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Asakitogum DA, Nutor JJ, Pozzar R, Hammer M, Alismail S, Kober KM, Miaskowski C. Multidimensional Model of Energy in Patients With Cancer. Semin Oncol Nurs 2024:151644. [PMID: 38692969 DOI: 10.1016/j.soncn.2024.151644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Evidence suggests that energy is a distinct symptom from fatigue in patients with cancer. The purpose of this paper is to present the Multidimensional Model of Energy in Patients with Cancer (MMEPC) that is based on emerging evidence and to make recommendations for clinical practice and future research. METHODS The literature was reviewed to determine various factors associated with variations in energy in patients with cancer. In addition, some of the emerging evidence in the model is supported by studies of energy in the general population and in patients with other chronic conditions. RESULTS Based on a review of the literature, specific concepts in the MMEPC include: person factors, clinical factors, cancer-related factors, biological factors, factors associated with energy balance, and co-occurring symptoms. The evidence to support the association between each of these factors and variations in energy levels in patients with cancer is described and synthesized. CONCLUSION This article provides emerging evidence on factors that influence variations in energy levels in patients with cancer. While the fundamental biobehavioral and biologic mechanisms that underlie variations in energy levels are not well understood, the model can be used to design pre-clinical and clinical studies of energy in patients with cancer. In addition, while emerging evidence supports the hypothesis that fatigue and energy are distinct symptoms, additional research on common and distinct risk factors and underlying mechanisms is warranted to be able to develop and test precision interventions for one or both symptoms. IMPLICATIONS FOR NURSING PRACTICE The risk factors (eg, being female, sleep quality) associated with variations in energy levels in patients with cancer identified in this paper have important clinical implications. Clinicians can use the identified risk factors to guide their assessments; identify high-risk patients with decrements in energy decrement; and develop targeted energy conservation interventions for the patients.
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Affiliation(s)
| | | | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Marilyn Hammer
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | | | - Kord M Kober
- School of Nursing, University of California, San Francisco
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco; School of Medicine, University of California, San Francisco
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Shin J, Hammer M, Cooley ME, Cooper BA, Paul SM, Cartwright F, Kober KM, Conley YP, Levine JD, Miaskowski C. Common and distinct risk factors that influence more severe and distressing shortness of breath profiles in oncology outpatients. Cancer Med 2024; 13:e7013. [PMID: 38400684 PMCID: PMC10891479 DOI: 10.1002/cam4.7013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Shortness of breath occurs in 10%-70% of oncology patients. Very little is known about interindividual variability in its severity and distress and associated risk factors. Using latent profile analyses (LPAs), purpose was to identify subgroups of patients with distinct severity and distress profiles for shortness of breath as single symptom dimensions. In addition, a joint LPA was done using patients' severity AND distress ratings. For each of the three LPAs, differences among the shortness of breath classes in demographic, clinical, symptom, stress, and resilience characteristics were evaluated. METHODS Patients completed ratings of severity and distress from shortness of breath a total of six times over two cycles of chemotherapy. All of the other measures were completed at enrollment (i.e., prior to the second or third cycle of chemotherapy). Separate LPAs were done using ratings of severity and distress, as well as a joint analysis using severity AND distress ratings. Differences among the latent classes were evaluated using parametric and nonparametric tests. RESULTS For severity, two classes were identified (Slight to Moderate [91.6%] and Moderate to Severe [8.4%]). For distress, two classes were identified (A Little Bit to Somewhat [83.9%] and Somewhat to Quite a Bit [16.1%]). For the joint LPA, two classes were identified (Lower Severity and Distress [79.9%] and Higher Severity and Distress [20.1%]). While distinct risk factors were associated with each of the LPAs, across the three LPAs, the common risk factors associated with membership in the worse class included: a past or current history of smoking, poorer functional status, and higher comorbidity burden. In addition, these patients had a higher symptom burden and higher levels of cancer-specific stress. CONCLUSIONS Clinicians can use the information provided in this study to identify high-risk patients and develop individualized interventions.
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Affiliation(s)
- Joosun Shin
- Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | | | - Bruce A. Cooper
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Steven M. Paul
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Kord M. Kober
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yvette P. Conley
- School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jon D. Levine
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Christine Miaskowski
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Asakitogum DA, Nutor JJ, Pozzar R, Hammer M, Miaskowski C. Systematic Review of the Literature on Multiple Co-occurring Symptoms in Patients Receiving Treatment for Gynecologic Cancers. Semin Oncol Nurs 2024; 40:151572. [PMID: 38246840 DOI: 10.1016/j.soncn.2023.151572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Patients with gynecologic cancers experience a very high symptom burden that has a negative impact on their quality of life. This systematic review aims to identify the common co-occurring symptoms, the prevalence of common symptoms, common instruments used to measure symptoms, associated risk factors, and the symptom burden in patients with gynecologic cancers. DATA SOURCES A search of four databases (ie, PubMed, Embase, Web of Science, and CINAHL) was done from January 1, 2012, through September 5, 2022. A qualitative synthesis of the extant literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA 2020). CONCLUSION A total of 118 studies met the prespecified inclusion criteria. Ninety-six symptoms were assessed across these studies. The top six symptoms and their grand mean prevalence rates were lack of energy (64.4%), fatigue (62.1%), abdominal pain (53.3%), depression (52.6%), concentration dysfunction (52.0%), and drowsiness (51.9%). Numerous methodologic challenges were evident across studies. Future research needs to develop a disease-specific symptom assessment measure, evaluate for risk factors associated with a higher symptom burden, and determine the impact of multiple symptoms on patient outcomes. IMPLICATION FOR NURSING PRACTICE The results are relevant for oncology clinicians to assess patients with gynecologic cancers for the presence of common symptoms and risk factors for higher symptom burden in the patients and to offer effective management interventions.
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Affiliation(s)
- David Ayangba Asakitogum
- Doctoral student, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA.
| | - Jerry John Nutor
- Assistant Professor, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA
| | - Rachel Pozzar
- Nurse Scientist and Instructor, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Marilyn Hammer
- Nurse Scientist and Instructor, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA; Director, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Christine Miaskowski
- Professor, Departments of Physiological Nursing and Anesthesia, School of Nursing and Medicine, University of California, San Francisco, CA
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Lin Y, Bailey DE, Xiao C, Hammer M, Paul SM, Cooper BA, Conley YP, Levine JD, Kober KM, Miaskowski C. Distinct Co-occurring Morning and Evening Fatigue Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy. Cancer Nurs 2024; 47:E28-E37. [PMID: 36076314 PMCID: PMC10232668 DOI: 10.1097/ncc.0000000000001148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with gastrointestinal cancers experience diurnal variations in fatigue severity during chemotherapy that decrease their functional status and quality of life. OBJECTIVES Study purposes were to identify subgroups of patients with distinct co-occurring morning and evening fatigue profiles and evaluate for differences among these subgroups in demographic, clinical, stress, and symptom characteristics. METHODS Patients with gastrointestinal cancers (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. The Lee Fatigue Scale was used to evaluate diurnal variations in fatigue severity. Latent profile analysis was used to identify subgroups of patients with distinct co-occurring morning AND evening fatigue profiles. Differences among the subgroups in demographic, clinical, stress, and symptom characteristics at enrollment were evaluated using parametric and nonparametric analyses. RESULTS Two classes were identified, namely: low morning and moderate evening fatigue (ie, Low-Moderate, 60.0%) and high morning and high evening fatigue (ie, Both High, 40.0%). Compared with the Low-Moderate class, the Both High class was significantly younger, female, unmarried, and unemployed and lacked regular exercise. In addition, they had childcare responsibilities, lower annual income, lower functional status, higher comorbidity burden, and self-reported anemia and depression. Patients in the Both High class reported higher levels of anxiety, depressive symptoms, sleep disturbance, pain, and stress, and lower levels of energy and cognitive function. CONCLUSIONS Findings provide new insights into the risk factors for higher levels of co-occurring morning and evening fatigue in patients with gastrointestinal cancers. IMPLICATIONS FOR PRACTICE Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.
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Affiliation(s)
- Yufen Lin
- Author Affiliations: Nell Hodgson Woodruff School of Nursing, Emory University (Drs Lin and Xiao), Atlanta, Georgia; School of Nursing, Duke University (Dr Bailey), Durham, North Carolina; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; School of Nursing, University of California San Francisco (Drs Paul, Cooper, Kober, and Miaskowski); School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania; and School of Medicine, University of California San Francisco (Drs Levine and Miaskowski)
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Leung SOA, Villa A, Duffey-Lind E, Welch K, Jabaley T, Hammer M, Feldman S. An Interactive Educational Tool to Improve Human Papillomavirus Vaccine Knowledge and Recommendation Among Nurses. J Cancer Educ 2023; 38:1880-1886. [PMID: 37610520 DOI: 10.1007/s13187-023-02352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
In United States, only 57% of women and 53% of men in the recommended age groups have received all recommended doses of the human papillomavirus (HPV) vaccine. Healthcare provider education has been associated with strong vaccine recommendation and vaccination uptake. Our objective was to create a 7-min interactive online educational tool to improve knowledge and willingness to recommend the HPV vaccine among nurses. This is a prospective pre-test/post-test study to evaluate the effectiveness of the educational tool consisting of 10 flashcards in a question-answer format. Oncology nurses at our cancer center were invited to participate by email, which led them to the educational tool (i.e., intervention) along with pre- and post-test questions on HPV-associated cancers, vaccine-eligible age groups, dosing schedules, adverse events, and willingness to recommend. Of the 110 participants (mean age of 41.2 ± 11.4, 98% female, 64% >10 years of practice), there was improvement in knowledge after intervention in HPV-associated cancers (81% to 97%; p = 0.02), percentage of cervical caused by HPV (33% to 64%; p < 0.05), and dosing schedule (47% to 93%; p < 0.05). All participants correctly stated that continued screening is needed after vaccination both pre- and post-intervention. Eighty-five percent strongly agreed that the intervention improved their HPV knowledge, and 77% stated they were more likely to recommend the HPV vaccine after the intervention. While nurses are willing to recommend the vaccine, there remains persistent knowledge gaps. A brief 7-min self-administered online interactive flashcard educational intervention is effective in improving the HPV vaccine knowledge among nurses.
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Affiliation(s)
- Shuk On Annie Leung
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McGill University Health Center, Cedars Cancer Centre, D02.7224, 1001 Décarie Blvd., Montreal, QC, H4A 3J1, Canada.
| | - Alessandro Villa
- Oral Medicine, Oral Oncology and Dentistry, Miami Cancer Institute, Miami, FL, USA
| | - Eileen Duffey-Lind
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Theresa Jabaley
- Phyllis F. Cantor Center for Research in nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Marilyn Hammer
- Phyllis F. Cantor Center for Research in nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA
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Oppegaard K, Kober KM, Harris C, Shin J, Morse L, Calvo-Schimmel A, Paul SM, Cooper BA, Conley YP, Hammer M, Dokiparthi V, Levine JD, Miaskowski C. Anxiety in oncology outpatients is associated with perturbations in pathways identified in anxiety focused network pharmacology research. Support Care Cancer 2023; 31:727. [PMID: 38012456 PMCID: PMC10682221 DOI: 10.1007/s00520-023-08196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Evaluate for perturbed signaling pathways associated with subgroups of patients with low versus high levels of state anxiety. These pathways were compared to the pathways identified across eight network pharmacology studies of the anxiolytic effect(s) of a variety of compounds. METHODS Adult outpatients had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct anxiety profiles based on Spielberger State Anxiety Inventory scores that were obtained six times over two cycles of chemotherapy. Blood samples were processed using RNA sequencing (i.e., RNA-seq sample, n = 244) and microarray (i.e., microarray sample; n = 256) technologies. Pathway perturbations were assessed using pathway impact analysis. Fisher's combined probability method was used to combine test results using a false discovery rate of 0.01. RESULTS In the RNA-seq sample, 62.3% and 37.7% of the patients were in the low- and high-anxiety classes, respectively. In the microarray sample, 61.3% and 38.7% were in the low and high-anxiety classes, respectively. Forty-one perturbed signaling pathways were identified. Eight of these pathways were common to those identified in the network pharmacology studies. CONCLUSIONS Findings increase our knowledge of the molecular mechanisms that underlie anxiety in patients receiving chemotherapy. This study provides initial insights into how anxiety in patients with cancer may share common mechanisms with anxiety in patients with other clinical conditions.
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Affiliation(s)
- Kate Oppegaard
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Kord M Kober
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Carolyn Harris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joosun Shin
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Lisa Morse
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Alejandra Calvo-Schimmel
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Vasuda Dokiparthi
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, CA, USA.
