The prevalence and correlates of symptom distress and quality of life in Chinese oesophageal cancer patients undergoing chemotherapy after radical oesophagectomy

Identification of Core Symptom Cluster in Patients With Digestive Cancer: A Network Analysis

BACKGROUND

A lack of identified core symptom clusters in digestive cancer patients hinders achieving precision symptom intervention. There are few studies on identifying digestive cancer symptom clusters based on network analysis.

OBJECTIVES

The aims of this study were to construct the symptom network of digestive cancer patients and identify the core symptom cluster.

METHODS

A cross-sectional study was conducted among 202 digestive cancer patients. The Chinese version of the MD Anderson Symptom Inventory for gastrointestinal cancer scale was used to assess the symptoms by convenience sampling. R software was used to construct a symptom network and identify core symptom clusters. Edge weight and centrality difference tests were used to test the accuracy of core symptom cluster identification.

RESULTS

The most common symptoms were distress, poor appetite, and sadness. The most serious symptoms were poor appetite, disturbed sleep, and fatigue. The core symptom cluster of the psychoemotional symptom group was distress, sadness, and numbness. The centrality index showed that the top 3 in strength were distress (Rs = 1.11), fatigue (Rs = 1.09), and sadness (Rs = 1.04). The edge weight difference test showed that the psychoemotional symptom group had high stability.

CONCLUSIONS

The psychoemotional symptoms of digestive cancer patients should be given priority for intervention. Network analysis must be extended to the symptom research of cancer patients as soon as possible to provide a scientific basis for symptom management.

IMPLICATIONS FOR PRACTICE

Nurses must perform comprehensive psychological and emotional assessments, initiate referrals for psychoemotional symptom management and psychological services, and administer pharmacologic and nonpharmacologic interventions to improve appetite loss in digestive cancer patients.

Early postoperative core symptoms and their relationship with resilience in oesophageal cancer patients-A multicentre cross-sectional study

AIM

To assess early postoperative core symptoms in oesophageal cancer patients and their relationship with resilience.

BACKGROUND

Patients with oesophageal cancer face a high number of severe symptoms in the early post-operative period and require the development of an effective symptom management programme. Identifying core symptoms through network analysis helps in accurate patient care.

DESIGN

A multicentre cross-sectional study.

METHODS

A cross-sectional survey was conducted from August 2022 to August 2023 at three hospitals in Anhui Province, China. A total of 469 patients were recruited for this study and 418 (89.1%) patients completed this investigation. Using network analysis to find early post-operative core symptoms in oesophageal cancer patients. Multiple linear regression was used to analyse resilience factors affecting core symptoms.

RESULTS

Sadness was the most core symptom in oesophageal cancer patients in the early post-operative period (rs = 1.41), followed by incision pain and difficulty breathing while resting (rs = 1.20, rs = 1.08). Resilience was significantly associated with patients' feelings of sadness, with optimism having the greatest impact on sadness (p < .01).

CONCLUSION

Sadness is the most core symptom in patients in the early post-operative period and special attention should be paid to improving their level of resilience. Local symptoms and dysfunction in the early post-operative period should be treated in a synergistic manner.

IMPACT

This study identifies core symptoms and their relationship to resilience in patients with oesophageal cancer in the early post-operative period. Symptoms as the main core symptom in patients in the early post-operative period, which was sadness and was significantly associated with resilience. Precise interventions can be made to target patients' core post-operative symptoms, which can help improve the effectiveness of symptom management.

REPORTING METHOD

We have complied with the relevant EQUATOR research reporting checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution in the study.

Identification of subgroups of patients with gastrointestinal cancers based on symptom severity and frequency: A latent profile and latent class analysis

PURPOSE

Identify subgroups of patients with gastrointestinal cancer with different frequency and severity of symptoms and assess differences in demographics, clinical characteristics, and degree of interference with daily life.

