knee extensor strength, and the sit-to-stand test. No significant correlation was found between body composition measures and CRF. IMPLICATIONS FOR NURSING The evidence suggests that muscle strength measures may be potential indicators for CRF assessment. Combining objective and subjective CRF assessments could assist clinicians in evaluating the effectiveness of CRF interventions more accurately.
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Nelson AM, Hyland KA, Small B, Kennedy B, Mishra A, Hoogland AI, Bulls HW, Jim HSL, Jacobsen PB. Contribution of Sleep Disruption and Sedentary Behavior to Fatigue in Survivors of Allogeneic Hematopoietic Cell Transplant. Ann Behav Med 2021; 55:870-878. [PMID: 33410478 DOI: 10.1093/abm/kaaa110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fatigue is a prominent quality of life concern among recipients of hematopoietic cell transplantation (HCT). PURPOSE The present study investigated whether objectively measured sleep efficiency and sedentary behavior are related to greater reports of fatigue. METHODS Eighty-two allogeneic HCT recipients who were 1-5 years post-transplant and returning for a follow-up visit participated (age M = 56, 52% female, 56% leukemia). They wore an actigraph assessing sleep efficiency and sedentary behavior for one week and completed an electronic log assessing fatigue each evening during the same period. RESULTS Twenty-six percent of patients reported clinically meaningful fatigue. On average, fatigue was mild (M = 2.5 on 0-10 scale, SD = 2.0), sleep was disturbed (sleep efficiency M = 78.9%, SD = 8.9), and patients spent the majority of time in sedentary (M = 55.4%, SD = 10.2) or light (M = 35.9%, SD = 8.6) activity. Multilevel model analysis of between-person differences indicated that patients who experienced less efficient sleep the previous evening provided greater evening reports of average fatigue, b = -0.06, 95% CI (-0.11, -0.01). Similarly, within-person analyses indicated that when patients experienced less efficient sleep the previous evening or were more sedentary as compared to their average, they provided greater evening reports of average fatigue, b = -0.02, 95% CI (-0.05, -0.004); b = 4.46, 95% CI (1.95, 6.97), respectively. CONCLUSIONS Findings demonstrate that poor sleep and daily sedentary behavior are related to evening reports of fatigue and should be considered modifiable targets for intervention.
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Affiliation(s)
- Ashley M Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, MA, USA
| | - Kelly A Hyland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Brent Small
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Brittany Kennedy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Asmita Mishra
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Hailey W Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
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Kallel F, Masmoudi S, Kassar O, Mallek R, Medhaffar M, Elloumi M. Prospective observational study of palliative care in hematological malignancies: Report of one year of practice. Transfus Clin Biol 2021; 29:44-48. [PMID: 34411747 DOI: 10.1016/j.tracli.2021.08.003] [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: 06/07/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Palliative care is an approach that improves the quality of life of patients with advanced disease. OBJECTIVE The aim of this study is to evaluate the process of palliative care in patients with hematologic malignancies. METHODS In this prospective observational study, we included patients with hematologic malignancies who received palliative care over a 12 month period from June 1, 2019, to May 31, 2020 at the day care hospital of the hematology department in University Hospital of Sfax, Tunisia. Blood transfusion was used to relieve symptoms of anemia and bleeding. RESULTS Fifty-five patients were included. The median age was 68 years. Forty-three percent of patients were diagnosed with acute leukemia and 41.8% with myelodysplastic syndrome. Red cell and platelet transfusions were indicated in 94.5% and 36.3% of cases respectively. Patients reported improvement after blood transfusion in 50% of cases. Twenty-five transfusion reactions (45%) were noted. Fever was noted in 33 patients (60%), with documented sites of infection in 84.8% of them. Pulmonary infection was frequently noted (50%). Antimicrobial treatment was prescribed in all febrile cases. Pain was reported in 22 patients and in 77.5% of these cases, it was nociceptive. Patients who received analgesics showed clinical improvement in pain in 81% of cases. Anorexia with malnutrition was reported in 23% of cases which was treated with enteral nutrition in 75% of cases. Sleep disturbance (20 patients), anxiety (7 patients), and depression (4 patients) were mentioned respectively. CONCLUSION Palliative care in hematology should be a multidisciplinary care approach with a global management of the various physical, psychological and sociological complications.
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Affiliation(s)
- Faten Kallel
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia.
| | - Sonda Masmoudi
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia
| | - Olfa Kassar
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia
| | - Rahma Mallek
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia
| | - Moez Medhaffar
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia
| | - Moez Elloumi
- Hedi chaker hospital, El Ain road, Km0 5, 3000, Sfax, Tunisia; Faculty medecine of sfax, Avenue Majida BOULILA, 3029 Sfax, Tunisia
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Anamorelin combined with physical activity, and nutritional counseling for cancer-related fatigue: a preliminary study. Support Care Cancer 2021; 30:497-509. [PMID: 34331589 DOI: 10.1007/s00520-021-06463-8] [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] [Received: 03/31/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cancer-related fatigue (CRF) is the most frequent and debilitating symptom in patients with advanced cancer. There are limited effective treatments for CRF. The objective of this prospective longitudinal study was to evaluate the change in CRF at Day 43 after treatment with combination therapy of oral Anamorelin 100 mg daily with physical activity and nutrition counseling. METHODS In this study, patients with CRF [≤ 34 Functional Assessment of Chronic Illness Therapy-Fatigue subscales(FACIT-F)] received Anamorelin 100 mg orally daily with standardized physical activity and nutrition counseling for 43 days. Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Anorexia Cachexia(FAACT-ACS), Multidimensional Fatigue Symptom Inventory-Short Form(MFSI-SF), Patient-Reported Outcomes Measurement Information System(PROMIS-Fatigue), body composition, and physical performance tests were assessed at baseline, Day 15, 29, and 43. Frequency and type of side effects were determined by NCI CTAE 4.0.(NCT03035409). RESULTS 28/45 (62%) of patients dosed were evaluable at Day 43. The mean, SD for FACIT-F subscale improvement from baseline was 4.89 (± 13.07), P = .058, MFSI-SF (G) - 3.46 (± 6.86), P = 0.013, PROMIS-fatigue - 4.14 (± 7.88), P = 0.010, FAACT ACS 3.48 (± 8.13), P = 0.035. Godin Liesure-Time physical activity questionnaire 7.41 (± 16.50), P = 0.038. Weight (kg) 1.81 (± 2.63), P = 0.005, and Lean Body Mass 1.54 (± 1.85), P = 0.001, IGF-1 36.50 (± 48.76), P = 0.015. There was no significant improvement in physical performance outcomes. No adverse events > grade 3 related to the study drug were reported. CONCLUSION The use of the combination therapy was associated with improvement of CRF (FACIT-F fatigue, PROMIS-fatigue, MFSI-SF-general), activity (Godin-leisure time), anorexia (FAACT), body composition, and IGF-1 levels. Further studies using combination therapy for CRF are justified.
