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Elamin N, Althebity N, Alkhamisi TA, Al-Foheidi M. Sleep quality and psychological disorders in breast cancer female patients receiving radiotherapy at a tertiary oncology center in West Saudi Arabia. Support Care Cancer 2024; 32:163. [PMID: 38367029 DOI: 10.1007/s00520-024-08368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/11/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE Breast cancer is the most prevalent type of cancer among women worldwide. Many recently diagnosed and treated breast cancer patients complain about sleep disorders, depression, anxiety, stress, and fatigue. This study aimed to evaluate sleep quality among breast cancer patients and to assess its association with psychological disorders, and socio-demographic and clinical characteristics of patients. METHODS This cross-sectional study was conducted among women who received radiotherapy for breast cancer (stage 1-3) at King Abdul-Aziz Medical City-Jeddah from January to August 2021. Each participant completed a personal information form, the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety, and Stress Scale-21 (DASS-21), and the International Physical Activity Questionnaire (IPAQ). Clinical data were collected from the medical records to evaluate certain risk factors. Descriptive statistics were used for participant characteristics, and analyses of variance were used to assess associations between the qualitative variables. RESULTS Fifty-six women with a mean age of 50.1 years and an average of 10 months after cancer diagnosis were included. Poor sleep quality was present in 58% of respondents. Symptomatic depression, anxiety, and stress were found in 34%, 32%, and 30% of women, respectively. Poor sleep quality was associated with depression (p = 0.031), anxiety (p = 0.03), and stress (p = 0.024) and was independently associated with hot flashes. In multivariate analysis, patients with depression or with cancer for more than 6 months were less likely to have good sleep after controlling other variables (21.74 and 14.71 times, respectively). CONCLUSION Poor sleep quality was present in 58% of women with breast cancer receiving radiotherapy and was significantly associated with depression, anxiety, stress, and hot flashes. Depression level and cancer duration were significant predictors of sleep quality. Early identification and proper management of psychological and sleep disorders are necessary to improve the quality of life and survival of breast cancer patients.
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Affiliation(s)
- Nadia Elamin
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, 21423, Jeddah, Saudi Arabia.
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
| | - Nisreen Althebity
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, 21423, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Taif A Alkhamisi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, 21423, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Meteb Al-Foheidi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, 21423, Jeddah, Saudi Arabia
- Oncology Center of Princess Norah, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia
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Victorson D, Mishra KK, Sauer J, Langford G, Maletich C, Horowitz B, Sauer C, Sejpal SV, Kalapurakal J. Implementation Readiness and Initial Effects of a Brief Mindfulness Audio Intervention Compared With a Brief Music Control During Daily Radiation Therapy for Prostate Cancer: A Randomized Pilot Study. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241249140. [PMID: 38694593 PMCID: PMC11062214 DOI: 10.1177/27536130241249140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 05/04/2024]
Abstract
Background The most common and debilitating side effects of radiation therapy (RT) for prostate cancer (PC) are fatigue, sleep disturbance, anxiety, and depression. Previous research has reported palliative benefits from certain self-management approaches, such as mindfulness meditation. Objective To develop, pre-test, and evaluate the feasibility, acceptability and initial benefit of brief, audio-based mindfulness delivered during daily RT for PC compared to a relaxing music control. Methods Following intervention development, participants were randomized to either brief guided mindfulness audio recordings or a relaxing music control during daily RT. A pre-testing phase was first conducted to determine optimal program start time, length, and content most associated with retention. A final program (n = 26) was delivered daily, starting on day one of week 2 of RT and lasting 4 consecutive weeks. Feasibility was defined as ≥70% on enrollment rate, retention, and audio program adherence. Acceptability was measured with a 12-item post-study survey. A secondary focus compared between group changes on patient reported outcomes of fatigue, anxiety, depression, sleep disturbance, and related outcomes at baseline and follow up assessments. Descriptive statistics and general linear models were used. Results Overall, 76% (n = 38) of approached men enrolled. Pre-testing retention rates were <70% while the final program's retention rate was 89%. The majority of acceptability criteria were met in both conditions, with relatively higher ratings in the mindfulness arm. Compared to music controls, mindfulness participants demonstrated significantly less uncertainty intolerance at 4-weeks (P = .046, d = .95); and significantly lower fatigue scores (P = .049, d = 1.3) and lower sleep disturbance scores (P = .035, d = 1.1) at the 3 months follow up. Conclusion The final intervention met feasibility and acceptability criteria. Pre-testing refinements played a key role for optimal program delivery and retention. Audio-based mindfulness delivered during RT for PC hold potential to help decrease RT-related physical and emotional side effects.
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Affiliation(s)
- David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Joseph Sauer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- University of Illinois-Chicago Medical School, Chicago, IL, USA
| | - Grace Langford
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carly Maletich
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bruriah Horowitz
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina Sauer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - John Kalapurakal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Calvo-Schimmel A, Paul SM, Cooper BA, Shin J, Harris C, Oppegaard K, Hammer MJ, Cartwright F, Conley YP, Kober KM, Levine JD, Miaskowski C. Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life. Cancer Nurs 2023; 46:417-431. [PMID: 35688433 PMCID: PMC9729413 DOI: 10.1097/ncc.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anxiety and sleep disturbance are frequent symptoms during chemotherapy. OBJECTIVES Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups. METHODS Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles. RESULTS Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life. CONCLUSIONS More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms. IMPLICATIONS FOR PRACTICE Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.
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Affiliation(s)
- Alejandra Calvo-Schimmel
- Author affiliations: School of Nursing, University of California, San Francisco (Drs Calvo-Schimmel, Paul, Cooper, Kober, and Miaskowski and Mss Shin, Harris, and Oppegaard); Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); Department of Nursing, Mount Sinai Medical Center, New York (Dr Cartwright); School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Conley); and School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski)
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Alzhrani AA, Alsuhail AI, Rababah AA. Fatigue Prevalence Among Palliative Care Cancer Patients in Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia: A Cross-Sectional Study. J Palliat Care 2023; 38:424-431. [PMID: 37501537 DOI: 10.1177/08258597231191615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objective: The aims of the current study are to assess the prevalence of cancer-related fatigue, to examine the difference in cancer-related fatigue severity in relation to patients' characteristics (age, gender, type of cancer, and palliative performance status), and to explore the correlation between cancer-related fatigue and pain, dyspnea, insomnia, and depression among palliative care patients. Methods: A cross-sectional descriptive observational study conducted at Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia. The study included cancer patients who received palliative care services from January 2016 to December 2021. Clinical data of study participants were retrospectively collected from Palliative Care department patient registry. Symptoms were assessed and scored using Edmonton Symptom Assessment Scale. Data analysis was performed using SPSS statistical software. Results: A total of 2616 patients were included in the study, 52.3% were females and 47.7% were males. The median age of study participants was 56 years (range: 2-101 years). Among all study population, the highest reported cancer type was gastrointestinal malignancy (33.5%), while the least was unknown primary malignancy (1.4%). With regards to Edmonton Symptom Assessment Scale, pain (86.4%) and fatigue (83%) were the highest reported symptom in comparison to constipation (17.3%) and insomnia (7.1%). Conclusion: Cancer-related fatigue is a prevalent and concerning issue among palliative care patients. It is essential that healthcare providers recognize the prevalence of fatigue among patients with life-limiting illnesses, assess patients for fatigue routinely, incorporate strategies for managing fatigue, work closely with affected individuals and their families in order to guide the establishment of a personalized care plan that addresses the patient's unique needs and preferences.
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Affiliation(s)
- Abdulaziz A Alzhrani
- Department of Palliative Care, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah I Alsuhail
- Department of Palliative Care, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad A Rababah
- Department of Palliative Care, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Koo DL, Park Y, Nam H, Chai YJ. Sleep quality of patients with papillary thyroid carcinoma: a prospective longitudinal study with 5-year follow-up. Sci Rep 2022; 12:18823. [PMID: 36335214 PMCID: PMC9637156 DOI: 10.1038/s41598-022-23549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022] Open
Abstract
We evaluated the pre- and postoperative sleep quality of patients with newly diagnosed papillary thyroid carcinoma (PTC) who underwent thyroid surgery, and investigated the factors associated with persistent poor sleep quality. The Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale, and Stanford sleepiness scale were used to estimate sleep quality and daytime sleepiness. Face-to-face surveys were conducted preoperatively, and 1, 4, and 10 months after thyroid surgery. The PSQI was administered during a telephone interview about after 5 years after surgery. Forty-six patients (mean age 47.3 ± 10.1 years) with PTC (11 males, 35 females) were included in this study. Twenty-one participants underwent lobectomy and 25 underwent total thyroidectomy. Preoperatively, 35 (76.1%) patients showed poor sleep quality. PSQI scores at postoperative 1, 4, and 10 months were significantly lower than preoperative scores (p < 0.001). Postoperative 5-year PSQI scores decreased significantly compared to the preoperative scores (p < 0.001). Patients newly diagnosed with PTC suffered from sleep disturbance before and after surgery for at least 10 months, recovering to a comparable rate of sleep disturbance with the general population by 5 years after surgery. Higher preoperative PSQI score was at risk for prolonged poor sleep quality in patients with PTC.