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Nayak MM, Chai PR, Tung S, Tulsky JA, Hammer M, Andrade N, Braun IM. Dispensary personnel's views and experiences regarding oncologic cannabis and the counsel they offer adults with cancer. Cancer Med 2023; 12:20617-20625. [PMID: 37882245 PMCID: PMC10660394 DOI: 10.1002/cam4.6634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/08/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND A minority of oncologists feel qualified to advise adults with cancer on issues pertaining to medicinal cannabis. Adults with cancer frequently access medicinal cannabis information from non-medical sources such as cannabis dispensaries. We explored dispensary personnel's views and experiences regarding oncologic cannabis and the counsel they extend individuals with cancer. METHODS Snowball sampling in this qualitative study facilitated recruitment across 13 states (N = 26). Semi-structured phone interviews ceased with thematic saturation. A multi-stage thematic analysis combined inductive and deductive codes. RESULTS Of the 26 dispensary personnel interviewed, 54% identified as female and 19% as non-white. Median age was 40 years. A consensus emerged among participants concerning the botanical's efficacy for cancer-related symptoms; less so regarding its antineoplastic potential. Principles for serving those with cancer included provision of client-centered, symptom-based, and trial-and-error approaches. Non-inhalation modes of administration were generally recommended. No consensus was reached as to whether delta-9-tetrahydrocannabinal (THC)- or cannabidiol-predominant products were preferable in this population. Challenges in oncologic advising included successfully identifying individuals with cancer at the dispensary counter, financial toxicity, the special treatment required for the THC-naïve, and operating in the absence of standardized guidelines. CONCLUSIONS These informed assertions suggest that members of the oncologic community should grapple with the extent to which they feel comfortable with both the nature and degree of counsel adults with cancer receive through dispensaries.
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Affiliation(s)
- Manan M. Nayak
- Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Phyllis F. Cantor Center for Research in NursingDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Peter R. Chai
- Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- The Fenway InstituteBostonMassachusettsUSA
| | - Stephanie Tung
- Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of PsychiatryBrigham and Women's HospitalBostonMassachusettsUSA
| | - James A. Tulsky
- Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Marilyn Hammer
- Phyllis F. Cantor Center for Research in NursingDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Nicole Andrade
- Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Ilana M. Braun
- Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of PsychiatryBrigham and Women's HospitalBostonMassachusettsUSA
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Shin J, Kober K, Yates P, Wong ML, Cooper BA, Paul SM, Hammer M, Conley Y, Levine JD, Wright F, Miaskowski C. Higher Lifetime Stress and Symptom Burden Contribute to the Occurrence of Shortness of Breath. Semin Oncol Nurs 2023; 39:151471. [PMID: 37500312 DOI: 10.1016/j.soncn.2023.151471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES Among four classes of patients with distinct shortness of breath profiles, evaluate for differences in levels of global, cancer-specific, and cumulative life stress, as well as resilience; evaluate for differences in the occurrence rates for various stressful life events, and evaluate for differences in the severity of common co-occurring symptoms. DATA SOURCES Outpatients (N = 1338) completed questionnaires six times over two cycles of chemotherapy. The occurrence of shortness of breath was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath profiles. Differences among the classes were evaluated using parametric and nonparametric tests. CONCLUSION Shortness of breath classes were labeled based on their distinct occurrence trajectories: None (70.5%), Decreasing (8.2%), Increasing (7.8%), and High (13.5%). Compared to None class, Decreasing and High classes had higher global and cancer-specific stress scores. The High class reported higher occurrence rates for several adverse childhood experiences. Compared to None class, Decreasing and High classes had higher depression, anxiety, and morning fatigue scores and lower morning energy and cognitive function scores. IMPLICATIONS FOR NURSING PRACTICE Given the additive or synergistic relationships between stress, co-occurring symptoms, and shortness of breath, multimodal interventions that include stress management, exercise training, and/or symptom management may decrease shortness of breath in oncology patients.
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Affiliation(s)
- Joosun Shin
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Kord Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melisa L Wong
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Marilyn Hammer
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Yvette Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesia, School of Nursing and School of Medicine, University of California, San Francisco, California.
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Brassil KJ, Wright A, Arthur E, Barr A, Flora L, Halpenny B, Jackson MK, Krok-Schoen J, Lally R, Loftis J, Kelly DL, Saligan L, Schmidt R, Smith GL, Starkweather A, Tavormina A, Tlusty G, Vazquez M, Hammer M. Abstract 742: Trial in progress: Comprehensive outcomes for after cancer health (COACH), a randomized trial assessing health outcomes following primary cancer therapy. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Purpose: This study evaluates feasibility and acceptability of a digital health coaching intervention for individuals who are within one year of completing primary cancer treatment of any modality, as well as its effect on health self-efficacy. Secondary endpoints evaluate trends in patient-reported outcomes (PRO), including financial toxicity, for which the Economic StraiN and Resilience in Cancer (ENRICh) tool is being validated. Additional endpoints explore associations between patient-reported symptoms, wearable, biomarker, and clinical data. This study seeks to fill a critical knowledge gap as to how health behavioral changes prompted by health coaching may modulate symptoms and physical/psychosocial well-being through the longitudinal tracking of patient reported, clinical, and bioinformatic data.
Methods: This randomized, wait-list control trial is being conducted at geographically diverse National Cancer Institute-designated cancer centers. Per site enrollment is <150 participants, aged 18 and older, following completion of primary treatment for breast, ovarian, endometrial, lung, or gastric cancer or population specific (eg, ≥65 years) cohorts. A 6-month coaching intervention utilizing phone calls coupled with supplemental digital content via text, email, or web-based application is delivered during months 1 through 6 (intervention) or months 7 through 12 (wait-list control). PROMIS and other validated questionnaires and activity data are collected over 12 months. Gut microbiome specimens and the Diet History Questionnaire (DHQ) III are collected at enrollment and 6 months. Feasibility (retention rate ≥70%) and acceptability (≤20% scoring “not at all helpful”), are assessed with descriptive statistics.
Summary Data: To date, 47 individuals have been enrolled at 3 study sites, Nebraska Medicine (36), Dana-Farber Cancer Institute (10), and The Ohio State University James Cancer Center (1). This includes 1 male and 46 female participants, with an average age of 63.62 (R 33-75), of whom 44 identify as White and 3 as Black or African American, and 47 identify as non-Hispanic. Among participants, 35 have a history of breast, 10 ovarian, 1 endometrial, and 1 gastric cancer. Two additional sites are planned to begin enrollment in 2023, one of which will primarily enroll participants identifying as Black and/or Hispanic.
Conclusions: Enrollment is anticipated to complete by December 2023 with site-specific and composite results reported by December 2024. Novel outcomes related to the use of digital health coaching in the context of survivorship, as well as robust data assessing clinical, microbiome, dietary, patient-reported, and wearable data is expected to enhance existing evidence regarding outcomes in patients on both active surveillance and maintenance therapies for diverse tumor types.
Citation Format: Kelly J. Brassil, Alexi Wright, Elizabeth Arthur, Austin Barr, Laura Flora, Barbara Halpenny, Mariah K. Jackson, Jessica Krok-Schoen, Robin Lally, Jennifer Loftis, Debra Lynch Kelly, Leorey Saligan, Rachael Schmidt, Grace L. Smith, Angela Starkweather, Anna Tavormina, Gisele Tlusty, Michael Vazquez, Marilyn Hammer. Trial in progress: Comprehensive outcomes for after cancer health (COACH), a randomized trial assessing health outcomes following primary cancer therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 742.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Robin Lally
- 4University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | - Grace L. Smith
- 8The University of Texas MD Anderson Cancer Center, Houston, TX
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Morse L, Paul SM, Cooper BA, Oppegaard K, Shin J, Calvo-Schimmel A, Harris C, Hammer M, Conley Y, Wright F, Levine JD, Kober KM, Miaskowski C. Higher Stress in Oncology Patients is Associated With Cognitive and Evening Physical Fatigue Severity. J Pain Symptom Manage 2023; 65:203-215. [PMID: 36423801 DOI: 10.1016/j.jpainsymman.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Cognitive and physical fatigue are common symptoms experienced by oncology patients. Exposure to stressful life events (SLE), cancer-related stressors, coping styles, and levels of resilience may influence the severity of both dimensions of fatigue. OBJECTIVES Evaluate for differences in global, cancer-specific, and cumulative life stress, as well as resilience and coping in oncology patients (n=1332) with distinct cognitive fatigue AND evening physical fatigue profiles. METHODS Latent profile analysis, which combined the two symptom scores, identified three subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles (i.e., Low, Moderate, High). Patients completed measures of global, cancer-specific, and cumulative life stress as well measures of resilience and coping. Differences among the latent classes in the various measures were evaluated using parametric and nonparametric tests. RESULTS Compared to Low class, the other two classes reported higher global and cancer-specific stress. In addition, they reported higher occurrence rates for sexual harassment and being forced to touch prior to 16 years of age. Compared to the other two classes, High class reported lower resilience scores and higher use of denial, substance use, and behavioral disengagement. CONCLUSION To decrease both cognitive and evening physical fatigue, clinicians need to assess for relevant stressors and initiate interventions to increase resilience and the use of engagement coping strategies. Additional research is warranted on the relative contribution of various social determinants of health to both cognitive and physical fatigue in oncology patients receiving chemotherapy.
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Affiliation(s)
- Lisa Morse
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Bruce A Cooper
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Kate Oppegaard
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Joosun Shin
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Alejandra Calvo-Schimmel
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Carolyn Harris
- School of Nursing (C.H.,Y.C.,), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marilyn Hammer
- Dana Farber Cancer Institute (M.H.), Boston, Massachusetts
| | - Yvette Conley
- School of Nursing (C.H.,Y.C.,), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fay Wright
- Rory Meyers College of Nursing (F.W.), New York University, New York, New York
| | - Jon D Levine
- School of Medicine (J.D.L, C.M.), University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Christine Miaskowski
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California;; School of Medicine (J.D.L, C.M.), University of California, San Francisco, California, USA.
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Lally RM, Schmidt RL, Tlusty G, Arthur EK, Flora LK, Krok-Schoen JL, Jones JT, Whisenant M, Kaler A, Tripathy D, Saligan L, Hammer M, Barr A, Jackson L, Loftis J, Brassil KJ. Abstract OT2-06-01: Breast Cancer Cohort of the Comprehensive Outcomes for After Cancer Health (COACH) Study: Study Protocol. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot2-06-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Women with breast cancer account for the largest cohort (23%) of over 18 million cancer survivors in the United States. Of the nearly 4 million breast cancer survivors, many, including individuals with metastatic breast cancer, will require lifelong treatment for chronic conditions. As part of a multi-site study including diverse tumor types, breast cancer survivors are being recruited to explore the feasibility and outcomes of a digital health coaching (DHC) program following the completion of primary therapy to support self-management of symptoms and general wellness. Trial design: A randomized-wait list control design will evaluate outcomes related to engagement in a DHC program following completion of primary therapy. Participants will be enrolled in a 6-month DHC program delivering evidence-based content via weekly calls, text, and email, in addition to usual support from their respective healthcare teams. The intervention group will receive coaching upon enrollment. The control group will receive coaching after a 6-month monitoring period. Twelve months of longitudinal clinical, patient-reported outcomes, activity tracking (via Fitbit), and microbiome data will be collected from both groups. Eligibility criteria: The breast cancer cohort will consist of individuals with both localized and metastatic disease within 1 year of completion of primary therapy, defined as treatment of curative intent, first-line or later, from which the individual is advancing to active surveillance or follow-up, with or without maintenance therapy. All study participants must be >18 years old, able to read and speak English, have access to mobile technology, and agree to wear and have data collected from an activity tracker. Specific aims: 1) Assess the feasibility and acceptability of a DHC program and its effect on participant health self-efficacy; 2) characterize associations between participant symptoms, physical/psychosocial well-being, and health self-management and gut microbiota changes; and 3) explore patient-generated health data outcomes among participants (patient reported and wearable biometrics outcomes). Statistical methods: Feasibility and acceptability will be assessed through descriptive statistics. Feasibility for this study is defined as a retention rate ≥70%, and acceptability is defined as ≤20% scoring “not at all helpful.” Secondary aims will be assessed using linear mixed models. Cross-cohort analysis of physical function, measured by the PROMIS Physical Function 10a, will be conducted. Assuming a power of 0.8 and significance level of .05, we will be able to detect a 2.51 difference in PROMIS score means between the control and intervention group (SD 10) with a sample of 500 total participants. Sub-group analysis will be conducted with the anticipated 250 participants in the breast cancer cohort with a focus on feasibility, acceptability, and descriptive and exploratory endpoints for this population as a whole and comparing early stage and metastatic participants. Target and present accruals: 500 individuals with diverse tumor types will be enrolled across 5 collaborating sites, of which 4 ill include individuals with breast cancer. An estimated 250 breast cancer participants (approximately 50% of the total study population), including 150 with de novo or progressive metastatic breast cancer, are planned to be recruited. To date, 1 Midwestern site has enrolled the first 7 breast cancer survivors. Two additional sites plan to enroll in July 2022, with the remaining 2 sites to begin enrollment by the end of 2022.
