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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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Kuballa L, Kessler CS, Kandil FI, von Scheidt C, Meinköhn M, Koch B, Wischnewsky M, Michalsen A, Jeitler M. Effects of an Integrative Day Care Clinic Program with a Focus on Nature Therapy in a Hospital Park Setting on Quality of Life in Oncological Patients-A Non-Randomized Controlled Study. Cancers (Basel) 2023; 15:4595. [PMID: 37760564 PMCID: PMC10527019 DOI: 10.3390/cancers15184595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Cancer often causes long-term physical and psychological impairments. Lifestyle modification and nature-based interventions (NBIs) can have a positive impact on patients' quality of life (QOL). This participants-blinded, non-randomized controlled study assessed parameters at weeks 0, 12, and 24, including, as a primary endpoint, QOL in cancer patients on the Functional Assessment of Cancer Therapy-General (FACT-G) at week 12. QOL in breast cancer patients, fatigue, well-being, stress, anxiety/depression, socio-psychological well-being, benefits of nature interaction, insomnia, self-efficacy, mindfulness, and self-compassion were assessed as secondary endpoints. N = 107 cancer patients (96.3% women; 52.5 ± 9.3 years, 80.4% breast cancer) were assigned to either a 12-week nature-based (NDC; n = 56) or conventional (DC; n = 51) oncology day care clinic program, whereby the assignment group was not known to the participants. There was no significant group difference for the primary endpoint. At week 24, QOL, fatigue, mindfulness and self-compassion scores were significantly higher, and at weeks 12 and 24, the insomnia score was significantly lower in NDC compared to DC. In conclusion, this study indicates positive and clinically relevant effects of the program on QOL, fatigue, and psychological parameters. NBIs seem to have a more pronounced effect.
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Affiliation(s)
- Lisa Kuballa
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
| | - Christian S. Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany; (C.v.S.); (B.K.)
| | - Farid I. Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
| | - Christel von Scheidt
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany; (C.v.S.); (B.K.)
| | - Meline Meinköhn
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
| | - Barbara Koch
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany; (C.v.S.); (B.K.)
| | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University Bremen, 28359 Bremen, Germany;
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany; (C.v.S.); (B.K.)
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (C.S.K.); (F.I.K.); (M.M.); (A.M.); (M.J.)
- Department of Internal Medicine and Nature-Based Therapies, Immanuel Hospital Berlin, 14109 Berlin, Germany; (C.v.S.); (B.K.)
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An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research. Cancers (Basel) 2022; 14:cancers14163933. [PMID: 36010925 PMCID: PMC9406296 DOI: 10.3390/cancers14163933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary This review focuses on sleep in patients with advanced cancer. Cancer patients experience multiple symptoms and they receive concomitant medications. These are all factors that may affect sleep. In this paper, we present recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that may contribute to insomnia. Sleep is an essential aspect of health-related quality of life; therefore, it is important for health care providers to focus on sleep to improve patient care. Abstract Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research.
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Shuboni-Mulligan DD, Young D, De La Cruz Minyety J, Briceno N, Celiku O, King AL, Munasinghe J, Wang H, Adegbesan KA, Gilbert MR, Smart DK, Armstrong TS. Histological analysis of sleep and circadian brain circuitry in cranial radiation-induced hypersomnolence (C-RIH) mouse model. Sci Rep 2022; 12:11131. [PMID: 35778467 PMCID: PMC9249744 DOI: 10.1038/s41598-022-15074-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
Disrupted sleep, including daytime hypersomnolence, is a core symptom reported by primary brain tumor patients and often manifests after radiotherapy. The biological mechanisms driving the onset of sleep disturbances after cranial radiation remains unclear but may result from treatment-induced injury to neural circuits controlling sleep behavior, both circadian and homeostatic. Here, we develop a mouse model of cranial radiation-induced hypersomnolence which recapitulates the human experience. Additionally, we used the model to explore the impact of radiation on the brain. We demonstrated that the DNA damage response following radiation varies across the brain, with homeostatic sleep and cognitive regions expressing higher levels of γH2AX, a marker of DNA damage, than the circadian suprachiasmatic nucleus (SCN). These findings were supported by in vitro studies comparing radiation effects in SCN and cortical astrocytes. Moreover, in our mouse model, MRI identified structural effects in cognitive and homeostatic sleep regions two-months post-treatment. While the findings are preliminary, they suggest that homeostatic sleep and cognitive circuits are vulnerable to radiation and these findings may be relevant to optimizing treatment plans for patients.
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Affiliation(s)
| | - Demarrius Young
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Nicole Briceno
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Orieta Celiku
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amanda L King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeeva Munasinghe
- Mouse Imaging Facility, National Institute of Neurological Disorder and Stroke, NIH, Bethesda, MD, USA
| | - Herui Wang
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kendra A Adegbesan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - DeeDee K Smart
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Zhang J, Yang M, So TH, Chang TY, Qin Z, Chen H, Lam WL, Yeung WF, Chung KF, Jiang F, Lao L, Zhang ZJ. Electroacupuncture Plus Auricular Acupressure on Chemotherapy-Related Insomnia in Patients With Breast Cancer (EACRI): Study Protocol for a Randomized, Sham-Controlled Trial. Integr Cancer Ther 2021; 20:15347354211058695. [PMID: 34802291 PMCID: PMC8606933 DOI: 10.1177/15347354211058695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Insomnia is a highly prevalent and disturbing symptom in breast cancer patients under or post chemotherapy. If not appropriately treated, it can persist for years after the completion of cancer treatments. Acupuncture has been widely used for alleviating insomnia. The aim of this study is to examine the feasibility, efficacy and safety of acupuncture for chemotherapy-related insomnia among patients with breast cancer. MATERIALS AND METHODS This is a trial protocol for a randomized, sham-controlled, subject- and assessor-blinded clinical trial. A total of 138 eligible participants will be assigned randomly to acupuncture or sham control group at a ratio of 1:1. Participants in acupuncture group will receive electroacupuncture (EA) plus auricular acupressure (AA) treatment, while subjects in sham acupuncture group will receive sham EA plus sham AA. Both acupuncture and sham treatments will be given twice weekly for 6 weeks, followed by maintenance treatments once every 4 weeks for 12 weeks (15 sessions totally). The primary outcome is the change of Insomnia Severity Index score between baseline and the end of 6-week treatment. Secondary outcome measurements include Actiwatch, sleep diary, Pittsburgh Sleep Quality Index, Functional Assessment of Cancer Therapy-Breast Cancer, Hospital Anxiety and Depression Scale, Brief Pain Inventory-Short Form, Brief Fatigue Inventory, Acupuncture Expectancy Scale, credibility, and adverse events. Participants will be followed up to 42 weeks. CONCLUSIONS This trial will expand our understanding of the feasibility, efficacy, and safety of acupuncture as a treatment for alleviating chemotherapy-related insomnia in patients with breast cancer. EA plus AA, if proven to be effective, can be implemented into routine settings to play a role in insomnia management for patients with breast cancer.
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Affiliation(s)
- Jialing Zhang
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, Guangdong, China.,School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mingxiao Yang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tsz Him So
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tien Yee Chang
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Clinical Oncology, Hong Kong Sanatorium Hospital, Hong Kong, China
| | - Zongshi Qin
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Haiyong Chen
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing Lok Lam
- School of Chinese Medicine, LKS 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
| | - Ka Fai Chung
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Fei Jiang
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China
| | - Lixing Lao
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Virginia University of Integrative Medicine, Fairfax, Virginia, USA
| | - Zhang-Jin Zhang
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, Guangdong, China.,School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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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: 7] [Impact Index Per Article: 2.3] [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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Wintheiser GA, Ruddy KJ, Herrin J, Rahman PA, Pachman DR, Leppin AL, Rutten LJF, Lee MK, Griffin JM, Tofthagen C, Chlan LL, Ridgeway JL, Mitchell SA, Cheville AL. Receptivity to a Nurse-Led Symptom Management Intervention Amongst Highly Symptomatic Patients with Cancer. J Natl Cancer Inst 2021; 114:458-466. [PMID: 34508602 PMCID: PMC8902324 DOI: 10.1093/jnci/djab172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/09/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The symptom burden associated with cancer and its treatment can negatively impact patients' quality of life and survival. Symptom-focused collaborative care model (CCM) interventions can improve outcomes, but only if patients engage with them. We assessed the receptivity of severely symptomatic oncology patients to a remote nurse-led CCM intervention. METHODS In a pragmatic, cluster-randomized, stepped wedge trial conducted as part of the NCI IMPACT Consortium (E2C2, NCT03892967), patients receiving cancer care were asked to rate their sleep disturbance, pain, anxiety, emotional distress, fatigue, and limitations in physical function. Patients reporting at least one severe symptom (≥7/10) were offered phone consultation with a nurse symptom care manager (RN SCM). Initially, patients had to "opt-in" to receive a call, but the protocol was later modified so they had to "opt-out" if they did not want a call. We assessed the impact of opt-in vs. opt-out framing and patient characteristics on receptiveness to RN SCM calls. All statistical tests were 2-sided. RESULTS Of the 1204 symptom assessments (from 864 patients) on which at least one severe symptom was documented, 469 (39.0%) indicated receptivity to an RN SCM phone call. The opt-out period (odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.12 to 2.32, p=.01), receiving care at a tertiary care center (OR = 3.59, 95% CI = 2.18 to 5.91, p<.001), and having severe pain (OR = 1.80, 95% CI = 1.24 to 2.62, p=.002), were associated with statistically significantly greater willingness to receive a call. CONCLUSION Many severely symptomatic patients were not receptive to an RN SCM phone call. Better understanding of reasons for refusal and strategies for improving patient receptivity are needed.