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Affiliation(s)
- Dae Lim Koo
- grid.31501.360000 0004 0470 5905Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
| | - Yangmi Park
- grid.31501.360000 0004 0470 5905Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
| | - Hyunwoo Nam
- grid.31501.360000 0004 0470 5905Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
| | - Young Jun Chai
- grid.412479.dDepartment of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 39 Boramae-Gil, Dongjak-Gu, Seoul, 156-707 South Korea ,grid.412484.f0000 0001 0302 820XTransdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, South Korea
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Sparasci D, Napoli I, Rossi L, Pereira-Mestre R, Manconi M, Treglia G, Marandino L, Ottaviano M, Turco F, Mangan D, Gillessen S, Vogl UM. Prostate Cancer and Sleep Disorders: A Systematic Review. Cancers (Basel) 2022; 14:cancers14071784. [PMID: 35406556 PMCID: PMC8997021 DOI: 10.3390/cancers14071784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Longer survival times for prostate cancer patients due to efficient treatments consisting of local radiotherapy, prostatectomy and androgen-deprivation therapy, as well as androgen-receptor-targeted agents, increases the importance of side effect management. Sleep disturbances are higher in this group than the general population and no clear mechanism(s) explains this. This systematic review finds a reported effect in 14 of 16 included studies on sleep quality changes for these patients. All reported treatments showed some kind of negative effect on sleep quality, including ADT. Limitations are discussed and recommendations made for progressing the understanding and then for mitigation strategies of these side effects. Abstract Prostate cancer (PCa) treatment involves multiple strategies depending on the disease’s stage. Androgen deprivation therapy (ADT) remains the gold standard for advanced and metastatic stages. Sleep quality has been suggested as being additionally influenced also by local radiotherapy, prostatectomy and androgen-receptor (AR)-targeted agents. We performed a systematic review exploring the landscape of studies published between 1 January 1990 and 31 July 2021, investigating sleep disturbances in PCa patients receiving active treatments, including the influence of hormonal therapy on sleep quality as a factor affecting their quality of life. Out of 45 articles identified, 16 studies were selected, which recruited patients with PCa, undergoing active treatment in either a prospective longitudinal or cross-sectional study. Development of sleep disorders or changes in sleep quality were reported in 14 out of 16 trials included. Only five trials included objective measurements such as actigraphy, mostly at one time point and without a baseline assessment. Limitations to be addressed are the small number of existing trials, lack of randomized trials and heterogeneity of methodologies used. This systematic review outlines the lack of prospective trials investigating sleep disorders, with a rigorous methodology, in homogeneous cohorts of PCa patients. Future trials are needed to clarify the prevalence and impact of this side effect of PCa treatments.
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Affiliation(s)
- Davide Sparasci
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (M.M.)
| | - Ilenia Napoli
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Radiation Oncology Unit, Department of Biomedical, Dental Science, Morphological and Functional Imaging, University Hospital Messina, 98122 Messina, Italy
| | - Lorenzo Rossi
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
| | - Ricardo Pereira-Mestre
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Institute of Oncology Research (IOR), 6500 Bellinzona, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (M.M.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Department of Neurology, University Hospital Inselspital, 3010 Bern, Switzerland
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland
| | - Laura Marandino
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Margaret Ottaviano
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80138 Naples, Italy
| | - Fabio Turco
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Oncology, Division of Medical Oncology, University of Turin San Luigi Gonzaga Hospital, Regione Gonzole, 10043 Orbassano, Italy
| | - Dylan Mangan
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Division of Population Health, University of Manchester, Manchester M13 9PL, UK
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Ursula Maria Vogl
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Correspondence:
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Distinct Sleep Disturbance Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy. Cancer Nurs 2022; 45:E417-E427. [PMID: 34183521 PMCID: PMC8712619 DOI: 10.1097/ncc.0000000000000975] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Patients with gastrointestinal cancers experience moderate to high levels of sleep disturbance during chemotherapy that decreases their functional status and quality of life (QOL). OBJECTIVE The objectives of this study were to identify subgroups of patients with gastrointestinal cancers with distinct sleep disturbance profiles and evaluate for differences among these subgroups in demographic, clinical, and sleep characteristics, as well as co-occurring symptoms and QOL outcomes. METHODS Patients (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct sleep disturbance profiles. RESULTS Three distinct sleep disturbance profiles (ie, low, high, very high) were identified. Compared with the low class, patients in the other 2 classes were significantly younger and less likely to be married and to exercise on a regular basis and received a higher number of previous treatments. Compared with the low class, patients in the other 2 classes reported higher levels of anxiety, depressive symptoms, morning and evening fatigue, and pain and lower levels of attentional function and QOL scores at enrollment. CONCLUSIONS This study is the first to use latent profile analysis to identify subgroups of patients with gastrointestinal cancers with distinct sleep disturbance profiles. Findings provide new insights on the associations between sleep disturbance and multiple co-occurring symptoms in these patients. IMPLICATIONS FOR PRACTICE Clinicians can identify patients who are at the highest risk for sleep disturbance and recommend a variety of sleep hygiene interventions (eg, establishment of a bedtime routine), as well as initiate interventions for other co-occurring symptoms.
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Rades D, Narvaez CA, Dziggel L, Janssen S, Olbrich D, Tvilsted S, Kjaer TW. A prospective interventional study investigating sleep disorders prior to and during adjuvant radiotherapy for breast cancer. BMC Cancer 2021; 21:1349. [PMID: 34930172 PMCID: PMC8686268 DOI: 10.1186/s12885-021-09084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most breast cancer patients with non-metastatic disease receive adjuvant local or loco-regional radiotherapy. To be scheduled for irradiation may cause distress and fears that can lead to sleep disorders. Few reports focused on sleep problems in patients assigned to radiotherapy. This study evaluates the course of sleep disorders during adjuvant radiotherapy for primary breast cancer and potential risk factors including the use of smartphones or tablets at bedtime. METHODS The main goal is the evaluation of sleep disorders prior to radiotherapy and after 15 fractions of radiotherapy. A potential effect of habituation to the procedure of radiotherapy can be assumed that will likely lead to improvement (decrease) of sleep disorders. Improvement of sleep disorders (compared to baseline before radiotherapy) is defined as decrease of the severity of sleep disorders by ≥2 points on a patient self-rating scale (0 = no problems; 10 = maximum problems) or decrease of distress caused by sleep disorders by ≥2 points on a self-rating scale (0 = no distress; 10 = maximum distress) or reduction of the dose of sleeping drugs by ≥25%. Additional endpoints include sleep disorders after 5 fractions and at the end of radiotherapy. Moreover, potential risk factors including the use of smartphones or tablets at bedtime are evaluated. Fifty-one patients (48 plus potential drop-outs) are required. With this sample size, a one-sample binomial test with a one-sided significance level of 2.5% has a power of 80% to yield statistical significance, if the rate of patients with improvement of sleep disorders is 25% (rate under the alternative hypothesis) and assuming that a decrease of ≤10% has to be judged as a random, non-causal change in this uncontrolled study setting (null hypothesis). DISCUSSION If a decrease of sleep disorders during the course of radiotherapy is shown, this aspect should be included in the pre-radiotherapy consent discussion with the patients. Moreover, identification of additional risk factors will likely lead to earlier psychological support. If the use of smartphones or tablets at bedtime is a risk factor, patients should be advised to change this behavior. TRIAL REGISTRATION clinicaltrials.gov (NCT04879264; URL: https://clinicaltrials.gov/show/NCT04879264 ); registered on 7th of May, 2021.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Carlos A Narvaez
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Liesa Dziggel
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | | | - Soeren Tvilsted
- Research Projects and Clinical Optimization, Zealand University Hospital, Koege, Denmark
| | - Troels W Kjaer
- Neurological Department, Zealand University Hospital, Roskilde, Denmark
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Rades D, Narvaez CA, Schild SE, Tvilsted S, Kjaer TW. Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer. In Vivo 2021; 35:2253-2260. [PMID: 34182504 DOI: 10.21873/invivo.12498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIM The anticipation of radiotherapy can cause distress and sleep disorders, which may be aggravated by the COVID-19 pandemic. This study investigated sleep disorders in a large cohort of patients with breast cancer before and during the pandemic. PATIENTS AND METHODS Twenty-three characteristics were retrospectively analyzed for associations with pre-radiotherapy sleep disorders in 338 patients. Moreover, 163 patients presenting before and 175 patients presenting during the COVID-19 pandemic were compared for sleep disorders. RESULTS Sleep disorders were significantly associated with age ≤60 years (p=0.006); high distress score (p<0.0001); more emotional (p<0.0001), physical (p<0.0001) or practical (p<0.0001) problems; psycho-oncological need (p<0.0001); invasive cancer (p=0.003); chemotherapy (p<0.001); and hormonal therapy (p=0.006). Sleep disorders were similarly common in both groups (prior to vs. during the pandemic: 40% vs. 45%, p=0.38). CONCLUSION Although additional significant risk factors for sleep disorders were identified, the COVID-19 pandemic appeared to have no significant impact on sleep disorders in patients scheduled for irradiation of breast cancer.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
| | - Carlos A Narvaez
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Soeren Tvilsted
- Research Projects and Clinical Optimization, Zealand University Hospital, Koege, Denmark
| | - Troels W Kjaer
- Neurological Department, Zealand University Hospital, Roskilde, Denmark
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Stewart RJ, Humphris GM, Donaldson J, Cruickshank S. Does Cancer Type Influence the Impact of Recurrence? A Review of the Experience of Patients With Breast or Prostate Cancer Recurrence. Front Psychol 2021; 12:635660. [PMID: 34267696 PMCID: PMC8276075 DOI: 10.3389/fpsyg.2021.635660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/04/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: Patients will experience a plethora of issues when faced with a recurrence of their cancer. It is unclear if cancer type is a significant factor in how recurrence is experienced by an individual. The aim of the current review is to explore the evidence base and summarise the experiences of patients specifically with a recurrence of breast or prostate cancer (the most common for women and men, respectively) and then provide a comparison of these experiences. These experiences include the physical, psychological and psychosocial issues that arise at this time. Methods: A systematic search was conducted of studies published between January 1994 and April 2019. Due to the mix of research designs used previously in the literature, this review was conducted in an integrative manner; allowing for inclusion of diverse research designs. Results were synthesised narratively, with data categorised according to physical, psychological, and psychosocial indices of quality of life. The review protocol was registered in the international database of prospective systematic reviews in health and social care- (CRD42019137381). Results: Fifteen breast cancer and six prostate cancer articles were identified, each reporting one relevant study. Patients reported several negative issues at the time of a breast or prostate cancer recurrence. Similarities were found between cancer types, with physical problems such as fatigue, psychological issues including anxiety and depressive symptoms, and psychosocial concerns such as issues with healthcare professionals common in both cancers. Certain findings were inconsistent across studies, with some experiences differing between studies rather than due to cancer type. Conclusions: Differences in the experience of recurrent cancer appear to be more heavily influenced by individual factors, rather than cancer type. Findings are confounded by gender; and should be considered preliminary. Effects of recurrence should be studied in samples where cancer type and gender are not confounded. Concerns are raised about available study quality and differing outcome measures in this interpretation. Care and support of the individual at the time of a cancer recurrence is a key focus. Future research suggestions with implications for clinical practise are included. Systematic Review Registration: PROSPERO 2019 CRD42019137381.
