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Miladinia M, Zarea K, Gheibizadeh M, Jahangiri M, Karimpourian H, Rokhafroz D. A multiphase study protocol of identifying, and predicting cancer-related symptom clusters: applying a mixed-method design and machine learning algorithms. Front Digit Health 2024; 6:1290689. [PMID: 38707194 PMCID: PMC11066191 DOI: 10.3389/fdgth.2024.1290689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives In recent years, there has been increasing attention on the cluster approach to symptom management. Two significant challenges in the symptom cluster (SC) approach are identifying and predicting these clusters. This multiphase protocol aims to identify SCs in patients with advanced cancer as the primary objective, with the secondary objective of developing machine learning algorithms to predict SCs identified in the first phase. Methods The 2-MIXIP study consists of two main phases. The first phase involves identifying SCs, and the second phase focuses on developing predictive algorithms for the identified SCs. The identification of SCs involves a parallel mixed-method design (quantitative and qualitative). Quantitative and qualitative methods are conducted simultaneously and given equal importance. The data are collected and analyzed independently before being integrated. The quantitative part is conducted using a descriptive-analytical method. The qualitative analysis is conducted using a content analysis approach. Then, the identified SCs from both parts are integrated to determine the final clusters and use them in the second phase. In the second phase, we employ a tree-based machine learning method to create predictive algorithms for SCs using key demographic and clinical patient characteristics. Conclusion The findings of the 2-MIXIP study can help manage cancer patients' symptoms more effectively and enhance clinical decision-making by using SCs prediction. Furthermore, the results of this study can provide guidance for clinical trials aimed at managing symptoms.
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Affiliation(s)
- Mojtaba Miladinia
- Department of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kourosh Zarea
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahin Gheibizadeh
- Department of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mina Jahangiri
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hossein Karimpourian
- Department of Medical Oncology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Darioush Rokhafroz
- Department of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Hsiao CP, Von Ah D, Chen MK, Saligan LN. Relationship of cancer-related fatigue with psychoneurophysiological (PNP) symptoms in breast cancer survivors. Eur J Oncol Nurs 2024; 68:102469. [PMID: 38039708 PMCID: PMC10922833 DOI: 10.1016/j.ejon.2023.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a highly prevalent and debilitating symptom reported by breast cancer survivors (BCS). CRF has been associated with the co-occurrence of anxiety, depression, poor sleep quality, cognitive impairment, which are collectively termed as psychoneurophysiological (PNP) symptoms. CRF and these PNP symptoms are often reported during and after treatment with long-lasting distress. It is unclear how CRF and these PNP symptoms influence each other. This study aimed to explore predictive factors (i.e., PNP symptoms and social-demographic factors) of CRF, and test exploratory path models of the relationships of CRF with PNP symptoms (depression, anxiety, sleep disturbance, pain, and cognitive function) in BCS. METHODS This paper is part of a larger descriptive, correlational, and cross-sectional study. Validated and reliable instruments assessed CRF, depression, anxiety, sleep disturbance, pain, and cognitive function. Descriptive statistics, Pearson correlation, multiple linear regression models, and path analysis were employed. RESULTS Patients (N = 373) who reported less bodily pain had worst CRF (r = -0.45, p < .01). Significant predictors of CRF included depression, sleep disorder, bodily pain, perceived cognitive ability, and dispositional (state) optimism. Depression alone accounted for 31% of the variance in CRF. An integrative path model with bodily pain, neuropathic pain, CRF, and depression showed a good fit across different indices (CFI = 0.993, RMSEA = 0.047, 90% CI 0-0.12, SRMR = 0.027). CONCLUSIONS This study identified significant predictors of CRF and revealed a good fit mediation model with significant pathways for CRF, suggesting that a common etiology may underpin the co-occurrence of CRF with PNP symptoms (pain and depression). However, further investigation with longitudinal design is necessary to explore the causal relationships of these symptoms. Evidence-based strategies/interventions are needed to reduce or eliminate the burden of these symptoms on the lives of BCS.
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Affiliation(s)
- Chao-Pin Hsiao
- Case Western Reserve University School of Nursing, Cleveland, OH, USA
| | - Diane Von Ah
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Mei-Kuang Chen
- The University of Arizona Department of Psychology, Tucson, AZ, USA
| | - Leorey N Saligan
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
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Storey S, Luo X, Ren J, Huang K, Von Ah D. Symptom clusters in breast cancer survivors with and without type 2 diabetes over the cancer trajectory. Asia Pac J Oncol Nurs 2024; 11:100343. [PMID: 38222966 PMCID: PMC10784674 DOI: 10.1016/j.apjon.2023.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/10/2023] [Indexed: 01/16/2024] Open
Abstract
Objective This study aimed to investigate symptoms and symptom clusters in breast cancer survivors (BCS) with and without type 2 diabetes across three crucial periods during the cancer trajectory (0-6 months, 12-18 months, and 24-30 months) post-initial chemotherapy. Methods Eight common symptoms in both BCS and individuals with diabetes were identified through natural language processing of electronic health records from January 2007 to December 2018. Exploratory factor analysis was employed to discern symptom clusters, evaluating their stability, consistency, and clinical relevance. Results Among the 4601 BCS in the study, 20% (n = 905) had a diabetes diagnosis. Gastrointestinal symptoms and fatigue were prevalent in both groups. While BCS in both groups exhibited an equal number of clusters, the composition of these clusters differed. Symptom clusters varied over time between BCS with and without diabetes. BCS with diabetes demonstrated less stability (repeated clusters) and consistency (same individual symptoms comprising clusters) than their counterparts without diabetes. This suggests that BCS with diabetes may experience distinct symptom clusters at pivotal points in the cancer treatment trajectory. Conclusions Healthcare providers must be attentive to BCS with diabetes throughout the cancer trajectory, considering intensified and/or unique profiles of symptoms and symptom clusters. Interdisciplinary cancer survivorship models are essential for effective diabetes management in BCS. Implementing a comprehensive diabetes management program throughout the cancer trajectory could alleviate symptoms and symptom clusters, ultimately enhancing health outcomes and potentially reducing healthcare resource utilization.