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Affiliation(s)
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Jeph Herrin
- Yale University School of Medicine, New Haven, CT, USA
| | - Parvez A Rahman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Aaron L Leppin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Minji K Lee
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Cindy Tofthagen
- Department of Nursing, Nursing Research Division, Mayo Clinic, Jacksonville, FL, USA
| | - Linda L Chlan
- Department of Nursing, Nursing Research Division, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea L Cheville
- Division of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Sleep During Pelvic-Abdominal Radiotherapy for Cancer: A Longitudinal Study With Special Attention to Sleep in Relation to Nausea and Quality of Life. Cancer Nurs 2021; 44:333-344. [PMID: 32371667 DOI: 10.1097/ncc.0000000000000826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poor sleep, nausea, psychological distress, and a lowered quality of life are common during radiotherapy for cancer. There is a lack of studies on the relationship between radiotherapy-induced nausea and sleep. This longitudinal study analyzes data from 196 patients who underwent pelvic-abdominal radiotherapy for cancer. OBJECTIVE The aim of this study was to investigate sleep parameters weekly before, during, and after radiotherapy in relation to nausea and other patient characteristics, clinical characteristics, psychological distress, and quality of life. METHODS Patients (n = 196, 84% women; mean age, 63 years; 68% had gynecological tumor, 28% had colorectal tumor, and 4% had other tumors) longitudinally answered questionnaires before, during, and after their radiotherapy over the abdominal and pelvic fields. RESULTS Poor sleep was experienced by 30% of the participants, and sleep (quality and difficulty falling asleep) improved during and after treatment compared with baseline. Experiencing nausea during treatment was associated with worse sleep quality during radiotherapy. Baseline anxiety was associated with worse sleep quality before, during, and after treatment. Poor sleep was associated with worse quality of life. CONCLUSION Nausea, more than a number of other variables, is a possible predictor of poor sleep in patients during radiotherapy for cancer. IMPLICATIONS FOR PRACTICE The results indicate that effectively managing nausea may be important for sleep quality, and possibly quality of life, in patients undergoing radiotherapy for cancer. More research is needed before recommendations for practice can be made.
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Haller H, Voiß P, Cramer H, Paul A, Reinisch M, Appelbaum S, Dobos G, Sauer G, Kümmel S, Ostermann T. The INTREST registry: protocol of a multicenter prospective cohort study of predictors of women's response to integrative breast cancer treatment. BMC Cancer 2021; 21:724. [PMID: 34162339 PMCID: PMC8220783 DOI: 10.1186/s12885-021-08468-2] [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: 04/30/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer registries usually assess data of conventional treatments and/or patient survival. Beyond that, little is known about the influence of other predictors of treatment response related to the use of complementary therapies (CM) and lifestyle factors affecting patients' quality and quantity of life. METHODS INTREST is a prospective cohort study collecting register data at multiple German certified cancer centers, which provide individualized, integrative, in- and outpatient breast cancer care. Patient-reported outcomes and clinical cancer data of anticipated N = 715 women with pTNM stage I-III breast cancer are collected using standardized case report forms at the time of diagnosis, after completing neo-/adjuvant chemotherapy, after completing adjuvant therapy (with the exception of endocrine therapy) as well as 1, 2, 5, and 10 years after baseline. Endpoints for multivariable prediction models are quality of life, fatigue, treatment adherence, and progression-based outcomes/survival. Predictors include the study center, sociodemographic characteristics, histologic cancer and comorbidity data, performance status, stress perception, depression, anxiety, sleep quality, spirituality, social support, physical activity, diet behavior, type of conventional treatments, use of and belief in CM treatments, and participation in a clinical trial. Safety is recorded following the Common Terminology Criteria for Adverse Events. DISCUSSION This trial is currently recruiting participants. Future analyses will allow to identify predictors of short- and long-term response to integrative breast cancer treatment in women, which, in turn, may improve cancer care as well as quality and quantity of life with cancer. TRIAL REGISTRATION German Clinical Trial Register DRKS00014852 . Retrospectively registered at July 4th, 2018.
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Affiliation(s)
- Heidemarie Haller
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.
| | - Petra Voiß
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.,Breast Unit, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
| | - Anna Paul
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
| | | | - Sebastian Appelbaum
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten / Herdecke University, Witten, Germany
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
| | - Georg Sauer
- Department of Gynecology and Obstetrics, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Sherko Kümmel
- Breast Unit, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Thomas Ostermann
- Department of Psychology, Chair of Research Methodology and Statistics in Psychology, Witten / Herdecke University, Witten, Germany
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Hoang HTX, Molassiotis A, Chan CW, Vu AH, Bui PT. Pilot randomized sham-controlled trial of self-acupressure to manage the symptom cluster of insomnia, depression, and anxiety in cancer patients undergoing chemotherapy. Sleep Breath 2021; 26:445-456. [PMID: 33855642 DOI: 10.1007/s11325-021-02370-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Current evidence for using self-acupressure to manage the cancer-related symptom cluster of insomnia, depression, and anxiety, while promising, is unknown. This study evaluated the feasibility of self-acupressure to manage this symptom cluster and to explore its potential effectiveness. METHODS Participants were assigned randomly to three study groups, namely the true acupressure (TAP), the sham acupressure (SAP), and the enhanced standard care group (ESC). Participants in the TAP and SAP groups received a training session on acupressure and were required to practice self-acupressure at home once per day for 28 days. The duration of participant involvement was 8 weeks. Patients completed a Numerical Rating Scale (NRS) for each symptom, the Insomnia Severity Index, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-General at baseline (T1), post-intervention (T2, week 4), and post follow-up (T3, week 8). RESULTS The results indicated that the intervention had clinical significance in improving the targeted symptoms and quality of life. In the TAP group, the symptom cluster severity was significantly lower than in the other groups at T2 (p < 0.05). The insomnia severity and anxiety scores in the TAP and SAP groups were significantly lower than those in ESC at T2 and T3 (p < 0.05). CONCLUSION The trial was feasible. The promising results of the study suggest that further testing of self-acupressure is warranted to inform its effectiveness on the targeted symptom cluster in patients with cancer. A placebo effect was evident alongside therapeutic effects. TRIAL REGISTRATION ClinicalTrials.gov (ID: NCT03823456) on January 30th, 2019.
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Affiliation(s)
- Huong Thi Xuan Hoang
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon, Hong Kong. .,Faculty of Nursing, Phenikaa University, Hanoi, Vietnam.
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon, Hong Kong
| | - Choi Wan Chan
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon, Hong Kong
| | - Anh Hoang Vu
- Faculty of Nursing, Phenikaa University, Hanoi, Vietnam
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11
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Davis MP, Rybicki LA, Samala RV, Patel C, Parala-Metz A, Lagman R. Pain or fatigue: which correlates more with suffering in hospitalized cancer patients? Support Care Cancer 2021; 29:4535-4542. [PMID: 33479793 DOI: 10.1007/s00520-021-05996-2] [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] [Received: 09/08/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association of pain and suffering seems intuitive, but evidence substantiating this association is lacking. In studies of cancer patients, fatigue, rather than pain, is the most prevalent and debilitating symptom. This study aimed to compare the correlation of pain and fatigue to suffering, and identify other potential sources of suffering in cancer patients treated in a palliative care unit. METHODS One hundred fifty cancer patients were surveyed. Fifteen variables were measured on a 0- to 10-point scale: suffering, pain, level of acceptable pain, effect of pain on quality of life, fatigue, level of acceptable fatigue, effect of fatigue on quality of life, and specific types of suffering. Univariable associations with suffering were made with Pearson correlation (continuous variables) or t test (binary predictors). Multivariable associations with suffering were assessed with linear regression analysis and bootstrapping. RESULTS In multivariable analysis, highest pain (parameter estimate 0.38) had a greater impact on suffering than highest fatigue (parameter estimate 0.21). When other variables were assessed, 38% of the variability in suffering was accounted for by pain "now", fatigue in the past 24 hours, and age. CONCLUSION The most important predictors of greater suffering in hospitalized cancer patients are pain, younger age, and fatigue. Despite their significant effect on suffering, other underlying contributors to suffering have yet to be identified. Designing interventions to reduce fatigue, in addition to pain management, may help in alleviating overall suffering.