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Affiliation(s)
- Ross James Stewart
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | | | - Jayne Donaldson
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Susanne Cruickshank
- Royal Marsden National Health Service Foundation Trust, London, United Kingdom
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11
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R Buskbjerg C, Zachariae R, Buus S, H Gravholt C, Haldbo-Classen L, Hosseini SMH, Amidi A. Cognitive impairment and associations with structural brain networks, endocrine status, and risk genotypes in patients with newly diagnosed prostate cancer referred to androgen-deprivation therapy. Cancer 2020; 127:1495-1506. [PMID: 33351221 DOI: 10.1002/cncr.33387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Evidence suggests that patients with prostate cancer (PCPs) receiving androgen-deprivation therapy (ADT) are at risk for cognitive impairment. Research with other populations with cancer indicates that cognitive impairment may also occur before systemic treatment. The authors assessed cognitive impairment in untreated PCPs referred to ADT and explored associations with structural brain networks, endocrine status, and selected genotypes. METHODS Forty untreated PCPs and 27 healthy controls (HCs) who completed a questionnaire package underwent neuropsychological testing, magnetic resonance imaging, and blood sampling. Cognitive impairment was defined as a z score ≤-2 on 1 neuropsychological test or ≤-1.5 on 2 neuropsychological tests. Structural brain networks were investigated using diffusion-weighted imaging and graph theory. Associations of cognitive performance with patient-reported outcome measures (PROMs), brain networks, testosterone levels, and genotypes (apolipoprotein ε [APOE], catechol-O-methyltransferase [COMT], and brain-derived neurotrophic factor [BDNF]) were explored. RESULTS PCPs performed poorer than HCs on 7 of 15 neuropsychological tests and exhibited a higher frequency of cognitive impairment (57.5% vs 22.2%; P ≤ .01 to .03). All neuropsychological outcomes were associated with ≥1 PROM (P ≤ .01 to .04). Compared with the HC group, the PCP group exhibited altered global network organization as well as disrupted regional network characteristics in frontal and temporal regions (P < .01). PCPs had lower testosterone levels (P < .01) than HCs, which correlated with better visuospatial performance (r = -0.33; P = .04). No effects were found of APOE, COMT, or BDNF. CONCLUSIONS The current results suggest that untreated PCPs may demonstrate cognitive impairment and that psychological and behavioral symptoms (PROMs), as well as impairment in structural brain networks, might be the underlying mechanisms.
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Affiliation(s)
- Cecilie R Buskbjerg
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Simon Buus
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus H Gravholt
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
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12
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Kreutz C, Müller J, Schmidt ME, Steindorf K. Comparison of subjectively and objectively assessed sleep problems in breast cancer patients starting neoadjuvant chemotherapy. Support Care Cancer 2020; 29:1015-1023. [PMID: 32556623 PMCID: PMC7767899 DOI: 10.1007/s00520-020-05580-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/13/2020] [Indexed: 12/29/2022]
Abstract
Purpose To characterize sleep problems and to compare subjective and objective assessments in breast cancer patients starting neoadjuvant chemotherapy. Methods Sleep characteristics of 54 breast cancer patients starting neoadjuvant chemotherapy were analyzed. Subjective sleep characteristics were assessed with the Pittsburgh Sleep Quality Index (PSQI) and objective sleep measurements with an accelerometer (ActiGraph wGT3X-BT) worn on the wrist for 7 consecutive days. Results According to the common PSQI cut-off of 8, 10 (18.87%) of the patients were poor sleepers. ActiGraph measures did not mirror this classification as values for poor, and good sleepers did not differ significantly. Overall, Bland-Altman plots illustrated higher ActiGraph values for sleep efficiency and effective sleep time and lower values for sleep latency, compared with PSQI. For total sleep time, less disagreement between both measures was observed. Actigraphy was limited in precise identification of sleep begin and sleep latency but provided supplementary information about number and minutes of awakenings during the night. Conclusion Subjective and objective measurement methods differed substantially in various parameters, with limitations in both methods. A combination of both methods might be most promising. Trial Registration Clinicaltrials.gov: NCT02999074 Electronic supplementary material The online version of this article (10.1007/s00520-020-05580-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Kreutz
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- Faculty of Medicine Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Jana Müller
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- Institute of Sports and Sport Science, Heidelberg University, Im Neuenheimer Feld 700, 69120, Heidelberg, Germany
- Working Group Exercise Oncology, Division of Medical Oncology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
- Division of Physical Activity, Prevention and Cancer (C110), German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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13
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Tejada M, Viele C, Kober KM, Cooper BA, Paul SM, Dunn LB, Hammer MJ, Wright F, Conley YP, Levine JD, Miaskowski C. Identification of subgroups of chemotherapy patients with distinct sleep disturbance profiles and associated co-occurring symptoms. Sleep 2020; 42:5541565. [PMID: 31361899 DOI: 10.1093/sleep/zsz151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/31/2019] [Indexed: 01/09/2023] Open
Abstract
STUDY OBJECTIVES Purposes of this study were to identify subgroups of patients with distinct sleep disturbance profiles and to evaluate for differences in demographic, clinical, and various sleep characteristics, as well for differences in the severity of co-occurring symptoms among these subgroups. METHODS Outpatients with breast, gynecological, gastrointestinal, or lung cancer (n = 1331) completed questionnaires six times over two chemotherapy cycles. Self-reported sleep disturbance was evaluated using the General Sleep Disturbance Scale (GSDS). Latent profile analysis was used to identify distinct subgroups. RESULTS Three latent classes with distinct sleep disturbance profiles were identified (Low [25.5%], High [50.8%], Very High [24.0%]) across the six assessments. Approximately 75% of the patients had a mean total GSDS score that was above the clinically meaningful cutoff score of at least 43 across all six assessments. Compared to the Low class, patients in High and Very High classes were significantly younger, had a lower functional status, had higher levels of comorbidity, and were more likely to be female, more likely to have childcare responsibilities, less likely to be employed, and less likely to have gastrointestinal cancer. For all of the GSDS subscale and total scores, significant differences among the latent classes followed the expected pattern (Low < High < Very High). For trait and state anxiety, depressive symptoms, morning and evening fatigue, decrements in attentional function, and decrements in morning and evening energy, significant differences among the latent classes followed the expected pattern (Low < High < Very High). CONCLUSIONS Clinicians need to perform in-depth assessments of sleep disturbance and co-occurring symptoms to identify high-risk patients and recommend appropriate interventions.