Citation Format: Robin M. Lally, Rachael L. Schmidt, Gisele Tlusty, Elizabeth K. Arthur, Laura K. Flora, Jessica L. Krok-Schoen, Jessica T. Jones, Meagan Whisenant, Abbey Kaler, Debu Tripathy, Leorey Saligan, Marilyn Hammer, Austin Barr, Lindsey Jackson, Jennifer Loftis, Kelly J. Brassil. Breast Cancer Cohort of the Comprehensive Outcomes for After Cancer Health (COACH) Study: Study Protocol [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-06-01.
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Affiliation(s)
| | | | - Gisele Tlusty
- 3University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Laura K. Flora
- 5The Ohio State University James Cancer and Solove Research Hospital
| | - Jessica L. Krok-Schoen
- 6School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | | | | | | | - Debu Tripathy
- 10The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Leorey Saligan
- 11National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | | | | | - Lindsey Jackson
- 14Pack Health, a Quest Diagnostics Company, birmingham, Alabama
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Singh K, Pituch K, Zhu Q, Gu H, Ernst B, Tofthagen C, Brewer M, Kober KM, Cooper BA, Paul SM, Conley YP, Hammer M, Levine JD, Miaskowski C. Distinct Nausea Profiles Are Associated With Gastrointestinal Symptoms in Oncology Patients Receiving Chemotherapy. Cancer Nurs 2023; 46:92-102. [PMID: 35671438 PMCID: PMC9437145 DOI: 10.1097/ncc.0000000000001076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unrelieved chemotherapy-induced nausea (CIN) occurs 48% of patients undergoing chemotherapy and is one of the most debilitating symptoms that patients report. OBJECTIVE The aims of this study were to identify subgroups of patients with distinct CIN profiles and determine how these subgroups differed on demographic and clinical characteristics; severity, frequency, and distress of CIN; and the co-occurrence of common gastrointestinal symptoms. METHODS Patients (n = 1343) completed demographic questionnaire and Memorial Symptom Assessment Scale 6 times over 2 cycles of chemotherapy. Latent class analysis was used to identify subgroups of patients with distinct CIN profiles. Differences among these subgroups were evaluated using parametric and nonparametric statistics. RESULTS Four distinct CIN profiles were identified: none (40.8%), increasing-decreasing (21.5%), decreasing (8.9%), and high (28.8%). Compared with the none class, patients in the high class were younger, had a lower annual household income, had child care responsibilities, had a lower Karnofsky Performance Status score and a higher Self-administered Comorbidity Questionnaire score, and were more likely to have received chemotherapy on a 14-day cycle and a highly emetogenic chemotherapy regimen. In addition, patients in the high class reported high occurrence rates for dry mouth, feeling bloated, diarrhea, lack of appetite, abdominal cramps, difficulty swallowing, mouth sores, weight loss, and change in the way food tastes. CONCLUSIONS That 60% of the patients reported moderate to high CIN occurrence rates confirms that this unrelieved symptom is a significant clinical problem. IMPLICATIONS FOR PRACTICE Nurses need to evaluate patients' level of adherence to their antiemetic regimen and make appropriate referrals for physical therapy, psychological services, and dietary counseling.
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Affiliation(s)
- Komal Singh
- Author Affiliations: Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Drs Singh, Pituch, and Brewer); Biodesign Center for Fundamental and Applied Microbiomics, Arizona State University, Tempe (Dr Zhu); Department of Environmental Health Sciences, Florida International University, Port Saint Lucie (Dr Gu); Cancer Center, Mayo Clinic, Phoenix, Arizona (Drs Singh and Ernst); Department of Nursing, Mayo Clinic, Jacksonville, Florida (Dr Tofthagen), HonorHealth Research Institute, Scottsdale, Arizona (Dr Brewer); School of Nursing, University of California, San Francisco (Drs Kober, Cooper, Paul, and Miaskowski); School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley); The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski)
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Shin J, Kober KM, Wong ML, Yates P, Cooper BA, Paul SM, Hammer M, Conley Y, Levine JD, Miaskowski C. Distinct Shortness of Breath Profiles in Oncology Outpatients Undergoing Chemotherapy. J Pain Symptom Manage 2023; 65:242-255. [PMID: 36423799 DOI: 10.1016/j.jpainsymman.2022.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/03/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Shortness of breath is a distressing symptom that occurs in 10% to 70% of oncology patients. Despite this broad range in its occurrence, little is known about inter-individual variability in shortness of breath and associated risk factors among patients receiving chemotherapy. OBJECTIVES Identify subgroups of patients with distinct shortness of breath profiles; evaluate for differences among these subgroups in demographic and clinical characteristics; evaluate for differences among symptom dimensions of shortness of breath, and evaluate for differences in quality of life outcomes. METHODS Outpatients (n=1338) completed questionnaires six times over two chemotherapy cycles. Occurrence of shortness of breath was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath profiles. RESULTS Four distinct shortness of breath profiles were identified (None [70.5%], Decreasing [8.2%], Increasing [7.8%], High [13.5%]). Risk factors for membership in High class included: history of smoking, self-reported diagnosis of lung disease, having lung cancer, and receipt of a higher number of cancer treatments. Compared to the None class, High class reported poorer physical, psychological, and social functioning. CONCLUSIONS Almost 14% of patients with heterogeneous types of cancer receiving chemotherapy had persistently high occurrence rates of shortness of breath for almost two months. In addition, compared to the Decreasing and Increasing classes, the High class' episodes of shortness of breath were more frequent and more severe. Clinicians need to assess all oncology patients for shortness of breath and provide targeted interventions.
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Affiliation(s)
- Joosun Shin
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Melisa L Wong
- School of Medicine (M.L.W., J.D.L., C.M.), University of California, San Francisco, California, USA
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health (P.Y.), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bruce A Cooper
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Marilyn Hammer
- Dana Farber Cancer Institute (M.H.), Boston, Massachusetts, USA
| | - Yvette Conley
- School of Nursing (Y.C.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jon D Levine
- School of Medicine (M.L.W., J.D.L., C.M.), University of California, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA; School of Medicine (M.L.W., J.D.L., C.M.), University of California, San Francisco, California, USA.
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14
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Stacker T, Kober KM, Dunn L, Viele C, Paul SM, Hammer M, Conley YP, Levine JD, Miaskowski C. Associations Between Demographic, Clinical, and Symptom Characteristics and Stress in Oncology Patients Receiving Chemotherapy. Cancer Nurs 2023; 46:E62-E69. [PMID: 35671412 PMCID: PMC9437148 DOI: 10.1097/ncc.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients undergoing cancer treatment experience global stress and cancer-specific stress. Both types of stress are associated with a higher symptom burden. OBJECTIVE In this cross-sectional study, we used a comprehensive set of demographic, clinical, and symptom characteristics to evaluate their relative contribution to the severity of global and cancer-specific stress. METHODS Patients (N = 941) completed study questionnaires before their second or third cycle of chemotherapy. RESULTS Consistent with our a priori hypothesis, we found both common and distinct characteristics associated with higher levels of global stress and cancer-specific stress. A significant proportion of our patients had scores on the Impact of Event Scale-Revised suggestive of subsyndromal (29.4%) or probable (13.9%) posttraumatic stress disorder. Four of the 5 stepwise linear regression analyses for the various stress scales explained between 41.6% and 54.5% of the total variance. Compared with various demographic and clinical characteristics, many of the common symptoms associated with cancer and its treatments uniquely explained a higher percentage of the variance in the various stress scales. Symptoms of depression made the largest unique contribution to the percentage of total explained variance across all 5 scales. CONCLUSION Clinicians need to assess for global stress, cancer-specific stress, and depression in patients receiving chemotherapy. IMPLICATIONS FOR PRACTICE Patients may benefit from integrative interventions (eg, mindfulness-based stress reduction, cognitive behavioral therapy, acupuncture) that simultaneously address stress and symptoms commonly associated with cancer and its treatments.
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Affiliation(s)
- Tara Stacker
- Author Affiliations: School of Nursing, University of California (Ms Stacker and Viele, and Drs Kober, Paul, and Miaskowski), San Francisco; School of Medicine, Stanford University (Dr Dunn), California; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania; and School of Medicine, University of California (Drs Levine and Miaskowski), San Francisco
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Shin J, Kober KM, Harris C, Oppegaard K, Calvo-Schimmel A, Paul SM, Cooper BA, Olshen A, Dokiparthi V, Conley YP, Hammer M, Levine JD, Miaskowski C. Perturbations in Neuroinflammatory Pathways Are Associated With a Worst Pain Profile in Oncology Patients Receiving Chemotherapy. J Pain 2023; 24:84-97. [PMID: 36115520 DOI: 10.1016/j.jpain.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/26/2022] [Accepted: 08/06/2022] [Indexed: 02/08/2023]
Abstract
Unrelieved pain occurs in 55% of cancer patients. Identification of molecular mechanisms for pain may provide insights into therapeutic targets. Purpose was to evaluate for perturbations in neuroinflammatory pathways between oncology patients with and without severe pain. Worst pain severity was rated using a 0 to 10 numeric rating scale six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct pain profiles. Pathway impact analyses were performed in two independent samples using gene expression data obtained from RNA sequencing (n = 192) and microarray (n = 197) technologies. Fisher's combined probability test was used to identify significantly perturbed pathways between None versus the Severe pain classes. In the RNA sequencing and microarray samples, 62.5% and 56.3% of patients were in the Severe pain class, respectively. Nine perturbed pathways were related to neuroinflammatory mechanisms (i.e., retrograde endocannabinoid signaling, gamma-aminobutyric acid synapse, glutamatergic synapse, Janus kinase-signal transducer and activator of transcription signaling, phagosome, complement and coagulation cascades, cytokine-cytokine receptor interaction, chemokine signaling, calcium signaling). First study to identify perturbations in neuroinflammatory pathways associated with severe pain in oncology outpatients. Findings suggest that complex neuroimmune interactions are involved in the maintenance of chronic pain conditions. Perspective: In this study that compared oncology patients with none versus severe pain, nine perturbed neuroinflammatory pathways were identified. Findings suggest that complex neuroimmune interactions are involved in the maintenance of persistent pain conditions.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Carolyn Harris
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kate Oppegaard
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Adam Olshen
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA.
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Harris CS, Dodd M, Kober KM, Dhruva AA, Hammer M, Conley YP, Miaskowski CA. Advances in Conceptual and Methodological Issues in Symptom Cluster Research: A 20-Year Perspective. ANS Adv Nurs Sci 2022; 45:309-322. [PMID: 35502915 PMCID: PMC9616968 DOI: 10.1097/ans.0000000000000423] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two conceptual approaches are used to evaluate symptom clusters: "clustering" symptoms (ie, variable-centered analytic approach) and "clustering" patients (ie, person-centered analytic approach). However, these methods are not used consistently and conceptual clarity is needed. Given the emergence of novel methods to evaluate symptom clusters, a review of the conceptual basis for older and newer analytic methods is warranted. Therefore, this article will review the conceptual basis for symptom cluster research; compare and contrast the conceptual basis for using variable-centered versus patient-centered analytic approaches in symptom cluster research; review their strengths and weaknesses; and compare their applications in symptom cluster research.
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Affiliation(s)
| | - Marylin Dodd
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Anand A. Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christine A. Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, CA, USA
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Oppegaard K, Shin J, Harris CS, Schimmel A, Paul SM, Cooper BA, Levine JD, Conley YP, Hammer M, Dunn L, Kober KM, Miaskowski C. Higher stress and symptom severity are associated with worse depressive symptom profiles in patients receiving chemotherapy. Eur J Oncol Nurs 2022; 58:102031. [PMID: 35397404 PMCID: PMC10788966 DOI: 10.1016/j.ejon.2021.102031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE In a sample of oncology patients, identify subgroups of patients with distinct depressive symptom profiles and evaluate for differences in demographic and clinical characteristics, levels of stress and resilience, and the severity of common co-occurring symptoms. METHODS Patients (n = 1327) had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Demographic and clinical characteristics, stress, resilience, and co-occurring symptoms were evaluated at enrollment. Depressive symptoms were evaluated using the Center for Epidemiological Studies-Depression (CES-D) scale a total of six times over two cycles of chemotherapy. Latent profile analysis (LPA) was used to identify subgroups of patients (i.e., latent classes) with distinct depressive symptom profiles using the six CES-D scores. RESULTS Based on the findings from the LPA, 47.3% of the patients were classified as "None"; 33.6% as "Subsyndromal"; 13.8% as "Moderate"; and 5.3% as "High". Compared to None class, patients in the Subsyndromal, Moderate, and High classes had a lower functional status, a higher comorbidity burden, and a self-reported diagnosis of depression or back pain. Those patients with higher levels of depressive symptoms reported higher levels of stress, lower levels of resilience, and increased severity of co-occurring symptoms. CONCLUSIONS Inter-individual variability in depressive symptoms was associated with demographic and clinical characteristics, multiple types of stress and levels of resilience, as well as with the increased severity of multiple co-occurring symptoms. The risk factors associated with worse depressive symptom profiles can assist clinicians to identify high risk patients and initiate more timely supportive care interventions.