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Affiliation(s)
- Mellar P Davis
- Department of Palliative and Supportive Care, Cleveland Clinic, 9500 Euclid Ave. CA-53, Cleveland, OH, 44195, USA
| | - Lisa A Rybicki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Renato V Samala
- Department of Palliative and Supportive Care, Cleveland Clinic, 9500 Euclid Ave. CA-53, Cleveland, OH, 44195, USA.
| | - Chirag Patel
- Department of Palliative and Supportive Care, Cleveland Clinic, 9500 Euclid Ave. CA-53, Cleveland, OH, 44195, USA
| | - Armida Parala-Metz
- Department of Palliative and Supportive Care, Cleveland Clinic, 9500 Euclid Ave. CA-53, Cleveland, OH, 44195, USA
| | - Ruth Lagman
- Department of Palliative and Supportive Care, Cleveland Clinic, 9500 Euclid Ave. CA-53, Cleveland, OH, 44195, USA
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12
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Naughton MJ, Salani R, Peng J, Lustberg M, DeGraffinreid C, Moon J, Loyan H, Beverly Hery CM, Paskett ED. Feasibility of implementing a text-based symptom-monitoring program of endometrial, ovarian, and breast cancer patients during treatment. Qual Life Res 2020; 30:3241-3254. [PMID: 33052514 PMCID: PMC8528739 DOI: 10.1007/s11136-020-02660-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Purpose To evaluate the feasibility of implementing systematic patient symptom monitoring during treatment using a smartphone. Methods Endometrial [n = 50], ovarian [n = 70] and breast [n = 193] cancer patients participated in text-based symptom reporting for up to 12 months. In order to promote equity, patients without a smartphone were provided with a device, with the phone charges paid by program funds. Each month, patients completed the Patient Health Questionnaire (PHQ-9), and 4 single items assessing fatigue, sleep quality, pain, and global quality of life during the past 7 days rated on a 0 (low) –10 (high) scale. Patients’ responses were captured using REDCap, with oncologists receiving monthly feedback. Lay navigators provided assistance to patients with non-medical needs. Results Patients utilizing this voluntary program had an overall mean age of 60.5 (range 26–87), and 85% were non-Hispanic white. iPhones were provided to 42 patients, and navigation services were used by 69 patients. Average adherence with monthly surveys ranged between 75–77%, with breast patients having lower adherence after 5 months. The most commonly reported symptoms across cancer types were moderate levels (scores of 4–7) of fatigue and sleep disturbance. At 6 months, 71–77% of all patients believed the surveys were useful to them and their health care team. Conclusions We established the feasibility of initiating and managing patients in a monthly text-based symptom-monitoring program. The provision of smartphones and patient navigation were unique and vital components of this program.
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Affiliation(s)
- Michelle J Naughton
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, 1590 N. High St, Suite 525, Columbus, OH, 43201, USA.
| | - Ritu Salani
- Division of Gynecologic Oncology, School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Juan Peng
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Maryam Lustberg
- Division of Medical Oncology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Cecilia DeGraffinreid
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, 1590 N. High St, Suite 525, Columbus, OH, 43201, USA
| | - Jennifer Moon
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, 1590 N. High St, Suite 525, Columbus, OH, 43201, USA
| | - Hibaq Loyan
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, 1590 N. High St, Suite 525, Columbus, OH, 43201, USA
| | - Chloe M Beverly Hery
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, 1590 N. High St, Suite 525, Columbus, OH, 43201, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, 1590 N. High St, Suite 525, Columbus, OH, 43201, USA
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13
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LeBaron V, Bennett R, Alam R, Blackhall L, Gordon K, Hayes J, Homdee N, Jones R, Martinez Y, Ogunjirin E, Thomas T, Lach J. Understanding the Experience of Cancer Pain From the Perspective of Patients and Family Caregivers to Inform Design of an In-Home Smart Health System: Multimethod Approach. JMIR Form Res 2020; 4:e20836. [PMID: 32712581 PMCID: PMC7481872 DOI: 10.2196/20836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/11/2020] [Accepted: 07/25/2020] [Indexed: 01/20/2023] Open
Abstract
Background Inadequately managed pain is a serious problem for patients with cancer and those who care for them. Smart health systems can help with remote symptom monitoring and management, but they must be designed with meaningful end-user input. Objective This study aims to understand the experience of managing cancer pain at home from the perspective of both patients and family caregivers to inform design of the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) smart health system. Methods This was a descriptive pilot study using a multimethod approach. Dyads of patients with cancer and difficult pain and their primary family caregivers were recruited from an outpatient oncology clinic. The participant interviews consisted of (1) open-ended questions to explore the overall experience of cancer pain at home, (2) ranking of variables on a Likert-type scale (0, no impact; 5, most impact) that may influence cancer pain at home, and (3) feedback regarding BESI-C system prototypes. Qualitative data were analyzed using a descriptive approach to identity patterns and key themes. Quantitative data were analyzed using SPSS; basic descriptive statistics and independent sample t tests were run. Results Our sample (n=22; 10 patient-caregiver dyads and 2 patients) uniformly described the experience of managing cancer pain at home as stressful and difficult. Key themes included (1) unpredictability of pain episodes; (2) impact of pain on daily life, especially the negative impact on sleep, activity, and social interactions; and (3) concerns regarding medications. Overall, taking pain medication was rated as the category with the highest impact on a patient’s pain (=4.79), followed by the categories of wellness (=3.60; sleep quality and quantity, physical activity, mood and oral intake) and interaction (=2.69; busyness of home, social or interpersonal interactions, physical closeness or proximity to others, and emotional closeness and connection to others). The category related to environmental factors (temperature, humidity, noise, and light) was rated with the lowest overall impact (=2.51). Patients and family caregivers expressed receptivity to the concept of BESI-C and reported a preference for using a wearable sensor (smart watch) to capture data related to the abrupt onset of difficult cancer pain. Conclusions Smart health systems to support cancer pain management should (1) account for the experience of both the patient and the caregiver, (2) prioritize passive monitoring of physiological and environmental variables to reduce burden, and (3) include functionality that can monitor and track medication intake and efficacy; wellness variables, such as sleep quality and quantity, physical activity, mood, and oral intake; and levels of social interaction and engagement. Systems must consider privacy and data sharing concerns and incorporate feasible strategies to capture and characterize rapid-onset symptoms.
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Affiliation(s)
- Virginia LeBaron
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Rachel Bennett
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Ridwan Alam
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Leslie Blackhall
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Kate Gordon
- Virginia Commonwealth University Health, Richmond, VA, United States
| | - James Hayes
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Nutta Homdee
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Randy Jones
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Yudel Martinez
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Emmanuel Ogunjirin
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Tanya Thomas
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - John Lach
- The George Washington University School of Engineering & Applied Science, Washington, DC, United States
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14
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Khater W, Masha'al D, Al-Sayaheen A. Sleep assessment and interventions for patients living with cancer from the patients' and nurses' perspective. Int J Palliat Nurs 2020; 25:316-324. [PMID: 31339821 DOI: 10.12968/ijpn.2019.25.7.316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Difficulty sleeping is a common symptom for patients living with cancer that significantly affects their lives. However, although sleep disorders are common, it is an overlooked problem in cancer care. PURPOSE This study assessed the prevalence of sleep disturbances among patients living with cancer, and assessed the adequacy of sleep assessment and intervention for patients from both nurses' and patients' perspectives. METHOD Descriptive, cross-sectional and correlational design was used in this study. A convenience sample of 129 patients with cancer and 113 registered nurses working with cancer patients was recruited. A structured face-to-face interview was used to complete the patients' questionnaires and a self-administered questionnaire was given to nurses. FINDINGS The majority of patients with cancer reported having poor sleep quality (69.8%). About 86.7% (n=98) of nurses reported that they have never screened patients with cancer for any sleep problems, and 76.7% (n=99) of the patients reported that they have never been assessed for sleep problems by the nursing staff during hospitalisation. Only 8% of patients with cancer who reported having problems sleeping to a nurse received interventions to promote better sleep. CONCLUSION Assessment of sleep disturbances in patients with cancer should be unified using a comprehensive reliable valid instrument, as well as providing evidence-based interventions according to patient's need. A written policy should be introduced to encourage sleep documentation and to make sleep care for patients part of routine nursing care.
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Affiliation(s)
- Wejdan Khater
- Associate Professor, Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology
| | - Dina Masha'al
- Associate Professor, Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology
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15
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Steineck A, Bradford MC, Lau N, Scott S, Yi-Frazier JP, Rosenberg AR. A Psychosocial Intervention's Impact on Quality of Life in AYAs with Cancer: A Post Hoc Analysis from the Promoting Resilience in Stress Management (PRISM) Randomized Controlled Trial. CHILDREN-BASEL 2019; 6:children6110124. [PMID: 31684055 PMCID: PMC6915541 DOI: 10.3390/children6110124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/11/2019] [Accepted: 10/23/2019] [Indexed: 01/15/2023]
Abstract
Promoting Resilience in Stress Management (PRISM), a psychosocial intervention for adolescents and young adults (AYAs) with serious illness, enhances resilience resources via four skills-based training sessions. A recent randomized controlled trial showed PRISM improved health-related quality of life (HRQOL) compared to usual care (UC). This post hoc exploratory analysis aimed to better understand the effect of PRISM on HRQOL by describing changes in HRQOL subdomain scores. English-speaking AYAs (12–25 years) with cancer were randomized to PRISM or UC. At enrollment and six months later, HRQOL was assessed using the Pediatric Quality of Life Inventory (PedsQL) Generic Short Form (SF-15) and Cancer Module. Scores at each time point were summarized descriptively and individual HRQOL trajectories were categorized (<70 vs. ≥70). “Positive” trajectories indicate participants maintained scores ≥70 or improved from <70 to ≥70 during the study period. Baseline assessments were completed by 92 participants (48 PRISM, 44 UC); six-month assessments were completed by 74 participants (36 PRISM, 38 UC). For the SF-15, positive trajectories in psychosocial domains were more common with PRISM; trajectories in the physical subdomain were similar across groups. For the Cancer Module, positive trajectories were more common with PRISM in the following subdomains: nausea, treatment anxiety, worry, cognitive, physical appearance, and communication. From this, we conclude PRISM may improve HRQOL, especially in psychosocial domains of wellbeing.