METHODS

This was a cross-sectional study. A total of 202 patients with gastrointestinal cancers completed the Chinese version of the MD Anderson Symptom Inventory for Gastrointestinal Cancer Module by convenience sampling. Subgroups of patients were identified using latent profile analysis and latent class analysis. Chi-squared, Mann-Whitney-U, and Kruskal-Wallis tests assessed differences among subgroups.

RESULTS

In terms of symptom severity, low (70.3%), Moderate (13.4%), and high (16.3%) classes were identified. Compared with the other two classes, the Moderate group had a higher proportion of patients with a history of tobacco and alcohol, esophageal cancer, and gastric cancer (P < 0.05). In terms of symptom frequency, all -high (57.9%), high physical symptoms (9.9%), and all-low (32.2%) classes were identified. All-high groups had a younger age and a higher proportion of patients with cancer stage IV (P < 0.05). The high group had the most interference with daily life in both perspectives (P < 0.001), and psycho-emotional symptoms were frequent and severe.

CONCLUSIONS

The two perspectives of symptom severity and frequency can play a complementary role in identifying high-risk groups. Clinical practitioners should strengthen psychological interventions in young and advanced cancer patients and provide pharmaceutical and non-pharmaceutical interventions for dysphagia symptoms in esophageal and gastric cancer patients with a history of tobacco and alcohol.

Understanding the supportive care needs among discharged patients with esophageal cancer after esophagectomy: A qualitative study

PURPOSE

Patients with esophageal cancer experience physical and psychosocial difficulties after surgery. Understanding their unmet supportive care needs could help medical staff in providing high quality of care. This study aimed to gain insights into the supportive care needs of discharged patients with esophageal cancer after esophagectomy.

METHOD

A descriptive qualitative study design was used. A purposive sample of 20 patients was studied using semi-structured interviews. The thematic analysis approach was used to analyze the data.

RESULTS

Four themes and 14 sub-themes emerged from the analysis: (1) symptom management needs (dysphagia, reflux, fatigue, and other symptoms), (2) dietary and nutritional needs (unclear nutrition information, eating habit change, and dining out restriction), (3) psychosocial adjustment needs (stigma, dependency, fear of recurrence, and desire for normalcy), and (4) social support needs (medical staff support, family support, and peer support).

CONCLUSION

Chinese patients with esophageal cancer have various unmet supportive care needs after esophagectomy. Medical professionals should recognize patients' unmet supportive care needs in time, provide professional access and practical guidance, relieve their bad mood, and fully utilize online communicating channels, such as a consulting platform or a WeChat group, for further support.

Symptom clusters and impact on quality of life in esophageal cancer patients

BACKGROUND

Esophageal cancer patients can experience co-occurring, related symptoms labeled symptom clusters. This study aimed to identify symptom clusters and explore which SCs independently affect the quality of life (QoL) among esophageal cancer patients.

METHODS

This cross-sectional study was performed in Shenyang, China, from February 2021 to February 2022. Finally, 118 esophageal cancer patients effectively completed the survey. Questionnaires' information included the Functional Assessment of Cancer Therapy-General (FACT-G), the MD Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI), the Multidimensions Scale of Perceived Social Support, and demographic and clinical characteristics. Exploratory factor analysis with principal axis factoring was used to identify symptom clusters, and multiple regression analysis was employed to analyze the influencing factors of QoL.

RESULTS

The mean score of FACT-G was 69.88 (SD = 17.85) among 118 esophageal cancer patients. Four symptom clusters were identified: psychological-somatic, dysphagia, fatigue-pain, and gastrointestinal symptom clusters. Results of regression analysis indicated a significant impact on QoL for chemotherapy (β = 0.140, P < 0.045), psychological-somatic symptom cluster (β = - 0.329, P = 0.013), and social support (β = 0.409, P < 0.001) after adjusting demographic and clinical characteristics. The linear combination explained 47.8% of the variance in QoL.

CONCLUSIONS

There is a critical need to emphasize the importance of psychological-somatic symptoms clusters management programs and increasing social support to improve QoL in esophageal cancer patients.

