Symptom experience in Korean adults with lung cancer

The Preliminary Efficacy of a Technology-Based Cancer Pain Management Program Among Asian American Breast Cancer Survivors

With few existing technology-based programs to support cancer pain management, the need for culturally tailored programs to support ethnic minority cancer survivors has been highlighted. The purpose of this study was to explore the preliminary efficacy of the technology-based CAncer Pain management support Program for Asian American survivors of breast cancer, a technology-based cancer pain management program, in improving the cancer pain experience of Asian American breast cancer survivors. This pilot study adopted a randomized repeated-measures pretest/posttest control group design with a sample of 94 Asian American breast cancer survivors. Study measures included the Brief Pain Inventory-Short Form, Support Care Needs Survey-34 Short Form, and Mishel Uncertainty in Illness Scale-Community. Data were analyzed using descriptive and inferential statistics including repeated-measures analysis of covariance. Although there were no significant differences in pain, there were significant changes in perceived isolation (F = 9.937, P < .01), personal resources (F = 6.612, P < .05), support care need (F = 8.299, P < .01), and degree of uncertainty (F = 8.722, P < .01) in the intervention group from pretest to posttest. These findings support the positive effects of CAncer Pain management support Program for Asian American survivors of breast cancer on the cancer pain experience of Asian American breast cancer survivors.

Challenges in a Technology-Based Cancer Pain Management Program Among Asian American Breast Cancer Survivors

This paper aims to discuss the challenges faced during a pilot study that tested a technology-based cancer pain management program among Asian American survivors of breast cancer and provide directions for future technology-based interventions for racial and ethnic minorities. Data consisting of research diaries and meeting minutes underwent content analysis to extract themes that reflected the challenges. The challenges included those related to (1) diversities within the population of Asian American survivors of breast cancer; (2) survivors' treatment and healing process; (3) Internet resources from the participants' countries of origin; (4) building trust between researchers and participants/gatekeepers; (5) fidelity of the intervention; and (6) cultural sensitivity. Future design and implementation of technology-based programs for racial and ethnic minorities must consider these challenges.

A Systematic Review of the Symptom Distress Scale in Advanced Cancer Studies

BACKGROUND

The 13-item Symptom Distress Scale (SDS) is a widely used symptom measurement tool, yet a systematic review summarizing the symptom knowledge generated from its use in patients with advanced cancer is nonexistent.

OBJECTIVES

This was a systematic review of the research literature in which investigators utilized the SDS as the measure of symptoms in patients with advanced cancer.

METHODS

We searched PubMed, CINAHL, EMBASE, and Web of Science for primary research studies published between 1978 and 2013 that utilized the SDS as the measurement tool in patients with advanced cancer. Nine hundred eighteen documents were found. Applying inclusion/exclusion criteria, 21 articles and 2 dissertations were included.

RESULTS

The majority of investigators utilized descriptive, cross-sectional research designs conducted with convenience samples. Inconsistent reporting of SDS total scores, individual item scores, age ranges and means, gender distributions, cancer types, cancer stages, and psychometric properties made comparisons difficult. Available mean SDS scores ranged from 17.6 to 38.8. Reports of internal consistency ranged from 0.67 to 0.88. Weighted means indicated fatigue to be the most prevalent and distressing symptom. Appetite ranked higher than pain intensity and pain frequency.

CONCLUSIONS

The SDS captures the patient's symptom experience in a manner that informs the researcher or clinician about the severity of the respondents' reported symptom distress.

IMPLICATIONS FOR PRACTICE

The SDS is widely used in a variety of cancer diagnoses. The SDS is a tool clinicians can use to assess 11 symptoms experienced by patients with advanced cancer.

Assessment of Palliative Care in Lung Cancer in Turkey

OBJECTIVE

To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms.

SUBJECTS AND METHODS

This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis.

RESULTS

The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled.

CONCLUSION

In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

Symptoms experienced by cancer patients during the first year from diagnosis: patient and informal caregiver ratings and agreement

OBJECTIVE

The aim of this study was to explore the symptom experience of patients with cancer, identify changes in symptoms over time, and explore the congruence of symptom reports between patients and their informal caregivers.