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Affiliation(s)
- Angela Steineck
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98105, USA.
| | - Miranda C Bradford
- Children's Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA 98105, USA.
| | - Nancy Lau
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98105, USA.
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA 98105, USA.
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA 98105, USA.
| | - Samantha Scott
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
| | - Joyce P Yi-Frazier
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
| | - Abby R Rosenberg
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA 98105, USA.
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA 98105, USA.
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16
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Avan R, Janbabaei G, Hendouei N, Alipour A, Borhani S, Tabrizi N, Salehifar E. The effect of pregabalin and duloxetine treatment on quality of life of breast cancer patients with taxane-induced sensory neuropathy: A randomized clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:52. [PMID: 30057636 PMCID: PMC6040148 DOI: 10.4103/jrms.jrms_1068_17] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/24/2018] [Accepted: 03/07/2018] [Indexed: 12/21/2022]
Abstract
Background: The primary side effect of adjuvant chemotherapy with taxanes is the taxane-induced peripheral neuropathy (TIPN), which may have substantial negative impacts on patients’ quality of life (QOL). We investigated the effect of pregabalin and duloxetine on QOL of breast cancer patients who experienced TIPN. Materials and Methods: This was a randomized, double-blind clinical trial conducted at a chemotherapy center of Mazandaran University of Medical Sciences, Sari, Iran. Breast cancer patients 18 or more years old were included if they received paclitaxel or docetaxel and experienced neuropathy grade one or higher; and neuropathic pain score of four or more. Patients were treated with pregabalin or duloxetine until 6 weeks. Assessment of sensory neuropathy and QOL was performed at baseline, and 6 weeks after the initiation of the treatment. Results: At baseline, the mean score of global health status/QOL scale for pregabalin and duloxetine groups were 61 (standard deviation [SD]; 5.11) and 60.28 (SD; 5.44), respectively (P = 0.54). After 6 weeks, both interventions were associated with improvement of global QOL compared to baseline. The global health status/QOL score was not different between two groups after 6 weeks. While the emotional functioning was improved more favorably with duloxetine (P < 0.001); pregabalin was associated with more improvement in insomnia and pain scores (P = 0.05 and P < 0.001, respectively). Conclusion: Pregabalin as well as duloxetine improve the global QOL of breast cancer patients with TIPN. Different effects of treatments on subscale of QLQ-C30 could help clinicians to select the appropriate agent individually.
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Affiliation(s)
- Razieh Avan
- Department of Clinical Pharmacy, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.,Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Ghasem Janbabaei
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Narjes Hendouei
- Psychiatry Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Department of Community Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samaneh Borhani
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nasim Tabrizi
- Department of Neurology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Salehifar
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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17
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Kwekkeboom KL, Tostrud L, Costanzo E, Coe CL, Serlin RC, Ward SE, Zhang Y. The Role of Inflammation in the Pain, Fatigue, and Sleep Disturbance Symptom Cluster in Advanced Cancer. J Pain Symptom Manage 2018; 55:1286-1295. [PMID: 29360570 PMCID: PMC5899940 DOI: 10.1016/j.jpainsymman.2018.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/04/2018] [Accepted: 01/11/2018] [Indexed: 01/08/2023]
Abstract
CONTEXT Symptom researchers have proposed a model of inflammatory cytokine activity and dysregulation in cancer to explain co-occurring symptoms including pain, fatigue, and sleep disturbance. OBJECTIVES We tested the hypothesis that psychological stress accentuates inflammation and that stress and inflammation contribute to one's experience of the pain, fatigue, and sleep disturbance symptom cluster (symptom cluster severity, symptom cluster distress) and its impact (symptom cluster interference with daily life, quality of life). METHODS We used baseline data from a symptom cluster management trial. Adult participants (N = 158) receiving chemotherapy for advanced cancer reported pain, fatigue, and sleep disturbance on enrollment. Before intervention, participants completed measures of demographics, perceived stress, symptom cluster severity, symptom cluster distress, symptom cluster interference with daily life, and quality of life and provided a blood sample for four inflammatory biomarkers (interleukin-1β, interleukin-6, tumor necrosis factor-α, and C-reactive protein). RESULTS Stress was not directly related to any inflammatory biomarker. Stress and tumor necrosis factor-α were positively related to symptom cluster distress, although not symptom cluster severity. Tumor necrosis factor-α was indirectly related to symptom cluster interference with daily life, through its effect on symptom cluster distress. Stress was positively associated with symptom cluster interference with daily life and inversely with quality of life. Stress also had indirect effects on symptom cluster interference with daily life, through its effect on symptom cluster distress. CONCLUSION The proposed inflammatory model of symptoms was partially supported. Investigators should test interventions that target stress as a contributing factor in co-occurring pain, fatigue, and sleep disturbance and explore other factors that may influence inflammatory biomarker levels within the context of an advanced cancer diagnosis and treatment.
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Affiliation(s)
| | | | | | | | | | | | - Yingzi Zhang
- University of Wisconsin, Madison, Wisconsin, USA
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19
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Schaller A, Dragioti E, Liedberg GM, Larsson B. Quality of life during early radiotherapy in patients with head and neck cancer and pain. J Pain Res 2017; 10:1697-1704. [PMID: 28761374 PMCID: PMC5522674 DOI: 10.2147/jpr.s138113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) have a potentially severe diagnosis and often suffer from tumor-related pain as well as from adverse side effects of treatment such as radiotherapy (RT). Knowledge about quality of life (QoL) during early RT in this group is limited and should be assessed in relation to diagnosis and treatment. PURPOSE The purpose of this cross-sectional study was to identify potential factors that may influence QoL in patients with HNC during the early stages of RT (no later than two weeks of ongoing RT). We hypothesized that pain intensity, pain interference, catastrophizing, and mood disturbances are associated with QoL during early RT. PATIENTS AND METHODS In this study, 54 patients (53% of eligible patients) diagnosed with HNC were consecutively recruited from the regular flow to the Pain and Rehabilitation Center at Linköping University. The patients completed self-reported questionnaires on sociodemographics, pain intensity, pain interference, anxiety, depression, pain catastrophizing, and QoL. RESULTS The patients in this study scored high for QoL, low for pain intensity, and low for pain interference. The patients reported minor depressive symptoms and anxiety symptoms. Regression analyses showed that pain intensity and depressive symptoms negatively influenced QoL. CONCLUSION No later than two weeks of RT, pain intensity and depression negatively influenced QoL in patients with HNC. Early screening for pain and depression in a targeted preventive strategy might maintain QoL during the course of the RT for patients with HNC. This assumption needs to be further investigated.
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Affiliation(s)
- Anne Schaller
- Department of Medical and Health Sciences, Division of Community Medicine, Faculty of Health Sciences, Linköping University, Pain and Rehabilitation Centre, County Council of Östergötland, Linköping
| | - Elena Dragioti
- Department of Medical and Health Sciences, Division of Community Medicine, Faculty of Health Sciences, Linköping University, Pain and Rehabilitation Centre, County Council of Östergötland, Linköping
| | - Gunilla M Liedberg
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Britt Larsson
- Department of Medical and Health Sciences, Division of Community Medicine, Faculty of Health Sciences, Linköping University, Pain and Rehabilitation Centre, County Council of Östergötland, Linköping
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20
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Jeitler M, Jaspers J, von Scheidt C, Koch B, Michalsen A, Steckhan N, Kessler CS. Mind-body medicine and lifestyle modification in supportive cancer care: A cohort study on a day care clinic program for cancer patients. Psychooncology 2017; 26:2127-2134. [PMID: 28370730 DOI: 10.1002/pon.4433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We developed an integrative day care clinic program for cancer patients focusing on mind-body techniques and health-promoting lifestyle modification (7-hour once-per-week group sessions over 12 weeks). METHODS A cohort study design with a waiting group was implemented. Outcome parameters were assessed at the beginning, at the end of the active program, and at a 6-month follow-up. Patients waiting >4 and <12 weeks before treatment start were allocated to the waiting group and additionally assessed at the start of their day care program. Outcome measures included quality of life (FACT-G, FACT-B/C, WHO-5), fatigue (FACIT-F), depression/anxiety (HADS), and mood states (ASTS). A per protocol analysis using mixed linear models was performed. RESULTS One hundred patients were screened on-site for eligibility. Eighty-six cancer survivors (83% female; mean age 53.7 ± 9.7 years; 49% breast cancer) were included into the study. Sixty-two patients were allocated to the intervention group and 24 patients, to the waiting group (mean waiting time 5 ± 1 weeks). Sixty-six data sets were included in the final analysis. Significant improvements were observed in favor of the intervention group after 12 weeks compared with the waiting group at the end of the waiting period for quality of life, anxiety/depression, and fatigue. Results from the 6-month follow-up for the whole study population showed lasting improvement of quality of life. CONCLUSIONS The program can be considered as an effective means to improve quality of life, fatigue, and mental health of cancer patients. Moreover, it appears to have a sustainable effect, which has to be proved in randomized trials.