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Affiliation(s)
- Susan Storey
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Xiao Luo
- Department of Management Science and Information Systems, School of Business, Oklahoma State University, OK, USA
| | - Jie Ren
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine Indianapolis, IN, USA
| | - Kun Huang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine; Regenstrief Institute, Indianapolis, IN, USA
| | - Diane Von Ah
- College of Nursing, Cancer Research, Center for Healthy Aging, Self-Management and Complex Care, The Ohio State University, Columbus, OH, USA
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Kim HJ, Moon JH, Chung SW, Abraham I. The role of cytokines and Indolamine-2.3 dioxygenase in experiencing a psycho-neurological symptom cluster in hematological cancer patients: IL-1alpha, IL-1beta, IL-4, IL-6, TNF-alpha, kynurenine, and tryptophan. J Psychosom Res 2023; 173:111455. [PMID: 37586292 DOI: 10.1016/j.jpsychores.2023.111455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/07/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE This study examined (a) whether there are a subgroup of cancer patients experiencing the selected psycho-neurological symptoms as a cluster (depression, cognitive impairment, fatigue, sleep disturbance, and pain); (b) whether demographic and clinical characteristics and pro-inflammatory cytokines (IL-1α, IL-1β, IL-4, IL-6, TNF-alpha) are associated with subgroup membership; and (c) whether the activity of indolamine-2.3 dioxygenase(IDO) is associated with pro-inflammatory cytokine activity and psycho-neurological symptom cluster experience. METHODS This was a prospective cohort study where 149 hematologic patients were recruited from a university hospital and 65 healthy volunteers provided control data. Latent profile analyses were conducted to identify subgroups at two time points: the last day of chemotherapy and 1 week after chemotherapy completion. Influencing factors of subgroup membership were examined by logistic regression. RESULTS A substantial number of patients (33%, 34% at each time point) experienced the selected psycho-neurological symptoms as a cluster. Older age and elevated IL-1α and IL-6 were associated with experiencing the psycho-neurological symptom cluster. IDO activity was higher in the patients experiencing psycho-neurological symptom cluster; and was positively associated with IL-6. Symptom severity, IL-1α, IL-6, and IDO activity were all significantly higher in cancer patients than in the healthy controls. The findings were preserved across time points. CONCLUSIONS The activation of pro-inflammatory cytokines and their cross-talk with IDO may be a common biological mechanism, underlying a psycho-neurological symptom cluster experience. The novel approaches for symptom assessment and management can be developed by assessing multiple psycho-neurological symptoms as a cluster and by targeting their common biological pathway.
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Affiliation(s)
- Hee-Ju Kim
- College of Nursing, The Catholic University of Korea, Seoul, South Korea.
| | - Joon Ho Moon
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Deagu, South Korea
| | - Su Wol Chung
- Department of Biological Sciences, College of Natural Sciences, University of Ulsan, Ulsan, South Korea
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research and Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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Durán-Gómez N, López-Jurado CF, Nadal-Delgado M, Montanero-Fernández J, Palomo-López P, Cáceres MC. Prevalence of Psychoneurological Symptoms and Symptom Clusters in Women with Breast Cancer Undergoing Treatment: Influence on Quality of Life. Semin Oncol Nurs 2023; 39:151451. [PMID: 37217435 DOI: 10.1016/j.soncn.2023.151451] [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: 09/22/2022] [Revised: 03/27/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To identify subgroups of psychoneurological symptoms (PNS) and their relationship to different clinical variables in a sample of women with breast cáncer (BC) with different type of treatment, and the possible influence of these on quality of life (QoL), using a factorial principal components analysis. DATA SOURCES Observational, cross-sectional, non-probability study (2017-2021) at Badajoz University Hospital (Spain). A total of 239 women with BC receiving treatment were included. RESULTS 68% of women presented fatigue, 30% depressive symptoms, 37.5% anxiety, 45% insomnia, and 36% cognitive impairment. The average score obtained for pain was 28.9. All the symptoms were related between themselves, and within the cluster of PNS. The factorial analysis showed three subgroups of symptoms, which accounted for 73% of variance: state and trait anxiety (PNS-1), cognitive impairment, pain and fatigue (PNS-2), and sleep disorders (PNS-3). The depressive symptoms were explained equally by PNS-1 and PNS-2. Additionally, two dimensions of QoL were found (functional-physical and cognitive-emotional. These dimensions correlated with the three PNS subgroups found. A relationship was found between chemotherapy treatment and PNS-3, and its negative impact on QoL. CONCLUSIONS A specific pattern of grouped symptoms in a psychoneurological cluster with different underlying dimensions has been identified which negatively influences QoL of survivors of BC. IMPLICATION FOR NURSING PRACTICE It is important to raise awareness among professionals and patients about the existence of a cluster of PNS, the patient's profile, as well as the factors that exacerbate them. This will allow them to be treated more effectively and comprehensively.
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Affiliation(s)
- Noelia Durán-Gómez
- PhD, Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006, Badajoz, Spain
| | - Casimiro F López-Jurado
- PhD, Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006, Badajoz, Spain
| | - Marta Nadal-Delgado
- PhD, Hospital Universitario de Badajoz, Asociación Oncológica Extremeña, 06006 Badajoz, Spain
| | - Jesús Montanero-Fernández
- PhD, Departamento de Matemáticas, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain
| | - Patricia Palomo-López
- PhD, Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006, Badajoz, Spain
| | - Macarena C Cáceres
- PhD, Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006, Badajoz, Spain.
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Ebbestad FE, Ammitzbøll G, Horsbøll TA, Andersen I, Johansen C, Zehran B, Dalton SO. The long-term burden of a symptom cluster and association with longitudinal physical and emotional functioning in breast cancer survivors. Acta Oncol 2023; 62:706-713. [PMID: 36912039 DOI: 10.1080/0284186x.2023.2185909] [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: 10/23/2022] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Fatigue, insomnia and pain are some of the most common and distressing symptoms experienced during breast cancer (BC) treatment and survivorship. The symptoms have been found to impact one another and to form a symptom cluster, and greater severity of the symptoms may be negatively associated with physical and emotional functioning in survivorship. In exploratory analyses from a randomized controlled trial examining the effect of progressive resistance training on the development of lymphedema after BC, we aimed to examine the burden of the symptom cluster fatigue-pain-insomnia, and its prognostic value for long-term symptom severity as well as emotional and physical functioning. MATERIAL AND METHODS Latent profile analysis was used to identify groups with similar severity of pain, fatigue and insomnia among 158 patients with BC two weeks after surgery. Mixed effects Tobit regression models were used to estimate fatigue, pain, insomnia, and physical and emotional functioning 20 weeks, 1 year and 3.5 years after surgery. RESULTS Two symptom burden groups were identified: 80% of women had a low severity while 20% of women had a high severity of the three symptoms after BC surgery. 3.5 years later, the women with high symptom burden post-surgery still had higher pain, insomnia and fatigue scores than women with low symptom burden. High symptom burden post-surgery was associated with worse physical functioning 3.5 years later, while emotional functioning was only negatively impacted during the first year. DISCUSSION These findings warrant larger studies investigating if symptom burden early in BC trajectory can be used for risk stratification for persistent symptoms and diminished physical functioning with the purpose of developing and implementing targeted interventions.
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Affiliation(s)
- Freja Ejlebæk Ebbestad
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Gunn Ammitzbøll
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- COMPAS, Danish Research Center for Equality in Cancer, Zealand University Hospital, Næstved, Denmark
| | | | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE), Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Denmark
| | - Bo Zehran
- Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- COMPAS, Danish Research Center for Equality in Cancer, Zealand University Hospital, Næstved, Denmark
- Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Denmark
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Zhou KN, Wang Y, Xie Y, Yang SH, Liu SY, Fang YH, Zhang Y. Symptom burden survey and symptom clusters in patients with cervical cancer: a cross-sectional survey. Support Care Cancer 2023; 31:338. [PMID: 37191783 DOI: 10.1007/s00520-023-07802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE The purpose of this study is to determine the incidence and severity of symptoms of patients with cervical cancer within 6 months after radiotherapy and chemotherapy, form a symptom burden report, evaluate the distribution characteristics of symptoms, identify symptom clusters, and provide a basis for clinical doctors and nurses to improve the symptom management of patients with cervical cancer after radiotherapy and chemotherapy. METHODS The patients with cervical cancer within 6 months after radiotherapy and chemotherapy were recruited to investigate their symptom burden. Exploratory factor analysis was used to identify symptom clusters. RESULTS A total of 250 patients participated in the study. The study found that the most common symptom among the 40 symptoms was fatigue, and the most serious symptom was nocturia. Based on the occurrence rate and severity of symptoms, nine symptom clusters were identified, including psycho-emotion-related symptom cluster, pain-disturbed sleep-related symptom cluster, menopausal symptom cluster, tinnitus-dizziness-related symptom cluster, urinary-related symptom cluster, dry mouth-bitter taste-related symptom cluster, intestinal-related symptom cluster, memory loss-numbness-related symptom cluster, and emaciation-related symptom cluster. The three most serious symptom clusters are pain-disturbed sleep-related symptom cluster, urinary-related symptom cluster, and memory loss-numbness-related symptom cluster. CONCLUSION The symptoms of patients with cervical cancer within 6 months after radiotherapy and chemotherapy are complex, and nine symptom clusters can be identified according to the incidence and severity of symptoms. We can find the potential biological mechanism of each symptom cluster through the discussion of previous mechanism research and clinical research. The number of symptom clusters and the number of symptoms within the symptom cluster are closely related to the symptom evaluation scale selected for the study. Therefore, the symptom cluster study urgently needs a targeted symptom evaluation scale that can comprehensively reflect the patient's condition.