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Balachandran DD, Miller MA, Faiz SA, Yennurajalingam S, Innominato PF. Evaluation and Management of Sleep and Circadian Rhythm Disturbance in Cancer. Curr Treat Options Oncol 2021; 22:81. [PMID: 34213651 DOI: 10.1007/s11864-021-00872-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT Sleep and circadian rhythm disturbance are among the most commonly experienced symptoms in patients with cancer. These disturbances occur throughout the spectrum of cancer care from diagnosis, treatment, and long into survivorship. The pathogenesis of these symptoms and disturbances is based on common inflammatory pathways related to cancer and its' treatments. The evaluation of sleep and circadian disorders requires an understanding of how these symptoms cluster with other cancer-related symptoms and potentiate each other. A thorough evaluation of these symptoms and disorders utilizing validated diagnostic tools, directed review of clinical information, and diagnostic testing is recommended. Treatment of sleep and circadian disturbance in cancer patients should be based on the findings of a detailed evaluation, including specific treatment of primary sleep and circadian disorders, and utilize integrative and personalised management of cancer-related symptoms through multiple pharmacologic and non-pharmacologic modalities. Recognition, evaluation, and treatment of sleep and circadian rhythm disturbance in cancer may lead to improved symptom management, quality of life, and outcomes.
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Affiliation(s)
- Diwakar D Balachandran
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street. Unit 1462, Houston, TX, 77030-4009, USA.
| | - Michelle A Miller
- Division of Health Sciences (Mental Health & Wellbeing), University of Warwick, Warwick Medical School, Gibbet Hill, Coventry, UK
| | - Saadia A Faiz
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street. Unit 1462, Houston, TX, 77030-4009, USA
| | - Sriram Yennurajalingam
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pasquale F Innominato
- North Wales Cancer Treatment Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK
- Cancer Chronotherapy Team, Warwick Medical School, Coventry, UK
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Castro-Figueroa EM, Torres-Blasco N, Rosal MC, Jiménez JC, Castro-Rodríguez WP, González-Lorenzo M, Vélez-Cortés H, Toro-Bahamonde A, Costas-Muñiz R, Armaiz-Peña GN, Jim H. Brief Report: Hispanic Patients' Trajectory of Cancer Symptom Burden, Depression, Anxiety, and Quality of Life. NURSING REPORTS 2021; 11:475-483. [PMID: 34968222 PMCID: PMC8608069 DOI: 10.3390/nursrep11020044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Anxiety and depression symptoms are known to increase cancer symptom burden, yet little is known about the longitudinal integrations of these among Hispanic/Latinx patients. The goal of this study was to explore the trajectory and longitudinal interactions among anxiety and depression, cancer symptom burden, and health-related quality of life in Hispanic/Latinx cancer patients undergoing chemotherapy. Methods: Baseline behavioral assessments were performed before starting chemotherapy. Follow-up behavioral assessments were performed at 3, 6, and 9 months after starting chemotherapy. Descriptive statistics, chi-square tests, Fisher’s exact tests, and Mann–Whitney tests explored associations among outcome variables. Adjusted multilevel mixed-effects linear regression models were also used to evaluate the association between HADS scores, follow-up visits, FACT—G scale, MDASI scale, and sociodemographic variables. Results: Increased cancer symptom burden was significantly related to changes in anxiety symptoms’ scores (adjusted β^ = 0.11 [95% CI: 0.02, 0.19]. Increased quality of life was significantly associated with decreased depression and anxiety symptoms (adjusted β^ = −0.33; 95% CI: −0.47, −0.18, and 0.38 adjusted β^= −0.38; 95% CI: −0.55, −0.20, respectively). Conclusions: Findings highlight the need to conduct periodic mental health screenings among cancer patients initiating cancer treatment.