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Affiliation(s)
- Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Jessica Jaspers
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany
| | - Christel von Scheidt
- Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Barbara Koch
- Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Medical University, Berlin, Germany.,Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany
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21
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Cabilan CJ, Hines S. The short-term impact of colorectal cancer treatment on physical activity, functional status and quality of life: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:517-566. [PMID: 28178025 DOI: 10.11124/jbisrir-2016003282] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Physical activity, functional status and quality of life (QoL) are important determinants of the quality of life (QoL) after colorectal cancer (CRC) treatment; however, little is known on how the treatment impacts these outcomes. Having this understanding could help clinicians develop and implement strategies that would enhance or maintain the QoL of CRC patients. OBJECTIVES To identify the impact of curative CRC treatment (surgery with or without radiotherapy and/or chemotherapy) on physical activity, functional status and QoL within one year of treatment or diagnosis. INCLUSION CRITERIA TYPES OF PARTICIPANTS Colorectal cancer survivors aged 18 years and over. TYPES OF INTERVENTIONS Curative CRC treatment, which was surgery with or without radiotherapy and/or chemotherapy. TYPES OF STUDIES Pre- and post-observational and experimental studies. OUTCOMES Physical activity, ability to perform activities of daily living (functional status) and QoL. SEARCH STRATEGY CINAHL, Embase, MEDLINE, OpenGrey and ProQuest Dissertations and Theses were used to obtain published and unpublished studies in English. The date range was the start of indexing to February 2015. METHODOLOGICAL QUALITY All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. DATA EXTRACTION Data from included papers were extracted using a modified data extraction tool. Data that were presented graphically were extracted using online software. DATA SYNTHESIS The differences between postoperative and baseline values were calculated using the Review Manager 5.3.5 (Copenhagen: The Nordic Cochrane Centre, Cochrane) calculator and expressed as mean difference and their corresponding 95% confidence interval. Where possible, study results were pooled in statistical meta-analysis. The physical activity, functional status and some QoL results are presented in a narrative and table form. RESULTS A total of 23 studies were included in this review: two studies (N = 2019 patients) evaluated physical activity, two studies (N = 6908 patients) assessed functional status and 22 studies (N = 2890 patients) measured QoL. Physical activity was observed to decrease at six months after treatment. The functional status of CRC patients decreased, particularly in the elderly (Summary of findings 1 and 2). As for QoL, only the physical and functional aspects were seen to decline up to six months, but scores almost returned to baseline levels at one year after treatment. The QoL studies that used the European Organization for Research and Treatment of Cancer QLQ-C30 tool were pooled in statistical meta-analysis and summarized in Summary of findings 2. The results must be interpreted carefully due to the heterogeneity of studies and scarcity of recent studies. CONCLUSION In spite of the limitations, it is likely that the physical and functional capacity of CRC survivors deteriorates after treatment. IMPLICATIONS FOR PRACTICE The period between diagnosis and treatment provides an opportunity for clinicians to implement interventions (e.g. exercise interventions) that could enhance or restore the physical and functional capacity of CRC survivors. IMPLICATIONS FOR RESEARCH The paucity of studies and heterogeneity need to be addressed. The outcomes for colon and rectal cancer survivors, ostomates and non-ostomates must be analyzed separately.
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Affiliation(s)
- C J Cabilan
- 1Nursing Research Centre, Mater Misericordiae Limited, and The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence 2School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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The Value of Patient Reported Outcomes and Other Patient-Generated Health Data in Clinical Hematology. Curr Hematol Malig Rep 2016; 10:213-24. [PMID: 26040262 DOI: 10.1007/s11899-015-0261-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
With cures and long-term survival rates increasing in hematologic malignancies, increased focus has been placed on gaining a better understanding of the patient experience from disease and treatment effects. This has been the basis for the utilization of patient reported outcomes (PRO) and other patient-generated health data (PGHD) in efforts to improve long-term health-related quality of life (HRQOL). This review will summarize the impact PROs have had on the evolving standard of care for patients with hematologic malignant conditions and will conclude with a template for the integration of PRO and PGHD to enhance the patient experience, using stem cell transplantation as an example.
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Matthews EE, Tanner JM, Dumont NA. Sleep Disturbances in Acutely Ill Patients with Cancer. Crit Care Nurs Clin North Am 2016; 28:253-68. [PMID: 27215362 DOI: 10.1016/j.cnc.2016.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Intensive care units may place acutely ill patients with cancer at additional risk for sleep loss and associated negative effects. Research suggests that communication about sleep in patients with cancer is suboptimal and sleep problems are not regularly assessed or adequately treated throughout the cancer trajectory. However, many sleep problems and fatigue can be managed effectively. This article synthesizes the current literature regarding the prevalence, cause, and risk factors that contribute to sleep disturbance in the context of acute cancer care. It describes the consequences of poor sleep and discusses appropriate assessment and treatment options.
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Affiliation(s)
- Ellyn E Matthews
- Department of Nursing Science, College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham Street, #529, Little Rock, AR 72205, USA.
| | - J Mark Tanner
- Department of Nursing Science, College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham Street, #529, Little Rock, AR 72205, USA
| | - Natalie A Dumont
- Department of Nursing Science, College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham Street, #529, Little Rock, AR 72205, USA
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Schuler MK, Trautmann F, Radloff M, Schmädig R, Hentschel L, Eberlein-Gonska M, Petzold T, Vetter H, Oberlack S, Ehninger G, Schmitt J. Implementation of a mobile inpatient quality of life (QoL) assessment for oncology nursing. Support Care Cancer 2016; 24:3391-9. [PMID: 26984243 DOI: 10.1007/s00520-016-3163-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/07/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE Cancer patients suffer from a variety of symptoms, but little is known about changes during hospitalization and symptom burden at discharge. We implemented an electronic quality of life (QoL) assessment used by the nursing team in routine inpatient care. Feasibility, acceptance, and the course of QoL were investigated. METHODS A self-administered electronic questionnaire based on the EQ-5D and the EORTC QLQ-C30 was applied in clinical routine. Cancer patients were approached by the nursing staff to complete the QoL assessment twice, at admission and at the day of discharge. Both the feedback of the nursing staff as well as characteristics of participants were used to evaluate the electronic assessment. RESULTS Out of 210 patients from an oncologic ward, 85 patients (40 %) were invited to participate, 95 % of whom (n = 81) agreed to participate. Participation rate depended on the day of admission, the presence of the coordinating nurse, the overall morbidity assessed by patient clinical complexity level, and the patient age. Forty-six patients (56 %) asked for assistance in completing the questionnaire. Patients older than 53 years and male patients were more likely to need assistance. Twenty-two percent of the nursing staff (n = 5) use the information assessed for individual patient care. Fifty-two percent (n = 12) rated the additional workload as very little or little and 68 % (n = 15) agreed that handling for the patient was easy. Global QoL improved during the stay. Most severe symptoms at admission included fatigue, pain, appetite loss, and insomnia. CONCLUSIONS The results of this study indicate that it is feasible to implement and use an electronic QoL assessment by the nursing staff in routine inpatient cancer care. Obstacles and worries of staff members have to be considered when further developing this program.