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Affiliation(s)
- Kai-Nan Zhou
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Ge Street, Xicheng District, Beijing, 100053, China
| | - Yan Wang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Ge Street, Xicheng District, Beijing, 100053, China
| | - Yi Xie
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Ge Street, Xicheng District, Beijing, 100053, China
- Graduate School, Beijing University of Chinese Medicine, No. 11, Beisanhuan Dong Road, Chaoyang District, Beijing, 100029, China
| | - Shu-Han Yang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Ge Street, Xicheng District, Beijing, 100053, China
- Graduate School, Beijing University of Chinese Medicine, No. 11, Beisanhuan Dong Road, Chaoyang District, Beijing, 100029, China
| | - Su-Ying Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Ge Street, Xicheng District, Beijing, 100053, China
| | - Yu-Hang Fang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Ge Street, Xicheng District, Beijing, 100053, China
- Graduate School, Beijing University of Chinese Medicine, No. 11, Beisanhuan Dong Road, Chaoyang District, Beijing, 100029, China
| | - Ying Zhang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixian Ge Street, Xicheng District, Beijing, 100053, China.
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Shin H, Dudley WN, Bhakta N, Horan MR, Wang Z, Bartlett TR, Srivastava D, Yasui Y, Baker JN, Robison LL, Ness KK, Krull KR, Hudson MM, Huang IC. Associations of Symptom Clusters and Health Outcomes in Adult Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study. J Clin Oncol 2023; 41:497-507. [PMID: 36166720 PMCID: PMC9870227 DOI: 10.1200/jco.22.00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To identify symptom clusters among adult survivors of childhood cancers and test associations with health-related quality of life (HRQOL) and physical and neurocognitive performance. METHODS This cross-sectional study included 3,085 survivors (mean age at evaluation 31.9 ± 8.3 years; mean years from diagnosis 28.1 ± 9.1) participating in the St Jude Lifetime Cohort Study. Survivors self-reported the presence of 37 symptoms capturing 10 domains (cardiac, pulmonary, sensory, motor/movement, nausea, pain, fatigue, memory, anxiety, and depression). The Short Form-36's Physical/Mental Component Summaries assessed HRQOL; the Physical Performance Test evaluated physical performance; and neurocognitive batteries tested attention, processing/psychomotor speed, memory, and executive function. Latent class analysis identified subgroups of survivors experiencing different patterns of symptom burden (ie, symptom clusters). Multivariable regression models identified risk of cluster membership and tested associations with health outcomes. RESULTS Four symptom clusters were identified including cluster 1 (prevalence 52.4%; low physical, somatization, and psychologic domains), cluster 2 (16.1%; low physical, moderate somatic, and high psychologic domains), cluster 3 (17.6%; high physical, moderate somatic, and low psychologic domains), and cluster 4 (13.9%; high in all three domains). Compared with cluster 1, survivors in cluster 4 were more likely to have less than high school education (odds ratio [OR], 7.71; 95% CI, 4.46 to 13.31), no insurance (OR, 1.49; 95% CI, 1.04 to 2.13), and exposure to corticosteroids (OR, 1.76; 95% CI, 1.02 to 3.03); survivors in cluster 3 were more likely to have received platinum agents (OR, 2.22; 95% CI, 1.34 to 3.68) and brain radiation ≥ 30 Gy (OR, 3.99; 95% CI, 2.33 to 6.86). Survivors in cluster 4 reported the poorest Physical Component Summary/Mental Component Summary scores (31.0/26.7) and physical and neurocognitive performance versus survivors in the other clusters (P < .001). CONCLUSION Nearly 50% of survivors had moderate to high multisymptom burden, which was associated with sociodemographic, treatment factors, HRQOL, and functional outcomes.
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Affiliation(s)
- Hyewon Shin
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - William N. Dudley
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Madeline R. Horan
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | | | - Deokumar Srivastava
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Justin N. Baker
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
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Koleck TA, Topaz M, Tatonetti NP, George M, Miaskowski C, Smaldone A, Bakken S. Characterizing shared and distinct symptom clusters in common chronic conditions through natural language processing of nursing notes. Res Nurs Health 2021; 44:906-919. [PMID: 34637147 PMCID: PMC8641786 DOI: 10.1002/nur.22190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 01/08/2023]
Abstract
Data-driven characterization of symptom clusters in chronic conditions is essential for shared cluster detection and physiological mechanism discovery. This study aims to computationally describe symptom documentation from electronic nursing notes and compare symptom clusters among patients diagnosed with four chronic conditions-chronic obstructive pulmonary disease (COPD), heart failure, type 2 diabetes mellitus, and cancer. Nursing notes (N = 504,395; 133,977 patients) were obtained for the 2016 calendar year from a single medical center. We used NimbleMiner, a natural language processing application, to identify the presence of 56 symptoms. We calculated symptom documentation prevalence by note and patient for the corpus. Then, we visually compared documentation for a subset of patients (N = 22,657) diagnosed with COPD (n = 3339), heart failure (n = 6587), diabetes (n = 12,139), and cancer (n = 7269) and conducted multiple correspondence analysis and hierarchical clustering to discover underlying groups of patients who have similar symptom profiles (i.e., symptom clusters) for each condition. As expected, pain was the most frequently documented symptom. All conditions had a group of patients characterized by no symptoms. Shared clusters included cardiovascular symptoms for heart failure and diabetes; pain and other symptoms for COPD, diabetes, and cancer; and a newly-identified cognitive and neurological symptom cluster for heart failure, diabetes, and cancer. Cancer (gastrointestinal symptoms and fatigue) and COPD (mental health symptoms) each contained a unique cluster. In summary, we report both shared and distinct, as well as established and novel, symptom clusters across chronic conditions. Findings support the use of electronic health record-derived notes and NLP methods to study symptoms and symptom clusters to advance symptom science.