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Affiliation(s)
- Kate Oppegaard
- School of Nursing, University of California, San Francisco, CA, USA
| | - Joosun Shin
- School of Nursing, University of California, San Francisco, CA, USA
| | - Carolyn S Harris
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Laura Dunn
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA.
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Harris CS, Kober KM, Conley YP, Dhruva AA, Hammer M, Miaskowski CA. Symptom clusters in patients receiving chemotherapy: A systematic review. BMJ Support Palliat Care 2022; 12:10-21. [PMID: 34921000 PMCID: PMC8857036 DOI: 10.1136/bmjspcare-2021-003325] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Since 2001, symptom cluster research has grown considerably. However, because multiple methodological considerations remain, ongoing synthesis of the literature is needed to identify gaps in this area of symptom science. This systematic review evaluated the progress in symptom clusters research in adults receiving primary or adjuvant chemotherapy since 2016. METHODS Eligible studies were published in English between 1 January 2017 and 17 May 2021; evaluated for and identified symptom clusters 'de novo;' and included only adults being treated with primary or adjuvant chemotherapy. Studies were excluded if patients had advanced cancer or were receiving palliative chemotherapy; symptoms were measured after treatment; symptom clusters were pre-specified or a patient-centred analytic approach was used. For each study, symptom instrument(s); statistical methods and symptom dimension(s) used to create the clusters; whether symptoms were allowed to load on more than one factor; method used to assess for stability of symptom clusters and associations with secondary outcomes and biomarkers were extracted. RESULTS Twenty-three studies were included. Memorial Symptom Assessment Scale was the most common instrument and exploratory factor analysis was the most common statistical method used to identify symptom clusters. Psychological, gastrointestinal, and nutritional clusters were the most commonly identified clusters. Only the psychological cluster remained relatively stable over time. Only five studies evaluated for secondary outcomes. DISCUSSION While symptom cluster research has evolved, clear criteria to evaluate the stability of symptom clusters and standardised nomenclature for naming clusters are needed. Additional research is needed to evaluate the biological mechanism(s) for symptom clusters. PROSPERO REGISTRATION NUMBER CRD42021240216.
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Affiliation(s)
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anand A. Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Christine A. Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA,School of Medicine, University of California, San Francisco, CA, USA
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Mandolfo NR, Berger AM, Struwe L, Hanna KM, Goldner W, Klute K, Langenfeld S, Hammer M. Glycemic Variability Within 1 Year Following Surgery for Stage II-III Colon Cancer. Biol Res Nurs 2022; 24:64-74. [PMID: 34610762 PMCID: PMC9248290 DOI: 10.1177/10998004211035184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine glycemic variability within 1 month and 1 year following surgery among adult patients, with and without Type 2 Diabetes (T2D), treated for stage II-III colon cancer. METHOD A retrospective analysis of electronic health record data was conducted. Glycemic variability (i.e., standard deviation [SD] and coefficient of variation [CV] of > 2 blood glucose measures) was assessed within 1 month and within 1 year following colon surgery. Chi-square (χ2), Fisher's exact, and Mann-Whitney U tests were used for the analyses. RESULTS Among the sample of 165 patients with stage II-III colon cancer, those with T2D had higher glycemic variability compared to patients without T2D (p < .001), with values within 1 month following surgery (SD = 44.69 mg/dL, CV = 27.4%) vs (SD = 20.55 mg/dL, CV = 17.53%); and within 1 year following surgery (SD = 45.04 mg/dL, CV = 29.04%) vs (SD = 21.36 mg/dL, CV = 18.6%). Associations were found between lower body mass index and higher glycemic variability (i.e., SD [r = -.413, p < .05] and CV [r = -.481, p < .01]) within 1 month following surgery in patients with T2D. Higher preoperative glucose was associated with higher glycemic variability (i.e., SD r = .448, p < .01) within 1 year in patients with T2D. Demographic and clinical characteristics were weakly associated with glycemic variability in patients without T2D. CONCLUSIONS Patients with stage II-III colon cancer with T2D experienced higher glycemic variability within 1 month and within 1 year following surgery compared to those without T2D. Associations between glycemic variability and demographic and clinical characteristics differed by T2D status. Further research in prospective studies is warranted.
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Affiliation(s)
- Natalie Rasmussen Mandolfo
- College of Nursing, Nebraska Medical
Center, University of Nebraska Medical Center, Omaha, NE, USA,Natalie Rasmussen Mandolfo, PhD, APRN-NP,
AOCN, University of Nebraska Medical Center, 985330 Nebraska Medical Center,
Omaha, NE 68198, USA. Emails: ;
| | - Ann M. Berger
- College of Nursing, Nebraska Medical
Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Leeza Struwe
- College of Nursing, Nebraska Medical
Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kathleen M. Hanna
- College of Nursing, Nebraska Medical
Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Whitney Goldner
- Department of Internal Medicine,
Section of Diabetes, Nebraska Medical Center, University of Nebraska Medical Center,
Omaha, NE, USA
| | - Kelsey Klute
- Department of Internal Medicine,
Division of Oncology & Hematology, Nebraska Medical Center, University of
Nebraska Medical Center, Omaha, NE, USA
| | - Sean Langenfeld
- Department of Surgery, Nebraska Medical
Center, University of Nebraska Medical Center, Omaha, NE, USA
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Miaskowski C, Paul SM, Harris CS, Shin J, Oppegaard K, Conley YP, Hammer M, Kober KM, Levine JD. Determination of Cutpoints for Symptom Burden in Oncology Patients Receiving Chemotherapy. J Pain Symptom Manage 2022; 63:42-51. [PMID: 34333099 PMCID: PMC10791137 DOI: 10.1016/j.jpainsymman.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
CONTEXT Cutpoints can be used as a threshold for screening symptom(s) that warrant intervention(s) and for monitoring patients' responses to these interventions. OBJECTIVES In a sample of oncology patients undergoing chemotherapy, study purposes were to determine the optimal cutpoints for low, moderate, and high symptom burden and determine if these cutpoints distinguished among the symptom groups in any demographic, clinical, and stress characteristics, as well as QOL outcomes. METHODS Total of 1329 patients completed a modified version of the Memorial Symptom Assessment Scale (38 symptoms). Using the methodology of Serlin and colleagues, cutpoints were created using symptom occurrence rates and cancer-specific quality of life (QOL) scores. Cutpoints were validated using measures of stress and resilience and a generic measure of QOL (i.e., Medical Outcomes Study Short Form 12 (SF-12)). RESULTS Of the 25 possible cutpoints evaluated, the optimal cutpoint, with the largest between category F statistic, was CP8,15 (Low = 0-8, Moderate = 9-15, High = 16-38 symptoms). Percentage of patients in the Low, Moderate, and High cutpoint groups were 25.3%, 36.3%, and 38.4%, respectively. Significant differences were found among the symptom burden groups in global, cancer-specific, and cumulative life stress (i.e., Low < Moderate < High) and resilience and SF-12 (i.e., Low > Moderate > High) scores. CONCLUSION Our findings provide evidence for clinically meaningful cutpoints that can be used to guide symptom assessment and management. These cutpoints may be used to establish alert thresholds for electronic monitoring of symptoms in oncology patients.
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Affiliation(s)
- Christine Miaskowski
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA; School of Medicine (C.M., J.D.L.), University of California, San Francisco, California, USA.
| | - Steven M Paul
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA
| | - Carolyn S Harris
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA
| | - Joosun Shin
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA
| | - Kate Oppegaard
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing (Y.P.C.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Dana Farber Cancer Institute (M.H.), Boston, Massachusetts, USA
| | - Kord M Kober
- School of Nursing (C.M., S.M.P., C.S.H., J.S., K.O., K.M.K.), University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine (C.M., J.D.L.), University of California, San Francisco, California, USA
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21
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Shin J, Harris C, Oppegaard K, Kober KM, Paul SM, Cooper BA, Hammer M, Conley Y, Levine JD, Miaskowski C. Worst Pain Severity Profiles of Oncology Patients Are Associated With Significant Stress and Multiple Co-Occurring Symptoms. J Pain 2022; 23:74-88. [PMID: 34298161 PMCID: PMC10788964 DOI: 10.1016/j.jpain.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022]
Abstract
Little is known about the associations between pain, stress, and co-occurring symptoms in oncology patients. Purpose was to identify subgroups of patients with distinct worst pain profiles and evaluate for differences among the subgroups in demographic and clinical characteristics, as well as stress and symptom scores. Oncology outpatients (n = 1305) completed questionnaires prior to their second or third chemotherapy cycle. Worst pain intensity was assessed 6 times over 2 chemotherapy cycles using a 0 to 10 numeric rating scale. The 371 patients (28.4%) who had ≤1 occurrence of pain over the 6 assessments were classified as the None class. For the remaining 934 patients whose data were entered into the latent profile analysis, 3 distinct worst pain profiles were identified (ie Mild [12.5%], Moderate [28.6%], Severe [30.5%]). Compared to None class, Severe class had fewer years of education and a lower annual income; were less likely to be employed and married; less likely to exercise on a regular basis, had a higher comorbidity burden, and a worse functional status. Compared to None class, Severe class reported higher levels of general, disease-specific, and cumulative life stress and lower levels of resilience, as well as higher levels of depressive symptoms, anxiety, fatigue, sleep disturbance, and cognitive dysfunction. This study is the first to identify distinct worst pain profiles in a large sample of oncology patients receiving chemotherapy and associated risk factors. PERSPECTIVE: Unrelieved pain remains a significant problem for oncology patients receiving chemotherapy. High levels of stress and co-occurring symptoms contribute to a more severe pain profile in these patients.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, California
| | - Carolyn Harris
- School of Nursing, University of California, San Francisco, California
| | - Kate Oppegaard
- School of Nursing, University of California, San Francisco, California
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California
| | | | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, California; School of Medicine, University of California, San Francisco, California.
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22
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Oppegaard K, Harris CS, Shin J, Paul SM, Cooper BA, Chan A, Anguera JA, Levine J, Conley Y, Hammer M, Miaskowski CA, Chan RJ, Kober KM. Cancer-related cognitive impairment is associated with perturbations in inflammatory pathways. Cytokine 2021; 148:155653. [PMID: 34388477 PMCID: PMC10792770 DOI: 10.1016/j.cyto.2021.155653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023]
Abstract
Cancer-related cognitive impairment (CRCI) is a significant problem for patients receiving chemotherapy. While a growing amount of pre-clinical and clinical evidence suggests that inflammatory mechanisms underlie CRCI, no clinical studies have evaluated for associations between CRCI and changes in gene expression. Therefore, the purpose of this study was to evaluate for differentially expressed genes and perturbed inflammatory pathways across two independent samples of patients with cancer who did and did not report CRCI. The Attentional Function Index (AFI) was the self-report measure used to assess CRCI. AFI scores of <5 and of >7.5 indicate low versus high levels of cognitive function, respectively. Of the 185 patients in Sample 1, 49.2% had an AFI score of <5 and 50.8% had an AFI score of >7.5. Of the 158 patients in Sample 2, 50.6% had an AFI score of <5 and 49.4% had an AFI score of >7.5. Data from 182 patients in Sample 1 were analyzed using RNA-seq. Data from 158 patients in Sample 2 were analyzed using microarray. Twelve KEGG signaling pathways were significantly perturbed between the AFI groups, five of which were signaling pathways related to inflammatory mechanisms (e.g., cytokine-cytokine receptor interaction, tumor necrosis factor signaling). This study is the first to describe perturbations in inflammatory pathways associated with CRCI. Findings highlight the role of cytokines both in terms of cytokine-specific pathways, as well as pathways involved in cytokine production and cytokine activation. These findings have the potential to identify new targets for therapeutics and lead to the development of interventions to improve cognition in patients with cancer.
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Affiliation(s)
- Kate Oppegaard
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Carolyn S Harris
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Joosun Shin
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Steven M Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Bruce A Cooper
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Alexandre Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, 147B Bison Modular, Irvine, CA 92697, USA.
| | - Joaquin A Anguera
- School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA.
| | - Jon Levine
- School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA; School of Dentistry, University of California, 513 Parnassus Ave, MSB, San Francisco, CA 94117, USA.
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
| | - Marilyn Hammer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA 02215, USA.
| | - Christine A Miaskowski
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA; School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA.