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Affiliation(s)
- Markus K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Freya Trautmann
- Center for Evidence Based Healthcare (ZEGV), Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden and German Cancer Research Center (DKFZ), Fetscherstraße 74, 01307, Dresden, Germany
| | - Mirko Radloff
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Roman Schmädig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Leopold Hentschel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Maria Eberlein-Gonska
- Department of Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Thomas Petzold
- Center for Evidence Based Healthcare (ZEGV), Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,Department of Quality and Medical Risk Management, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Heike Vetter
- Department of Medical Information Technology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sebastian Oberlack
- Department of Medical Information Technology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence Based Healthcare (ZEGV), Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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López E, de la Torre-Luque A, Lazo A, Álvarez J, Buela-Casal G. Assessment of sleep disturbances in patients with cancer: Cross-sectional study in a radiotherapy department. Eur J Oncol Nurs 2016; 20:71-6. [DOI: 10.1016/j.ejon.2014.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 12/27/2014] [Accepted: 12/31/2014] [Indexed: 11/17/2022]
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Fang HF, Miao NF, Chen CD, Sithole T, Chung MH. Risk of Cancer in Patients with Insomnia, Parasomnia, and Obstructive Sleep Apnea: A Nationwide Nested Case-Control Study. J Cancer 2015; 6:1140-7. [PMID: 26516362 PMCID: PMC4615350 DOI: 10.7150/jca.12490] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/30/2015] [Indexed: 01/13/2023] Open
Abstract
Purpose: Insomnia, parasomnia, and obstructive sleep apnea have been associated with a number of disease pathologies, but little is known about the relationship of these sleep disorders and cancer. The study explored the risk of sleep disorder (SD)-induced cancer using nationwide population data. Two million data from the National Health Insurance system of Taiwan was used to assess for the relationship. Patients and Methods: Patients with cancer as our cases and patients without cancer as our control group in 2001-20011. The study patients were traced back to seek the exposure risk factor of sleep disorders, which was divided into three categories: insomnia, obstructive sleep apnea (OSA) and parasomnia. Patients were selected excluding patients who had cancer prior to presenting with the sleep disorder and the person-year is less than 2 years. Each case was randomly matched with two cases with the same age, gender, and index year. Results: There were significantly increased risks of breast cancer in the patients with insomnia (AHR=1.73; 95% CI: 1.57-1.90), patients with parasomnia (AHR=2.76; 95% CI: 1.53-5.00), and patients with OSA (AHR=2.10; 95% CI: 1.16-3.80). Moreover, patients with parasomnia had significantly higher risk of developing oral cancer (AHR=2.71; 95% CI: 1.02-7.24) compared with patients without parasomnia. The risk of suffering from nasal cancer (AHR=5.96, 95% CI: 2.96-11.99) and prostate cancer (AHR=3.69, 95% CI: 1.98- 6.89) in patients with OSA was significantly higher than that of patients without OSA. Conclusions: Our findings provided the evidence that people diagnosed with insomnia, parasomnia and OSA are at a higher risk of developing cancers to remind people to improve sleep quality.
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Affiliation(s)
- Hui-Feng Fang
- 1. Deputy Director, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Nae-Fang Miao
- 2. Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chi-Dan Chen
- 3. Assistant, Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Trevor Sithole
- 4. Nurse, Maternity Department, Emkhuzweni Health Center, Swaziland ; 5. Nurse, Customer Care Officer, Emkhuzweni Health Center, Swaziland
| | - Min-Huey Chung
- 6. Associate Professor, School of Nursing, Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Fujisawa D, Inoguchi H, Shimoda H, Yoshiuchi K, Inoue S, Ogawa A, Okuyama T, Akechi T, Mimura M, Shimizu K, Uchitomi Y. Impact of depression on health utility value in cancer patients. Psychooncology 2015; 25:491-5. [PMID: 26283141 DOI: 10.1002/pon.3945] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 07/28/2015] [Accepted: 07/28/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The quality-adjusted life year, which is usually calculated from the health utility value, is now a standard measurement used in political decision-making in health. Although depression is the leading cause of decrement in health utility in general population, impact of comorbid depression among cancer patients has not been studied sufficiently. Therefore, this study aimed to measure the impact of depression on cancer patients' health utility score, according to the severity of depression. METHODS Impact of depression severity (measured by the Patient Health Questionnaire) on health utility score (measured by the EuroQoL-5 scale) was evaluated in a sample of 328 Japanese cancer patients, controlling for performance status, symptom burden, and demographic variables. RESULTS The patients with depression had significantly lower health utility value than those without depression (mean decrement = 0.14). Decrements in health utility of 0.13, 0.18, and 0.19 were observed for mild, moderate, and moderately severe to severe level of depression, respectively. The difference was significant between groups. Depression severity was a significant predictor for health utility (standardized coefficient beta = -0.25), which was comparable with physical symptom burden and performance status. Participants' age, gender, cancer stage, and comorbid illness were not significant. The model explained 37.9% of the variance. CONCLUSIONS Even mild level of depression caused clinically meaningful decrement in health utility value in cancer patients, which was comparable with decrements due to major physical complications of cancer. Influence of depression should be carefully investigated when interpreting the quality-adjusted life year among cancer patients. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Daisuke Fujisawa
- Department of Neuropsychiatry and Palliative Care Center, Keio University School of Medicine, Japan.,Department of Psycho-Oncology, National Cancer Center, Japan
| | | | - Haruki Shimoda
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan.,Department of Mental Health, University of Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Science and Psychosomatic Medicine, University of Tokyo, Japan
| | | | - Asao Ogawa
- Department of Psycho-Oncology, National Cancer Center, Japan
| | - Toru Okuyama
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry and Palliative Care Center, Keio University School of Medicine, Japan
| | - Ken Shimizu
- Department of Psycho-Oncology, National Cancer Center, Japan
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center, Japan
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Gorini A, Mazzocco K, Gandini S, Munzone E, McVie G, Pravettoni G. Development and psychometric testing of a breast cancer patient-profiling questionnaire. BREAST CANCER-TARGETS AND THERAPY 2015; 7:133-46. [PMID: 26064067 PMCID: PMC4457218 DOI: 10.2147/bctt.s80014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction The advent of “personalized medicine” has been driven by technological advances in genomics. Concentration at the subcellular level of a patient’s cancer cells has meant inevitably that the “person” has been overlooked. For this reason, we think there is an urgent need to develop a truly personalized approach focusing on each patient as an individual, assessing his/her unique mental dimensions and tailoring interventions to his/her individual needs and preferences. The aim of this study was to develop and test the psychometric properties of the ALGA-Breast Cancer (ALGA-BC), a new multidimensional questionnaire that assesses the breast cancer patient’s physical and mental characteristics in order to provide physicians, prior to the consultation, with a patient’s profile that is supposed to facilitate subsequent communication, interaction, and information delivery between the doctor and the patient. Methods The specific validation processes used were: content and face validity, construct validity using factor analysis, reliability and internal consistency using test–retest reliability, and Cronbach’s alpha correlation coefficient. The exploratory analysis included 100 primary breast cancer patients and 730 healthy subjects. Results The exploratory factor analysis revealed eight key factors: global self-rated health, perceived physical health, anxiety, self-efficacy, cognitive closure, memory, body image, and sexual life. Test–retest reliability and internal consistency were good. Comparing patients with a sample of healthy subjects, we also observed a general ability of the ALGA-BC questionnaire to discriminate between the two. Conclusion The ALGA-BC questionnaire with 29 items is a valid instrument with which to obtain a patient’s profile that is supposed to help physicians achieve meaningful personalized care which supplements biological and genetic analyses.
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Affiliation(s)
- Alessandra Gorini
- Department of Health Science, University of Milan, Milan, Italy ; European Institute of Oncology, Milan, Italy
| | - Ketti Mazzocco
- Department of Health Science, University of Milan, Milan, Italy ; European Institute of Oncology, Milan, Italy
| | | | | | | | - Gabriella Pravettoni
- Department of Health Science, University of Milan, Milan, Italy ; European Institute of Oncology, Milan, Italy
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Sklenarova H, Haun M, Krümpelmann A, Friederich HC, Huber J, Thomas M, Winkler E, Girgis A, Dinkel A, Herzog W, Hartmann M. Psychometric evaluation of the German Version of the Supportive Care Needs Survey for Partners and Caregivers (SCNS-P&C-G) of cancer patients. Eur J Cancer Care (Engl) 2015; 24:884-97. [DOI: 10.1111/ecc.12325] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 11/27/2022]
Affiliation(s)
- H. Sklenarova
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
| | - M.W. Haun
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
| | - A. Krümpelmann
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
| | - H.-C. Friederich
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
| | - J. Huber
- Department of Urology; University Hospital Carl Gustav Carus; Technical University of Dresden; Dresden 01307 Germany
| | - M. Thomas
- Thoraxklinik-Heidelberg gGmbH; Heidelberg University Hospital; 69126 Heidelberg Germany
| | - E.C. Winkler
- Heidelberg University Hospital; National Center for Tumor Diseases Heidelberg; 69120 Heidelberg Germany
| | - A. Girgis
- Ingham Institute for Applied Medical Research; The University of New South Wales; Liverpool BC NSW 1871 Australia
| | - A. Dinkel
- Department of Psychosomatic Medicine and Psychotherapy; Klinikum rechts der Isar der TU München; 81675 München Germany
| | - W. Herzog
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
| | - M. Hartmann
- Department of General Internal Medicine & Psychosomatics; Heidelberg University Hospital; D-69120 Heidelberg Germany
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Dobos G, Overhamm T, Büssing A, Ostermann T, Langhorst J, Kümmel S, Paul A, Cramer H. Integrating mindfulness in supportive cancer care: a cohort study on a mindfulness-based day care clinic for cancer survivors. Support Care Cancer 2015; 23:2945-55. [PMID: 25711654 DOI: 10.1007/s00520-015-2660-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 02/15/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to investigate the effects of a mindfulness-based day care clinic group program for cancer survivors on health-related quality of life and mental health; and to investigate which psychological variables are associated with changes in health variables. METHODS One hundred seventeen cancer survivors (91.0 % female; mean age 53.9 ± 10.7 years; 65.0 % breast cancer; mean time since diagnosis 27.2 ± 46.5 months) participated in an 11-week mindfulness-based day care clinic group program, 6 h per week. The intervention incorporated mindfulness-based meditation, yoga, cognitive-behavioral techniques, and lifestyle modification. Outcome measures including health-related quality of life (EORTC QLQ-C30), depression and anxiety (HADS); and psychological variables including life satisfaction (BMLSS), mindfulness (FMI), adaptive coping styles (AKU), spiritual/religious attitudes in dealing with illness (SpREUK), and interpretation of illness (IIQ) were assessed before, after, and 3 months after the intervention. RESULTS Using mixed linear models, significant improvements in global health status, physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning were found. Cancer-related symptoms, including fatigue, pain, insomnia, constipation, anxiety, and depression, also improved significantly. Mindfulness, life satisfaction, health satisfaction, all coping styles, all spiritual/religious attitudes, and interpretation of illness as something of value increased; interpretation of illness as punishment decreased significantly (all p < 0.05). Improved outcomes were associated with increases in psychological variables, mainly life satisfaction, health satisfaction, and trust in medical help (R (2) = 7.3-43.6 %). CONCLUSION Supportive mindfulness-based interventions can be considered as an effective means to improve cancer survivors' physical and mental health. Functional improvements are associated with improved satisfaction and coping styles.