Impact of discriminant factors on the comfort-care of nurses caring for trans-arterial chemoembolisation patients

PURPOSE

This study was conducted to identify the levels of comfort-care provided by trans-arterial chemoembolisation (TACE) nurses and examine the discriminant factors thereof.

METHODS

Nurses (n = 146) with experience in caring for TACE patients, participated in this study. The data were collected using an online self-rated questionnaire and analysed with descriptive statistics and discriminant analysis. The discriminating factors included perception of post-embolisation syndrome and symptom interference, caring attitude, barriers to pain and nausea/vomiting management, and supportive care competence.

RESULTS

The participants were classified into three groups, depending on the level of their comfort-care: "low" (n = 27), "moderate" (n = 88), and "high" (n = 31) comfort-care groups. One function significantly discriminated between the low and high comfort-care groups and correctly classified 79.3% of the participants in the cross-validation run. Supportive care competence (0.864), caring attitude (0.685), perception of symptom interference (0.395), perception of post-embolisation syndrome (0.321), and barriers to nausea/vomiting management (- 0.343) were significant discriminant factors of comfort-care.

CONCLUSION

A low proportion of the participants provided high levels of comfort-care, which was determined by five discriminant factors. The study's findings imply that the development of supportive care competence, authentic human caring attitude, early detection of patients' symptoms and symptom interference, and the development of manuals and guidelines for removing barriers for nausea and vomiting are needed to improve the comfort-care of nurses caring for TACE patients.

Factors associated with psychosocial adjustment in working-age colorectal cancer survivors: A cross-sectional study

Objective

This study aimed to describe the level of psychosocial adjustment and identify factors associated with psychosocial adjustment in working-age colorectal cancer survivors.

Methods

This cross-sectional study involved 212 colorectal cancer survivors visiting a cancer clinic at a specialized oncology hospital in China. Socio-demographic characteristics, disease-related characteristics, status of returning to work, Work Ability Index scores, M. D. Anderson Symptom Inventory for Gastrointestinal Cancer scores, and self-reported Psychological Adjustment to Illness Scale scores were collected from all participants. Data analyses included descriptive statistics, independent t-test, one-way analysis of variance, correlation analysis, and multiple linear regression analysis, which were performed using the Statistical Package for the Social Sciences version 25.0 (IBM Corporation, Armonk, NY, USA).

Results

Participants reported a medium level of psychosocial maladjustment (35.73 ​± ​19.68), with 19.3% of participants experiencing severe maladjustment, 29.7% experiencing moderate maladjustment, and 50.9% experiencing mild maladjustment, respectively. Age, gender, marital status, having a child, education level, having a stoma, comorbidities, return to work, work ability, and symptom distress were entered into a multiple linear regression analysis. The strongest factor influencing the level of psychosocial adjustment was work ability (β ​= ​−0.393, P ​< ​0.001), followed by symptom distress (β ​= ​0.380, P ​< ​0.001) and an education level of college or above (β ​= ​0.150, P ​= ​0.027). These variables accounted for 46.1% of the variance in psychosocial adjustment.

Conclusions

Colorectal cancer survivors with low work ability, high symptom distress, and an education level of college or above are at a high risk for psychosocial maladjustment. Nursing interventions for psychosocial adjustment should attach increased importance to the work status and symptom distress of colorectal cancer survivors.