METHOD

This was a prospective longitudinal evaluation of symptoms over 1 year from start of treatments (T1) using the Memorial Symptom Assessment Scale. Assessments and follow up took place at 3 months (T2), 6 months (T3) and 12 months (T4). A heterogeneous sample of 100 patients with cancer participated, providing 325 assessments over time. Furthermore, 82 caregivers also participated, providing 238 dyadic patient-caregiver assessments over the same time.

RESULTS

The most commonly occurring, and by far most distressing, symptom was "lack of energy." Common symptoms reported were lack of concentration, difficulties sleeping, shortness of breath, cough, pain, dry mouth, and feeling drowsy. Symptom occurrence and distress improved over time, particularly from T2 to T3 (p < 0.05), but the "chronicity" of some generic symptoms was notable. Caregivers tended to overestimate occurrence and distress compared to patients, particularly in symptoms of psychological nature; κ statistics had a highest coefficient of 0.45, suggesting moderate agreement between patients and caregivers at best.

SIGNIFICANCE OF RESULTS

More attention needs to be paid to the commonly reported symptoms by patients, as they have the potential of impacting on quality of life (QOL). As patient-caregiver reports had moderate agreement, effort should be directed to improving this agreement, as caregivers are often communicating patient symptoms to clinicians.

Dyspnea in lung cancer patients: a systematic review

Dyspnea is a common and distressing symptom experienced by 19%-51% of patients with advanced cancer. Higher incidences are reported in patients approaching end of life. While the prevalence of dyspnea has been reported to be as frequent as pain in people with lung cancer, less attention has been paid to the distress associated with dyspnea. This review of the literature was undertaken to investigate how dyspnea has been assessed and whether breathlessness in people with lung cancer is distressing. Using a predetermined search strategy and inclusion criteria, 31 primary studies were identified and included in this review. Different outcome measures were used to assess the experience of dyspnea, with domains including intensity, distress, quality of life, qualitative sensation, and prevalence. Overall, the studies report a high prevalence of dyspnea in lung cancer patients, with subjects experiencing a moderate level of dyspnea intensity and interference with activities of daily living. Distress associated with breathing appears to be variable, with some studies reporting dyspnea to be the most distressing sensation, and others reporting lower levels of distress. However, taking into account the prevalence, intensity, and distress of dyspnea, the general consensus appears to be that the experience of dyspnea in people with lung cancer is common, with varying degrees of intensity, but involves considerable unpleasantness. Thus, if dyspnea and pain are both distressing sensations for people with lung cancer, this has potential implications for both clinical and academic areas with regards to both management strategies and further research.

Age-related differences in quality of life in cancer patients: a pilot study of a cancer care coordination/home-telehealth program

The cancer care dialogues model emphasizes daily telehealth interactions between patients and a care coordinator (a registered nurse serving as a liaison to the oncologist) to assist patients in the management of common chemotherapy-related symptoms at home. We examined the impact of the dialogues on age-related differences in health-related quality of life (HRQOL) among newly diagnosed cancer patients receiving chemotherapy. We assessed HRQOL among 34 patients, including 15 older adults (65 years or older) and 19 younger adults who were followed for 6 months. Older patients consistently reported better HRQOL scores over the treatment period. In multivariate analysis, older patients reported 10.35 points higher in HRQOL (P = .007). In addition, patients who reported no nervousness while undergoing chemotherapy had an 8.60-point increase in HRQOL scores (P = .012). The dialogues model can make important improvement in symptom management and HRQOL, especially in older adults receiving chemotherapy. Older and younger adults with cancer may benefit equally in cancer treatment in a setting with appropriately managed symptoms. The dialogues model offers promising potential for promoting nurses' better understanding of both the patient needs as the patient receives treatment and innovative technologies in patient management.