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Affiliation(s)
- Eida M. Castro-Figueroa
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
- Correspondence:
| | - Normarie Torres-Blasco
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
| | - Milagros C. Rosal
- Population and Quantitative Health Sciences, School of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA;
| | - Julio C. Jiménez
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
| | | | - Marilis González-Lorenzo
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
| | - Héctor Vélez-Cortés
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
| | | | - Rosario Costas-Muñiz
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, Puerto Rico, CA 00984, USA;
| | - Guillermo N. Armaiz-Peña
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
| | - Heather Jim
- Moffitt Cancer Center, Tampa, FL 33612, USA;
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Yennurajalingam S, Carmack C, Balachandran D, Eng C, Lim B, Delgado M, Guzman Gutierrez D, Raznahan M, Park M, Hess KR, Williams JL, Lu Z, Ochoa J, Bruera E. Sleep disturbance in patients with cancer: a feasibility study of multimodal therapy. BMJ Support Palliat Care 2021; 11:170-179. [PMID: 31924662 DOI: 10.1136/bmjspcare-2019-001877] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Our aim was to determine feasibility and effect sizes of bright light therapy (BLT), melatonin (MLT), methylphenidate (MP) and eight combinations (BLT+MLT+MP, BLT+MLT, BLT+MP, BLT alone, MLT+MP, MLT alone, MP alone, placebo for BLT, MLT and MP) defined as multimodal therapy (MMT), to improve sleep quality (SQ) (Pittsburgh Sleep Quality Index (PSQI)) from baseline to day 15. We also examined the effects of MMT on insomnia, fatigue, depression, quality of life and actigraphy. METHODS Patients with advanced cancer with poor SQ (PSQI ≥5) were eligible. Using a double-blind randomised factorial study design, patients were randomised into 1 of the 8 arms for 2 weeks. Feasibility and effect sizes were assessed. RESULTS 81% (54/67) of randomised patients completed the study. There were no differences in the demographics and SQ between groups. The adherence rates for BLT, MLT and MP were 93%, 100% and 100%, respectively. BLT+MLT+placebo of MP; BLT+placebo of MLT+placebo of MP; BLT+MLT+MP showed an effect size (Cohen's d) for change in PSQI scores of 0.64, 0.57 and 0.63, respectively. PSQI change using linear regression showed BLT (n=29) has effect size of 0.46, p=0.017; MLT (n=26), 0.24, p=0.20; MP (n=26), 0.06, p=0.46. No significant differences were observed in scores for insomnia, fatigue, depression, quality of life and actigraphy. There were no differences in adverse events by groups(p=0.80). CONCLUSIONS The use of MMT to treat SQ disturbance was feasible. BLT+MLT showed the most promising effect size in improvement in SQ, and additional larger studies are needed. TRIAL REGISTRATION NUMBER NCT01628029.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cindy Carmack
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dave Balachandran
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cathy Eng
- Department of Gastrointestinal Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Bora Lim
- Department of Breast Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marvin Delgado
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Guzman Gutierrez
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Monica Raznahan
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Minjeong Park
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth R Hess
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhanni Lu
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jewel Ochoa
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Ratcliff CG, Zepeda SG, Hall MH, Tullos EA, Fowler S, Chaoul A, Spelman A, Arun B, Cohen L. Patient characteristics associated with sleep disturbance in breast cancer survivors. Support Care Cancer 2020; 29:2601-2611. [PMID: 32964261 DOI: 10.1007/s00520-020-05777-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Disturbed sleep is common among breast cancer survivors. Identifying patients at risk for disturbed sleep and its sequelae will aid in improving screening and intervention strategies to improve sleep and cancer-related quality of life (QOL). METHODS Women with stages I-III breast cancer undergoing neoadjuvant or adjuvant chemotherapy (N = 415) reported subjectively assessed sleep quality (PSQI) and actigraphy-assessed wake after sleep onset (AAS-WASO), total sleep time (AAS-TST), and sleep efficiency (AAS-SE), sociodemographic, and clinical characteristics and completed questionnaires assessing physical and mental health QOL at study entry and 3, 6, 12, and 15 months later. RESULTS Being from a racially/ethnically underserved population was associated with poorer sleep in all indices (p's < .04). Lower income was associated with poorer subjective sleep and greater AAS-WASO (p's < .02). BMI was associated with lower AAS-SE (p < .001). Baseline subjective sleep complaints were positively associated with depression, fatigue, and health-related QOL and cancer-related symptoms across follow-up (p's < 0.05). Baseline AAS-WASO was positively associated with anxiety and negatively associated with physical health-related QOL at the 3-month follow-up (p's < .001). Baseline AAS-WASO and AAS-SE were associated with mental health-related QOL at the 6-month follow-up (p's < .05). CONCLUSIONS In keeping with previous health disparity research, racially/ethnically underserved populations, lower household income, and higher BMI were associated with increased risk for disturbed sleep. Sleep disturbance may have long-term effects on multiple aspects of QOL for women undergoing treatment for breast cancer. Results may inform strategies to identify patients at greatest risk for disturbed sleep and its sequelae.
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Affiliation(s)
- Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA. .,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Stephanie G Zepeda
- Departmnet of Psychology, Our Lady of the Lake University, The Woodlands, TX, USA
| | - Martica H Hall
- Department of Psychology, The University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily A Tullos
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
| | - Shaelyn Fowler
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
| | | | - Amy Spelman
- Office of Protocol Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Cheung DST, Yeung WF, Chau PH, Lam TC, Yang M, Lai K, Ip CY, Lao L, Lin CC. Patient-centred, self-administered acupressure for Chinese advanced cancer patients experiencing fatigue and co-occurring symptoms: A pilot randomised controlled trial. Eur J Cancer Care (Engl) 2020; 31:e13314. [PMID: 32896014 DOI: 10.1111/ecc.13314] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 06/18/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the feasibility and potential effects of patient-centred self-administered acupressure for alleviating fatigue and co-occurring symptoms among Chinese advanced cancer patients receiving treatment. METHODS Thirty advanced cancer patients who screened positive for moderate/severe fatigue with symptoms of insomnia and/or pain were recruited from a hospital in Hong Kong. They were randomly assigned (1:1) to receive a 4-week patient-centred self-administered acupressure intervention or health education. Fatigue (primary outcome) and secondary outcomes (sleep quality, pain, fatigue-sleep disturbance-pain symptom cluster severity, anxiety, depression and quality of life) were measured by questionnaires and actigraphy. RESULTS Twenty-four participants (80%) completed the study. Adherence to self-administered acupressure practice was satisfactory, with all retained participants attending all sessions and 90.9% practising acupressure daily. All completers rated the class as very enjoyable or quite enjoyable. Fatigue, pain, symptom cluster severity, anxiety, depression and quality of life appeared to improve from baseline to post-intervention in the intervention group. Among these outcomes, only the between-group difference in anxiety post-intervention was significant. The group × time interaction effect was nonsignificant for all outcomes. CONCLUSIONS Patient-centred self-administered acupressure appears to be feasible and acceptable among advanced cancer patients. A fully powered trial is warranted to confirm the intervention effect.