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park SA5042, Australia.
| | - Kord M Kober
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
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Oppegaard K, Harris CS, Shin J, Paul SM, Cooper BA, Levine JD, Conley YP, Hammer M, Cartwright F, Wright F, Dunn L, Kober KM, Miaskowski C. Anxiety profiles are associated with stress, resilience and symptom severity in outpatients receiving chemotherapy. Support Care Cancer 2021; 29:7825-7836. [PMID: 34176016 PMCID: PMC10788963 DOI: 10.1007/s00520-021-06372-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purposes of this study, in a sample of oncology patients (n = 1326) receiving chemotherapy, were to identify subgroups of patients with distinct anxiety profiles and evaluate for differences in demographic and clinical characteristics, stress and resilience measures, and severity of co-occurring symptoms (i.e., depression, sleep disturbance, attentional function, fatigue, pain). METHODS Patients completed self-report questionnaires a total of six times over two cycles of chemotherapy. Severity of state anxiety was evaluated using the Spielberger State Anxiety Inventory and resilience was assessed using the Connor-Davidson Resilience Scale. Symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, General Sleep Disturbance Scale, Lee Fatigue Scale, Attentional Function Index and Brief Pain Inventory. RESULTS Based on the findings from the latent profile analysis that utilized the six assessments of state anxiety, 47.7% of the patients were classified as "Low," 28.3% as "Moderate," 19.5% as "High," and 4.5.% as "Very High." Anxiety levels remained relatively stable across the six timepoints. Compared to the Low class, membership in the Moderate, High, and Very High classes was associated with a number of characteristics (e.g., younger age, female gender, lower functional status, more comorbidities). Those patients with higher levels of anxiety reported higher levels of stress, lower levels of resilience, and increased severity of co-occurring symptoms. CONCLUSION Our findings suggest that a substantial number of oncology patients may warrant referral to psychological services. Clinicians need to perform systematic assessments of anxiety, stress, and common symptoms and initiate appropriate interventions to enhance resilience and coping.
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Affiliation(s)
- Kate Oppegaard
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Carolyn S Harris
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Joosun Shin
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Steven M Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Bruce A Cooper
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Jon D Levine
- School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA
- School of Dentistry, University of California, 513 Parnassus Ave, MSB, San Francisco, CA, 94117, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Marilyn Hammer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA, 02215, USA
| | - Frances Cartwright
- Department of Nursing, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1068, New York, NY, 10029, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, Room 740, New York, NY, 10010, USA
| | - Laura Dunn
- School of Medicine, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA
| | - Kord M Kober
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Christine Miaskowski
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA.
- School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, USA.
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Carr C, Bressler T, Hammer M, Frey M, Ellis A, Shao T, Mazzola E, Pozzar R, Kolev V, Cohen S, Hayes MP, Ruiz M, Blank S. Priority assessment for women with recurrent ovarian cancer: a pilot study. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00703-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hammer M, Grand JG. Inverted V-shaped extracapsular stabilisation technique and arthroscopic findings in six dogs with medial shoulder instability. J Small Anim Pract 2021; 62:795-804. [PMID: 34041760 DOI: 10.1111/jsap.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this case series was to report arthroscopic findings and to evaluate clinical outcomes of dogs treated with an inverted V-shaped extracapsular stabilisation technique without additional external coaptation for medial shoulder instability. MATERIAL AND METHODS Medical records of dogs with medial shoulder instability that underwent arthroscopy and an inverted V-shaped extracapsular stabilisation technique were retrospectively reviewed. Extracapsular stabilisation was performed in all dogs using screws and spiked washers as anchor points for the coated polyester prosthetic ligament. No additional external coaptation was used in any dog. A minimum 18-month follow-up period was required for study inclusion. Complications and long-term outcomes were recorded. RESULTS The subscapularis tendon and medial glenohumeral ligament were the structures most commonly affected. All dogs had pathological cartilage fibrillations. Implants were successfully placed in all dogs. Implant loosening was recorded in two out of six dogs on recheck but no revision surgery was performed. Function at the time of last clinical follow-up (median, 28 months, range 18 to 33 months) was full in four out of six and acceptable in two out of six dogs. CLINICAL SIGNIFICANCE Surgical treatment of medial shoulder instability using the novel inverted V-shaped extracapsular stabilisation technique was successful. Potential complications such as implant loosening may occur. Despite the limited number of cases, the present study suggests that additional postoperative external coaptation may not be necessary for successful management of dogs with medial shoulder instability.
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Affiliation(s)
- M Hammer
- Department for Small Animal Surgery, Clinique Vétérinaire Aquivetet, Eysines, 33320, France
| | - J G Grand
- Department for Small Animal Surgery, Clinique Vétérinaire Aquivetet, Eysines, 33320, France
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Gormley M, Knobf MT, Vorderstrasse A, Aouizerat B, Hammer M, Fletcher J, D'Eramo Melkus G. Exploring the effects of genomic testing on fear of cancer recurrence among breast cancer survivors. Psychooncology 2021; 30:1322-1331. [PMID: 33742530 DOI: 10.1002/pon.5679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/06/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is the greatest unmet psychosocial need among breast cancer survivors (BCS). The Oncotype Dx® test predicts the 10-year risk of distant recurrence and benefit of adjuvant chemotherapy among women with early stage hormone receptor-positive breast cancer. Despite the test's clinical utility, psychosocial responses are poorly understood. METHODS A descriptive cross-sectional study was conducted to explore associations between Oncotype Dx® test results (Recurrence Score [RS]) and FCR, health-related quality of life (HRQOL), distress, anxiety, depression, illness representation and perceived risk. Bivariate analyses were used to examine the associations between variables followed by multiple linear regression to examine predictors of FCR. RESULTS Greater FCR was associated with higher distress, anxiety, depression, illness representation and poorer HRQOL. BCS's with a high Oncotype Dx® RS reported higher overall fear (p = 0.013) and greater perceived consequences of their cancer (p = 0.034) compared to BCS's with a low RS. Using multiple linear regression, anxiety ( β = 0.21, p = 0.016), greater emotional response ( β = 0.45, p < 0.001) and perceived consequences ( β = 0.18, p = 0.039) of illness explained 58% of the variance (p < 0.001) in FCR. CONCLUSION BCS's with higher risk of recurrence may experience higher FCR. However, for FCR, modifiable factors such as anxiety and illness representation (greater emotional response and perceived consequences of illness) may be more important than non-modifiable factors such as Oncotype Dx® test results and age. Further research is needed to develop personalized interventions to improve BCS's outcomes.
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Affiliation(s)
- Maurade Gormley
- Rory Meyers College of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - M Tish Knobf
- School of Nursing, Yale University School of Nursing, Orange, Connecticut, USA
| | - Allison Vorderstrasse
- College of Nursing, University of Massachusetts Amherst College of Nursing, Amherst, Massachusetts, USA
| | - Bradley Aouizerat
- College of Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Marilyn Hammer
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jason Fletcher
- Rory Meyers College of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Gail D'Eramo Melkus
- Rory Meyers College of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
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Zack F, Warnke P, Manhart J, Angeli A, Nizze H, Rudnick JO, Steinhagen I, Kolbe V, Hammer M, Büttner A. Enterokolitis als Ursache eines akuten unerwarteten Todes eines Orang-Utans in Zoohaltung. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00448-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ZusammenfassungEs wird von einem 13 Jahre alt gewordenen weiblichen Orang-Utan berichtet, der 4 Tage vor dem Tod an einer akuten Enterokolitis erkrankte. Die tierärztliche Ultraschalluntersuchung einen Tag vor dem Tod erbrachte den Nachweis von vermehrter Flüssigkeit im Zäkum und einer abschnittsweise verdickten Kolonwand. Nach dem für die Veterinärmediziner und die Zoomitarbeiter unerwarteten Todeseintritt erfolgte eine Obduktion durch Rechtsmediziner der Universitätsmedizin Rostock mit Unterstützung von Ärzten weiterer Fachrichtungen. Dabei wurde als Todesursache eine akute Escherichia-coli-Enterokolitis mit massiver Blutung in den Darm festgestellt. Begünstigend oder ursächlich für die letale Enterokolitis dürften wahrscheinlich zahlreiche rezidivierende Durchfallerkrankungen in der Anamnese des Orang-Utans als Folge eines Verweigerns des Stillens durch die Mutter nach der Geburt gewesen sein.
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Schweitzer D, Haueisen J, Brauer JL, Hammer M, Klemm M. Comparison of algorithms to suppress artifacts from the natural lens in fluorescence lifetime imaging ophthalmoscopy (FLIO). Biomed Opt Express 2020; 11:5586-5602. [PMID: 33149973 PMCID: PMC7587265 DOI: 10.1364/boe.400059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/08/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
Fluorescence lifetime imaging ophthalmoscopy (FLIO) has developed as a new diagnostic tool in ophthalmology. FLIO measurements are taken from 30° retinal fields in two spectral channels (short spectral channel (SSC): 498-560 nm, long spectral channel (LSC): 560-720 nm). Because of the layered structure of the eye, the detected signal is an interaction of the fluorescence decay of the anterior part and of the fundus. By comparing FLIO measurements before and after cataract surgery, the impact of the natural lens was proven, despite the application of a confocal laser scanning (cSLO) technique. The goal of this work was to determine the best algorithmic solution to isolate the sole fundus fluorescence lifetime from the measured signal, suppressing artifacts from the natural lens. Three principles based on a tri-exponential model were investigated: a tailfit, a layer-based approach with a temporally shifted component, and the inclusion of a separately measured fluorescence decay of the natural lens. The mean fluorescence lifetime τm,12 is calculated using only the shortest and the intermediate exponential component. τm,all is calculated using all three exponential components. The results of tri-exponential tailfit after cataract surgery were considered as a reference, because the implanted artificial lens can be assumed as non-fluorescent. In SSC, the best accordance of τm,all of the reference was determined with τm,12 of the tailfit before surgery. If high-quality natural lens measurements are available, the correspondence of τm,12 is best with τm,all of the reference. In LSC, there is a good accordance for all models between τm,12 before and after surgery. To study the pure fundus fluorescence decay in eyes with natural lenses, we advise to utilize fluorescence lifetime τm,12 of a triple-exponential tailfit, as it corresponds well with the mean fluorescence lifetime τm,all of eyes with fluorescence-less artificial intraocular lenses.
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Affiliation(s)
- D. Schweitzer
- Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - J. Haueisen
- Institute of Biomedical Engineering and Informatics, POB 100565, 98694 Ilmenau, Germany
| | - J. L. Brauer
- Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - M. Hammer
- Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - M. Klemm
- Institute of Biomedical Engineering and Informatics, POB 100565, 98694 Ilmenau, Germany
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Mandolfo N, Berger A, Hammer M. Glycemic variability in patients with gastrointestinal cancer: An integrative review. Eur J Oncol Nurs 2020; 48:101797. [PMID: 32862096 DOI: 10.1016/j.ejon.2020.101797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Glycemic variability is associated with risks for adverse events in patients with cancer. Several studies have evaluated the presence and impact of hyperglycemia and/or hypoglycemia in patients with cancer; however, few studies have evaluated glycemic variability. The purpose of this integrative review of studies in patients with gastrointestinal cancers was to investigate the presence and methods of reporting glycemic variability during and following treatments. METHODS A comprehensive review of the literature was conducted. PubMed, CINAHL, EMBASE, and Cochrane databases were searched for publications between 1/1/1969 and 7/24/2019. Studies of patients with gastrointestinal cancer following surgery, during treatment, and <5 years following treatment were included and evaluated by cancer type and method of glucose and glycemic variability measurement. RESULTS Among 1526 patients with gastrointestinal cancer across 19 studies, gastric and pancreatic cancers were most prevalent. Timing of glucose testing and methods of analyzing glycemic variability varied. Most analyses used the standard deviation or interquartile range. Glycemic variability was more prevalent among patients with Type 2 Diabetes and among those with pancreatic cancer. In some patients glycemic variability remained notable > one year following surgery despite improvements in glycemic control. CONCLUSION Patients with gastrointestinal cancer experience glycemic variability during and up to one year following treatment. There was heterogeneity in methods related to timing of testing and reporting glycemic variability among the 19 studies in this review. Future investigations need to identify the presence and define the methods of measuring glycemic variability in patients with gastrointestinal cancer.