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Affiliation(s)
- Maria Tejada
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Carol Viele
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Kord M Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Laura B Dunn
- Department of Physiological Nursing, School of Medicine, Stanford University, Stanford, CA
| | | | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
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14
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Effects of a multidisciplinary quality of life intervention on sleep quality in patients with advanced cancer receiving radiation therapy. Palliat Support Care 2019; 18:307-313. [PMID: 31554519 DOI: 10.1017/s1478951519000750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Sleep disturbances are prevalent in cancer patients, especially those with advanced disease. There are few published intervention studies that address sleep issues in advanced cancer patients during the course of treatment. This study assesses the impact of a multidisciplinary quality of life (QOL) intervention on subjective sleep difficulties in patients with advanced cancer. METHOD This randomized trial investigated the comparative effects of a multidisciplinary QOL intervention (n = 54) vs. standard care (n = 63) on sleep quality in patients with advanced cancer receiving radiation therapy as a secondary endpoint. The intervention group attended six intervention sessions, while the standard care group received informational material only. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), administered at baseline and weeks 4 (post-intervention), 27, and 52. RESULTS The intervention group had a statistically significant improvement in the PSQI total score and two components of sleep quality and daytime dysfunction than the control group at week 4. At week 27, although both groups showed improvements in sleep measures from baseline, there were no statistically significant differences between groups in any of the PSQI total and component scores, or ESS. At week 52, the intervention group used less sleep medication than control patients compared to baseline (p = 0.04) and had a lower ESS score (7.6 vs. 9.3, p = 0.03). SIGNIFICANCE OF RESULTS A multidisciplinary intervention to improve QOL can also improve sleep quality of advanced cancer patients undergoing radiation therapy. Those patients who completed the intervention also reported the use of less sleep medication.
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15
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Miaskowski C, Conley YP, Mastick J, Paul SM, Cooper BA, Levine JD, Knisely M, Kober KM. Cytokine Gene Polymorphisms Associated With Symptom Clusters in Oncology Patients Undergoing Radiation Therapy. J Pain Symptom Manage 2017; 54:305-316.e3. [PMID: 28797847 PMCID: PMC5610097 DOI: 10.1016/j.jpainsymman.2017.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/07/2017] [Accepted: 05/09/2017] [Indexed: 01/08/2023]
Abstract
CONTEXT Most of the reviews on the biological basis for symptom clusters suggest that inflammatory processes are involved in the development and maintenance of the symptom clusters. However, no studies have evaluated for associations between genetic polymorphisms and common symptom clusters (e.g., mood disturbance, sickness behavior). OBJECTIVES Examine the associations between cytokine gene polymorphisms and the severity of three distinct symptom clusters (i.e., mood-cognitive, sickness-behavior, treatment-related) in a sample of patients with breast and prostate cancer (n = 157) at the completion of radiation therapy. METHODS Symptom severity was assessed using the Memorial Symptom Assessment Scale. Symptom clusters were created using exploratory factor analysis. The associations between cytokine gene polymorphisms and the symptom cluster severity scores were evaluated using regression analyses. RESULTS Polymorphisms in C-X-C motif chemokine ligand 8 (CXCL8), interleukin (IL13), and nuclear factor kappa beta 2 (NFKB2) were associated with severity scores for the mood-cognitive symptom cluster. In addition to interferon gamma (IFNG1), the same polymorphism in NFKB2 (i.e., rs1056890) that was associated with the mood-cognitive symptom cluster score was associated with the sickness-behavior symptom cluster. Polymorphisms in interleukin 1 receptor 1 (IL1R1), IL6, and NFKB1 were associated with severity factor scores for the treatment-related symptom cluster. CONCLUSION Our findings support the hypotheses that symptoms that cluster together have a common underlying mechanism and the most common symptom clusters in oncology patients are associated polymorphisms in genes involved in a variety of inflammatory processes.
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Affiliation(s)
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, 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
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Mitchell Knisely
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
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16
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Gonzalez VJ, Tofthagen CS, Chen X, Pedro E, Saligan LN. Differences in fatigue severity in a sample of adult cancer patients. J Clin Nurs 2017; 27:3345-3354. [DOI: 10.1111/jocn.13840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 01/05/2023]
Affiliation(s)
| | | | - Xusheng Chen
- University of South Florida College of Nursing; Tampa FL USA
| | - Elsa Pedro
- School of Pharmacy; University of Puerto Rico, Medical Science Campus; San Juan Puerto Rico
| | - Leorey N Saligan
- Symptom Management Branch; National Institute of Nursing Research Intramural Research Program; Bethesda MD USA
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17
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Wright F, Cooper BA, Conley YP, Hammer MJ, Chen LM, Paul SM, Levine JD, Miaskowski C, Kober KM. Distinct Evening Fatigue Profiles in Oncology Outpatients Receiving Chemotherapy. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2017; 5:131-144. [PMID: 29725554 DOI: 10.1080/21641846.2017.1322233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Fatigue is the most common and debilitating symptom experienced by oncology patients during chemotherapy (CTX). Fatigue severity demonstrates a large amount of inter-individual and diurnal variability. Purpose Study purposes were to evaluate for subgroups of patients with distinct evening fatigue profiles and evaluate how these subgroups differed on demographic, clinical, and symptom characteristics. Methods Outpatients with breast, gastrointestinal, gynecological, or lung cancer (n=1332) completed questionnaires six times over two cycles of CTX. Lee Fatigue Scale (LFS) evaluated evening fatigue severity. Latent profile analysis was used to identify distinct evening fatigue profiles. Results Four distinct evening fatigue classes (i.e., Low (14.0%), Moderate (17.2%), High (36.0%), Very High (32.8%)) were identified. Compared to the Low class, patients in the Very High evening fatigue class were: younger, female, had childcare responsibilities, had more years of education, had a lower functional status, had a higher comorbidity burden, and were diagnosed with breast cancer. Patients in the Very High class reported higher levels of depressive symptoms, sleep disturbance, and evening fatigue at enrollment. Conclusions Findings provide new insights into modifiable risk factors for higher levels of evening fatigue. Clinicians can use this information to identify higher risk patients and plan appropriate interventions.
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Affiliation(s)
- Fay Wright
- School of Nursing, Yale University, New Haven, CT
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA
| | | | | | - Lee-May Chen
- School of Medicine, University of California, San Francisco, CA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA
| | | | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA
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18
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Tarrasch R, Carmel-Neiderman NN, Ben-Ami S, Kaufman B, Pfeffer R, Ben-David M, Gamus D. The Effect of Reflexology on the Pain-Insomnia-Fatigue Disturbance Cluster of Breast Cancer Patients During Adjuvant Radiation Therapy. J Altern Complement Med 2017; 24:62-68. [PMID: 28440664 DOI: 10.1089/acm.2017.0023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To evaluate the effects of reflexology treatment on quality of life, sleep disturbances, and fatigue in breast cancer patients during radiation therapy. METHODS/SUBJECTS A total of 72 women with breast cancer (stages 1-3) scheduled for radiation therapy were recruited. DESIGN Women were allocated upon their preference either to the group receiving reflexology treatments once a week concurrently with radiotherapy and continued for 10 weeks or to the control group (usual care). OUTCOME MEASURES The Lee Fatigue Scale, General Sleep Disturbance Scale, and Multidimensional Quality of Life Scale Cancer were completed by each patient in both arms at the beginning of the radiation treatment, after 5 weeks, and after 10 weeks of reflexology treatment. RESULTS The final analysis included 58 women. The reflexology treated group demonstrated statistically significant lower levels of fatigue after 5 weeks of radiation therapy (p < 0.001), compared to the control group. It was also detected that although the quality of life in the control group deteriorated after 5 and 10 weeks of radiation therapy (p < 0.01 and p < 0.05, respectively), it was preserved in the reflexology group, which also demonstrated a significant improvement in the quality of sleep after 10 weeks of radiation treatment (p < 0.05). Similar patterns were obtained in the assessment of the pain levels experienced by the patients. CONCLUSIONS The results of the present study indicate that reflexology may have a positive effect on fatigue, quality of sleep, pain, and quality of life in breast cancer patients during radiation therapy. Reflexology prevented the decline in quality of life and significantly ameliorated the fatigue and quality of sleep of these patients. An encouraging trend was also noted in amelioration of pain levels.
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Affiliation(s)
- Ricardo Tarrasch
- 1 The Jaime and Joan Constantiner School of Education, Tel-Aviv University , Tel-Aviv, Israel
| | | | - Sarah Ben-Ami
- 3 Oncology Department, Sheba Medical Center , Ramat-Gan, Israel
| | - Bella Kaufman
- 3 Oncology Department, Sheba Medical Center , Ramat-Gan, Israel
| | - Raphi Pfeffer
- 4 Radiation Oncology Department, Sheba Medical Center , Ramat-Gan, Israel
| | - Merav Ben-David
- 4 Radiation Oncology Department, Sheba Medical Center , Ramat-Gan, Israel .,5 Sackler School of Medicine, Tel-Aviv University , Tel-Aviv, Israel
| | - Dorit Gamus
- 2 Complementary and Integrative Medicine Service, Sheba Medical Center , Ramat-Gan, Israel
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Trudel-Fitzgerald C, Zhou ES, Poole EM, Zhang X, Michels KB, Eliassen AH, Chen WY, Holmes MD, Tworoger SS, Schernhammer ES. Sleep and survival among women with breast cancer: 30 years of follow-up within the Nurses' Health Study. Br J Cancer 2017; 116:1239-1246. [PMID: 28359077 PMCID: PMC5418457 DOI: 10.1038/bjc.2017.85] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/09/2017] [Accepted: 03/07/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Breast cancer is a leading cause of cancer death in women. Sleep has been linked with mortality among cancer-free population; however, its association with survival among women with breast cancer is understudied. METHODS Breast cancer patients (N=3682) reported their average sleep duration post diagnosis. Subsamples also provided their pre-diagnosis sleep duration (n=1949) and post-diagnosis sleep difficulties (n=1353). Multivariate Cox models estimated hazard ratios (HR) and confidence intervals (CI) of all-cause, breast cancer, and non-breast cancer mortality. RESULTS At diagnosis, the mean age was 64.9 years and 91.7% were stage I or II. Women sleeping ⩾9 h per night post diagnosis had a strong higher risk of all-cause (multivariate HRs: MV-HR=1.37, CI=1.10-1.71), breast cancer (MV-HR=1.46, CI=1.02-2.07), and non-breast cancer mortality (MV-HR=1.34, CI=1.01-1.79), compared to women sleeping 8 h per night. Increased sleep duration post diagnosis (vs unchanged) and regular sleep difficulties (vs rare/none) were associated with a strong elevated risk of all-cause mortality (MV-HRincreased duration=1.35, CI=1.04-1.74; MV-HRregular difficulties=1.49, CI=1.02-2.19) and a moderate greater risk of breast cancer and non-breast cancer mortality. CONCLUSIONS Various facets of sleep were associated with higher all-cause mortality risk. If replicated, these findings support evaluation of breast cancer patients' sleep duration and difficulties to identify those at risk for poorer outcomes.