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Affiliation(s)
- Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tai Chung Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mingxiao Yang
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kithelia Lai
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Chun Yat Ip
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Lixing Lao
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Virginia University of Integrative Medicine, Virginia, United States
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong, China.,School of Nursing, College of Nursing, Taipei Medical University, Taiwan
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The short-term impact of methylprednisolone on patient-reported sleep in patients with advanced cancer in a randomized, placebo-controlled, double-blind trial. Support Care Cancer 2020; 29:2047-2055. [PMID: 32856209 PMCID: PMC7892512 DOI: 10.1007/s00520-020-05693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022]
Abstract
Purpose Although corticosteroids are frequently used in patients with advanced cancer, few studies have examined the impact of these drugs on patient-reported sleep. We aimed to examine the short-term impact of methylprednisolone on patient-reported sleep in patients with advanced cancer. Methods Patient-reported sleep was a predefined secondary outcome in a prospective, randomized, placebo-controlled, double-blind trial that evaluated the analgesic efficacy of corticosteroids in advanced cancer patients (18+), using opioids, and having pain ≥ 4 past 24 h (NRS 0–10). Patients were randomized to the methylprednisolone group with methylprednisolone 16 mg × 2/day or placebo for 7 days. The EORTC QLQ-C30 (0–100) and the Pittsburgh Sleep Quality Index questionnaire (PSQI) (0–21) were used to assess the impact of corticosteroids on sleep at baseline and at day 7. Results Fifty patients were randomized of which 25 were analyzed in the intervention group and 22 in the control group. Mean age was 64 years, mean Karnofsky performance status was 67 (SD 13.3), 51% were female, and the mean oral daily morphine equivalent dose was 223 mg (SD 222.77). Mean QLQ-C30 sleep score at baseline was 29.0 (SD 36.7) in the methylprednisolone group and 24.2 (SD 27.6) in the placebo group. At day 7, there was no difference between the groups on QLQ-C30 sleep score (methylprednisolone 20.3 (SD 32.9); placebo 28.8 (SD 33.0), p = 0.173). PSQI showed similar results. Conclusions Methylprednisolone 16 mg twice daily for 7 days had no impact on patient-reported sleep in this cohort of patients with advanced cancer. Trial registration Clinical trial information NCT00676936 (13.05.2008)
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Brain-derived neurotrophic factor polymorphism Val66Met protects against cancer-related fatigue. Transl Psychiatry 2020; 10:302. [PMID: 32848137 PMCID: PMC7450091 DOI: 10.1038/s41398-020-00990-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/26/2022] Open
Abstract
Cancer-related fatigue is an extremely common and debilitating psychiatric symptom that affects up to 80% of cancer patients. Despite its negative impact on the patient's quality of life, there is no well-established biomarker or mechanisms associated with this debilitating condition. The functional brain-derived neurotrophic factor (BDNF) Val66Met single nucleotide polymorphism (SNP) has been associated with a variety of psychiatric illnesses. We hypothesized that Val66Met may influence the risk for developing cancer-related fatigue. BDNF Val66Met was analyzed by polymerase chain reaction in 180 patients with confirmed cancer diagnoses. Fatigue was measured using the Functional Assessment of Cancer Therapy-Fatigue (FACIT-Fatigue) questionnaire. Depression was measured using the Hamilton Depression Scale (HAM-D). Data were transformed when necessary and regression models were constructed to access the association between genotype and symptom severity. Participants carrying the Met allele reported significantly less fatigue compared to the Val/Val genotype group. The presence of the Met allele did not influence depression levels. The results suggest that the BDNF Val66Met polymorphism confers protective advantage against cancer-related fatigue; whereas having the Val/Val genotype may be a genetic risk factor. Findings from this study not only provide clues to the neural basis of cancer-related fatigue, but also allow for symptom severity prediction and patient education with the goal to improve symptom management.
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Begnini D, Giradon-Perlini NMO, Beuter M, Silva L, Sand ICPVD, Misko MD. Family experience living with advanced neoplasm: a glance at the rural population. Rev Bras Enferm 2020; 73:e20180895. [PMID: 32520097 DOI: 10.1590/0034-7167-2018-0895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/06/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to understand the experience of rural families living with advanced cancer, from Family Management Style Framework's perspective. METHODS a qualitative research conducted in seven cities of the northern of state of Rio Grande do Sul in homes of 11 families (27 people). Data collection took place in 2014, using the genogram and narrative interview. Analysis followed Family Management Style Framework's theoretical model. RESULTS the results were organized into three categories based on conceptual components of the referred model: no more normal life: situation definition; attempt to reconcile care and work: management behavior; imminence of the finitude of life: perception of consequences. FINAL CONSIDERATIONS living in rural context gives families specific ways of dealing with advanced cancer. Understanding the movements undertaken by rural families throughout the experience can guide nursing professionals in planning interventions collaborating with this population's health.
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Affiliation(s)
- Danusa Begnini
- Universidade Federal do Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Mardrig Beuter
- Universidade Federal de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil
| | - Lucía Silva
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
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Fatigue and Sleep Disturbance in Arabic Cancer Patients After Completion of Therapy. Cancer Nurs 2020; 44:378-387. [DOI: 10.1097/ncc.0000000000000825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Innominato P, Komarzynski S, Karaboué A, Ulusakarya A, Bouchahda M, Haydar M, Bossevot-Desmaris R, Mocquery M, Plessis V, Lévi F. Home-Based e-Health Platform for Multidimensional Telemonitoring of Symptoms, Body Weight, Sleep, and Circadian Activity: Relevance for Chronomodulated Administration of Irinotecan, Fluorouracil-Leucovorin, and Oxaliplatin at Home-Results From a Pilot Study. JCO Clin Cancer Inform 2019; 2:1-15. [PMID: 30652550 DOI: 10.1200/cci.17.00125] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess the impact of chronomodulated irinotecan fluorouracil-leucovorin and oxaliplatin (chronoIFLO4) delivered at home on the daily life of patients with cancer in real time using a home-based e-Health multifunction and multiuser platform. This involved multidimensional telemonitoring of circadian rest-activity rhythm (CircAct), sleep, patient-reported outcome measures, and body weight changes (BWCs). PATIENTS AND METHODS Patients received chronoIFLO4 fortnightly at home. Patients completed the 19-item MD Anderson Symptom Inventory on an interactive electronic screen, weighed themselves on a dedicated scale, and continuously wore a wrist accelerometer for CircAct and sleep monitoring. Daily data were securely teletransmitted to a specific server accessible by the hospital team. The clinically relevant CircAct parameter dichotomy index I < O and sleep efficiency (SE) were calculated. The dynamic patterns over time of patient-reported outcome measures, BWC, I < O, and SE informed the oncology team on tolerance in real time. RESULTS The platform was installed in the home of 11 patients (48 to 72 years of age; 45% men; 27% with performance status = 0), who were instructed on its use on site. They received 26 cycles and provided 5,891 data points of 8,736 expected (67.4%). The most severe MD Anderson Symptom Inventory scores were: interference with work (mean: 5.1 of 10) or general activity (4.9), fatigue (4.9), distress (4.2), and appetite loss (3.6). Mean BWC was -0.9%, and mean SE remained > 82%. CircAct disruption (I < O ≤ 97.5%) was observed in four (15%) cycles before chronoIFLO4 start and in five (19%) cycles at day 14. CONCLUSION The patient-centered multidimensional telemonitoring solution implemented here was well accepted by patients receiving multidrug chemotherapy at home. Moreover, it demonstrated that chronoIFLO4 was a safe therapeutic option. Such integrated technology allows the design of innovative management approaches, ultimately improving patients' experience with chemotherapy, wellbeing, and outcomes.