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Affiliation(s)
- N Mandolfo
- University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - A Berger
- University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - M Hammer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA, 02215, USA
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Singh K, Cao H, Miaskowski C, Conley YP, Hammer M, Wright F, Levine JD, Kober KM. Perturbations in Endocytotic and Apoptotic Pathways Are Associated With Chemotherapy-Induced Nausea. Biol Res Nurs 2020; 23:238-247. [PMID: 32815385 DOI: 10.1177/1099800420951271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While vomiting is well controlled with current antiemetic regimens, unrelieved chemotherapy-induced nausea (CIN) is a significant clinical problem. Perturbations in endocytotic and apoptotic pathways in the gut can influence the functioning of the microbiome-gut-brain-axis and the occurrence of gastrointestinal (GI) symptoms. However, limited information is available on the mechanisms that underlie unrelieved CIN. OBJECTIVES The purpose of this study was to evaluate for perturbed biological pathways associated with endocytosis and apoptosis in oncology patients who did (n = 353) and did not (n = 275) report CIN prior to their second or third cycle of chemotherapy (CTX). METHODS Oncology patients (n = 735) completed study questionnaires in the week prior to their second or third cycle of CTX. CIN occurrence was evaluated using the Memorial Symptom Assessment Scale. Pathway impact analyses (PIA) were performed in 2 independent samples using RNA-sequencing (sample 1, n = 334) and microarray (sample 2, n = 294) methodologies. Fisher's combined probability method was used to identify signaling pathways related to endocytotic and apoptotic mechanisms that were significantly perturbed between the 2 nausea groups across both samples. RESULTS CIN was reported by 63.6% of the patients in sample 1 and 48.9% of the patients in sample 2. Across the 2 samples, PIA identified 4 perturbed pathways that are involved in endocytosis (i.e., endocytosis, regulation of actin cytoskeleton) and apoptosis (i.e., apoptosis, PI3K/Akt signaling). CONCLUSIONS Our findings suggest that CTX-induced inflammation of the GI mucosa, that results in the initiation of endocytotic and apoptotic processes in the gut, is associated with the occurrence of CIN.
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Affiliation(s)
- Komal Singh
- Edson College of Nursing and Health Innovation, 7864Arizona State University, Phoenix, AZ, USA
| | - Huangshen Cao
- Biodesign Center for Fundamental and Applied Microbiomics, 7864Arizona State University, Tempe, AZ, USA
| | | | - Yvette P Conley
- School of Nursing, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Marilyn Hammer
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, MA, USA
| | - Fay Wright
- Rory Myers College of Nursing, New York University, NY, USA
| | - Jon D Levine
- School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Kord M Kober
- School of Nursing, 8785University of California, San Francisco, CA, USA
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Zucco L, Santer P, Levy N, Hammer M, Grabitz SD, Nabel S, Ramachandran SK. A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single-centre cohort study. Anaesthesia 2020; 76:36-44. [PMID: 32743803 DOI: 10.1111/anae.15203] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 11/28/2022]
Abstract
Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (Sp O2 < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and sub-group analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m-2 ); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94-1.04, p = 0.598). These findings were consistent across all sub-groups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.
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Affiliation(s)
- L Zucco
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - P Santer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - N Levy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - M Hammer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S D Grabitz
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S Nabel
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S K Ramachandran
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Sewerin P, Freynhagen R, Tölle T, Hammer M, Baerwald C, Walter J, Schröder R, Schneider M, Baron R. THU0478 IS NEUROPATHIC PAIN IN INFLAMMATORY RHEUMATIC DISORDERS AN UNDERESTIMATED PROBLEM? RESULTS FROM THE GERMAN PAINDETECT DATABASE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The aim of the study was to investigate the impact and relevance of neuropathic pain in inflammatory rheumatic disorders (IRD) and osteoarthritis (OA).Objectives:Pain is one of the main symptoms in patients with IRD and OA. To enhance a mechanistic based treatment of pain the differentiation between nociceptive and neuropathic pain via screening tools (e.g. painDETECT questionaire) might possibly be helpful. The goal of the study was to investigate (1) if neuropathic pain is a significant burden for patients with IRD and (2) if pain patterns differs from degenerative joint diseases such as OA in over 9.000 patients in each group.Methods:painDETECT is a questionnaire that has been evaluated and used in numerous clinical trials to detect neuropathic pain in various diseases. The collected data is centrally managed and evaluated. In total (end of 2019) 395.984 patients have been documented. Out of the painDETECT database 9256 patients with IRD and 9436 patients with OA were extracted, analyzed and compared on their neuropathic pain pattern (screening was performed using the painDETECT-questionaire., PDQ). Secondary parameters were: intensity of pain, functional status, depression, chronicity and sleep disorder. Patients had been recruited from general practitioners (GPs), Rheumatologists, Orthopedics and Neurologists from 862 office-based physicians into the painDETECT-database. This project is an open label registry study in Germany.Results:The median PDQ-score of patients with inflammatory rheumatic disorders adds up to 14,2 (1-38) and of OA patients to 13,8. 28.7% of inflammatory rheumatic disorders and 27.2% of OA-patients showed signs for neuropathic pain by positive PDQ. The difference was according to this high patient numbers statistically significant (P=0.0015). VAS-Score, Depressions-Score, Chronicity -Score and Functional -Score showed no clinically relevant differences between these two groups.Conclusion:Nearly one third of patients with IRD as well as patients with OA showed neuropathic pain components by using PDQ. Despite increasingly better disease control through more effective therapies, pain still remains a major burden for many patients and has a profound impact on their quality of life. The present data indicate a surprisingly high symptoms of neuropathic pain even in IRD patients and should be considered in the management of our patients. A new documentation system for Rheumatologists (RheumaAssist) could help to address these questions.Percentage of PDQ-categories (negative/unclear/positive) for patients with inflammatory rheumatic disorders (IRD) or Arthrosis (OA)Acknowledgments:This investigation was supported within a grant of Pfizer Deutschland GmbH.Disclosure of Interests: :Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KGBristol-Myers Squibb Celgene GmbHLilly Deutschland GmbHNovartis Pharma GmbH Pfizer Deutschland GmbHRheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Rainer Freynhagen Consultant of: AOP Orphan Pharma, Grünenthal, Lilly, Merck, Mitsubishi Tanabe Pharma, Pfizer, Scilex Pharmaceutics, Speakers bureau: AOP Orphan Pharma, Grünenthal, Lilly, Merck, Mitsubishi Tanabe Pharma, Pfizer, Scilex Pharmaceutics, Thomas Tölle Consultant of: AOP Orphan, Almiral Hermal, Bionest Partners, Benkitt Renkiser, Grünenthal, Hexal, Indivior, Kaia Health, Lilly, Medscape Mundipharma, MSD, Novartis, Pfizer, Recordati Pharma, Sanofi-Aventis, and TAD Pharma, Speakers bureau: AOP Orphan, Almiral Hermal, Bionest Partners, Benkitt Renkiser, Grünenthal, Hexal, Indivior, Kaia Health, Lilly, Medscape Mundipharma, MSD, Novartis, Pfizer, Recordati Pharma, Sanofi-Aventis, and TAD Pharma, Michael Hammer Consultant of: Abbvie, Pfizer, Medac and Janssen, Speakers bureau: Abbvie, Pfizer, Medac and Janssen, Christoph Baerwald Consultant of: CGB received speaker or consulting fees from AbbVie, Paid instructor for: CGB received speaker or consulting fees from AbbVie, Speakers bureau: CGB received speaker or consulting fees from AbbVie, Jochen Walter Consultant of: Pfizer, Speakers bureau: AbbVie, Frauenhofer Institut, Gilead, Janssen-Cilag, Medac, Novartis, Pfizer, Ralf Schröder Shareholder of: Pfizer Pharma GmbH, Employee of: Pfizer Pharma GmbH, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Ralf Baron Consultant of: RB received speaker or consulting fees from AbbVie, Paid instructor for: RB received speaker or consulting fees from AbbVie, Speakers bureau: RB received speaker or consulting fees from AbbVie
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Hammer M, Storey S, Hershey DS, Brady VJ, Davis E, Mandolfo N, Bryant AL, Olausson J. Hyperglycemia and Cancer: A State-of-the-Science Review. Oncol Nurs Forum 2020; 46:459-472. [PMID: 31225836 DOI: 10.1188/19.onf.459-472] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Hyperglycemia can increase the risk for adverse events and outcomes in patients undergoing treatment for cancer. The purposes of this state-of-the-science review were to explore the complexity of hyperglycemia in patients with cancer and to analyze physiologic mechanisms and outcomes in individuals with or at risk for cancer. LITERATURE SEARCH PubMed® and the Cochrane Library databases were searched, and 95 articles were included. Findings were evaluated for their methods and analyses. Studies assessed as methodologically flawed were not included. DATA EVALUATION The synthesis of the articles provided the evidence for describing normal and glycemic pathways. Hyperglycemia in patients with cancer was explored through chronic inflammatory mechanisms that lead to increased risks for adverse events and outcomes. SYNTHESIS This article discusses normal glucose regulation and hyperglycemic pathways, hyperglycemia in patients with cancer, hyperglycemia and cancer-related inflammation, and outcomes (e.g., infections, mortality, symptoms). IMPLICATIONS FOR RESEARCH Understanding the contributors to and consequences of hyperglycemia can guide the development of screening tools to predict which individuals are at the greatest risk for hyperglycemic episodes prior to starting cancer therapies. Research can lead to glycemic guidelines specific to patients with cancer for better outcomes.
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Wright F, Kober KM, Cooper BA, Paul SM, Conley YP, Hammer M, Levine JD, Miaskowski C. Higher levels of stress and different coping strategies are associated with greater morning and evening fatigue severity in oncology patients receiving chemotherapy. Support Care Cancer 2020; 28:4697-4706. [PMID: 31956947 PMCID: PMC7223171 DOI: 10.1007/s00520-020-05303-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/09/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE A cancer diagnosis and associated treatments are stressful experiences for most patients. Patients' perceptions of stress and their use of coping strategies may influence fatigue severity. This study extends our previous work describing distinct profiles of morning (i.e., Very Low, Low, High, and Very High) and evening (i.e., Low, Moderate, High, and Very High) fatigue in oncology patients by evaluating for differences in stress and coping strategies among these fatigue classes. METHODS This longitudinal study evaluated for changes in morning and evening fatigue in oncology patients (n = 1332) over two cycles of chemotherapy (CTX). Patients completed measures of cumulative exposure to stressful life events (SLEs) (i.e., the Life Stressor Checklist-Revised), general stress (i.e., Perceived Stress Scale [PSS]), cancer-specific stress (i.e., Impact of Event Scale-Revised [IES-R]), and coping strategies (i.e., Brief Cope). Differences among the latent classes were evaluated using analyses of variance, Kruskal-Wallis, or chi-square tests. RESULTS Patients in both the Very High morning and evening fatigue classes reported higher numbers of and a higher impact from previous SLEs and higher PSS scores than the other fatigue classes. The IES-R scores for the Very High morning fatigue class met the criterion for subsyndromal PTSD. Patients in the Very High evening fatigue class used a higher number of engagement coping strategies compared with the Very High morning fatigue class. CONCLUSIONS Our findings suggest that interventions to reduce stress and enhance coping warrant investigation to decrease fatigue in patients undergoing CTX.
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Affiliation(s)
- Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA. .,School of Medicine, University of California, San Francisco, CA, USA. .,Department of Physiological Nursing, University of California, 2 Koret Way - N631F, San Francisco, CA, 94143-0610, USA.
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Han CJ, Reding K, Cooper BA, Paul SM, Conley YP, Hammer M, Kober KM, Levine JD, Miaskowski C. Stability of Symptom Clusters in Patients With Gastrointestinal Cancers Receiving Chemotherapy. J Pain Symptom Manage 2019; 58:989-1001.e10. [PMID: 31404646 PMCID: PMC6878189 DOI: 10.1016/j.jpainsymman.2019.07.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/27/2019] [Accepted: 07/30/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT Limited evidence suggests that patients with gastrointestinal (GI) cancers receiving chemotherapy (CTX) experience an average of 13 co-occurring symptoms. An alternative to counting symptoms is to evaluate for symptom clusters. OBJECTIVES In a sample of patients with GI cancers receiving CTX (n = 399), we evaluated the occurrence, severity, and distress of 38 symptoms in the week before patients' second or third cycle of CTX (Time 1 [T1]), approximately one week after CTX (Time 2 [T2]), and approximately two weeks after CTX (Time 3 [T3]); evaluated for differences in the number and types of symptom clusters at each of these three assessments using ratings of occurrence, severity, and distress; and evaluated for changes in symptom clusters over time. METHODS Modified version of the Memorial Symptom Assessment Scale collected data on 38 common symptoms. Exploratory factor analyses were used to create the symptom clusters. RESULTS Five distinct symptom clusters were identified across the three symptom dimensions and the three assessments (i.e., psychological, CTX-related, weight change, GI, and epithelial). Psychological, CTX-related, and weight change clusters were relatively stable across all three symptom dimensions and time. Across all three symptom dimensions, GI cluster was identified only at T1 and epithelial cluster was identified at T2 and T3. CONCLUSION The number and types of symptom clusters appear to be relatively stable over time and across the symptom dimensions. Ongoing assessment and management of these clusters is warranted across the entire course of CTX. The underlying mechanism for these clusters warrants investigation.