Association of Genetic Polymorphisms with Psychological Symptoms in Cancer: A Systematic Review

Cancer patients suffer from a repertoire of symptoms, including such psychological and psychiatric symptoms as anxiety, depression, and posttraumatic stress. Exploration of genetic factors that modify the risk and severity of these symptoms may facilitate the development of personalised care plans for managing these symptoms. This review aims to provide an overview on the variations in genes that may contribute to the occurrence and severity of anxiety, depression, and posttraumatic stress disorder (PTSD) among cancer patients. Literature search was performed in nine English and Chinese electronic databases, and extracted data are presented narratively. The reporting quality of the included studies was assessed using selected items of The STrengthening the REporting of Genetic Association (STREGA) checklist. Twenty-nine studies were included in the review. Most studies involved breast cancer patients, while patients of other cancer types appeared to be understudied. A number of studies reported the association between genes involved in inflammatory pathways and depression and anxiety. Other genes found to show associations with anxiety, depression, and PTSD among cancer patients are those involved in neurotrophic signalling, serotonergic signalling, regulation of stress response, antioxidation, dopamine catabolism and cellular apoptosis, despite some inconsistencies in findings between studies. Our review highlighted a need for further research for enhancing our knowledge on the association between genetic variations and anxiety, depression, and PTSD of patients of various cancer types. Future studies examining such associations in patients of various cancers should utilise standardised instruments for outcome assessments and stratify the patients based on their age for analysis.

A serial multiple mediator model of sense of coherence, coping strategies, depression, and quality of life among gynecologic cancer patients undergoing chemotherapy

PURPOSE

This study evaluated whether coping strategies (positive reframing, planning, and active coping) and depression mediate the relationship between sense of coherence (SOC) and quality of life (QoL) using a serial multiple mediator model in patients with gynecologic cancer who are undergoing chemotherapy.

METHODS

A sample of 148 participants, with a mean age of 52.17 years (range 20-75) and diagnosed with gynecological cancer (e.g., cervix, ovary and endometrium) was surveyed in a cross-sectional study. Data were collected using a structured self-reporting questionnaire. A serial multiple mediator model was analyzed to explain sequential causality among two mediators (coping strategy and depression) and to investigate the direct and indirect effects of the mediator model in SPSSWIN 26.0 and PROCESS macro program.

RESULTS

The conceptual serial mediation model of SOC, positive reframing, depression, and QoL revealed a significant positive total effect (coefficient c = 13.099, SE = 1.647, p < 0.001). The path through single mediation of positive reframing (Effect = 0.925) and depression (Effect = 5.942) and that through both mediators (Effect = 1.161) were statistically significant. The total indirect effect was also statistically significant (Effect = 8.028). Moreover, the conceptual serial mediation model on SOC, planning, depression, and QoL revealed a significant positive total effect (coefficient c = 13.099, SE = 1.647, p < 0.001). The path through both mediation of planning and depression (Effect = 1.162) and the total indirect effect were statistically significant (Effect = 8.172).

CONCLUSIONS

Helping patients with gynecologic cancer undergoing chemotherapy to strengthen SOC may improve QoL by equipping them with efficient positive reframing or planning strategies to reduce depression.

Distinct profiles of multiple co-occurring symptoms in patients with gastrointestinal cancers receiving chemotherapy

PURPOSE

Identify subgroups of gastrointestinal (GI) cancer patients with distinct multiple co-occurring symptom profiles and evaluate for differences among these subgroups in demographic and clinical characteristics and quality of life (QOL) outcomes.

METHODS

Patients with GI cancers (n = 399) completed the Memorial Symptom Assessment Scale (MSAS) that was used to assess for multiple co-occurring symptoms. Latent class analysis (LCA) was used to identify subgroups of patients with distinct symptom profiles using symptom occurrence ratings. Differences in demographic and clinical characteristics and QOL outcomes among the subgroups were evaluated using parametric and nonparametric tests.

RESULTS

All Low (36.6%), Moderate (49.4%), and All High (14.0%) classes were identified. Compared to the All Low class, patients in the other two classes were significantly younger and were more likely to report depression and back pain. Compared to the other two classes, patients in the All High class had fewer years of education and a higher number of comorbidities. Significant differences were found among the three classes for comorbidity burden and total number of MSAS symptoms (i.e., All Low < Moderate < All High), as well as for performance status (i.e., All Low > Moderate > All High). A higher symptom burden was associated with poorer QOL outcomes.