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Affiliation(s)
- Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
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Kotronoulas G, Kearney N, Maguire R, Harrow A, Di Domenico D, Croy S, MacGillivray S. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol 2014; 32:1480-501. [PMID: 24711559 DOI: 10.1200/jco.2013.53.5948] [Citation(s) in RCA: 630] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The systematic use of patient-reported outcome measures (PROMs) has been advocated as an effective way to standardize cancer practice. Yet, the question of whether PROMs can lead to actual improvements in the quality of patient care remains under debate. This review examined whether inclusion of PROM in routine clinical practice is associated with improvements in patient outcomes, processes of care, and health service outcomes during active anticancer treatment. METHODS A systematic review of five electronic databases (Medline, EMBASE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], PsycINFO, and Psychology and Behavioral Sciences Collection [PBSC]) was conducted from database inception to May 2012 to locate randomized and nonrandomized controlled trials of patients receiving active anticancer treatment or supportive care irrespective of type of cancer. RESULTS Based on prespecified eligibility criteria, we included 26 articles that reported on 24 unique controlled trials. Wide variability in the design and use of interventions delivered, outcomes evaluated, and cancer- and modality-specific context was apparent. Health service outcomes were only scarcely included as end points. Overall, the number of statistically significant findings were limited and PROMs' intervention effect sizes were predominantly small-to-moderate. CONCLUSION The routine use of PROMs increases the frequency of discussion of patient outcomes during consultations. In some studies, PROMs are associated with improved symptom control, increased supportive care measures, and patient satisfaction. Additional effort is required to ensure patient adherence, as well as additional support to clinicians who will respond to patient concerns and issues, with clear system guidelines in place to guide their responses. More research is required to support PROM cost-benefit in terms of patient safety, clinician burden, and health services usage.
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Affiliation(s)
- Grigorios Kotronoulas
- Grigorios Kotronoulas, Nora Kearney, Roma Maguire, University of Surrey, Guildford; Alison Harrow, Dundee Cancer Centre; David Di Domenico, Stephen MacGillivray, University of Dundee, Dundee; Suzanne Croy, Dementia Services Development Centre, University of Stirling, Stirling, United Kingdom
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Annin K, Saeed B, Yawson A, Musah AAI, Nakua E, Agyei-Baffour P, Nsowah-Nuamah NNN. Assessing the association between the degree of pain and socioeconomic status among older persons in Ghana. Glob J Health Sci 2014; 6:155-64. [PMID: 24762358 PMCID: PMC4825245 DOI: 10.5539/gjhs.v6n3p155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/18/2013] [Indexed: 11/23/2022] Open
Abstract
Objectives: The current study sought to examine the association between the degree of pain and socioeconomic status among older male and female Ghanaians. Method: Data were drawn from the 2007–08 World Health Organization Global Ageing and Adult Health (SAGE) survey conducted in Ghana (Young adults=803, Adults=1689 and Older adults=2616). This includes bodily aches Ghanaians experienced in the last 30 days. Analyses of the association of pain with predisposing and enabling factors were carried out by means of ordinal logistic regression analysis. Results: In the age-adjusted model, pain was statistically significantly associated with the cohabitating group as its marginal effect suggests that respondents in that category were less likely to experience pain as related to the others in women. Conclusion: This study established that Ghanaian men go through more pain than their women counterparts. This article is premier to our knowledge to apply ordered logistic for the degree of pain.
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Affiliation(s)
| | - Bahiru Saeed
- Mathematics and Statistics Department, Kumasi Polytechnic, Kumasi, Ghana.
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Al-Majid S, Wilson LD, Rakovski C, Coburn JW. Effects of exercise on biobehavioral outcomes of fatigue during cancer treatment: results of a feasibility study. Biol Res Nurs 2014; 17:40-8. [PMID: 25504949 DOI: 10.1177/1099800414523489] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Cancer treatment is associated with decreased hemoglobin (Hb) concentration and aerobic fitness (VO2 max), which may contribute to cancer-related fatigue (CRF) and decreased quality of life (QoL). Endurance exercise may attenuate CRF and improve QoL, but the mechanisms have not been thoroughly investigated. Objectives. To (a) determine the feasibility of conducting an exercise intervention among women receiving treatment for breast cancer; (b) examine the effects of exercise on Hb and VO2 max and determine their association with changes in CRF and QoL; and (c) investigate changes in selected inflammatory markers. Methods. Fourteen women receiving chemotherapy for Stages I-II breast cancer were randomly assigned to exercise (n = 7) or usual care (n = 7). Women in the exercise group performed supervised, individualized treadmill exercise 2-3 times/week for the duration of chemotherapy (9-12 weeks). Data were collected 4 times over 15-16 weeks. Results. Recruitment rate was 45.7%. Sixteen women consented and 14 completed the trial, for a retention rate of 87.5%. Adherence to exercise protocol was 95-97%, and completion of data collection was 87.5-100%. Exercise was well tolerated. VO2 max was maintained at prechemotherapy levels in exercisers but declined in the usual-care group (p < .05). Hb decreased (p < .001) in all participants as they progressed through chemotherapy. Exercise did not have significant effects on CRF or QoL. Changes in inflammatory markers favored the exercise group. CONCLUSIONS Exercise during chemotherapy may protect against chemotherapy-induced decline in VO2 max but not Hb concentration.
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Affiliation(s)
- Sadeeka Al-Majid
- School of Nursing, California State University, Fullerton, CA, USA
| | - Lori D Wilson
- Department of Kinesiology, California State University, Long Beach, Long Beach, CA, USA
| | - Cyril Rakovski
- Schmid College of Science & Technology, Chapman University, Orange, CA, USA
| | - Jared W Coburn
- Kinesiology Department, California State University, Fullerton, Fullerton, CA, USA
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Cramer H, Cohen L, Dobos G, Witt CM. Integrative oncology: best of both worlds-theoretical, practical, and research issues. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:383142. [PMID: 24371456 PMCID: PMC3863498 DOI: 10.1155/2013/383142] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 12/15/2022]
Abstract
More and more cancer patients use complementary therapies. As the majority of patients do not disclose their use of complementary therapies to their oncologists, they expose themselves to possible detrimental effects from the therapies due to drug interactions. To meet the needs of patients and health care professionals on valid information on complementary therapies, the collaborative research project "Competence Network Complementary Medicine in Oncology-KOKON", an interdisciplinary network for complementary medicine research in oncology, was established. Moreover, Integrative Oncology, a combination of conventional and evidenced-based complementary therapies delivered using a comprehensive approach, is now increasingly used in the United States and Europe. A variety of different Integrative Oncology models have been established worldwide including an expert-based model at the Kliniken Essen-Mitte, Essen, Germany and a patient-centered, evidenced-based approach at The University of Texas MD Anderson Cancer Center. Both models are briefly reviewed. More research is needed and Comparative Effectiveness Research that places strong emphasis on the comparison of different treatment options in usual care settings by including more heterogeneous patients, using less standardized treatment protocols, and measuring patient-centered outcomes would provide useful information for decision-making. To improve the quality of care and research in Integrative Oncology, sustainable financial models for Integrative Oncology and more funding for research are needed.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Lorenzo Cohen
- Department of General Oncology and the Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Claudia M. Witt
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, 10M7 Berlin, Germany
- University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, MD 21201, USA
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Jiwa M, McManus A, Dadich A. The impact of knowledge, attitudes and beliefs on the engagement of primary and community-based healthcare professionals in cancer care: a literature review. Curr Med Res Opin 2013; 29:1475-82. [PMID: 23998506 DOI: 10.1185/03007995.2013.838154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary health services are well placed to reinforce prevention, early intervention, and connected care. Despite this important role, primary care providers (PCPs) have a limited capacity to meet the varied needs of people with cancer and their carers - furthermore, the reasons for this largely remain unexplored. SCOPE To identify: (1) the knowledge, attitudes, and beliefs held by health professionals and patients that can influence the engagement of PCPs with the early detection of cancer and follow-up care; (2) evidence that attitudes and beliefs can be modified with measureable impact on the engagement of PCPs with cancer care; and (3) potential targets for intervention. This was achieved through a review of English publications from 2000 onwards, sourced from six academic databases and complemented with a search for grey literature. FINDINGS A total of 4212 articles were reviewed to identify studies conducted in the UK, Canada, Holland (or The Netherlands), Australia, or New Zealand given the comparable role of PCPs. Several factors hinder PCP participation in cancer care, all of which are related to knowledge, attitudes, and beliefs. Patients and specialists are uncertain about the role that primary care could play and whether their primary care team has the necessary expertise. PCPs have varied opinions about the ideal content of follow-up programs. Study limitations include: the absence of well accepted definitions of key terms; the indexing systems used by databases to code publications, which may have obscured all relevant publications; the paucity of robust research; and possible researcher bias which was minimized through independent review by trained reviewers and the implementation of rigorous inter-rater reliability measures. CONCLUSIONS Knowledge, attitudes, and beliefs influence PCP engagement in cancer care. It is important to develop shared understandings of these terms because the knowledge, attitudes, and beliefs of PCPs, specialists, patients, and their families can influence the effectiveness of treatment plans.