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Affiliation(s)
- Claire J Han
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Kerryn Reding
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Von Ah D, Brown C, Brown S, Bryant A, Davies M, Dodd M, Ferrell B, Hammer M, Knobf MT, Knoop T, LoBiondo-Wood G, Mayer D, Miaskowski C, Mitchell S, Song L, Watkins Bruner D, Wesmiller S, Cooley M. Research Agenda of the Oncology Nursing Society: 2019–2022. Oncol Nurs Forum 2019; 46:654-669. [DOI: 10.1188/19.onf.654-669] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Singh K, Kober KM, Paul SM, Hammer M, Wright F, Conley YP, Levine JD, Miaskowski C. Gastrointestinal symptoms are associated with trajectories of chemotherapy-induced nausea. Support Care Cancer 2019; 28:2205-2215. [PMID: 31428931 DOI: 10.1007/s00520-019-05031-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Between 19 and 58% of oncology patients experience chemotherapy-induced nausea (CIN). In a sample of outpatients with breast, gastrointestinal (GI), gynecological, and lung cancer, the study purposes were to evaluate for inter-individual differences in the severity of CIN over two cycles of chemotherapy (CTX) and to determine which demographic and clinical characteristics and GI symptoms were associated with higher initial levels as well as with the trajectories of CIN severity. METHODS Patients completed study questionnaires at six time points over two cycles of CTX. These questionnaires provided information on demographic and clinical characteristics, as well as the occurrence of twelve GI symptoms. Hierarchical linear modeling based on full maximum likelihood estimation was performed. RESULTS Of the 1251 patients, 47.2% reported CIN. Across two cycles of CTX, lower functional status scores and higher levels of comorbidity were associated with higher initial levels of CIN. Younger age and emetogenicity of the CTX regimen were associated with higher initial levels as well as worse trajectories of CIN. The occurrence of five GI symptoms (i.e., vomiting, lack of appetite, constipation, feeling bloated, and difficulty swallowing) was associated with higher initial levels of CIN. The occurrence of mouth sores was associated with higher initial levels as well as with worst trajectories of CIN. CONCLUSIONS This study is the first to identify distinct demographic, clinical, and GI symptom characteristics associated with CIN severity. These findings suggest that the etiology of CIN is complex and may warrant interventions beyond standard antiemetics.
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Affiliation(s)
- Komal Singh
- School of Nursing, Department of Physiological Nursing, University of California, 2 Koret Way-N631Y, San Francisco, CA, 94143-0610, USA
| | - Kord M Kober
- School of Nursing, Department of Physiological Nursing, University of California, 2 Koret Way-N631Y, San Francisco, CA, 94143-0610, USA
| | - Steven M Paul
- School of Nursing, Department of Physiological Nursing, University of California, 2 Koret Way-N631Y, San Francisco, CA, 94143-0610, USA
| | | | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, Department of Physiological Nursing, University of California, 2 Koret Way-N631Y, San Francisco, CA, 94143-0610, USA.
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Petrovchich I, Kober KM, Wagner L, Paul SM, Abrams G, Chesney MA, Topp K, Smoot B, Schumacher M, Conley YP, Hammer M, Levine JD, Miaskowski C. Deleterious Effects of Higher Body Mass Index on Subjective and Objective Measures of Chemotherapy-Induced Peripheral Neuropathy in Cancer Survivors. J Pain Symptom Manage 2019; 58:252-263. [PMID: 31047960 PMCID: PMC6679783 DOI: 10.1016/j.jpainsymman.2019.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/28/2022]
Abstract
CONTEXT Recent, albeit, limited evidence suggests that body mass index (BMI) may be a modifiable risk factor to reduce the deleterious effects of chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors. OBJECTIVES To evaluate for differences in demographic, clinical, pain, sensation, and balance characteristics among three BMI groups. We hypothesized that as BMI increased, survivors would report higher pain intensity scores and have significant decrements in measures of sensation and balance. METHODS A total of 416 survivors with CIPN were evaluated using subjective and objective measures of CIPN. Survivors were divided into three BMI groups (i.e., normal weight, overweight, and obese). Differences among the BMI groups were evaluated using parametric and nonparametric statistics. RESULTS Of the 416 survivors, 45.4% were normal weight, 32.5% were overweight, and 22.1% were obese. Compared with the normal-weight group, survivors in the other two groups had lower functional status scores, a higher comorbidity burden, higher pain intensity scores, and higher interference scores. In addition, compared with the normal-weight group, survivors in the other two BMI groups had significantly worse balance scores. CONCLUSION Our findings support the hypothesis that as BMI increased, pain sensation and balance characteristics worsened. Our findings suggest that nutritional counseling as well as exercise and weight management programs in survivors with CIPN may improve these clinically important problems.
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Affiliation(s)
- Iva Petrovchich
- School of Nursing, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Laura Wagner
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California, USA
| | - Margaret A Chesney
- School of Medicine, University of California, San Francisco, California, USA
| | - Kimberly Topp
- School of Medicine, University of California, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, California, USA
| | - Mark Schumacher
- School of Medicine, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Han CJ, Reding K, Cooper BA, Paul SM, Conley YP, Hammer M, Wright F, Cartwright F, Levine JD, Miaskowski C. Symptom Clusters in Patients With Gastrointestinal Cancers Using Different Dimensions of the Symptom Experience. J Pain Symptom Manage 2019; 58:224-234. [PMID: 31077784 PMCID: PMC6679763 DOI: 10.1016/j.jpainsymman.2019.04.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 12/26/2022]
Abstract
CONTEXT Patients with gastrointestinal (GI) cancers undergoing chemotherapy (CTX) experience multiple cooccurring symptoms. OBJECTIVES The aim of this study was to describe the occurrence, severity, and distress of 38 symptoms and to identify symptom clusters based on three symptom dimensions (i.e., occurrence, severity, and distress) in patients with GI cancers receiving CTX (n = 399). We compared whether the numbers and types of symptom clusters differed based on the dimension of the symptom experience used to create the clusters. METHODS A modified version of the Memorial Symptom Assessment Scale was used to assess the occurrence, severity, and distress of 38 symptoms before the initiation of the patient's next dose of CTX. Exploratory factor analysis was used to determine the symptom clusters. RESULTS These patients experienced 13.0 (±7.1) symptoms before their second or third dose of CTX. For all three symptom dimensions, four symptom clusters were identified, namely psychological distress, CTX-related, GI, and weight change. The number and types of symptom clusters were relatively similar using all three symptom dimensions. However, some variability was found in the specific symptoms within each of the clusters. CONCLUSION Our findings suggest that patients with GI cancers experience multiple cooccurring symptoms. Consistent with previous studies of patients with a variety of cancer diagnoses, psychological and GI clusters are common. Clinicians need to assess for and tailor interventions for these symptom clusters.
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Affiliation(s)
- Claire J Han
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Kerryn Reding
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Frances Cartwright
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Tytar V, Asykulov T, Hammer M. Using species distribution modelling to guide survey efforts of the snow leopard (Panthera uncia) in the Central Kyrgyz Ala-Too region. Theriol Ukr 2019. [DOI: 10.15407/pts2019.17.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hammer M, Günther M, Haeufle D, Schmitt S. Tailoring anatomical muscle paths: a sheath-like solution for muscle routing in musculoskeletal computer models. Math Biosci 2019; 311:68-81. [DOI: 10.1016/j.mbs.2019.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 11/15/2018] [Accepted: 02/11/2019] [Indexed: 11/28/2022]
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Russell J, Wong ML, Mackin L, Paul SM, Cooper BA, Hammer M, Conley YP, Wright F, Levine JD, Miaskowski C. Stability of Symptom Clusters in Patients With Lung Cancer Receiving Chemotherapy. J Pain Symptom Manage 2019; 57:909-922. [PMID: 30768960 PMCID: PMC6486424 DOI: 10.1016/j.jpainsymman.2019.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 11/24/2022]
Abstract
CONTEXT Patients with lung cancer who undergo chemotherapy (CTX) experience multiple symptoms. Evaluation of how these symptoms cluster together and how these symptom clusters change over time are salient questions in symptom clusters research. OBJECTIVES The purposes of this analysis, in a sample of patients with lung cancer (n = 145) who were receiving CTX, were to 1) evaluate for differences in the number and types of symptom clusters at three time points (i.e., before their next cycle of CTX, the week after CTX, and two weeks after CTX) using ratings of symptom occurrence and severity and 2) evaluate for changes in these symptom clusters over time. METHODS At each assessment, a modified version of the Memorial Symptom Assessment Scale was used to assess the occurrence and severity of 38 symptoms. Exploratory factor analyses were used to extract the symptom clusters. RESULTS Across the two symptom dimensions (i.e., occurrence and severity) and the three assessments, six distinct symptom clusters were identified; however, only three of these clusters (i.e., lung cancer specific, psychological, nutritional) were relatively stable across both dimensions and across time. Two additional clusters varied by time but not by symptom dimension (i.e., epithelial/gastrointestinal and epithelial). A sickness behavior cluster was identified at each assessment with the exception of the week before CTX using only the severity dimension. CONCLUSION Findings provide insights into the most common symptom clusters in patients with lung cancer undergoing CTX. Most common symptoms within each cluster appear to be relatively stable across the two dimensions, as well as across time.
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Affiliation(s)
- Jacquelyn Russell
- School of Nursing, University of California, San Francisco, California, USA
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, California, USA
| | - Lynda Mackin
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Flowers E, Flentje A, Levine J, Olshen A, Hammer M, Paul S, Conley Y, Miaskowski C, Kober KM. A Pilot Study Using a Multistaged Integrated Analysis of Gene Expression and Methylation to Evaluate Mechanisms for Evening Fatigue in Women Who Received Chemotherapy for Breast Cancer. Biol Res Nurs 2019; 21:142-156. [PMID: 30701989 PMCID: PMC6700896 DOI: 10.1177/1099800418823286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Fatigue is the most common symptom associated with cancer and its treatment. Investigation of molecular mechanisms associated with fatigue may identify new therapeutic targets. OBJECTIVE The objective of this pilot study was to evaluate the relationships between gene expression and methylation status and evening fatigue severity in women with breast cancer who received chemotherapy. METHODS Latent class analysis (LCA) was used to identify evening fatigue phenotypes. In this analysis, the lowest (i.e., moderate, n = 7) and highest (i.e., very high, n = 29) fatigue-severity classes identified using LCA were analyzed via two stages. First, a total of 32,609 transcripts from whole blood were evaluated for differences in expression levels between the classes. Next, 637 methylation sites located within the putative transcription factor binding sites for those genes demonstrating differential expression were evaluated for differential methylation state between the classes. RESULTS A total of 89 transcripts in 75 unique genes were differentially expressed between the moderate (the lowest fatigue-severity class identified) and very high evening fatigue classes. In addition, 23 differentially methylated probes and three differentially methylated regions were found between the moderate and very high evening fatigue classes. CONCLUSIONS Using a multistaged integrated analysis of gene expression and methylation, differential methylation was identified in the regulatory regions of genes associated with previously hypothesized mechanisms for fatigue, including inflammation, immune function, neurotransmission, circadian rhythm, skeletal muscle energy, carbohydrate metabolism, and renal function as well as core biological processes including gene transcription and the cell-cycle regulation.
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Affiliation(s)
- Elena Flowers
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Annesa Flentje
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Jon Levine
- School of Medicine, University of California, San Francisco, San Francisco,
CA, USA
| | - Adam Olshen
- School of Medicine, University of California, San Francisco, San Francisco,
CA, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Hospital, New York, NY, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburg, Pittsburg, PA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
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44
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Papachristou N, Barnaghi P, Cooper B, Kober KM, Maguire R, Paul SM, Hammer M, Wright F, Armes J, Furlong EP, McCann L, Conley YP, Patiraki E, Katsaragakis S, Levine JD, Miaskowski C. Network Analysis of the Multidimensional Symptom Experience of Oncology. Sci Rep 2019; 9:2258. [PMID: 30783135 PMCID: PMC6381090 DOI: 10.1038/s41598-018-36973-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
Oncology patients undergoing cancer treatment experience an average of fifteen unrelieved symptoms that are highly variable in both their severity and distress. Recent advances in Network Analysis (NA) provide a novel approach to gain insights into the complex nature of co-occurring symptoms and symptom clusters and identify core symptoms. We present findings from the first study that used NA to examine the relationships among 38 common symptoms in a large sample of oncology patients undergoing chemotherapy. Using two different models of Pairwise Markov Random Fields (PMRF), we examined the nature and structure of interactions for three different dimensions of patients’ symptom experience (i.e., occurrence, severity, distress). Findings from this study provide the first direct evidence that the connections between and among symptoms differ depending on the symptom dimension used to create the network. Based on an evaluation of the centrality indices, nausea appears to be a structurally important node in all three networks. Our findings can be used to guide the development of symptom management interventions based on the identification of core symptoms and symptom clusters within a network.