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Affiliation(s)
- Claudia Trudel-Fitzgerald
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Eric S Zhou
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Elizabeth M Poole
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, USA
| | - Xuehong Zhang
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Karin B Michels
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095, USA
| | - A Heather Eliassen
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Wendy Y Chen
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, USA
| | - Michelle D Holmes
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Shelley S Tworoger
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Eva S Schernhammer
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
- Department of Epidemiology, Medical University of Vienna, Marianneng. 14/Top 105, Vienna 1090, Austria
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20
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Efficacy, feasibility, and acceptability of a novel technology-based intervention to support physical activity in cancer survivors. Support Care Cancer 2016; 25:1291-1300. [DOI: 10.1007/s00520-016-3523-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/05/2016] [Indexed: 11/24/2022]
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21
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Wang Y, Zhu X, Li L, Yi J, He J. What Factors Affect the Insomnia Symptom Trajectories in Women With Nonmetastatic Breast Cancer? J Pain Symptom Manage 2016; 52:850-858. [PMID: 27515406 DOI: 10.1016/j.jpainsymman.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/12/2016] [Accepted: 07/29/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to identify the trajectories of insomnia symptoms in Chinese women with nonmetastatic breast cancer and further determine the effects of sociodemographic, disease, and psychological variables on different insomnia symptoms. METHODS A total of 287 female breast cancer patients were recruited to complete measures of cognitive emotion regulation strategies, perceived social support, and insomnia symptoms at six time points from the week after diagnosis to four months after surgery. RESULTS Four distinct classes of insomnia symptom trajectories were identified using growth mixture modeling and were named low sustained class (n = 128, 44.60%), high sustained class (n = 33, 11.50%), moderate sustained class (n = 64, 22.30%), and decreasing class (n = 62, 21.60%). Patients in these trajectory classes differed in demographic characteristics (age, education, employment, and monthly income), pathologic stage, and psychological characteristics (perceived social support and cognitive emotion regulation strategies). Patients with less than nine years of education (adjusted odds ratio = 2.61-4.10) or higher levels of self-blame (adjusted odds ratio = 1.80-2.14) are most likely to belong to the high sustained, moderate sustained, and decreasing classes. CONCLUSION Four latent trajectories may be a reliable and valuable approach in analyzing insomnia symptoms in breast cancer patients. Heterogeneity should be considered to allow more attention to be paid on patients in high and moderate sustained class. Education and cognitive emotion regulation strategies are important factors for the onset and development of insomnia symptoms.
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Affiliation(s)
- Yuping Wang
- School of Humanities & Social Sciences, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China; Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China; Medical Psychological Institute of Central South University, Changsha, Hunan, P.R. China.
| | - Lingyan Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Jinyao Yi
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Jincai He
- The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
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Absolon N, Balneaves L, Truant T, Cashman R, Wong M, Hamm J, Witmans M. A Self-Administered Sleep Intervention for Patients With Cancer Experiencing Insomnia. Clin J Oncol Nurs 2016; 20:289-97. [DOI: 10.1188/16.cjon.289-297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Colloca G, Venturino A, Governato I, Checcaglini F. Incidence and Correlates of Fatigue in Metastatic Castration-Resistant Prostate Cancer: A Systematic Review. Clin Genitourin Cancer 2016; 14:5-11. [DOI: 10.1016/j.clgc.2015.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 07/30/2015] [Indexed: 11/30/2022]
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24
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Seok SH, Jun SE. Factors Affecting Sleep Quality in Women with Cancer Undergoing Radiotherapy. ASIAN ONCOLOGY NURSING 2016. [DOI: 10.5388/aon.2016.16.1.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sung-Hee Seok
- Department of Nursing, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sang-Eun Jun
- College of Nursing, Keimyung University, Daegu, Korea
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25
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Blomberg K, Wengström Y, Sundberg K, Browall M, Isaksson AK, Nyman MH, Langius-Eklöf A. Symptoms and self-care strategies during and six months after radiotherapy for prostate cancer - Scoping the perspectives of patients, professionals and literature. Eur J Oncol Nurs 2015; 21:139-45. [PMID: 26482003 DOI: 10.1016/j.ejon.2015.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 08/05/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Under-diagnosed and uncontrolled symptoms in patients with prostate cancer during radiotherapy can have a negative impact on the individual's quality of life. An opportunity for patients to report their symptoms systematically, communicate these symptoms to cancer nurses and to receive self-care advice via an application in an Information and Communication Technology-platform could overcome this risk. The content in the application must precisely capture symptoms that are significant to both patients and health care professionals. Therefore, the aim of the study was to map and describe symptoms and self-care strategies identified by patients with prostate cancer undergoing radiotherapy, by health care professionals caring for these patients, and in the literature. METHODS The study combines data from interviews with patients (n = 8) and health care professionals (n = 10) and a scoping review of the literature (n = 26) focusing on the period during and up to 6 months after radiotherapy. RESULTS There was a concordance between the patients, health care professionals, and the literature on symptoms during and after radiotherapy. Urinary symptoms, bowel problems, pain, sexual problems, fatigue, anxiety, depression, cognitive impairment and irregular symptoms were commonly described during the initial treatment period. Self-care strategies were rarely described in all three of the sources. CONCLUSIONS The results show which symptoms to regularly assess using an Information and Communication Technology-platform for patients with newly-diagnosed prostate cancer during radiotherapy. The next step is to evaluate the efficacy of using the platform and the accuracy of the selected symptoms and self-care advice included in a smartphone application.
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Affiliation(s)
- Karin Blomberg
- Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, S-70182 Örebro, Sweden.
| | - Yvonne Wengström
- Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, S-70182 Örebro, Sweden; Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Kay Sundberg
- Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Maria Browall
- Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden; School of Life Sciences, University of Skövde, Skövde, Sweden
| | - Ann-Kristin Isaksson
- Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, S-70182 Örebro, Sweden
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, S-70182 Örebro, Sweden
| | - Ann Langius-Eklöf
- Department NVS, Section for Nursing, Karolinska Institutet, Stockholm, Sweden
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26
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He Y, Meng Z, Jia Q, Hu F, He X, Tan J, Zhang G, Li X, Zhang J, Zhang Q, Liu L, Zhao L, Li J, Wang Y, Qian Y, Hou S, Liu H, Wang S, Wang R, Zheng W, Hu T, Liu N, Upadhyaya A, Liu Y. Sleep Quality of Patients with Differentiated Thyroid Cancer. PLoS One 2015; 10:e0130634. [PMID: 26083787 PMCID: PMC4471198 DOI: 10.1371/journal.pone.0130634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/21/2015] [Indexed: 12/31/2022] Open
Abstract
Objective We aimed to measure prevalence of sleep disturbance in patients with differentiated thyroid cancer (DTC) by calculating Pittsburgh Sleep Quality Index (PSQI), and compare these data with patients with benign thyroid nodules or normal participants. Methods Three groups of patients participated in this cross-sectional study. In the first group, 162 patients with DTC received total thyroidectomy, and then 131I therapy. The second group consisted of 84 patients with benign thyroid nodules, who received partial thyroidectomy. The third group was 78 normal healthy control cases. PSQI was used to assess the sleep quality. Inter-group differences were analyzed by Kruskal-Wallis test or independent samples T test. χ2 test was also used to check prevalence differences of poor sleep quality among the groups. Differences of PSQI score and poor sleep quality prevalence before and after 131I therapy in the same group of DTC participants were analyzed by paired T test and Mcnemar's test. Results Higher PSQI score (7.59 ± 4.21) and higher rate of poor sleep quality (54.32%) were shown in DTC patients than in any other group. After 131I therapy, PSQI score and prevalence of poor sleep quality in DTC patients increased significantly to 8.78 ± 4.72 and 70.99%. Then DTC patients were divided into two subgroups based on their metastatic status. DTC patients with metastasis (87/162 cases, 53.70%) had significantly higher PSQI score (10.87 ± 5.18) and higher prevalence of poor sleep quality (79.31%). Conclusion DTC patients suffer from sleep disturbance, 131I therapy and awareness of metastatic status could worsen sleep problem. Psychological fear of cancer, nuclear medicine therapy and metastasis could be one major underlying reason. Longitude and interventional studies are necessary for further investigations.