CONCLUSIONS

The first study to identify subgroups of patients with GI cancers based on distinct symptom profiles. LCA allowed for the identification of risk factors associated with a higher symptom burden. Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.

Effects of psychosocial factors on posttraumatic growth among lung cancer patients: A structural equation model analysis

OBJECTIVE

The purpose of this study was to investigate how locus of control, coping strategies, emotion regulation strategies and social support affect posttraumatic growth.

METHODS

A cross-sectional study design was adopted. A convenience sample of 540 patients with lung cancer was recruited from November 2016 to July 2017 at two tertiary grade A hospitals in China. The participants completed a series of questionnaires. Structural equation modelling was used to explore the effects of psychosocial factors on posttraumatic growth.

RESULTS

Social support had a direct positive effect on posttraumatic growth (β = 0.318, SE = 0.071, BC 95% CI = 0.252/0.390), and it also had indirect effects on posttraumatic growth (β = 0.112, SE = 0.023, BC 95%CI = 0.088/0.135) through mediating psychological factors. Coping strategies and the cognitive reappraisal emotion regulation strategy were the main mediating variables, explaining approximately 73.1% of the indirect effect between social support and posttraumatic growth.

CONCLUSIONS

Our study suggests that Chinese lung cancer survivors can show relatively high posttraumatic growth. There are many mediating paths between social support and posttraumatic growth. These results may help healthcare professionals to identify the psychosocial factors that may benefit lung cancer patients and develop interventions to promote posttraumatic growth.

The Prevalence and Correlates of Prehospital Delay and Health Belief in Chinese Patients With Colorectal Cancer

The objective of this study was to describe prehospital delay and health beliefs in Chinese patients with colorectal cancer. A total of 756 adult Chinese patients with a first-time diagnosis of colorectal cancer were recruited during 2016 in Guangzhou, China. All patients completed the Chinese-language version of a questionnaire developed specifically for this study as well as the Chinese-language version of the Champion Health Belief Model Scale. The results of this study showed that the median length of the prehospital delay was 12 weeks and that the average delay was 18.29 (SD = 14.66) weeks. The rate of prehospital delay was 47.35%. The score of health beliefs among these patients was 115.56 (SD = 9.00) and the average score of the entries was 3.21 (SD = 0.25). Health beliefs about colorectal cancer were negatively correlated with prehospital delay. A multiple logistic regression showed that the level of health beliefs, frequency of physical examinations, occupation, and the site of the cancer were the major factors influencing prehospital delay (p < .05). The patients had a low rate of physical examination (41.40%), and colorectal cancer screening was not routine prior to their physical examination. This study showed that the incidence of prehospital delay among Chinese patients with colorectal cancer was 47.35%. Multiple factors influenced prehospital delay among Chinese patients with colorectal cancer.

The value of WeChat application in chronic diseases management in China

The prevalence of chronic diseases in China has increased rapidly in recent decades. Although the management rate of chronic diseases has improved, there is still no unified and effective management measure for chronic diseases at present. This highlights the importance of effectively managing chronic diseases. With the development of e-health, the ways of getting medical consultation have changed. WeChat is an extremely popular social application in China. It is easy to operate and can offer multiple functions. Many researches have reported the effectiveness of WeChat in chronic diseases management. Based on the status of WeChat application in chronic diseases management and the characteristics of WeChat technology, we firstly focused on the WeChat application on the management of chronic diseases such as hypertension, diabetes, coronary heart disease and cancer. Then we discussed the value of WeChat in chronic diseases management and analyzed the potential reasons. Lastly, we discussed the limitations of present researches. WeChat can be an effective tool for the management of chronic diseases, but the promotion of this mode needs support and efforts from various aspects to eventually realize improving public health.

Unmet supportive care needs and associated factors among Chinese discharged patients with esophageal cancer after esophagectomy: A cross-sectional study

PURPOSE

After esophagectomy, patients experience a series of problems that severely affect their quality of life. Understanding their unmet needs could help medical staff provide better supportive care. The aim of this study was to investigate the supportive care needs of discharged patients with esophageal cancer after esophagectomy and explore the factors associated with these needs.