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Affiliation(s)
- Theresa A. Koleck
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, New York
- Data Science Institute, Columbia University, New York, New York
| | - Nicholas P. Tatonetti
- Data Science Institute, Columbia University, New York, New York
- Department of Biomedical Informatics, Columbia University, New York, New York
- Department of Systems Biology, Columbia University, New York, New York
- Department of Medicine, Columbia University, New York, New York
- Institute for Genomic Medicine, Columbia University, New York, New York
| | - Maureen George
- School of Nursing, Columbia University, New York, New York
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California
| | - Arlene Smaldone
- School of Nursing, Columbia University, New York, New York
- College of Dental Medicine, Columbia University, New York, New York
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York
- Data Science Institute, Columbia University, New York, New York
- Department of Biomedical Informatics, Columbia University, New York, New York
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Adam S, Thong MSY, Martin-Diener E, Camey B, Egger Hayoz C, Konzelmann I, Mousavi SM, Herrmann C, Rohrmann S, Wanner M, Staehelin K, Strebel RT, Randazzo M, John H, Schmid HP, Feller A, Arndt V. Identifying classes of the pain, fatigue, and depression symptom cluster in long-term prostate cancer survivors-results from the multi-regional Prostate Cancer Survivorship Study in Switzerland (PROCAS). Support Care Cancer 2021; 29:6259-6269. [PMID: 33847829 PMCID: PMC8464556 DOI: 10.1007/s00520-021-06132-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/04/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Aside from urological and sexual problems, long-term (≥5 years after initial diagnosis) prostate cancer (PC) survivors might suffer from pain, fatigue, and depression. These concurrent symptoms can form a cluster. In this study, we aimed to investigate classes of this symptom cluster in long-term PC survivors, to classify PC survivors accordingly, and to explore associations between classes of this cluster and health-related quality of life (HRQoL). METHODS Six hundred fifty-three stage T1-T3N0M0 survivors were identified from the Prostate Cancer Survivorship in Switzerland (PROCAS) study. Fatigue was assessed with the EORTC QLQ-FA12, depressive symptoms with the MHI-5, and pain with the EORTC QLQ-C30 questionnaire. Latent class analysis was used to derive cluster classes. Factors associated with the derived classes were determined using multinomial logistic regression analysis. RESULTS Three classes were identified: class 1 (61.4%) - "low pain, low physical and emotional fatigue, moderate depressive symptoms"; class 2 (15.1%) - "low physical fatigue and pain, moderate emotional fatigue, high depressive symptoms"; class 3 (23.5%) - high scores for all symptoms. Survivors in classes 2 and 3 were more likely to be physically inactive, report a history of depression or some other specific comorbidity, be treated with radiation therapy, and have worse HRQoL outcomes compared to class 1. CONCLUSION Three distinct classes of the pain, fatigue, and depression cluster were identified, which are associated with treatment, comorbidities, lifestyle factors, and HRQoL outcomes. Improving classification of PC survivors according to severity of multiple symptoms could assist in developing interventions tailored to survivors' needs.
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Affiliation(s)
- Salome Adam
- National Institute for Cancer Epidemiology and Registration (NICER), c/o University of Zurich, Zurich, Switzerland
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Eva Martin-Diener
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | | | | | - Seyed Mohsen Mousavi
- Cancer Registry East Switzerland, St. Gallen, Switzerland
- Cancer Registry Graubünden and Glarus, Chur, Switzerland
| | - Christian Herrmann
- Cancer Registry East Switzerland, St. Gallen, Switzerland
- Cancer Registry Graubünden and Glarus, Chur, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Miriam Wanner
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | | | - Räto T Strebel
- Department of Urology, Graubünden Cantonal Hospital, Chur, Switzerland
| | - Marco Randazzo
- Department of Urology, GZO Spital Wetzikon AG, Wetzikon, Switzerland
- Department of Urology, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - Hubert John
- Department of Urology, Winterthur Cantonal Hospital, Winterthur, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine (Med-HSG), St. Gallen, Switzerland
| | - Anita Feller
- National Institute for Cancer Epidemiology and Registration (NICER), c/o University of Zurich, Zurich, Switzerland
| | - Volker Arndt
- National Institute for Cancer Epidemiology and Registration (NICER), c/o University of Zurich, Zurich, Switzerland
- Unit of Cancer Survivorship, German Cancer Research Center (DKFZ), Heidelberg, Germany
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11
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Cáceres M, Pérez-Civantos D, Guerrero-Martín J, Delgado M, Jurado C, Durán-Gómez N. Depressive Symptoms and Quality of Life Associated With the Use of Monoclonal Antibodies in Breast Cancer Treatment. Oncol Nurs Forum 2021; 48:535-545. [PMID: 34411080 DOI: 10.1188/21.onf.535-545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the relationship between (a) chemotherapy and monoclonal antibody (mAb) treatments and (b) depressive symptoms and quality of life (QOL) in patients with breast cancer. SAMPLE & SETTING 182 women with breast cancer in Spain who were undergoing chemotherapy with or without mAbs. METHODS & VARIABLES An observational, cross-sectional study was carried out. The European Organisation for Research and Treatment of Cancer (EORTC) QOL Questionnaire-Core 30 and the EORTC QOL Questionnaire-Breast Cancer were used to assess QOL. Patients were screened for depressive symptoms using the Beck Depression Inventory-II. RESULTS No relationship was found between the use of mAbs with chemotherapy and QOL, except for incidence of diarrhea. However, depressive symptoms had a negative and highly significant influence on the majority of the QOL parameters. IMPLICATIONS FOR NURSING The presence of depressive symptoms negatively affects QOL. Used concurrently, mAbs and chemotherapy do not negatively influence QOL, but some adverse effects, such as diarrhea, are common.
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12
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Yao LQ, Tan JYB, Turner C, Wang T. Feasibility and potential effects of tai chi for the fatigue-sleep disturbance-depression symptom cluster in patients with breast cancer: protocol of a preliminary randomised controlled trial. BMJ Open 2021; 11:e048115. [PMID: 34408044 PMCID: PMC8375769 DOI: 10.1136/bmjopen-2020-048115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The fatigue-sleep disturbance-depression symptom cluster (FSDSC) is one of the most common and debilitating side effects in patients with breast cancer (BC) throughout their treatment trajectory. Tai chi has been supported as a promising non-pharmacological intervention for the individual symptom relief of cancer-related fatigue, sleep disturbance and depression. However, relevant evidence of using tai chi for FSDSC management in patients with BC has been lacking. METHODS This study will be a two-arm, single-blinded pilot randomised controlled trial involving an 8-week intervention and a 4-week follow-up. Seventy-two patients with BC experiencing the FSDSC will be recruited from two tertiary medical centres in China. The participants will be randomised to either a tai chi group (n=36) or a control group (n=36). The participants in the tai chi group will receive an 8-week tai chi intervention in addition to standard care, while the participants in the control group will receive standard care only consisting of a booklet on the self-management of cancer symptoms. The primary outcomes will include a series of feasibility assessments of the study protocol in relation to the study's methodological procedures, including subject recruitment and follow-up process, completion of study questionnaires and the feasibility, acceptability and safety of the intervention. The secondary outcomes will be the clinical outcomes regarding the effects of tai chi on the FSDSC and quality of life, which will be evaluated by the Brief Fatigue Inventory, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale and the Functional Assessment of Cancer Therapy-Breast questionnaires. ETHICS AND DISSEMINATION Ethics approval was obtained from relevant sites (H19094, KY2019133, 201932). The findings of the study will be published in peer-reviewed scientific journals and at conferences. TRAIL REGISTRATION NUMBER NCT04190342; Pre-results.