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Affiliation(s)
- Yajing He
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
- * E-mail: (ZM); (JT)
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Fang Hu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Xianghui He
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
- * E-mail: (ZM); (JT)
| | - Guizhi Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Xue Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Jianping Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Qing Zhang
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Li Liu
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Lili Zhao
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Jing Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Yuling Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Yumei Qian
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Shuling Hou
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Hua Liu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Sheng Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Renfei Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Tianpeng Hu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Na Liu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Arun Upadhyaya
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
| | - Yang Liu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, P. R. China
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Pan Y, Yang K, Wang Y, Zhang L, Liang H. Could yoga practice improve treatment-related side effects and quality of life for women with breast cancer? A systematic review and meta-analysis. Asia Pac J Clin Oncol 2015; 13:e79-e95. [PMID: 25560636 DOI: 10.1111/ajco.12329] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/27/2022]
Abstract
AIM To determine if yoga as a complementary and alternative therapy was associated with enhanced health and treatment-related side effects in patients with breast cancer. This systematic review examines whether yoga practice provides any measurable benefit, both physically and psychologically, for women with breast cancer. METHODS PubMed, EMBASE and the Cochrane Library for randomized controlled trials (RCTs) throughout June 2013. We evaluated the quality of the included studies by the Cochrane Handbook 5.2 standards and analyzed the data using the Stata software, version 10.0. Meta-regression and subgroup analysis were also performed to identify additional predictors of outcome and to assess heterogeneity. RESULTS Sixteen RCTs with a total of 930 participants were included. Comparing yoga groups to control groups, there was a statistically significant difference in overall health-related quality of life, depression, anxiety and gastrointestinal symptoms. Meta-regression analyses revealed that the duration of yoga practice and type of control group partly explained the heterogeneity. Subgroup analyses revealed that yoga had a positive effect on anxiety only when it had been practiced for longer than 3 months. Only the wait-list control group showed an effect of yoga on physical well-being. CONCLUSION The current evidence demonstrates that yoga practice could be effective in enhancing health and managing some treatment-related side effects for patients recovering from breast cancer. In future clinical studies, clinicians should consider the patient's wishes along with the current best evidence of the effects of yoga practice in their clinical decision-making.
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Affiliation(s)
- Yuanqing Pan
- Department of Medical Psychology, Lanzhou University, Lanzhou, Gansu, China
| | - Kehu Yang
- Evidence-Based Medicine Center, Key Laboratory of Clinical Translational Research and Evidence-Based Medicine of Gansu Province, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Yuliang Wang
- Department of Orthopaedic Surgery, the 2nd Hospital of Lanzhou University, Lanzhou, Gansu, China
| | | | - Haiqing Liang
- Department of Neurosurgery, the Affiliated Hospital of Logistics University of CAPF, Tianjin, China
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Incorporating measures of sleep quality into cancer studies. Support Care Cancer 2014; 23:1145-55. [PMID: 25510361 DOI: 10.1007/s00520-014-2537-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/21/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION/BACKGROUND Sleep disturbance may influence the development of cancer and responses to treatment. It is also closely tied to recovery and quality of life in cancer patients, survivors, and caregivers, and recent studies have begun to show beneficial effects of sleep-promoting interventions. Despite the importance of sleep to cancer and its treatment and the availability of numerous tools for measuring sleep quality and quantity, sleep measurements are underutilized in cancer studies. METHODS This review, written for cancer researchers interested in incorporating sleep measures into their studies, is designed to raise awareness about the importance of sleep and suggests strategies for including sleep evaluation in cancer studies. CONCLUSIONS Inclusion of readily available sleep measures may ultimately improve cancer care by facilitating studies that lead to a greater understanding of how sleep and sleep disturbance influence all aspects of cancer care and the patient experience.
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Otte JL, Carpenter JS, Manchanda S, Rand KL, Skaar TC, Weaver M, Chernyak Y, Zhong X, Igega C, Landis C. Systematic review of sleep disorders in cancer patients: can the prevalence of sleep disorders be ascertained? Cancer Med 2014; 4:183-200. [PMID: 25449319 PMCID: PMC4329003 DOI: 10.1002/cam4.356] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/26/2014] [Accepted: 09/07/2014] [Indexed: 11/13/2022] Open
Abstract
Although sleep is vital to all human functioning and poor sleep is a known problem in cancer, it is unclear whether the overall prevalence of the various types of sleep disorders in cancer is known. The purpose of this systematic literature review was to evaluate if the prevalence of sleep disorders could be ascertained from the current body of literature regarding sleep in cancer. This was a critical and systematic review of peer-reviewed, English-language, original articles published from 1980 through 15 October 2013, identified using electronic search engines, a set of key words, and prespecified inclusion and exclusion criteria. Information from 254 full-text, English-language articles was abstracted onto a paper checklist by one reviewer, with a second reviewer randomly verifying 50% (k = 99%). All abstracted data were entered into an electronic database, verified for accuracy, and analyzed using descriptive statistics and frequencies in SPSS (v.20) (North Castle, NY). Studies of sleep and cancer focus on specific types of symptoms of poor sleep, and there are no published prevalence studies that focus on underlying sleep disorders. Challenging the current paradigm of the way sleep is studied in cancer could produce better clinical screening tools for use in oncology clinics leading to better triaging of patients with sleep complaints to sleep specialists, and overall improvement in sleep quality.
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Affiliation(s)
- Julie L Otte
- Indiana University School of Nursing, Indianapolis, Indiana
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30
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Reis D, Walsh ME, Young-McCaughan S, Jones T. Effects of Nia exercise in women receiving radiation therapy for breast cancer. Oncol Nurs Forum 2014; 40:E374-81. [PMID: 23989030 DOI: 10.1188/13.onf.e374-e381] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To compare a 12-week nontraditional exercise Nia program practiced at home to usual care on fatigue, quality of life (QOL), aerobic capacity, and shoulder flexibility in women with breast cancer undergoing radiation therapy. DESIGN Randomized clinical trial. SETTING Large community-based hospital in the midwestern United States. SAMPLE 41 women with stage I, II, or III breast cancer starting radiation therapy. METHODS 22 women were randomized to the Nia group and 19 to the usual care group. Those in the Nia group were instructed to practice Nia 20-60 minutes three times per week for 12 weeks. Those in the usual care group were instructed to continue normal activities. MAIN RESEARCH VARIABLES Fatigue, QOL, aerobic capacity, and shoulder flexibility. FINDINGS Controlling for baseline scores, change over time between groups was significantly different for the women who practiced Nia at least 13 times during the 12-week period; those in the Nia intervention reported significantly less fatigue between weeks 6 and 12, as compared to control group (p = 0.05). No statistical differences in QOL, aerobic capacity, or shoulder flexibility were found, but trends favoring Nia were identified. CONCLUSIONS For women undergoing radiation therapy for breast cancer, Nia can help relieve fatigue. Additional research in arm and shoulder mobility and preservation also may be beneficial. IMPLICATIONS FOR NURSING Oncology nurses are in a unique position to offer suggestions to help manage fatigue, and Nia could be considered as part of a cancer survivorship program. KNOWLEDGE TRANSLATION Exercise is beneficial for women with breast cancer, and interest is growing in nontraditional exercise options. Nia can benefit women with breast cancer undergoing radiation therapy.
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Affiliation(s)
- Debra Reis
- ProMedica Cancer Institute, Sylvania, OH
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Palesh O, Aldridge-Gerry A, Zeitzer JM, Koopman C, Neri E, Giese-Davis J, Jo B, Kraemer H, Nouriani B, Spiegel D. Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep 2014; 37:837-42. [PMID: 24790261 DOI: 10.5665/sleep.3642] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Poor sleep, prevalent among cancer survivors, is associated with disrupted hormonal circadian rhythms and poor quality of life. Using a prospective research design, this study aimed to clarify the relationship between objective measures of sleep efficiency and sleep disruption with survival among women with advanced breast cancer. METHOD We examined sleep quality and duration via wrist-worn actigraphy and sleep diaries for 3 days among 97 women in whom advanced breast cancer was diagnosed (age = 54.6 ± 9.8 years). Sleep efficiency was operationalized using actigraphy as the ratio of total sleep time to total sleep time plus wake after sleep onset. RESULTS As hypothesized, better sleep efficiency was found to predict a significant reduction in overall mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94-0.98; P < 0.001) at median 6 y follow-up. This relationship remained significant (HR, 0.94; 95% CI, 0.91-0.97; P < 0.001) even after adjusting for other known prognostic factors (age, estrogen receptor status, cancer treatment, metastatic spread, cortisol levels, and depression). Secondary hypotheses were also supported (after adjusting for baseline prognostic factors) showing that less wake after sleep onset (HR, 0.41; 95% CI, 0.25-0.67; P < 0.001), fewer wake episodes, (HR, 0.93; 95% CI, 0.88-0.98; P = 0.007); and shorter wake episode duration (HR, 0.29; 95% CI, 0.14-0.58; P < 0.001) also contributed to reductions in overall mortality. CONCLUSIONS These findings show that better sleep efficiency and less sleep disruption are significant independent prognostic factors in women with advanced breast cancer. Further research is needed to determine whether treating sleep disruption with cognitive behavioral and/or pharmacologic therapy could improve survival in women with advanced breast cancer.