Symptoms and problems with functioning among women and men with inoperable lung cancer--a longitudinal study

The aim of this study is to compare the prevalence and intensity of symptoms and problems with functioning between women and men with inoperable lung cancer (LC) during 3 months post-diagnosis. One hundred and fifty-nine patients completed the EORTC QLQ C-30+LC13 at three time points: close to diagnosis and prior to treatment, and one, and 3 months later. Descriptive cross-sectional analyses and longitudinal analyses using repeated measure ANOVA were conducted. These patients reported many and intense symptoms and problems with functioning. The most salient finding from the cross-sectional analysis was that women reported both more, and more intense problems with emotional functioning close to diagnosis. Statistically significant improvements over time were found in both men and women with regard to emotional functioning, dyspnea, insomnia, cough, pain in arm/shoulder, while physical functioning, fatigue, constipation, dysphagia, peripheral neuropathy and alopecia deteriorated significantly over time. The longitudinal analyses suggest that, with the exception of emotional functioning, gender differences were not only related to biological sex alone, but were also found to be related to other components of the patients' life situation, such as education, age, civil status and type of LC. Sensitivity to different symptom experiences and responses to those experiences between and within women and men is also necessary in the management of symptoms in patients with inoperable LC.

Promoting Enhanced Patient and Family Caregiver Congruence on Lung Cancer Symptom Experiences

PURPOSE/OBJECTIVES

To test the effects of different perspective-taking instructional sets, gender, caregivers' personal histories with cancer, and caregiving relationship factors on family caregiver and patient perceptual agreement of symptom experiences of patients with lung cancer.

DESIGN

Counterbalanced.

SETTING

Thoracic oncology outpatient clinical setting in Canada.

SAMPLE

98 dyads consisting of patients with lung cancer and their family caregivers.

METHODS

Data were collected on a one-time basis by employing an abbreviated version of the Memorial Symptom Assessment Scale targeting lack of energy and worrying. Caregivers were randomized to one of six counterbalanced conditions of perspective-taking instructions.

MAIN RESEARCH VARIABLES

Caregiver discrepancy scores, instructional sets (i.e., neutral, self-report, and imagine-self and imagine-patient perspective-taking), order effects, gender, caregivers' personal history with cancer, and caregiving relationship factors.

FINDINGS

No order effects were found for the instructional sets. Instructions to imagine the patient's perspective over imagining how the caregiver would feel if he or she had cancer were most effective in enhancing the caregiver's ability to estimate the patient's lack of energy and worrying. Gender had no significant effects. The amount of patient-caregiver communication had a positive impact on the accuracy of caregivers' perspectives.

CONCLUSIONS

The patient-oriented instructions had a limited impact on enhancing patient-caregiver congruence on patient symptoms. This likely is related to the study's convenience sample of caregivers who appear to naturally engage in empathic processes of patient-oriented perspective-taking when they assessed and reported on patient symptom conditions.

IMPLICATIONS FOR NURSING

Further exploratory work should identify interpersonal conditions that negatively hamper the effects of caregiver perspective-taking on their reasonable understanding of patient symptoms.

Course of psychological distress and its predictors in advanced non-small cell lung cancer patients

This study investigated longitudinal changes and predictive factors for psychological distress among 85 newly diagnosed advanced non-small cell lung cancer (NSCLC) patients. Whereas tension-anxiety after diagnosis (T1) was significantly reduced at two months (T2) and six months (T3) after diagnosis and depression-dejection at T1 was significantly reduced at T2, other forms of psychological distress, including anger-hostility, vigor, fatigue, and confusion, did not show significant changes. Total mood disturbance did not show significant change. Only a higher total mood disturbance at T1 was a significant predictor of total mood disturbance at T3. These findings demonstrate that most types of psychological distress experienced by advanced NSCLC patients is likely to persist during the subsequent clinical course. The findings also suggest that initial psychological distress itself after cancer diagnosis is the most important predictor for subsequent psychological distress and that early intervention beginning immediately after the disclosure of a diagnosis of cancer is one way to prevent and/or reduce subsequent psychological distress in advanced NSCLC patients.