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Affiliation(s)
- Li-Qun Yao
- College of Nursing and Midwifery, CDU Brisbane Centre, Charles Darwin University, Brisbane, Queensland, Australia
| | - Jing-Yu Benjamin Tan
- College of Nursing and Midwifery, CDU Brisbane Centre, Charles Darwin University, Brisbane, Queensland, Australia
| | - Catherine Turner
- College of Nursing and Midwifery, CDU Brisbane Centre, Charles Darwin University, Brisbane, Queensland, Australia
| | - Tao Wang
- College of Nursing and Midwifery, CDU Brisbane Centre, Charles Darwin University, Brisbane, Queensland, Australia
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13
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Harrison RA, Sharafeldin N, Rexer JL, Streck B, Petersen M, Henneghan AM, Kesler SR. Neurocognitive Impairment After Hematopoietic Stem Cell Transplant for Hematologic Malignancies: Phenotype and Mechanisms. Oncologist 2021; 26:e2021-e2033. [PMID: 34156729 DOI: 10.1002/onco.13867] [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: 05/24/2020] [Accepted: 06/14/2021] [Indexed: 12/16/2022] Open
Abstract
Hematopoietic stem cell transplant (HSCT) plays a central role in the treatment of hematologic cancers. With the increasing survival of patients after HSCT, survivorship issues experienced by this population have become an important outcome. Cognitive impairment is an established sequela of HSCT, with studies to date establishing its presence, associated risk factors, and clinical phenotype. There are multiple potential contributors to cognitive impairment after HSCT. Efforts are ongoing to further characterize its clinical phenotype, associated biomarkers, and biologic underpinnings. A fundamental knowledge of post-HSCT cognitive impairment is of value for all clinicians who interface with this population, and further academic efforts are needed to more fully understand the impact of this cancer treatment on brain health. IMPLICATIONS FOR PRACTICE: As survival outcomes after hematopoietic stem cell transplant (HSCT) improve, an awareness of the post-treatment challenges faced by this population has become central to its care. HSCT can have a sustained and broad impact on brain health, causing cognitive dysfunction, fatigue, disturbed mood, and sleep. In affected patients, autonomy, return to work, relationships, and quality of life may all be affected. A fundamental fluency in this area is important for clinicians interfacing with HSCT survivors, facilitating the identification and management of cognitive dysfunction and concurrent symptom clusters, and stimulating interest in these sequelae as areas for future clinical research.
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Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Noha Sharafeldin
- Department of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennie L Rexer
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brennan Streck
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Melissa Petersen
- Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Ashley M Henneghan
- School of Nursing, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA.,Department of Oncology, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA
| | - Shelli R Kesler
- School of Nursing, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA.,Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA
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14
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Tabudlo JB. A Proposed Theory of Symptom Cluster Management. BELITUNG NURSING JOURNAL 2021; 7:78-87. [PMID: 37469941 PMCID: PMC10353591 DOI: 10.33546/bnj.1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 07/21/2023] Open
Abstract
Background Symptom cluster management is in its early stages in many chronic and debilitating illnesses. The development of a proposed theory should be an initial step in advancing this area of interest. Objective This article presents the development of a Proposed Theory of Symptom Cluster Management. Methods The concept analysis, statement synthesis, and theory synthesis by Walker and Avant were used in the development of this proposed theory. A search from July to September 2020 for published empirical and theoretical articles was conducted in scientific databases, expanded on the web, and secondary references from identified articles. Results The Proposed Theory of Symptom Cluster Management is both a descriptive and explanatory theory. The defining characteristics of symptom cluster management include the basic and effectiveness components. Antecedents for symptom cluster management include socio-demographic characteristics, symptom cluster characteristics, individual clinical characteristics, individual illness factors, and situational factors or symptom experience. The consequences are clustered as personal-related, health-related, social-related outcomes, and existential outcomes. Measurement tools for the antecedents and outcomes in symptom cluster management and the analytical and statistical strategies were considered. Relational statements were also identified. Theoretical assertions were advanced. Conclusion The Proposed Theory of Symptom Cluster Management may provide a holistic approach because it integrates both the symptom cluster and management strategies. The concepts, statements including the complete representation of the proposed theory identified in this article, may provide cues to policymakers and clinical researchers towards the development of tailored interventions and programs.
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Affiliation(s)
- Jerick B. Tabudlo
- University of the Philippines Manila, College of Nursing, Philippines
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15
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Beloni S, Arrigoni C, Dellafiore F, Diamanti O, Piredda A, Caruso R. Symptom clusters in cancer patients: An Italian survey to validate and describe unwarranted clinical variation, inequality in access to healthcare, knowledge, and risk of malpractice. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021015. [PMID: 33855990 PMCID: PMC8138803 DOI: 10.23750/abm.v92is2.11331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/04/2021] [Indexed: 12/09/2022]
Abstract
Background and aims: The perceptions of professionals involved in cancer care regarding the importance of their symptoms-specific knowledge, unwarranted clinical variation (UCV), and inequalities in access to healthcare are still underdescribed. This study aims to confirm the construct validity of a previously initially developed questionnaire and describe nurses’ perceptions about the relevance of their knowledge referred to cancer symptoms management, the UCV, the inequalities in access to healthcare, and malpractice risk. Method: A cross-sectional pan-national study was conducted using a convenience sample, collecting data through a previously initially validated questionnaire. Construct validity was corroborated through confirmatory factor analysis, and descriptive statistics were employed for summarizing the questionnaire’s scores. The scores between the nurses working in accredited cancer centers and nurses employed in general hospitals were inferentially compared. Results: The sample comprised 810 nurses, 480 were nurses working in accredited cancer centers, and 330 were nurses working in general hospitals. The questionnaire showed adequate construct validity and reliability. Nurses perceived the cluster of psychosocial symptoms with a greater risk of UCV and inequalities in access to cancer services than the cluster of physical symptoms. Discussion and conclusions: A paradigm shift aimed at integrating psychosocial cancer symptoms in the care paths emerged as pivotal for improving cancer care in Italy.
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Affiliation(s)
- Silvia Beloni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy .
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Orejeta Diamanti
- Research Nursing Centre, IRCCS Istituto Oncologico Veneto, Padova, Italy .
| | - Alessio Piredda
- Italian Association of Cancer Nurses, European Institute of Oncology, Milan, Italy .
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
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16
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Wiggenraad F, Bolam KA, Mijwel S, van der Wall E, Wengström Y, Altena R. Long-Term Favorable Effects of Physical Exercise on Burdensome Symptoms in the OptiTrain Breast Cancer Randomized Controlled Trial. Integr Cancer Ther 2021; 19:1534735420905003. [PMID: 32090630 PMCID: PMC7040931 DOI: 10.1177/1534735420905003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: We evaluate longitudinal changes in symptom clusters and core burdensome symptoms in breast cancer patients who participated in the OptiTrain trial. Methods: 240 women were randomized to 16 weeks of supervised exercise (RT-HIIT or AT-HIIT) or usual care (UC) during adjuvant chemotherapy. Symptom clusters were composed using the Memorial Symptom Assessment Scale (MSAS), assessed at baseline, 16 weeks and 12 months later. Three symptom clusters were formed. Results: Three symptom clusters were identified: "emotional," "treatment-related toxicity," and "physical," with core burdensome symptoms present over time. At 16 weeks, the reported burdens of "feeling sad" (RT-HIIT vs UC: effect size [ES] = -0.69; AT-HIIT vs UC: ES = -0.56) and "feeling irritable" (ES = -0.41 RT-HIIT; ES = -0.31 AT-HIIT) were significantly lower in both intervention groups compared with UC. At 12 months, the AT-HIIT group continued to have significantly lower scores for the core burdensome symptoms "feeling sad" (ES = -0.44), "feeling irritable" (ES = -0.44), and "changes in the way food tastes" (ES = -0.53) compared with UC. No between-group differences were found for physical symptoms. Conclusion: We identified 3 symptom clusters in breast cancer patients during and after adjuvant chemotherapy, composed of "emotional," "treatment-related toxicity," and "physical" symptoms. After treatment completion up to 12 months post-baseline, patients in the physical exercise groups reported lower symptom burden scores for emotional symptoms, compared with UC. Our findings indicate a preserved and long-term beneficial effect of physical exercise on self-reported emotional well-being in chemotherapy-treated breast cancer patients.