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Affiliation(s)
- Pasquale Innominato
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Sandra Komarzynski
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Abdoulaye Karaboué
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Ayhan Ulusakarya
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Mohamed Bouchahda
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Mazen Haydar
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Rachel Bossevot-Desmaris
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Magali Mocquery
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Virginie Plessis
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Francis Lévi
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
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Sleep quality in hospitalized patients with advanced cancer: an observational study using self-reports of sleep and actigraphy. Support Care Cancer 2019; 28:2015-2023. [PMID: 31392550 DOI: 10.1007/s00520-019-04998-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Although patients with advanced cancer report poor sleep quality, few studies have assessed sleep quality with a combination of subjective and objective measures. We aimed to examine sleep quality in hospitalized patients with advanced cancer by combining patient-reported outcome-measures (PROMs) and polysomnography (PSG) or actigraphy. METHODS A one-night prospective observational study of sleep in hospitalized patients with metastatic cancer using WHO step III opioids was conducted. Total sleep time, sleep onset latency, number of awakenings, and wake after sleep onset were assessed by PROMs and actigraphy. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) (range; 0-21), where higher scores indicate worse sleep quality. RESULTS Forty patients were monitored. Median age was 70, median oral morphine equivalent dose was 80 mg/24 h (10-1725), median Karnofsky Performance Score was 50 (20-90), and median time to death from inclusion was 38 days (4-319). Mean PSQI score was 6.5 (SD ± 3.4). PROMs and actigraphy of mean (SD) sleep onset latency were 46 (± 64) and 35 min (± 61), respectively, while mean time awake at night was 37 (± 35) and 40 min (± 21). PROMs and actigraphy differed on number of awakenings (mean 2 (± 1) vs. 24 (± 15), p ˂ 0.001). Bland-Altman plots showed large individual differences between PROMs and actigraphy. PSG was not feasible. CONCLUSIONS PROMs and actigraphy documented poor sleep quality, but a lack of agreement across methods. The study demonstrates a need to improve assessment of sleep quality and treatment of sleep disturbance in hospitalized patients with advanced cancer near end of life.
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Mirandola M, Sabogal Rueda MD, Andreis F, Meriggi F, Codignola C, Gadaldi E, Prochilo T, Libertini M, Di Biasi B, Abeni C, Noventa S, Rota L, Ogliosi C, Zaniboni A. Yoga Protocol for Cancer Patients: A Systematic Exploration of Psychophysiological Benefits. Rev Recent Clin Trials 2019; 14:261-268. [PMID: 31362680 DOI: 10.2174/1574887114666190729143742] [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: 03/26/2019] [Revised: 04/24/2019] [Accepted: 07/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several studies report that practicing Yoga may lead to numerous psychophysiological benefits in patients undergoing treatment for cancer. Moreover, it may result in an effective alternative for coping with sleep disturbances, anxiety, depression and fatigue symptoms. A study based on the "Yoga in Oncology" project of the Foundation Poliambulanza was carried out, and it was designed to explore the benefits of Yoga, therefore corroborating Yoga as a therapeutic activity that can have a beneficial impact on patients diagnosed with cancer. METHODS Seventy patients were recruited, of whom 20% were males and 80% were females 18 years of age and older. All patients were being treated at the oncology department for gastrointestinal, mammary or genital carcinoma, and the disease was metastatic in 80% of patients. Data were collected between April 2013 and May 2017. The protocol consisted of a weekly 90-minute Yoga lesson for 8 consecutive weeks, and the data collection was carried out in 2 phases: (T0) preprotocol assessment and (T1) postprotocol assessment. Psychophysiological assessment was carried out with the following scales: the (BFI) Brief Fatigue Inventory, (HADS) Hospital Anxiety and Depression Scale and (PSQI) Pittsburgh Sleep Quality Index. RESULTS Data analysis showed a significant difference between the (T0) and (T1) HADS (Hospital Anxiety and Depression Scale) scores. The constructs of this scale consist of psychological variables for the assessment of anxiety and depression. In contrast, scores from the (BFI) Brief Fatigue Inventory and (PSQI) Pittsburgh Sleep Quality Index did not show significant differences between (T0) and (T1): such scales are relative to psychophysiological variables for an assessment of the perception of fatigue and quality of sleep. CONCLUSION It is noteworthy that the data, once analyzed, showed a significant difference between preprotocol and postprotocol levels of anxiety and depression but not for the perception of fatigue or the quality of sleep. In accordance with the scientific literature, data from this study highlight that practicing Yoga may promote changes in the levels of perceived anxiety and depression in patients undergoing treatment for cancer, thus positively affecting their (QoL). It is clear that the difference in significance between the psychological and physiological variables considered here and the statistical significance found only in levels of anxiety and depression encourage further studies to account for the nature of fatigue and sleep disturbances and how to address these symptoms in oncological patients. Moreover, other points of interest for future clinical research regard the evaluation of the reason for the possible denial to participate to this kind of study, as well as the social-cultural differences in patients' behavior.