METHOD

A total of 167 discharged patients with esophageal cancer after esophagectomy were recruited from a University Cancer Center in China and investigated using a self-designed demographic and clinical characteristics questionnaire, the 34-item Supportive Care Needs Survey, and the M.D. Anderson Symptom Inventory Gastrointestinal Cancer Module.

RESULTS

Approximately 95.2% of the patients had ≥1 unmet need(s). The overall level of supportive care needs of patients after esophagectomy was mild to medium. Most of the top 10 moderate-to-severe unmet needs were identified in the health and information domains. Age (β = -0.157, p = 0.011), dysphagia (β = -0.178, p = 0.005), recurrence (β = 0.175, p = 0.005), time since diagnosis (β = -0.150, p = 0.018), and symptom interference (β = 0.488, p < 0.001) were significantly associated with supportive care needs.

CONCLUSIONS

Discharged patients with esophageal cancer after esophagectomy had a wide range of unmet supportive care needs. It is essential to combine the associated factors to accurately evaluate patient needs. We should pay more attention to propose comprehensive measures for these patients and provide more individualized supportive care during the lengthy recovery period.

The effect of biofeedback training on intestinal function among patients with middle and low rectal cancer: a randomized controlled study

Background

To evaluate the effect of biofeedback on intestinal function among patients with middle and low rectal cancer.

Methods

Using a randomized controlled trial design, 109 patients with middle and low rectal cancer indicated to have preoperative radiochemotherapy, anterior resection of the rectum, and preventive stoma were randomly divided into three groups: the blank control group, the pelvic floor muscle exercise group, and the biofeedback training group. A 16-month intervention and longitudinal follow-up study was conducted, and a questionnaire on intestinal function by the Memorial Sloan-Kettering Cancer Center (MSKCC) was adopted into a Chinese version to evaluate patients' intestinal function situation.

Results

The intestinal function of the biofeedback training group was better than the blank control group and pelvic floor muscle exercise group. The total score of intestinal function and the scores of each dimension were statistically significant (P<0.05).

Conclusions

Biofeedback training could significantly improve the intestinal function of patients with middle and low rectal cancer, promote its recovery, and is thus worthy of clinical application.

Coping, mood and health-related quality of life: a cross-sectional study in Chinese patients with advanced lung cancer

OBJECTIVES

The ways patients cope with advanced cancer can influence their health-related quality of life (HRQoL). This study aims to examine the mediating role of positive and negative mood in the relationship between coping and HRQoL in patients with advanced lung cancer.

METHODS

A consecutive sample of 261 patients (mean age: 59.99±9.53) diagnosed with stage III or IV lung cancer was recruited from the inpatient unit in a hospital that specialises in chest-related disease in Shanghai, China. Participants completed measurements including Medical Coping Modes Questionnaire, Positive and Negative Affect Schedule, and 5-level EuroQol 5-dimension instrument.

RESULTS

Although the total effects of confrontation on HRQoL were not significant, competing indirect effects via mood were identified: (1) positive indirect effects through positive mood were found for confrontation on mobility, usual activities, pain/discomfort and overall utility index (indirect effect=0.01, 95% CI 0.003 to 0.03); (2) negative indirect effects through negative mood were found for confrontation on mobility, pain/discomfort, anxiety/depression and overall utility index (indirect effect=-0.01, 95% CI -0.03 to -0.001). Resigned acceptance was negatively associated with HRQoL, and indirect effects via mood were identified: (1) negative indirect effects through positive mood were found for resigned acceptance on mobility, self-care, usual activities, pain/discomfort and overall utility index (indirect effect=-0.01, 95% CI -0.03 to -0.003); (2) negative indirect effects through negative mood were found for resigned acceptance on domains of HRQoL and overall utility index (indirect effect=-0.04, 95% CI -0.06 to -0.02).