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Affiliation(s)
| | | | | | | | - Yvonne Wengström
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Renske Altena
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
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17
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The Influence of Multiple Chronic Conditions on Symptom Clusters in People With Solid Tumor Cancers. Cancer Nurs 2021; 45:E279-E290. [PMID: 33577204 PMCID: PMC8357857 DOI: 10.1097/ncc.0000000000000915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND People with cancer who also have multiple chronic conditions (MCCs) experience co-occurring symptoms known as symptom clusters. OBJECTIVE To describe MCC and symptom clusters in people with cancer and to evaluate the relationships between MCCs and symptom severity, symptom interference with daily life, and quality of life (QoL). METHODS Weekly over a 3-week chemotherapy cycle, 182 adults with solid tumor cancer receiving chemotherapy completed measures of symptom severity, symptom interference with daily life, and QoL. Medical records reviewed to count number of MCCs in addition to cancer. Exploratory factor analysis was performed to identify symptom clusters. The relationships between the number of MCCs and the outcomes (symptom severity and symptom interference with daily life and QoL) at each time point were examined using the χ2 test. Longitudinal changes in outcomes were examined graphically. RESULTS The number of MCCs ranged from 0 to 9, but most participants (62.1%) had 2 or fewer MCCs. Obesity was the most prevalent chronic condition. Four symptom clusters were identified: nutrition, neurocognitive, abdominal discomfort, and respiratory clusters. At each time point, no significant differences were found for MCCs and any outcome. However, symptom severity in all the symptom clusters, symptom interference with daily life, and QoL demonstrated a worsening in the week following chemotherapy. CONCLUSION A majority of our sample had 2 or fewer MCCs, and MCCs did contribute to patient outcomes. Rather, timing of chemotherapy cycle had the greatest influence of patient outcomes. IMPLICATIONS FOR PRACTICE Additional support on day 7 of chemotherapy treatment is needed for people with MCCs.
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18
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Zisberg A, Shulyaev K, Gur-Yaish N, Agmon M, Pud D. Symptom clusters in hospitalized older adults: Characteristics and outcomes. Geriatr Nurs 2020; 42:240-246. [PMID: 32891441 DOI: 10.1016/j.gerinurse.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
Hospital care in medical patients relies mostly on objective measures with limited assessment of subjective symptoms. We subgrouped 331 hospitalized older adults with medical diagnosis (age 75.5 ± 7.1) according to the severity of multiple symptoms to explore if these subgroups differed in health-related characteristics on admission and functional outcomes one month post-discharge. Cluster analysis identified three subgroups based on experiences with five highly distressing symptoms (fatigue, dyspnea, dizziness, sleep disturbance, pain): low levels of all symptoms, high levels of all symptoms; moderate levels of four symptoms with high dyspnea. Belonging in different subgroups was accompanied by different levels of cognitive and mental, but not physical or health status. Patients in the subgroup "Moderate Levels with High Dyspnea" had significantly lower risk of decline in post-discharge instrumental activities of daily living than other subgroups. Better understanding of older hospitalized adults' symptom profiles may yield important information on health condition and recovery.
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Affiliation(s)
- Anna Zisberg
- The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Israel.
| | - Ksenya Shulyaev
- The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Israel
| | | | - Maayan Agmon
- The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Israel
| | - Dorit Pud
- The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel, Israel.
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19
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Henneghan A, Wright ML, Bourne G, Sales AC. A Cross-Sectional Exploration of Cytokine-Symptom Networks in Breast Cancer Survivors Using Network Analysis. Can J Nurs Res 2020; 53:303-315. [PMID: 32482100 DOI: 10.1177/0844562120927535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of this study is to (a) visualize the symptom-cytokine networks (perceived stress, fatigue, loneliness, perceived cognitive impairment, daytime sleepiness, sleep quality, and 13 cytokines) and (b) explore centrality metrics of symptom-cytokine networks in breast cancer survivors who completed chemotherapy treatment. METHODS Cross-sectional analysis of data collected from 66 breast cancer survivors who were on average three years post chemotherapy completion. Perceived stress, fatigue, loneliness, perceived cognitive impairment, daytime sleepiness, and sleep quality were measured with self-report instruments, and a panel of 13 cytokines was measured from serum using multiplex assays. Symptoms and cytokines were simultaneously evaluated with correlations, network analysis, and community analysis. RESULTS Network analysis revealed the nodes with the greatest degree and closeness were interleukin-2, granulocyte-macrophage colony-stimulating factor, interleukin-13, and perceived cognitive impairment. Node betweenness was highest for perceived cognitive impairment and interleukin-2. Community analysis revealed two separate communities of nodes within the network (symptoms and the cytokines). Several edges connected the two communities including perceived cognitive impairment, stress, fatigue, depression, interleukin-2, granulocyte-macrophage colony-stimulating factor, interleukin-8, interleukin-13, and interleukin-10. Partial correlation analyses revealed significant negative relationships between interleukin-2 and fatigue, loneliness, stress, and perceived cognitive impairment (rs = -.27 to -.37, ps < .05) and a significant negative relationship between perceived cognitive impairment and granulocyte-macrophage colony-stimulating factor (r = -.34, p < .01). CONCLUSIONS Our analyses support that perceived cognitive impairment, stress, loneliness, depressive symptoms, and fatigue co-occur and extend the literature by suggesting that interleukin-2 may contribute to the underlying mechanistic pathway of these co-occurring symptoms. Our findings add to a growing body of literature that is shifting to study symptoms as they co-occur, or cluster, rather than individual symptoms.