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Affiliation(s)
- Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Arianna Aldridge-Gerry
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Cheryl Koopman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Janine Giese-Davis
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA ; Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Canada
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Helena Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Bita Nouriani
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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Annin K, Saeed B, Yawson A, Musah AAI, Nakua E, Agyei-Baffour P, Nsowah-Nuamah NNN. Assessing the association between the degree of pain and socioeconomic status among older persons in Ghana. Glob J Health Sci 2014; 6:155-64. [PMID: 24762358 PMCID: PMC4825245 DOI: 10.5539/gjhs.v6n3p155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/18/2013] [Indexed: 11/23/2022] Open
Abstract
Objectives: The current study sought to examine the association between the degree of pain and socioeconomic status among older male and female Ghanaians. Method: Data were drawn from the 2007–08 World Health Organization Global Ageing and Adult Health (SAGE) survey conducted in Ghana (Young adults=803, Adults=1689 and Older adults=2616). This includes bodily aches Ghanaians experienced in the last 30 days. Analyses of the association of pain with predisposing and enabling factors were carried out by means of ordinal logistic regression analysis. Results: In the age-adjusted model, pain was statistically significantly associated with the cohabitating group as its marginal effect suggests that respondents in that category were less likely to experience pain as related to the others in women. Conclusion: This study established that Ghanaian men go through more pain than their women counterparts. This article is premier to our knowledge to apply ordered logistic for the degree of pain.
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Affiliation(s)
| | - Bahiru Saeed
- Mathematics and Statistics Department, Kumasi Polytechnic, Kumasi, Ghana.
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34
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Miaskowski C, Paul SM, Cooper B, West C, Levine JD, Elboim C, Hamolsky D, Abrams G, Luce J, Dhruva A, Langford DJ, Merriman JD, Kober K, Baggott C, Leutwyler H, Aouizerat BE. Identification of patient subgroups and risk factors for persistent arm/shoulder pain following breast cancer surgery. Eur J Oncol Nurs 2014; 18:242-53. [PMID: 24485012 PMCID: PMC4013216 DOI: 10.1016/j.ejon.2013.12.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/10/2013] [Accepted: 12/12/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE In this prospective, longitudinal study, we extend our findings on persistent breast pain in patients (n = 398) following breast cancer surgery and evaluate the prevalence and characteristics of persistent pain in the arm/shoulder. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the arm pain classes, were evaluated. METHODS AND SAMPLE Patients were recruited from Breast Care Centers located in a Comprehensive Cancer Center, two public hospitals, and four community practices. Patients were assessed prior to and monthly for six months following breast cancer surgery. RESULTS Using growth mixture modeling, patients were classified into no (41.6%), mild (23.6%), and moderate (34.8%) arm pain classes based on ratings of worst arm/shoulder pain. Compared to the no pain class, patients in the moderate pain class were significantly younger, had a higher body mass index, and were more likely to report preoperative breast pain and swelling in the affected breast. In addition, patients in the moderate pain class reported higher levels of depression, anxiety, and sleep disturbance than the no pain class. CONCLUSIONS Findings suggest that approximately 35% of women experience persistent levels of moderate arm/shoulder pain in the first six months following breast cancer surgery. Moderate arm/shoulder pain is associated with clinically meaningful decrements in functional status and quality of life.
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Affiliation(s)
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Claudia West
- School of Nursing, University of California, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, CA, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, CA, USA
| | - Judith Luce
- School of Medicine, University of California, San Francisco, CA, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | - Dale J Langford
- School of Nursing, University of California, San Francisco, CA, USA
| | - John D Merriman
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | | | | | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, CA, USA; Institute for Human Genetics, University of California, San Francisco, CA, USA
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Predictors of Initial Levels and Trajectories of Depressive Symptoms in Women With Breast Cancer Undergoing Radiation Therapy. Cancer Nurs 2013; 36:E34-43. [DOI: 10.1097/ncc.0b013e31826fc9cc] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Keogh JWL, Patel A, MacLeod RD, Masters J. Perceived barriers and facilitators to physical activity in men with prostate cancer: possible influence of androgen deprivation therapy. Eur J Cancer Care (Engl) 2013; 23:263-73. [PMID: 24134506 DOI: 10.1111/ecc.12141] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/29/2022]
Abstract
While physical activity is beneficial for men with prostate cancer, too few perform sufficient activity for such benefit. This study examined perceptions of men with prostate cancer of their barriers and facilitators to physical activity, and how androgen deprivation therapy (ADT) may influence these perceptions. Two focus groups were conducted, involving six ADT and eight non-ADT patients respectively. Data were transcribed verbatim and themes developed using a general inductive thematic approach. Facilitators to physical activity common to both groups of cancer survivors included clinician and spousal involvement, with pre-existing co-morbidities and increased age cited as barriers by both groups. The ADT subgroup cited personal involvement as a facilitator to physical activity, with fatigue, reduced motivation and a relative lack of specific advice from their clinician as additional barriers. The non-ADT subgroup had no additional facilitators to physical activity but cited time constraints as a barrier. These results highlight the important role that cancer clinicians and spouses play in promoting physical activity for men with prostate cancer and how ADT may influence their other facilitators and barriers. As physical activity is beneficial for prostate cancer survivors, especially those on ADT, cancer clinicians should regularly discuss physical activity with their patients.
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Affiliation(s)
- J W L Keogh
- Exercise and Sports Sciences, Faculty of Health Sciences and Medicine, Bond University, Robina, Qld, Australia; Human Potential Centre, AUT University, Auckland, New Zealand; Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Qld, Australia
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Identification of patient subgroups and risk factors for persistent breast pain following breast cancer surgery. THE JOURNAL OF PAIN 2013; 13:1172-87. [PMID: 23182226 PMCID: PMC3511823 DOI: 10.1016/j.jpain.2012.09.013] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 08/10/2012] [Accepted: 09/10/2012] [Indexed: 01/07/2023]
Abstract
UNLABELLED Study purposes were to determine the prevalence of persistent pain in the breast; characterize distinct persistent pain classes using growth mixture modeling; and evaluate for differences among these pain classes in demographic, preoperative, intraoperative, and postoperative characteristics. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the pain classes, were evaluated. Patients (n = 398) were recruited prior to surgery and followed for 6 months. Using growth mixture modeling, patients were classified into no (31.7%), mild (43.4%), moderate (13.3%), and severe (11.6%) pain groups based on ratings of worst breast pain. Differences in a number of demographic, preoperative, intraoperative, and postoperative characteristics differentiated among the pain classes. In addition, patients in the moderate and severe pain classes reported higher preoperative levels of depression, anxiety, and sleep disturbance than the no pain class. Findings suggest that approximately 25% of women experience significant and persistent levels of breast pain in the first 6 months following breast cancer surgery. PERSPECTIVE Persistent pain is a significant problem for 25% of women following surgery for breast cancer. Severe breast pain is associated with clinically meaningful decrements in functional status and quality of life.
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Dhruva A, Aouizerat BE, Cooper B, Paul SM, Dodd M, West C, Wara W, Lee K, Dunn LB, Langford DJ, Merriman JD, Baggott C, Cataldo J, Ritchie C, Kober K, Leutwyler H, Miaskowski C. Differences in morning and evening fatigue in oncology patients and their family caregivers. Eur J Oncol Nurs 2013; 17:841-8. [PMID: 24012189 PMCID: PMC3867806 DOI: 10.1016/j.ejon.2013.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/10/2013] [Accepted: 06/21/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE OF THE RESEARCH To identify distinct latent classes of individuals based on ratings of morning and evening fatigue; evaluate for differences in phenotypic characteristics, as well as symptom and quality of life scores, among these latent classes; and evaluate for an overlap in morning and evening fatigue class membership. PATIENTS AND METHODS In a sample of 167 oncology outpatients and 85 of their FCs, growth mixture modeling was used to identify distinct latent classes based on ratings of morning and evening fatigue obtained before, during, and after radiation therapy. Analyses of variance and Chi Square analyses were used to evaluate for differences among the morning and evening fatigue latent classes. RESULTS Three distinct latent classes for morning fatigue were identified. Participants in the High Morning Fatigue class (47%) were younger and had lower functional status. Three distinct latent classes for evening fatigue were identified. Participants in the High Evening Fatigue class (61%) were younger, more likely to be female, more likely to have children at home, and more likely to be a FC. Only 10.3% of participants were classified in both the Very Low Morning and Low Evening Fatigue classes and 41.3% were classified in both the High Morning and High Evening Fatigue classes. CONCLUSIONS Different characteristics were associated with morning and evening fatigue, which suggests that morning and evening fatigue may be distinct but related symptoms. Additional research is needed to elucidate the mechanisms that may underlie diurnal variability in fatigue.