CONCLUSIONS

Confronting advanced lung cancer can fuel ambivalent emotional experiences. Nevertheless, accepting the illness in a resigned way can be maladaptive for health outcomes. The findings suggest interventions that facilitate adaptive coping, reduce negative mood and enhance positive mood, as this could help to improve or maintain HRQoL in patients with advanced lung cancer.

An integrative review of the theory of unpleasant symptoms

AIMS

The aim of this study was to explore how the theory of unpleasant symptoms (TOUS) has been used in the methodological design and analysis of symptom research.

DESIGN

An integrative review, using Whittemore and Knafl's approach.

DATA SOURCES

Searches were conducted between 26 January-10 February 2018. Databases included CINAHL Complete, PubMed, Proquest Nursing and Allied Health Source, Health Source: Nursing/Academic Edition, Academic Search Complete and Google Scholar.

REVIEW METHODS

A systematic approach to searching, screening and analysing the literature was applied. The matrix method, content analysis, constant comparison, counting and clustering were used.

RESULTS

Sixty-four records were included. Most studies were quantitative, cross-sectional, instrument-based and conducted in the USA. Various symptoms and patient populations were represented and each of the TOUS concepts were explored.

CONCLUSION

Although the theory has a role to play in furthering symptom science, attention should be paid to the areas of the model and of symptom research that have received less attention. More complex statistical approaches and big data will help to illuminate symptom experiences. Additional focus on intervention studies and all symptom dimensions will help to advance symptom science research.

IMPACT

This review is the first to provide a comprehensive, systematic summary of the uses of the TOUS across the research literature to date. This theory is a diverse, holistic middle-range theory capable of being applied to multiple symptoms and populations. Researchers should consider using the theory as a conceptual framework for studies to advance symptom science and explore symptoms holistically.

Measuring the Quality of Life among Head-and/or-Neck Cancer Patients with Oral Mucositis Using the Functional Assessment of Cancer Therapy-General in Jordan

Objective:

Quality of life (QOL) in cancer patients can be influenced by the presence of medical conditions, such as oral mucositis (OM). There is still limited knowledge about this issue among patients in Jordan, and this could be related to the absence of research instruments testing QOL among cancer patients with OM. This study measured the QOL among cancer patients using the Functional Assessment of Cancer Therapy-General (FACT-G), Arabic version.

Methods:

This was a cross-sectional study on 118 head-and/or-neck cancer patients with OM in Jordan. Data were submitted to measures of normality, reliability, and validity using exploratory factor analysis. The study also measured QOL among the study sample.

Results:

FACT-G demonstrated good internal consistency reliability and validity. Factor analysis indicated the presence of four factors explained by 24 items representing a valid FACT-G, Arabic version. Scores reflected low QOL compared to reported normative values in the literature. The values used to compare findings from this study were extracted from international literature; no similar values were present in published literature.

Conclusions:

FACT-G, Arabic version, is valid and reliable when applied to this study population. Further testing is recommended, which would include the establishment of normative values.

Phloretin induces apoptosis of human esophageal cancer via a mitochondria-dependent pathway

2,4,6-trihydroxy-3-(4-hydroxyphenyl)-propiophenone (phloretin) is found in apple tree leaves and the Manchurian apricot, and is a potent compound that exhibits anti-inflammatory, antioxidant and antitumor activities. However, the effect of phloretin on esophageal cancer cells is not well-defined. The present study aimed to examine whether and how phloretin induced apoptosis in human esophageal cancer cells. EC-109 cells were cultured in Dulbecco's modified Eagle's medium and incubated with 60, 70, 80, 90 and 100 µg/ml phloretin for 6, 12, 24 and 48 h. Cell proliferation was measured by an MTT assay. Cell apoptosis rate was measured using flow cytometric analysis subsequent to propidium iodide (PI) staining. The protein expression levels were determined by western blot analysis. It was found that phloretin significantly decreased viable cell numbers in a dose- and time-dependent manner and induced apoptosis in EC-109 cells. Additionally, phloretin exhibited potent anticancer activity in vitro, as evidenced by the downregulation of the anti-apoptosis-associated molecule B-cell lymphoma 2 (bcl-2) and an increase in the levels of the apoptosis-associated molecules bcl-2-like protein 4 and tumor protein p53. Phloretin treatment also affected the expression of apoptotic protease activating factor-1, the protein product of the direct binding of the inhibitor of apoptosis protein with low PI to the X-linked inhibitor of apoptosis protein. The present results indicated that phloretin may inhibit EC-109 cell growth by inducing apoptosis, which may be mediated through a mitochondria-dependent pathway.