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Affiliation(s)
- Ashley Henneghan
- Livestrong Cancer Institute, School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Michelle L Wright
- School of Nursing, Dell Medical School, University of Texas at Austin, Austin, TX, USA.,Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Garrett Bourne
- Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Adam C Sales
- Statistics, Measurement, and Research Design Techniques in Educational Research, University of Texas at Austin College of Education, Austin, TX, USA
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20
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Bjerkeset E, Röhrl K, Schou-Bredal I. Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics. Breast Cancer Res Treat 2020; 180:63-71. [PMID: 31938939 PMCID: PMC7031174 DOI: 10.1007/s10549-020-05522-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/04/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Breast cancer survivors may experience pain, fatigue, or psychological distress as a result of the treatment. These symptoms may co-occur and form a cluster. However little is known about symptom clusters (SCs) in long-term breast cancer survivors. This study aimed to identify subgroups of breast cancer survivors with the SC of pain, fatigue, and psychological distress, and to examine sociodemographic and clinical characteristics associated with this SC. METHODS Data were obtained from a nationwide survey of breast cancer survivors (N = 834). Exhaustive enumeration of possible combination of the three binary variables (pain, fatigue, psychological distress) was conducted. They were identified using the recommended threshold for the Hospital Anxiety and Depression Scale, the Fatigue Questionnaire, and a score of one or more on a numeric rating scale for pain. The SC was defined to include all the three variables, all other combinations were defined as no SC. Logistic regression analyses were conducted to examine the association between sociodemographic and clinical variables and the SC. RESULTS Of the 834 survivors, 13% had the SC. Younger age (OR 2.3, 95% CI 1.3-4.1, p = 0.003), lymphedema (OR 1.9, 95% CI 1.1-3.2, p = 0.02), working part-time (OR 2.9, 95% CI 1.6-5.3, p < 0.001), or being disabled (OR 4.1, 95% CI 2.2-7.8, p < 0.001) were all associated with the SC. CONCLUSION Thirteen percent of the survivors experienced the SC. It appears that premenstrual women are at greater risk, than postmenopausal women. Having this SC might have an impact on the survivors' ability to work.
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Affiliation(s)
- Ellen Bjerkeset
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Kari Röhrl
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Inger Schou-Bredal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
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21
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Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics. Breast Cancer Res Treat 2020. [PMID: 31938939 DOI: 10.1007/s10549‐020‐05522‐8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE Breast cancer survivors may experience pain, fatigue, or psychological distress as a result of the treatment. These symptoms may co-occur and form a cluster. However little is known about symptom clusters (SCs) in long-term breast cancer survivors. This study aimed to identify subgroups of breast cancer survivors with the SC of pain, fatigue, and psychological distress, and to examine sociodemographic and clinical characteristics associated with this SC. METHODS Data were obtained from a nationwide survey of breast cancer survivors (N = 834). Exhaustive enumeration of possible combination of the three binary variables (pain, fatigue, psychological distress) was conducted. They were identified using the recommended threshold for the Hospital Anxiety and Depression Scale, the Fatigue Questionnaire, and a score of one or more on a numeric rating scale for pain. The SC was defined to include all the three variables, all other combinations were defined as no SC. Logistic regression analyses were conducted to examine the association between sociodemographic and clinical variables and the SC. RESULTS Of the 834 survivors, 13% had the SC. Younger age (OR 2.3, 95% CI 1.3-4.1, p = 0.003), lymphedema (OR 1.9, 95% CI 1.1-3.2, p = 0.02), working part-time (OR 2.9, 95% CI 1.6-5.3, p < 0.001), or being disabled (OR 4.1, 95% CI 2.2-7.8, p < 0.001) were all associated with the SC. CONCLUSION Thirteen percent of the survivors experienced the SC. It appears that premenstrual women are at greater risk, than postmenopausal women. Having this SC might have an impact on the survivors' ability to work.
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22
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Choe YH, Kim SH, Oh HS, Seo WS, Lee SH. Chemotherapy-induced Peripheral Neuropathy in Patients with Breast Cancer: Associated Factors and Impact on Health-Related Quality of Life. ASIAN ONCOLOGY NURSING 2020. [DOI: 10.5388/aon.2020.20.2.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yu Hyeon Choe
- Department of Nursing, Inha University, Incheon, Korea
| | - Soo Hyun Kim
- Department of Nursing, Inha University, Incheon, Korea
| | - Hyun Soo Oh
- Department of Nursing, Inha University, Incheon, Korea
| | - Wha Sook Seo
- Department of Nursing, Inha University, Incheon, Korea
| | - Sun Hee Lee
- Department of Nursing, Chodang University, Muan, Korea
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Roles of biological and psychosocial factors in experiencing a psychoneurological symptom cluster in cancer patients. Eur J Oncol Nurs 2019; 42:97-102. [PMID: 31479847 DOI: 10.1016/j.ejon.2019.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/31/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE (a) To identify subgroups with unique psychoneurological symptom-cluster experience (depression, cognitive impairment, fatigue, sleep disturbance, and pain) and (b) to examine whether the selected demographic, clinical, psychological, and biological factors determine a symptom-cluster experience in cancer patients. METHOD The sample included 203 patients with diverse cancer types recruited from a Korean university hospital. Latent profile analyses were conducted to identify subgroups. Influencing factors of subgroup membership (demographic/clinical variables, hemoglobin level, social support, and psychological stress) were included as covariates in latent profile analysis and analyzed by multinomial logistic regression. RESULTS Latent profile analyses classified patients into two subgroups with a unique symptom cluster experience: patients experiencing high intensity in all symptoms within the cluster (the all-high-symptom subgroup, 71%) and patients experiencing low intensity in all symptoms within the cluster (all-low-symptom subgroup, 29%). The validity of the two subgroups was confirmed by the group classification accuracy (97% of the all-low-symptom subgroup and 99% of the all-high-symptom subgroup) and by significant Wald's mean equality tests, showing each symptom (depression, cognitive impairment, fatigue, sleep disturbance, and pain) significantly differentiated the two subgroups (ps < .001). Psychological stress independently determined the subgroup membership. Patients with high levels of stress were more likely to be in the all-high-symptom group (OR = 4.69, p < .0001). Hemoglobin level, cancer diagnosis, social support, and previous chemotherapy experience did not influence group membership. CONCLUSIONS A large number of patients experience five psychoneurological symptoms simultaneously due to psychological stress. Interventions targeted to stress would be beneficial for those patients.
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Yoon HG, Park H. The effect of auricular acupressure on sleep in breast cancer patients undergoing chemotherapy: A single-blind, randomized controlled trial. Appl Nurs Res 2019; 48:45-51. [DOI: 10.1016/j.apnr.2019.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/28/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Ammitzbøll G, Kristina Kjær T, Johansen C, Lanng C, Wreford Andersen E, Kroman N, Zerahn B, Hyldegaard O, Envold Bidstrup P, Oksbjerg Dalton S. Effect of progressive resistance training on health-related quality of life in the first year after breast cancer surgery - results from a randomized controlled trial. Acta Oncol 2019; 58:665-672. [PMID: 30702006 DOI: 10.1080/0284186x.2018.1563718] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aims: To examine the effect of progressive resistance training (PRT) on health related quality of life and a predefined symptom cluster of pain-sleep-fatigue. Methods: This study was a planned secondary analysis of a randomized controlled trial examining the effect of PRT on prevention of arm lymphedema in a population of women between 18 and 75 years undergoing breast cancer surgery with axillary lymph node dissection. Participants were allocated by computer randomization to usual care control or a PRT intervention in a 1:1 ratio. The intervention, initiated in the third post-operative week, consisted of three times PRT per week, supervised in groups in the first 20 weeks, and self-administered in the following 30 weeks. Questionnaire assessments were made at baseline, 20 weeks and 12 months, with the European Organization for Research and Treatment in Cancer Core questionnaire (EORTC QLQ C30) and the Functional Assessment of Chronic Illness Therapy-(FACIT) fatigue questionnaire. The symptom cluster of pain-sleep-fatigue was measured with a constructed score adding EORTC C30 subscales of insomnia, pain, and fatigue. Data were treated as repeated measurements and analyzed with mixed models. Results: Among 158 recruited participants, we found a clinically relevant increased emotional functioning with nine points at both follow-ups (p = .02), and 16 and 11 points at 20 weeks and 12 months respectively (p = .04) in social functioning. Furthermore, in the subgroup of women with the symptom cluster pain-sleep-fatigue present at baseline, a significant effect was found for global health status (p = .01) and social functioning (p = .02). Conclusion: To our knowledge, this is the first study to report clinically relevant effects of PRT on social and emotional functioning in the first postoperative year after breast cancer surgery. Furthermore, a subgroup of women with the pain-sleep-fatigue symptom cluster had particular benefit from PRT on global health status and social functioning.