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Affiliation(s)
- Moyez Jiwa
- Curtin University, Medical Education , Bentley, Perth , Australia
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Romito F, Cormio C, De Padova S, Lorusso V, Berio MA, Fimiani F, Piattelli A, Palazzo S, Abram G, Dudine L, Guglielmi A, Galise I, Romito S, Mattioli V. Patients attitudes towards sleep disturbances during chemotherapy. Eur J Cancer Care (Engl) 2013; 23:385-93. [PMID: 23947497 DOI: 10.1111/ecc.12106] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 11/27/2022]
Abstract
Sleep disturbances are among the most distressing symptoms in cancer: they often co-occur with fatigue, pain and psychological distress. Despite the negative impact on quality of life, patients rarely seek help for managing their sleep disturbances. This paper presents the results of a multicentre observational study on patients' attitudes towards their sleep problems. The study also investigates symptom correlates. Patients responded to a semi-structured interview and completed the following questionnaires: Pittsburgh Sleep Quality Index; Brief Fatigue Inventory; Hospital Anxiety and Depression Scale; and European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life QLQ-C30 Questionnaire (QLQ-C30). Four hundred and three cancer patients were enrolled in the study. Bad sleepers constituted 66% of the sample. Thirty-eight per cent of them had not turned to any professional to solve their sleep disturbances because they had various beliefs about the importance of the problem and the possibility to be treated. The main correlates of sleep disturbances were psychological distress, reduced physical functioning and reduced overall quality of life. In conclusion, there is a need to sensitise patients to actively search for a solution to their sleep disturbances so they can be solved along with other co-occurring symptoms. Doctors could also be encouraged to dedicate more attention to routinely asking cancer patients about eventual sleep disturbances.
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Affiliation(s)
- F Romito
- Experimental Unit of Psycho-Oncology, Department of Critical Area and Surgery, National Cancer Research Center, Istituto Tumori 'Giovanni Paolo II', Bari, Italy
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Aukst Margetić B, Kukulj S, Šantić Ž, Jakšić N, Jakovljević M. Predicting depression with temperament and character in lung cancer patients. Eur J Cancer Care (Engl) 2013; 22:807-14. [DOI: 10.1111/ecc.12080] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2013] [Indexed: 12/31/2022]
Affiliation(s)
- B. Aukst Margetić
- Department of Psychiatry; University Hospital Center Zagreb; Zagreb Croatia
| | - S. Kukulj
- Department of Pulmonary Diseases Jordanovac; University Hospital Center Zagreb; Zagreb Croatia
| | - Ž. Šantić
- University School of Medicine Mostar; Mostar Bosnia and Herzegovina
| | - N. Jakšić
- Department of Psychiatry; University Hospital Center Zagreb; Zagreb Croatia
| | - M. Jakovljević
- Department of Psychiatry; University Hospital Center Zagreb; Zagreb Croatia
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Schuh-Hofer S, Wodarski R, Pfau DB, Caspani O, Magerl W, Kennedy JD, Treede RD. One night of total sleep deprivation promotes a state of generalized hyperalgesia: a surrogate pain model to study the relationship of insomnia and pain. Pain 2013; 154:1613-1621. [PMID: 23707287 DOI: 10.1016/j.pain.2013.04.046] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 04/03/2013] [Accepted: 04/19/2013] [Indexed: 12/25/2022]
Abstract
Sleep disturbances are highly prevalent in chronic pain patients. Understanding their relationship has become an important research topic since poor sleep and pain are assumed to closely interact. To date, human experimental studies exploring the impact of sleep disruption/deprivation on pain perception have yielded conflicting results. This inconsistency may be due to the large heterogeneity of study populations and study protocols previously used. In addition, none of the previous studies investigated the entire spectrum of nociceptive modalities. To address these shortcomings, a standardized comprehensive quantitative sensory protocol was used in order to compare the somatosensory profile of 14 healthy subjects (6 female, 8 male, 23.5 ± 4.1 year; mean ± SD) after a night of total sleep deprivation (TSD) and a night of habitual sleep in a cross-over design. One night of TSD significantly increased the level of sleepiness (P<0.001) and resulted in higher scores of the State Anxiety Inventory (P<0.01). In addition to previously reported hyperalgesia to heat (P<0.05) and blunt pressure (P<0.05), study participants developed hyperalgesia to cold (P<0.01) and increased mechanical pain sensitivity to pinprick stimuli (P<0.05) but no changes in temporal summation. Paradoxical heat sensations or dynamic mechanical allodynia were absent. TSD selectively modulated nociception, since detection thresholds of non-nociceptive modalities remained unchanged. Our findings show that a single night of TSD is able to induce generalized hyperalgesia and to increase State Anxiety scores. In the future, TSD may serve as a translational pain model to elucidate the pathomechanisms underlying the hyperalgesic effect of sleep disturbances.
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Affiliation(s)
- Sigrid Schuh-Hofer
- Institute of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim, Heidelberg University, 68167 Mannheim, Germany Zentrum für Neurologie, Abteilung Epileptologie, Universitätsklinikum Tübingen der Eberhard Karls Universität, Germany Eli Lilly & Company, Erl Wood Manor, Windlesham, Surrey GU2 06PH, UK Eli Lilly & Company, Indianapolis, IN, USA
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Paul A, Cramer H, Lauche R, Altner N, Langhorst J, Dobos GJ. An oncology mind-body medicine day care clinic: concept and case presentation. Integr Cancer Ther 2013; 12:503-7. [PMID: 23329568 DOI: 10.1177/1534735412473639] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cancer diagnosis and treatment are often associated with physical and psychosocial impairments. Many cancer patients request complementary and alternative therapies such as mind-body medicine. CONCEPT The department of internal and integrative medicine at the Essen-Mitte Clinics offer a mind-body medicine day care clinic for cancer patients that is based on the Mindfulness-Based Stress Reduction Program and the mind-body medicine cancer program of the Harvard Mind/Body Medical Institute. The program encompasses mindfulness training, yoga, mindful exercise, nutrition, naturopathic self-help strategies, and cognitive restructuring. CASES Two patients who had participated in the day care clinic program are presented here. One patient presented with anxiety and depression after recently diagnosed breast cancer and the other with psychological impairments as a result of multiple nevi excision after malignant melanoma surgery. Both patients improved in terms of anxiety and further psychological symptoms. CONCLUSIONS The Essen-Mitte Clinics mind-body medicine day care clinic appears to alleviate psychological consequences of cancer and its treatment. Further studies and randomized controlled trials are necessary to confirm these results.
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Affiliation(s)
- Anna Paul
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Palesh O, Peppone L, Innominato PF, Janelsins M, Jeong M, Sprod L, Savard J, Rotatori M, Kesler S, Telli M, Mustian K. Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer. Nat Sci Sleep 2012; 4:151-162. [PMID: 23486503 PMCID: PMC3593248 DOI: 10.2147/nss.s18895] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Sleep problems are highly prevalent in cancer patients undergoing chemotherapy. This article reviews existing evidence on etiology, associated symptoms, and management of sleep problems associated with chemotherapy treatment during cancer. It also discusses limitations and methodological issues of current research. The existing literature suggests that subjectively and objectively measured sleep problems are the highest during the chemotherapy phase of cancer treatments. A possibly involved mechanism reviewed here includes the rise in the circulating proinflammatory cytokines and the associated disruption in circadian rhythm in the development and maintenance of sleep dysregulation in cancer patients during chemotherapy. Various approaches to the management of sleep problems during chemotherapy are discussed with behavioral intervention showing promise. Exercise, including yoga, also appear to be effective and safe at least for subclinical levels of sleep problems in cancer patients. Numerous challenges are associated with conducting research on sleep in cancer patients during chemotherapy treatments and they are discussed in this review. Dedicated intervention trials, methodologically sound and sufficiently powered, are needed to test current and novel treatments of sleep problems in cancer patients receiving chemotherapy. Optimal management of sleep problems in patients with cancer receiving treatment may improve not only the well-being of patients, but also their prognosis given the emerging experimental and clinical evidence suggesting that sleep disruption might adversely impact treatment and recovery from cancer.
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Affiliation(s)
- Oxana Palesh
- Stanford University School of Medicine, Stanford, CA, USA
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