Pain, Fatigue, Nausea, and Vomiting as the Predictors of Anxiety in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Prospective Cohort Study

The primary outcome was to assess the correlation between anxiety and pain, fatigue, nausea, and vomiting. The secondary outcome was to determine the predictive roles of pain, fatigue, nausea, and vomiting in anxiety among patients undergoing Hematopoietic Stem Cell Transplantation (HSCT). The present prospective cohort study was conducted on 200 patients treated by HSCT referred to the centers affiliated to Shiraz University of Medical Sciences. The data were collected using Spielberger Anxiety Questionnaire, Numerical Pain Scale, Brief Fatigue Inventory, and Rhodes Nausea and Vomiting Index. The data were analyzed using Spearman’s test and multiple regression analysis. The means of state anxiety, trait anxiety, pain, fatigue, and nausea, vomiting, and retching were 41.67 (SD = 9.71), 43.78 (SD = 9.00), 3.79 (SD = 2.79), 4.23 (SD = 2.48), and 6.31 (SD = 7.53), respectively. The results showed that the participants with higher pain and fatigue scores had higher anxiety levels. Those with more nausea and vomiting had higher anxiety levels, as well. This indicated that fatigue, pain, severity and frequency of nausea, and type of HSCT were the predictors of trait anxiety. The results also showed the predictor role of pain, fatigue, and type of HSCT in state anxiety. The findings revealed a correlation between anxiety and pain, fatigue, nausea, and vomiting among the HSCT patients. The results also showed fatigue and pain as the predictors of anxiety among these patients. Yet, future studies are recommended to determine the other factors contributing to anxiety amongst HSCT patients.

Comparing the effectiveness of three pain relief methods for inserting a needle into the implanted venous access chemoport: A randomized controlled trial

AIMS

Effective methods for relieving pain in inserting a needle for chemotherapy in cancer patients have been studied. This study examined the pain relief effects during needle insertion into the implanted venous access chemoport by comparing three methods.

METHODS

This randomized controlled trial included 120 cancer patients who were randomly assigned. The experimental groups received applications of lidocaine cream (n = 30), cryotherapy (n = 30) and cutaneous stimulation therapy (n = 30); the control group (n = 30) received routine care. Premeasurements and postmeasurements were evaluated using a visual analogue pain scale and nurses' careful observations of patients' pain behaviour checklists during needle insertion.

RESULTS

Pain levels were reduced by all three interventions, with the level of relief depending on the type of application. All experimental groups showed significant reduction in pain compared with the control group. Lidocaine cream had the strongest effect, followed by cryotherapy and then cutaneous stimulation.

CONCLUSION

Lidocaine cream, cryotherapy and cutaneous stimulation therapy all reduced cancer patients' pain levels during insertion of an implanted central venous access chemoport needle. Nurses can apply cryotherapy and cutaneous stimulation therapy independently to reduce the pain associated with this procedure. Future studies should consider using these methods to control for any individual differences that may exist.

A Concept Analysis of Spiritual Health

Spiritual health is an important dimension of health and forms part of a comprehensive care. This study was conducted to redefine and clarify the components of spiritual health based on different worldviews through Walker and Avant's concept analysis method. Being given a life and a soul and having beliefs are the antecedents of spiritual health. The attributes of this concept include a morality-oriented intellectual connectedness with the self, others, and the universe guided by a connection with the Transcendent and Superior being in order to create meaning in life and find its purpose in the context of culture and religion; transcendence is ultimately the consequence of spiritual heath. Using the attributes appeared in this conceptual analysis, nurses can evaluate the spiritual health of their clients and help them create positive outcome by providing appropriate interventions.

Trajectories of spiritual well-being in long-term survivors of cancer: A report from the American Cancer Society's Studies of Cancer Survivors-I

BACKGROUND

Existing research indicates that religion, spirituality, or both are important to the quality of life of patients with cancer. The current study is the first to characterize trajectories of spiritual well-being (SWB) over time and to identify their predictors in a large, diverse sample of long-term cancer survivors.

METHODS

The participants were 2365 cancer survivors representing 10 cancer diagnoses from the American Cancer Society's Studies of Cancer Survivors-I, and they were assessed at 3 time points: 1, 2, and 9 years after their diagnosis. SWB was assessed with the 3 subscales of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp; ie, Meaning, Peace, and Faith). Predictors included demographic, medical, and psychosocial variables. Latent growth mixture modeling was used to identify trajectories and test their predictors.

RESULTS

Four distinct trajectories of SWB were identified for each of the FACIT-Sp subscales: stable-high (45%-61% of the sample, depending on the subscale), stable-moderate (23%-33%), stable-low (7%-16%), and declining (6%-10%). Significant predictors of these trajectories included age, sex, race, education, comorbidities, symptom burden, social support, and optimism, but not always in the hypothesized direction. For some of the subscale trajectories, a recurrence of cancer, multiple cancers, or metastatic cancer was associated with lower SWB.

CONCLUSIONS

This is the first study to establish the existence and predictors of heterogeneous trajectories of SWB in long-term survivors of cancer. Because SWB is an important component of quality of life, the current results indicate characteristics of persons who could be at greater risk for a decline or consistently low scores in SWB and may warrant clinical attention.

Opioid-taking self-efficacy as influencing emotional status in patients with cancer pain

PURPOSE

The purpose of this study was to evaluate how much of the variance in emotional status amongst Taiwanese cancer patients could be accounted for by opioid-taking self-efficacy.

METHODS

This cross-sectional study included 109 cancer patients who had taken prescribed opioid analgesics for cancer related pain in the past week and completed the Opioid-Taking Self-Efficacy Scale-CA (OTSES-CA) and Hospital Anxiety and Depression Scale.

RESULTS

There was a significant and negative correlation between scores on anxiety and self-efficacy total scale (r = -0.29, p < 0.01), self-efficacy communication subscale (r = -0.37, p < 0.01), self-efficacy acquiring help subscale (r = -0.22, p < 0.05) and self-efficacy managing treatment related concerns subscale (r = -0.32, p < 0.01). However, the correlation between scores on depression and the self-efficacy total scale was not significant (r = -0.18, p > 0.05); only the self-efficacy communication subscale was significantly and negatively associated with depression (r = -0.27, p < 0.01). The opioid-taking self-efficacy total scale accounted for 8% of predicting the patients' anxiety. Opioid-taking self-efficacy subscales accounted for 20% (R² = 0.20, p = 0.000) of the variance in predicting anxiety and 10% (R² = 0.10, p = 0.02) of the variance in predicting depression.

CONCLUSIONS

This study highlights the potential importance of a patient's opioid-taking self-efficacy beliefs in their emotional status, which is relevant to cancer pain.