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Affiliation(s)
- Mara Mirandola
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | | | - Federica Andreis
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Fausto Meriggi
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Claudio Codignola
- General Surgery Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Elena Gadaldi
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Tiziana Prochilo
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Michela Libertini
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Brunella Di Biasi
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Chiara Abeni
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Silvia Noventa
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Luigina Rota
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Chiara Ogliosi
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
| | - Alberto Zaniboni
- Oncology Department, Poliambulanza Foundation, via Leonida Bissolati 57, 25124 Brescia, Italy
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Swedish women’s awareness of human papillomavirus, and health-related quality of life, anxiety, and depression after a notification of an abnormal Pap smear result: a cross-sectional study. Eur J Cancer Prev 2019; 28:96-101. [DOI: 10.1097/cej.0000000000000430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Salivary Cortisol Profile Under Different Stressful Situations in Female College Students: Moderating Role of Anxiety and Sleep. J Neurosci Nurs 2019; 50:279-285. [PMID: 30157098 PMCID: PMC6135468 DOI: 10.1097/jnn.0000000000000394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental digital content is available in the text. Objectives: This study investigated the level of cortisol under different stressful situations and its relationship with sleep and anxiety in female college students. Methods: Salivary cortisol was measured 6 times a day during a routine period free of examination stress and a stressful period. Area under the curve (AUC) was calculated for cortisol level for awakening response (AUCAG) and during the day (AUCTG). Sleep characteristics and anxiety were measured using an actigraph and the Spielberger State-Trait Anxiety Inventory, respectively, during the different periods. Results: Thirty-six people participated in the study. During the stressful period, anxiety had a positive correlation with sleep efficiency (P = .020), wake after sleep onset (P = .023), and mean wake episodes during sleep (P = .048). Poorer sleep efficiency (P = .014), greater wake after sleep onset (P = .008), and mean wake episodes during sleep (P = .044) were significantly associated with less AUCAG. Trait anxiety was significantly higher in participants with greater AUCTG (P = .008). Conclusions: Female college students with increased anxiety under the stressful situation slept better. Those with poor sleep showed attenuated morning cortisol secretion. Those with higher trait anxiety had greater cortisol during the day.
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Rask M, Swahnberg K, Oscarsson M. Notification of an abnormal Pap smear result: An intervention study. Eur J Cancer Care (Engl) 2018; 28:e12969. [PMID: 30457186 DOI: 10.1111/ecc.12969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/18/2018] [Accepted: 10/26/2018] [Indexed: 01/08/2023]
Abstract
This study aims to assess whether notification of an abnormal Pap smear result via a phone call, delivered by a trained healthcare provider, has an effect on women's HRQoL, coping and awareness of HPV. For this intervention study, women were consecutively recruited from a women's health clinic in Sweden. Women in the intervention group (n = 113) were notified of their Pap smear result via a phone call by a trained healthcare provider, while those in the comparison group (n = 122) were notified via a standard letter. A questionnaire was used to collect data. The results found no significant differences between the groups for HRQoL. However, 42.5% of women in the intervention group versus 48.3% in the comparison group reported anxiety. Women in the intervention group were more satisfied with the manner in which they were notified of their abnormal result than those in the comparison group (92.0% vs. 67.2%; p < 0.001), more aware of HPV (71% vs. 50%; p = 0.001), and called healthcare services less often (10.6% vs. 18.0%; p = 0.113), no significance. In conclusion, notification of an abnormal Pap smear result via a phone call does not increase women's HRQoL or reduce their anxiety.
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Affiliation(s)
- Marie Rask
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Department of Health Science I, Kristianstad University, Kristianstad, Sweden
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
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Innominato PF, Komarzynski S, Palesh OG, Dallmann R, Bjarnason GA, Giacchetti S, Ulusakarya A, Bouchahda M, Haydar M, Ballesta A, Karaboué A, Wreglesworth NI, Spiegel D, Lévi FA. Circadian rest-activity rhythm as an objective biomarker of patient-reported outcomes in patients with advanced cancer. Cancer Med 2018; 7:4396-4405. [PMID: 30088335 PMCID: PMC6143939 DOI: 10.1002/cam4.1711] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/25/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Psychosocial symptoms often cluster together, are refractory to treatment, and impair health-related quality of life (HR-QoL) in cancer patients. The contribution of circadian rhythm alterations to systemic symptoms has been overlooked in cancer, despite a causal link shown under jet lag and shift work conditions. We investigated whether the circadian rest-activity rhythm provides a reliable and objective estimate of the most frequent patient-reported outcome measures (PROMs). METHODS Two datasets were used, each involving concomitant 3-day time series of wrist actigraphy and HR-QoL questionnaires: EORTC QLQ-C30 was completed once by 237 patients with metastatic colorectal cancer; MD Anderson Symptom Inventory (MDASI) was completed daily by 31 patients with advanced cancer on continuous actigraphy monitoring, providing 1015 paired data points. Circadian function was assessed using the clinically validated dichotomy index I < O. Nonparametric tests compared PROMs and I < O. Effect sizes were computed. Sensitivity subgroup and temporal dynamics analyses were also performed. RESULTS I < O values were significantly lower with increasing symptom severity and worsening HR-QoL domains. Fatigue and anorexia were worse in patients with circadian disruption. The differences were both statistically and clinically significant (P < 0.001; d ≥ 0.33). Physical and social functioning, and global quality/enjoyment of life were significantly better in patients with robust circadian rhythm (P < 0.001; d ≥ 0.26). Sensitivity analyses validated these findings. CONCLUSION Objectively determined circadian disruption was consistently and robustly associated with clinically meaningfully severe fatigue, anorexia, and interference with physical and social functioning. This supports an important role of the circadian system in the determination of cancer patients' HR-QoL and symptoms that deserves therapeutic exploitation.