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Affiliation(s)
- Nikolaos Papachristou
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK.
| | - Payam Barnaghi
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK.
| | | | | | | | | | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, USA
| | - Fay Wright
- School of Nursing, Yale University, New Haven, USA
| | - Jo Armes
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK.,School of Health Sciences, University of Surrey, Guildford, UK
| | - Eileen P Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lisa McCann
- University of Strathclyde, Glasgow, Scotland
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, USA
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Papachristou N, Puschmann D, Barnaghi P, Cooper B, Hu X, Maguire R, Apostolidis K, P. Conley Y, Hammer M, Katsaragakis S, M. Kober K, D. Levine J, McCann L, Patiraki E, P. Furlong E, A. Fox P, M. Paul S, Ream E, Wright F, Miaskowski C. Learning from data to predict future symptoms of oncology patients. PLoS One 2018; 13:e0208808. [PMID: 30596658 PMCID: PMC6312306 DOI: 10.1371/journal.pone.0208808] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/24/2018] [Indexed: 01/04/2023] Open
Abstract
Effective symptom management is a critical component of cancer treatment. Computational tools that predict the course and severity of these symptoms have the potential to assist oncology clinicians to personalize the patient's treatment regimen more efficiently and provide more aggressive and timely interventions. Three common and inter-related symptoms in cancer patients are depression, anxiety, and sleep disturbance. In this paper, we elaborate on the efficiency of Support Vector Regression (SVR) and Non-linear Canonical Correlation Analysis by Neural Networks (n-CCA) to predict the severity of the aforementioned symptoms between two different time points during a cycle of chemotherapy (CTX). Our results demonstrate that these two methods produced equivalent results for all three symptoms. These types of predictive models can be used to identify high risk patients, educate patients about their symptom experience, and improve the timing of pre-emptive and personalized symptom management interventions.
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Affiliation(s)
- Nikolaos Papachristou
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
| | - Daniel Puschmann
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
| | - Payam Barnaghi
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
| | - Bruce Cooper
- University of California, San Francisco, United States of America
| | - Xiao Hu
- University of California, San Francisco, United States of America
| | | | | | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, United States of America
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, United States of America
| | | | - Kord M. Kober
- University of California, San Francisco, United States of America
| | - Jon D. Levine
- University of California, San Francisco, United States of America
| | - Lisa McCann
- University of Strathclyde, Glasgow, Scotland
| | | | - Eileen P. Furlong
- UCD School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Patricia A. Fox
- UCD School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Steven M. Paul
- University of California, San Francisco, United States of America
| | - Emma Ream
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, United Kingdom
| | - Fay Wright
- School of Nursing, Yale University, New Haven, United States of America
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Kober KM, Mazor M, Abrams G, Olshen A, Conley YP, Hammer M, Schumacher M, Chesney M, Smoot B, Mastick J, Paul SM, Levine JD, Miaskowski C. Phenotypic Characterization of Paclitaxel-Induced Peripheral Neuropathy in Cancer Survivors. J Pain Symptom Manage 2018; 56:908-919.e3. [PMID: 30172061 PMCID: PMC6289693 DOI: 10.1016/j.jpainsymman.2018.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
Abstract
CONTEXT Although paclitaxel is one of the most commonly used drugs to treat breast, ovarian, and lung cancers, little is known about the impact of paclitaxel-induced peripheral neuropathy (PIPN) on cancer survivors. OBJECTIVES The purposes of this study were to evaluate for differences in demographic and clinical characteristics as well as measures of sensation, balance, upper extremity function, perceived stress, symptom burden, and quality of life (QOL) between survivors who received paclitaxel and did (n = 153) and did not (n = 58) develop PIPN. METHODS Pain characteristics associated with PIPN are described in detail. Both subjective and objective measures were used to evaluate the impact of PIPN. RESULTS Survivors with PIPN were significantly older, had a higher body mass index, and a worse comorbidity profile. The duration of PIPN was almost four years, and pain scores were in the moderate range. Compared with survivors without PIPN, survivors with PIPN had a higher number of upper and lower extremity sites that had lost light touch, cold, and pain sensations. Survivors with PIPN had worse upper extremity function, more problems with balance, a higher symptom burden, and higher levels of perceived stress. In addition, survivors with PIPN had worse QOL scores particularly in the domain of physical functioning. CONCLUSION The findings from this large descriptive study are the first to document the impact of PIPN on survivors' symptom burden, functional status, and QOL.
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Affiliation(s)
- Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA.
| | - Melissa Mazor
- School of Nursing, University of California, San Francisco, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California, USA
| | - Adam Olshen
- School of Medicine, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Mark Schumacher
- School of Medicine, University of California, San Francisco, California, USA
| | - Margaret Chesney
- School of Medicine, University of California, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Kober KM, Olshen A, Conley YP, Schumacher M, Topp K, Smoot B, Mazor M, Chesney M, Hammer M, Paul SM, Levine JD, Miaskowski C. Expression of mitochondrial dysfunction-related genes and pathways in paclitaxel-induced peripheral neuropathy in breast cancer survivors. Mol Pain 2018; 14:1744806918816462. [PMID: 30426838 PMCID: PMC6293373 DOI: 10.1177/1744806918816462] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Paclitaxel is one of the most commonly used drugs to treat breast cancer. Its
major dose-limiting toxicity is paclitaxel-induced peripheral neuropathy
(PIPN). PIPN persists into survivorship and has a negative impact on
patient’s mood, functional status, and quality of life. No interventions are
available to treat PIPN. A critical barrier to the development of
efficacious interventions is the lack of understanding of the mechanisms
that underlie PIPN. Mitochondrial dysfunction has been evaluated in
preclinical studies as a hypothesized mechanism for PIPN, but clinical data
to support this hypothesis are limited. The purpose of this pilot study was
to evaluate for differential gene expression and perturbed pathways between
breast cancer survivors with and without PIPN. Methods Gene expression in peripheral blood was assayed using RNA-seq. Differentially
expressed genes (DEG) and pathways associated with mitochondrial dysfunction
were identified between survivors who received paclitaxel and did (n = 25)
and did not (n = 25) develop PIPN. Results Breast cancer survivors with PIPN were significantly older; more likely to be
unemployed; reported lower alcohol use; had a higher body mass index and
poorer functional status; and had a higher number of lower extremity sites
with loss of light touch, cold, and pain sensations and higher vibration
thresholds. No between-group differences were found in the cumulative dose
of paclitaxel received or in the percentage of patients who had a dose
reduction or delay due to PIPN. Five DEGs and nine perturbed pathways were
associated with mitochondrial dysfunction related to oxidative stress, iron
homeostasis, mitochondrial fission, apoptosis, and autophagy. Conclusions This study is the first to provide molecular evidence that a number of
mitochondrial dysfunction mechanisms identified in preclinical models of
various types of neuropathic pain including chemotherapy-induced peripheral
neuropathy are found in breast cancer survivors with persistent PIPN and
suggest genes for validation and as potential therapeutic targets.
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Affiliation(s)
- Kord M Kober
- 1 School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Adam Olshen
- 2 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yvettte P Conley
- 3 School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark Schumacher
- 2 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly Topp
- 2 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Betty Smoot
- 2 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa Mazor
- 1 School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Margaret Chesney
- 2 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Marilyn Hammer
- 4 Department of Nursing, Mount Sinai Medical Center, New York, NY, USA
| | - Steven M Paul
- 1 School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Jon D Levine
- 2 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- 1 School of Nursing, University of California, San Francisco, San Francisco, CA, USA
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Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S, Wakhloo A, Moonis M, Henniger N, Goddeau R, van den Berg R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Tunguturi A, Onteddu S, Carandang R, Howk M, Koudstaal PJ, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Meler P, Huerga E, Gelabert S, Coscojuela P, van Zwam WH, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Rovira A, Molina CA, Millán M, Muñoz L, Roos YB, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, García Bermejo P, Remollo S, Castaño C, García-Sort R, van der Lugt A, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Dávalos A, Chamorro A, Urra X, Obach V, van Oostenbrugge RJ, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Ariño H, Aceituno A, Rudilosso S, Renu A, Majoie CB, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Quesada H, Rubio F, Cano L, Lara B, Dippel DW, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Brown MM, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Liebig T, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Stijnen T, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Mutlu G, Rosso C, Szatmary Z, Yger M, Andersson T, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Leautaud A, Renkes C, Serre I, Desal H, Mattle H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Wahlgren N, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, van der Heijden E, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Birchenall J, Bodiguel E, Calvet D, Domigo V, Ghannouti N, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Trystram D, Turc G, Berge J, Sibon I, Fleitour N, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Hooijenga I, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, Bejot Y, Chavent A, Gentil A, Kazemi A, Puppels C, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Pellikaan W, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Geerling A, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, 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R, Banaras A, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Heshmatollah A, Harrison L, Keshvara R, Cunningham J, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez-Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Tantoy IY, Cooper BA, Dhruva A, Cataldo J, Paul SM, Conley YP, Hammer M, Wright F, Dunn LB, Levine JD, Miaskowski C. Changes in the Occurrence, Severity, and Distress of Symptoms in Patients With Gastrointestinal Cancers Receiving Chemotherapy. J Pain Symptom Manage 2018; 55:808-834. [PMID: 29051114 PMCID: PMC5834370 DOI: 10.1016/j.jpainsymman.2017.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 01/02/2023]
Abstract
CONTEXT Studies on multiple dimensions of the symptom experience of patients with gastrointestinal cancers are extremely limited. OBJECTIVE Purpose was to evaluate for changes over time in the occurrence, severity, and distress of seven common symptoms in these patients. METHODS Patients completed Memorial Symptom Assessment Scale, six times over two cycles of chemotherapy (CTX). Changes over time in occurrence, severity, and distress of pain, lack of energy, nausea, feeling drowsy, difficulty sleeping, and change in the way food tastes were evaluated using multilevel regression analyses. In the conditional models, effects of treatment group (i.e., with or without targeted therapy), age, number of metastatic sites, time from cancer diagnosis, number of prior cancer treatments, cancer diagnosis, and CTX regimen on enrollment levels, as well as the trajectories of symptom occurrence, severity, and distress were evaluated. RESULTS Although the occurrence rates for pain, lack of energy, feeling drowsy, difficulty sleeping, and change in the way food tastes declined over the two cycles of CTX, nausea and numbness/tingling in hands/feet had more complex patterns of occurrence. Severity and distress ratings for the seven symptoms varied across the two cycles of CTX. CONCLUSIONS Demographic and clinical characteristics associated with differences in enrollment levels as well as changes over time in occurrence, severity, and distress of these seven common symptoms were highly variable. These findings can be used to identify patients who are at higher risk for more severe and distressing symptoms during CTX and to enable the initiation of preemptive symptom management interventions.
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Affiliation(s)
- Ilufredo Y Tantoy
- School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, California, USA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Fay Wright
- School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Palo Alto, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Papachristou N, Barnaghi P, Cooper BA, Hu X, Maguire R, Apostolidis K, Armes J, Conley YP, Hammer M, Katsaragakis S, Kober KM, Levine JD, McCann L, Patiraki E, Paul SM, Ream E, Wright F, Miaskowski C. Congruence Between Latent Class and K-Modes Analyses in the Identification of Oncology Patients With Distinct Symptom Experiences. J Pain Symptom Manage 2018; 55:318-333.e4. [PMID: 28859882 PMCID: PMC5794511 DOI: 10.1016/j.jpainsymman.2017.08.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 12/20/2022]
Abstract
CONTEXT Risk profiling of oncology patients based on their symptom experience assists clinicians to provide more personalized symptom management interventions. Recent findings suggest that oncology patients with distinct symptom profiles can be identified using a variety of analytic methods. OBJECTIVES The objective of this study was to evaluate the concordance between the number and types of subgroups of patients with distinct symptom profiles using latent class analysis and K-modes analysis. METHODS Using data on the occurrence of 25 symptoms from the Memorial Symptom Assessment Scale, that 1329 patients completed prior to their next dose of chemotherapy (CTX), Cohen's kappa coefficient was used to evaluate for concordance between the two analytic methods. For both latent class analysis and K-modes, differences among the subgroups in demographic, clinical, and symptom characteristics, as well as quality of life outcomes were determined using parametric and nonparametric statistics. RESULTS Using both analytic methods, four subgroups of patients with distinct symptom profiles were identified (i.e., all low, moderate physical and lower psychological, moderate physical and higher Psychological, and all high). The percent agreement between the two methods was 75.32%, which suggests a moderate level of agreement. In both analyses, patients in the all high group were significantly younger and had a higher comorbidity profile, worse Memorial Symptom Assessment Scale subscale scores, and poorer QOL outcomes. CONCLUSION Both analytic methods can be used to identify subgroups of oncology patients with distinct symptom profiles. Additional research is needed to determine which analytic methods and which dimension of the symptom experience provide the most sensitive and specific risk profiles.
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Affiliation(s)
| | - Payam Barnaghi
- School of Health Sciences, University of Surrey, Guilford, UK
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Xiao Hu
- School of Nursing, University of California, San Francisco, California, USA
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | | | - Jo Armes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College, London, UK
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Stylianos Katsaragakis
- Faculty of Nursing, University of Peloponnese, Efstathiou & Stamatikis Valioti and Plateon, PC, Sparti, Greece
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Lisa McCann
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Elisabeth Patiraki
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guilford, UK
| | - Fay Wright
- School of Nursing, Yale University, New Haven, Connecticut, USA
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