An Analysis and Evaluation of the Theory of Unpleasant Symptoms

The Theory of Unpleasant Symptoms was developed to enhance understanding of relationships among multiple symptoms and symptom experiences. Although the theory has been used to guide research, no formal critique of the theory has been published since 2000. This article comprehensively analyzes and evaluates the theory using Fawcett and DeSanto-Madeya's framework. Although its semantic clarity, semantic and structural consistency, and parsimony could be improved, the theory demonstrates good social and theoretical significance, testability, and empirical and pragmatic adequacy. Understanding multiple patient symptoms is essential, and the theory demonstrates that nurses should focus on multiple rather than individual symptoms.

Validation of the Chinese version of functional assessment of anorexia-cachexia therapy (FAACT) scale for measuring quality of life in cancer patients with cachexia

PURPOSE

The assessment of quality of life (QOL) is an important part of cachexia management for cancer patients. Functional assessment of anorexia-cachexia therapy (FAACT), a specific QOL instrument for cachexia patients, has not been validated in Chinese population. The aim of this study was to validate the FAACT scale in Chinese cancer patients for its future use.

METHODS

Eligible cancer patients were included in our study. Patients' demographic and clinical characteristics were collected from the electronic medical records. Patients were asked to complete the Chinese version of FAACT scale and the MD Anderson symptom inventory (MDASI), and then the reliability and validity were analyzed.

RESULTS

A total of 285 patients were enrolled in our study, data of 241 patients were evaluated. Coefficients of Cronbach's alpha, test-retest and split-half analyses were all greater than 0.8, which indicated an excellent reliability for FAACT scale. In item-subscale correlation analysis and factor analysis, good construct validity for FAACT scale was found. The correlation between FAACT and MDASI interference subscale showed reasonable criterion-related validity, and for further clinical validation, the FAACT scale showed excellent discriminative validity for distinguishing patients in different cachexia status and in different performance status.

CONCLUSIONS

The Chinese version of FAACT scale has good reliability and validity and is suitable for measuring QOL of cachexia patients in Chinese population.

The influence of symptoms on quality of life among patients who have undergone oesophageal cancer surgery

PURPOSE

After oesophagectomy, anatomical changes and loss of function induce various symptoms that may affect quality of life (QoL) in oesophageal cancer patients. The purpose of this study was to identify the factors influencing QoL in Korean patients who have undergone oesophageal cancer surgery.

METHOD

This was a cross-sectional study of a convenience sample consisting of 120 surgery patients with oesophageal cancer. We used the EORTC QLQ-C30 and EORTC QLQ-OES18 to measure participants' oesophageal cancer-related symptoms and QoL. Multiple regression analyses were applied to analyse to the relationship between cancer-related symptoms and QoL.

RESULTS

The average score of oesophageal cancer-related symptoms was 19.28 points, and the most common symptom was reflux. The mean score for global health status/QoL was 60.55. There were significant differences in the functional and symptom subscales according to financial burden, operation type (procedure), and treatment period. Dysphagia most affected global health status/QoL, and eating problems most affected the functional and symptom subscales.

CONCLUSION

Dysphagia and eating problems were confirmed to be the most common symptoms affecting the QoL of patients who had undergone oesophageal cancer surgery. These results can be used to aid in the development of strategies to better manage symptoms in these patients.