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Affiliation(s)
- Pasquale F. Innominato
- North Wales Cancer CentreYsbyty GwyneddBetsi Cadwaladr University Health BoardBangorUK
- Cancer Chronotherapy TeamCancer Research CentreWarwick Medical SchoolCoventryUK
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
| | - Sandra Komarzynski
- Cancer Chronotherapy TeamCancer Research CentreWarwick Medical SchoolCoventryUK
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
| | - Oxana G. Palesh
- Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCalifornia
- Stanford Cancer InstituteStanford School of MedicineStanfordCalifornia
| | - Robert Dallmann
- Cancer Chronotherapy TeamCancer Research CentreWarwick Medical SchoolCoventryUK
| | | | - Sylvie Giacchetti
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
- Department of OncologySaint Louis HospitalPublic Hospitals of Paris (AP‐HP)ParisFrance
| | - Ayhan Ulusakarya
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
- Chronotherapy UnitDepartment of Medical OncologyPaul Brousse HospitalPublic Hospitals of Paris (AP‐HP)VillejuifFrance
| | - Mohamed Bouchahda
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
- Chronotherapy UnitDepartment of Medical OncologyPaul Brousse HospitalPublic Hospitals of Paris (AP‐HP)VillejuifFrance
- Mousseau ClinicsEvryFrance
| | - Mazen Haydar
- Chronotherapy UnitDepartment of Medical OncologyPaul Brousse HospitalPublic Hospitals of Paris (AP‐HP)VillejuifFrance
| | - Annabelle Ballesta
- Cancer Chronotherapy TeamCancer Research CentreWarwick Medical SchoolCoventryUK
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
- Warwick Mathematics InstituteUniversity of WarwickCoventryUK
| | | | | | - David Spiegel
- Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCalifornia
- Stanford Cancer InstituteStanford School of MedicineStanfordCalifornia
| | - Francis A. Lévi
- Cancer Chronotherapy TeamCancer Research CentreWarwick Medical SchoolCoventryUK
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
- Chronotherapy UnitDepartment of Medical OncologyPaul Brousse HospitalPublic Hospitals of Paris (AP‐HP)VillejuifFrance
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Good P, Pinkerton R, Bowler S, Craig J, Hardy J. Impact of Opioid Therapy on Sleep and Respiratory Patterns in Adults With Advanced Cancer Receiving Palliative Care. J Pain Symptom Manage 2018; 55:962-967. [PMID: 29208477 DOI: 10.1016/j.jpainsymman.2017.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT In advanced cancer, abnormal sleep patterns may contribute to poor quality of life, but the impact of opioid-related sleep disorders has not been explored in detail in these patients. OBJECTIVE To document sleep and respiratory patterns in patients with cancer, receiving a range of opioids, determine factors that contribute to severity of central or obstructive apnea, and to what extent these contribute to sleep disturbance. METHODS Adults with advanced cancer admitted to a palliative care service underwent a sleep analysis by an unattended polysomnography. Total sleep time, apnea hypopnea index, central apnea index, obstructive apnea hypopnea index, arousal index, and oxygen desaturation were measured. Baseline assessment included body habitus, Mallampati score, comorbidity indices, concomitant medications, and the Berlin questionnaire. Epworth Sleepiness Scale, Stanford Sleepiness Scale, and Wu cancer fatigue scales were documented. RESULTS Twenty-eight patients were studied, including 25 receiving opioids. In the latter group, the apnea hypopnea index was mildly abnormal in six patients and severely abnormal in 10 patients. Central apnea index and obstructive apnea hypopnea index were abnormal in nine and 17 patients, respectively. There was no significant correlation between opioid dose and polysomnographic results. CONCLUSION In patients with advanced cancer receiving opioid analgesia, there was a high prevalence of respiratory disturbance, both central and obstructive, and deranged sleep patterns. Addressing sleep-disordered breathing in cancer patients has the potential to improve daytime drowsiness and quality of life.
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Affiliation(s)
- Phillip Good
- Mater Health Services, Mater Research Institute-University of Queensland, St Vincent's Private Hospital, Brisbane, Queensland, Australia.
| | | | - Simon Bowler
- Mater Health Services, Brisbane, Queensland, Australia
| | - Justin Craig
- Queensland Sleep, Brisbane, Queensland, Australia
| | - Janet Hardy
- Mater Health Services, Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
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Yennurajalingam S, Kang DH, Hwu WJ, Padhye NS, Masino C, Dibaj SS, Liu DD, Williams JL, Lu Z, Bruera E. Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients With Advanced Cancer: A Preliminary Study. J Pain Symptom Manage 2018; 55:198-206. [PMID: 28870799 DOI: 10.1016/j.jpainsymman.2017.08.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Cranial electrotherapy stimulation (CES) is a safe modulation of brain activity for treating depression, anxiety, insomnia, and pain. However, there are no published studies in patients with advanced cancer (ACPs). OBJECTIVES The aim of the study was to determine the feasibility and preliminary efficacy of a four-week CES intervention on depression, anxiety, sleep disturbance, and pain scores. Concurrent salivary biomarker studies were conducted. METHODS In this one group open label pre- and post-intervention study with a four-week CES intervention, ACPs with one or more of four moderate intensity (≥3/10) Edmonton Symptom Assessment Scale (ESAS) symptoms (depression, anxiety, sleep disturbance, and pain) were eligible. Adherence (0%-100%), satisfaction rates (0-10), and safety were assessed. ESAS, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index, Brief Pain Inventory, and salivary levels (cortisol, alpha amylase, C-reactive protein, and interleukin-1β, and interleukin-6) were assessed from baseline to Week 4. RESULTS Thirty-three of 36 patients (92%) completed the CES. Median (interquartile range) adherence CES use and satisfaction scores were 93% (89-100) and 10% (9-10), respectively, and the adherence criteria was met in the study. CES use was safe (no Grade 3 or higher adverse events). HADS anxiety (P < 0.001), HADS depression (P = 0.024), ESAS anxiety (P = 0.001), ESAS depression (P = 0.025), Brief Pain Inventory pain (P = 0.013), Pittsburgh Sleep Quality Index daytime dysfunction (P = 0.002), and medication use (P = 0.006) scores improved after four-week CES treatment. CONCLUSION In this preliminary study, we found that the use of CES was safe and feasible in ACP. The use of CES was associated with significant improvement of depression, anxiety, pain, and sleep scores. These findings support further studies of CES in ACP for symptom control.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Duck-Hee Kang
- Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA
| | - Wen-Jen Hwu
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nikhil S Padhye
- Center for Nursing Research, University of Texas School of Nursing, Houston, Texas, USA
| | - Charles Masino