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Affiliation(s)
- Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
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Hofsø K, Rustøen T, Cooper BA, Bjordal K, Miaskowski C. Changes over time in occurrence, severity, and distress of common symptoms during and after radiation therapy for breast cancer. J Pain Symptom Manage 2013; 45:980-1006. [PMID: 23026547 DOI: 10.1016/j.jpainsymman.2012.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 06/04/2012] [Accepted: 06/14/2012] [Indexed: 10/27/2022]
Abstract
CONTEXT Little is known about changes over time in multiple dimensions of the symptom experience in patients with breast cancer undergoing radiation therapy (RT). OBJECTIVES This study evaluated for changes in and predictors of occurrence, severity, and distress of six common symptoms (lack of energy, worrying, difficulty sleeping, feeling drowsy, sweats, and pain) during RT for breast cancer. METHODS Patients (n = 188) completed the Memorial Symptom Assessment Scale before, during, and after the completion of RT, over a six-month period. Changes in symptom occurrence were evaluated using multilevel logistic regression analysis. Changes in severity and distress scores were evaluated using multilevel proportional odds ordinal logistic regression. The impact of five demographic and clinical characteristics (age, functional status, comorbidities, axillary lymph node dissection, and previous chemotherapy) was evaluated in these analyses. RESULTS The trajectories for occurrence, severity, and distress for the six symptoms followed similar patterns. For three of the six symptoms (lack of energy, feeling drowsy, and worrying), all three dimensions changed over time. For the other three symptoms (difficulty sleeping, sweats, and pain), no changes over time occurred for any of the symptom dimensions. The overall effect of the five covariates was to increase symptom burden across all three dimensions. CONCLUSION Findings from this study provide a more complete picture of the symptom experience of women who undergo RT for breast cancer. These findings can be used to identify patients at higher risk for more severe symptoms before, during, and after RT.
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Affiliation(s)
- Kristin Hofsø
- Centre for Shared Decision Making and Collaborative Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Schuh-Hofer S, Wodarski R, Pfau DB, Caspani O, Magerl W, Kennedy JD, Treede RD. One night of total sleep deprivation promotes a state of generalized hyperalgesia: a surrogate pain model to study the relationship of insomnia and pain. Pain 2013; 154:1613-1621. [PMID: 23707287 DOI: 10.1016/j.pain.2013.04.046] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 04/03/2013] [Accepted: 04/19/2013] [Indexed: 12/25/2022]
Abstract
Sleep disturbances are highly prevalent in chronic pain patients. Understanding their relationship has become an important research topic since poor sleep and pain are assumed to closely interact. To date, human experimental studies exploring the impact of sleep disruption/deprivation on pain perception have yielded conflicting results. This inconsistency may be due to the large heterogeneity of study populations and study protocols previously used. In addition, none of the previous studies investigated the entire spectrum of nociceptive modalities. To address these shortcomings, a standardized comprehensive quantitative sensory protocol was used in order to compare the somatosensory profile of 14 healthy subjects (6 female, 8 male, 23.5 ± 4.1 year; mean ± SD) after a night of total sleep deprivation (TSD) and a night of habitual sleep in a cross-over design. One night of TSD significantly increased the level of sleepiness (P<0.001) and resulted in higher scores of the State Anxiety Inventory (P<0.01). In addition to previously reported hyperalgesia to heat (P<0.05) and blunt pressure (P<0.05), study participants developed hyperalgesia to cold (P<0.01) and increased mechanical pain sensitivity to pinprick stimuli (P<0.05) but no changes in temporal summation. Paradoxical heat sensations or dynamic mechanical allodynia were absent. TSD selectively modulated nociception, since detection thresholds of non-nociceptive modalities remained unchanged. Our findings show that a single night of TSD is able to induce generalized hyperalgesia and to increase State Anxiety scores. In the future, TSD may serve as a translational pain model to elucidate the pathomechanisms underlying the hyperalgesic effect of sleep disturbances.
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Affiliation(s)
- Sigrid Schuh-Hofer
- Institute of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim, Heidelberg University, 68167 Mannheim, Germany Zentrum für Neurologie, Abteilung Epileptologie, Universitätsklinikum Tübingen der Eberhard Karls Universität, Germany Eli Lilly & Company, Erl Wood Manor, Windlesham, Surrey GU2 06PH, UK Eli Lilly & Company, Indianapolis, IN, USA
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Identification of distinct subgroups of breast cancer patients based on self-reported changes in sleep disturbance. Support Care Cancer 2013; 20:2611-9. [PMID: 22290719 DOI: 10.1007/s00520-012-1381-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE The purposes of this study were to identify distinct subgroups of patients based on self-reported sleep disturbance prior to through 6 months after breast cancer surgery and evaluate for differences in demographic, clinical, and symptom characteristics among these latent classes. METHODS Women (n = 398) who underwent unilateral breast cancer surgery were enrolled prior to surgery. Patients completed measures of functional status, sleep disturbance (i.e., General Sleep Disturbance Scale (GSDS); higher scores indicate higher levels of sleep disturbance), fatigue, attentional fatigue, depressive symptoms, and anxiety prior to surgery and monthly for 6 months. RESULTS Three distinct classes of sleep disturbance trajectories were identified using growth mixture modeling. The high sustained class (55.0%) had high and the low sustained class (39.7%) had low GSDS scores prior to surgery that persisted for 6 months. The decreasing class (5.3%) had high GSDS score prior to surgery that decreased over time. Women in the high sustained class were significantly younger, had more comorbidity and poorer function, and were more likely to report hot flashes compared to the low sustained class. More women who underwent mastectomy or breast reconstruction were in the decreasing class. Decreasing and high sustained classes reported higher levels of physical fatigue, attentional fatigue, depressive symptoms, and anxiety compared to the low sustained class. CONCLUSIONS A high percentage of women has significant sleep disturbance prior to surgery that persists during subsequent treatments (i.e., radiation therapy and chemotherapy). Clinicians need to perform routine assessments and initiate appropriate interventions to improve sleep prior to and following surgery.
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Van Onselen C, Paul SM, Lee K, Dunn L, Aouizerat BE, West C, Dodd M, Cooper B, Miaskowski C. Trajectories of sleep disturbance and daytime sleepiness in women before and after surgery for breast cancer. J Pain Symptom Manage 2013; 45:244-60. [PMID: 22921179 PMCID: PMC3561473 DOI: 10.1016/j.jpainsymman.2012.02.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/20/2012] [Accepted: 02/20/2012] [Indexed: 11/28/2022]
Abstract
CONTEXT Sleep disturbance is a problem for oncology patients. OBJECTIVES To evaluate how sleep disturbance and daytime sleepiness (DS) changed from before to six months following surgery and whether certain characteristics predicted initial levels and/or the trajectories of these parameters. METHODS Patients (n=396) were enrolled prior to surgery and completed monthly assessments for six months following surgery. The General Sleep Disturbance Scale was used to assess sleep disturbance and DS. Using hierarchical linear modeling, demographic, clinical, symptom, and psychosocial adjustment characteristics were evaluated as predictors of initial levels and trajectories of sleep disturbance and DS. RESULTS All seven General Sleep Disturbance Scale scores were above the cutoff for clinically meaningful levels of sleep disturbance. Lower performance status; higher comorbidity, attentional fatigue, and physical fatigue; and more severe hot flashes predicted higher preoperative levels of sleep disturbance. Higher levels of education predicted higher sleep disturbance scores over time. Higher levels of depressive symptoms predicted higher preoperative levels of sleep disturbance, which declined over time. Lower performance status; higher body mass index; higher fear of future diagnostic tests; not having had sentinel lymph node biopsy; having had an axillary lymph node dissection; and higher depression, physical fatigue, and attentional fatigue predicted higher DS prior to surgery. Higher levels of education, not working for pay, and not having undergone neo-adjuvant chemotherapy predicted higher DS scores over time. CONCLUSION Sleep disturbance is a persistent problem for patients with breast cancer. The effects of interventions that can address modifiable risk factors need to be evaluated.
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Affiliation(s)
- Christina Van Onselen
- School of Nursing, University of California, San Francisco, California 94143-0610, USA
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Miaskowski C, Cooper BA, Dhruva A, Dunn LB, Langford DJ, Cataldo JK, Baggott CR, Merriman JD, Dodd M, Lee K, West C, Paul SM, Aouizerat BE. Evidence of associations between cytokine genes and subjective reports of sleep disturbance in oncology patients and their family caregivers. PLoS One 2012; 7:e40560. [PMID: 22844404 PMCID: PMC3402493 DOI: 10.1371/journal.pone.0040560] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/08/2012] [Indexed: 11/18/2022] Open
Abstract
The purposes of this study were to identify distinct latent classes of individuals based on subjective reports of sleep disturbance; to examine differences in demographic, clinical, and symptom characteristics between the latent classes; and to evaluate for variations in pro- and anti-inflammatory cytokine genes between the latent classes. Among 167 oncology outpatients with breast, prostate, lung, or brain cancer and 85 of their FCs, growth mixture modeling (GMM) was used to identify latent classes of individuals based on General Sleep Disturbance Scale (GSDS) obtained prior to, during, and for four months following completion of radiation therapy. Single nucleotide polymorphisms (SNPs) and haplotypes in candidate cytokine genes were interrogated for differences between the two latent classes. Multiple logistic regression was used to assess the effect of phenotypic and genotypic characteristics on GSDS group membership. Two latent classes were identified: lower sleep disturbance (88.5%) and higher sleep disturbance (11.5%). Participants who were younger and had a lower Karnofsky Performance status score were more likely to be in the higher sleep disturbance class. Variation in two cytokine genes (i.e., IL6, NFKB) predicted latent class membership. Evidence was found for latent classes with distinct sleep disturbance trajectories. Unique genetic markers in cytokine genes may partially explain the interindividual heterogeneity characterizing these trajectories.
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Affiliation(s)
- Christine Miaskowski
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California, United States of America.
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