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Seyedeh S Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhanni Lu
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Grossberg AJ, Vichaya EG, Christian DL, Molkentine JM, Vermeer DW, Gross PS, Vermeer PD, Lee JH, Dantzer R. Tumor-Associated Fatigue in Cancer Patients Develops Independently of IL1 Signaling. Cancer Res 2017; 78:695-705. [PMID: 29217760 DOI: 10.1158/0008-5472.can-17-2168] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/20/2017] [Accepted: 11/27/2017] [Indexed: 12/19/2022]
Abstract
Fatigue is the most common symptom of cancer at diagnosis, yet causes and effective treatments remain elusive. As tumors can be highly inflammatory, it is generally accepted that inflammation mediates cancer-related fatigue. However, evidence to support this assertion is mostly correlational. In this study, we directly tested the hypothesis that fatigue results from propagation of tumor-induced inflammation to the brain and activation of the central proinflammatory cytokine, IL1. The heterotopic syngeneic murine head and neck cancer model (mEER) caused systemic inflammation and increased expression of Il1b in the brain while inducing fatigue-like behaviors characterized by decreased voluntary wheel running and exploratory activity. Expression of Il1b in the brain was not associated with any alterations in motivation, measured by responding in a progressive ratio schedule of food reinforcement, depression-like behaviors, or energy balance. Decreased wheel running occurred prior to Il1b detection in the brain, when systemic inflammation was minimal. Furthermore, mice null for two components of IL1β signaling, the type 1 IL1 receptor or the receptor adapter protein MyD88, were not protected from tumor-induced decreases in wheel running, despite attenuated cytokine action and expression. Behavioral and inflammatory analysis of four additional syngeneic tumor models revealed that tumors can induce fatigue regardless of their systemic or central nervous system inflammatory potential. Together, our results show that brain IL1 signaling is not necessary for tumor-related fatigue, dissociating this type of cancer sequela from systemic cytokine expression.Significance: These findings challenge the current understanding of fatigue in cancer patients, the most common and debilitating sequela associated with malignancy. Cancer Res; 78(3); 695-705. ©2017 AACR.
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Affiliation(s)
- Aaron J Grossberg
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. .,Department of Symptom Research, MD Anderson Cancer Center, Houston, Texas
| | | | - Diana L Christian
- Department of Symptom Research, MD Anderson Cancer Center, Houston, Texas
| | - Jessica M Molkentine
- Department of Experimental Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Daniel W Vermeer
- Cancer Biology Research Center, Sanford Research, Sioux Falls, South Dakota
| | - Phillip S Gross
- Department of Symptom Research, MD Anderson Cancer Center, Houston, Texas
| | - Paola D Vermeer
- Cancer Biology Research Center, Sanford Research, Sioux Falls, South Dakota
| | - John H Lee
- Cancer Biology Research Center, Sanford Research, Sioux Falls, South Dakota
| | - Robert Dantzer
- Department of Symptom Research, MD Anderson Cancer Center, Houston, Texas
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35
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The predictive value of symptoms for anxiety in hospice inpatients with advanced cancer. Palliat Support Care 2017; 16:602-607. [DOI: 10.1017/s1478951517000785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Insight into symptoms as predictors for anxiety may help to foster early identification of anxiety and to ameliorate anxiety management. The aim of this study was to determine which frequently occurring symptoms are predictors for anxiety in advanced cancer patients recently admitted to a hospice.Method:Symptom burden was measured in patients admitted to a hospice who died ≤3 month after admission using the Utrecht Symptom Diary. This is a Dutch-translated and adapted version of the Edmonton Symptom Assessment System to self-assess the 11 most prevalent symptoms and overall well-being on a 0–10 numerical rating scale. Multiple linear regression analysis was employed to analyze the predictive value of fatigue, nausea, pain, dyspnea, depressed mood, insomnia, and well-being on anxiety.Results:A total of 211 patients were included, 42% of whom were men, and the median age was 71 years (range = 31–95). Anxiety was uncommon and rarely severe: 25% had a score ≥1, and 14% had a score >3. After correction for age, gender, and marital status, depressed mood (p = 0.00) and dyspnea (p = 0.01) were independent predictors for anxiety and explained 23% of the variance in anxiety.Significance of results:Hospice inpatients with advanced cancer who suffer from dyspnea and/or depressed mood are at increased risk for anxiety. Treatment of dyspnea and depressed mood may contribute to adequate anxiety management. Further research should explore other factors associated with anxiety, especially in the psychological, social, and spiritual domains.
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Sleep-wake difficulties in community-dwelling cancer patients receiving palliative care: subjective and objective assessment. Palliat Support Care 2017; 16:756-766. [PMID: 28933313 DOI: 10.1017/s1478951517000815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Prevalence rates of sleep difficulties in advanced cancer patients have varied widely across studies (12 to 96%), and none of these employed a diagnostic interview to distinguish different types of sleep-wake disorders. Moreover, very limited information is available on subjective and objective sleep parameters in this population. Our study was conducted in palliative cancer patients and aimed to assess rates of sleep-wake disorders and subsyndromal symptoms and to document subjective and objective sleep-wake parameters across various types of sleep-wake difficulties. METHOD The sample was composed of 51 community-dwelling cancer patients receiving palliative care and having an Eastern Cooperative Oncology Group score of 2 or 3. Relevant sections of the Duke Interview for Sleep Disorders were administered over the phone. An actigraphic recording and a daily sleep diary were completed for 7 consecutive days. RESULTS Overall, 68.6% of the sample had at least one type of sleep-wake difficulty (disorder or symptoms): 31.4% had insomnia and 29.4% had hypersomnolence as their main sleep-wake problem. Participants with insomnia as their main sleep difficulty had greater disruptions of subjective sleep parameters, while objectively-assessed sleep was more disrupted in patients with hypersomnolence comorbid with another sleep-wake difficulty.Significance of the Results:The high rates of sleep-wake difficulties found in this study indicate a need to screen more systematically for sleep-wake disorders, including insomnia and hypersomnolence, in both palliative care research and clinical practice, and to develop effective nonpharmacological interventions specifically adapted to this population.
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