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Affiliation(s)
- Gunn Ammitzbøll
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Christoffer Johansen
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
- CASTLE Late Effects Unit, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Lanng
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | | | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Danish Cancer Society, Copenhagen, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Ole Hyldegaard
- Section for Hyperbaric Oxygen Treatment, Department for Anaesthetics and Operations, Center for Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Tometich DB, Small BJ, Carroll JE, Zhai W, Luta G, Zhou X, Kobayashi LC, Ahles T, Saykin AJ, Clapp JD, Jim HSL, Jacobsen PB, Hurria A, Graham D, McDonald BC, Denduluri N, Extermann M, Isaacs C, Dilawari A, Root J, Rini C, Mandelblatt JS. Pretreatment Psychoneurological Symptoms and Their Association With Longitudinal Cognitive Function and Quality of Life in Older Breast Cancer Survivors. J Pain Symptom Manage 2019; 57:596-606. [PMID: 30472317 PMCID: PMC6382533 DOI: 10.1016/j.jpainsymman.2018.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
CONTEXT Symptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied. OBJECTIVES The objectives of this study were to identify prototypical presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time. METHODS Women with newly diagnosed nonmetastatic breast cancer (n = 319) and matched noncancer controls (n = 347) aged 60+ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancer-specific QOL) by group, controlling for covariates. RESULTS Nearly one-fifth of older survivors were classified as having high pretherapy symptoms (n = 51; 16%); the remainder had low symptoms (n = 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancer-specific QOL at all time points (all P < 0.05). CONCLUSION Nearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention.
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Affiliation(s)
- Danielle B Tometich
- Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
| | - Brent J Small
- Moffitt Cancer Center, Tampa, Florida, USA; University of South Florida, Tampa, Florida, USA
| | - Judith E Carroll
- University of California Los Angeles and Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Wanting Zhai
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - George Luta
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Xingtao Zhou
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Lindsay C Kobayashi
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Tim Ahles
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Andrew J Saykin
- Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | - Jonathan D Clapp
- University of South Florida, Tampa, Florida, USA; Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | | | | | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Brenna C McDonald
- Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | | | | | - Claudine Isaacs
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Asma Dilawari
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - James Root
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Christine Rini
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA; John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Jeanne S Mandelblatt
- Georgetown University and Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
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Burrell SA, Yeo TP, Smeltzer SC, Leiby BE, Lavu H, Kennedy EP, Yeo CJ. Symptom Clusters in Patients With Pancreatic Cancer Undergoing Surgical Resection: Part I. Oncol Nurs Forum 2018; 45:E36-E52. [PMID: 29947349 DOI: 10.1188/18.onf.e36-e52] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe patient-reported symptoms and symptom clusters in patients with pancreatic cancer (PC) undergoing surgical resection. SAMPLE & SETTING 143 patients with stage II PC undergoing surgical resection alone or with subsequent adjuvant chemoradiation or chemotherapy were recruited to participate in a nested, longitudinal, exploratory study through convenience sampling techniques from Thomas Jefferson University Hospital, a National Cancer Institute-designated cancer center. METHODS & VARIABLES The Functional Assessment in Cancer Therapy-Hepatobiliary questionnaire was used to assess 17 PC symptoms preoperatively and at three, six, and nine months postoperatively. Exploratory and confirmatory factor analyses were used to identify symptom clusters. RESULTS Fatigue, trouble sleeping, poor appetite, trouble digesting food, and weight loss were consistently reported as the most prevalent and severe symptoms. Sixteen distinct symptom clusters were identified within nine months of surgery. Four core symptom clusters persisted over time. IMPLICATIONS FOR NURSING Findings may be used to provide anticipatory patient and family guidance and to inform clinical assessments of symptoms and symptom clusters in this population.
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Abstract
Symptoms of complex illnesses such as cancer often present with a high degree of heterogeneity between patients. At the same time, there are often core symptoms that act as common drivers for other symptoms, such as fatigue leading to depression and cognitive dysfunction. These symptoms are termed bridge symptoms and when combined with heterogeneity in symptom presentation, are difficult to detect using traditional unsupervised clustering techniques. This article develops a method for identifying patient communities based on bridge symptoms termed concordance network clustering. An empirical study of breast cancer symptomatology is presented, and demonstrates the applicability of this method for identifying bridge symptoms.
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Financial toxicity and symptom burden: what is the big deal? Support Care Cancer 2018; 26:1357-1359. [DOI: 10.1007/s00520-018-4092-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
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Im EO, Hu Y, Cheng CY, Ko Y, Chee E, Chee W. Clusters of midlife women identified by cognitive symptoms. Maturitas 2018; 110:33-40. [PMID: 29563033 DOI: 10.1016/j.maturitas.2018.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/23/2017] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The study aimed to identify clusters of midlife women by their cognitive symptoms and to examine racial/ethnic differences in the clusters. STUDY DESIGN This secondary analysis was conducted on the data from 1054 midlife women of multi-ethnic groups in two Internet studies (conducted from 2005 to 2013). MAIN OUTCOME MEASURES Only the data from the questions on background characteristics, health status, and menopausal status and the Cognitive Symptom Index for Midlife Women were used for this secondary analysis. The data were analyzed using factor analyses, hierarchical cluster analyses, chi-square tests, multinomial logistic analyses, and analyses of covariance. RESULTS Four clusters were extracted: the low total symptom group (Cluster 1; 49.9%), the low-moderate total symptom group with high tertiary symptoms (Cluster 2; 17.3%), the high-moderate total symptom group with low tertiary symptoms (Cluster 3; 21.2%); and the high total symptom group (Cluster 4; 11.7%). There were significant differences in the level of education, employment status, family income, marital status, social support, the country of birth, race/ethnicity, body mass index, perceived general health, diagnosed disease(s), access to health care, and menopausal status among the clusters (p < .01). There were significant racial/ethnic differences in the total numbers and total severity scores of tertiary symptoms in Cluster 1. Also, there were significant racial/ethnic differences in individual symptoms in each cluster. CONCLUSIONS Racial/ethnic differences in midlife women's cognitive symptoms and multiple factors that might differently influence their cognitive symptoms need to be considered in health care for midlife women in menopausal transition.
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Affiliation(s)
- Eun-Ok Im
- Duke University, School of Nursing, 307 Trent Dr., Durham, NC, 27710.
| | - Yun Hu
- Duke University, School of Nursing, 307 Trent Dr., Durham, NC, 27710; Shanghai Jia Tong University, South Chongqing Road, NO. 227, Building 1, 209, Shanghai.
| | - Ching-Yu Cheng
- Duke University, School of Nursing, 307 Trent Dr., Durham, NC, 27710; Chang Gung University of Science and Technology, 261 We-hua 1st Road, Kwei-shan, Tao-yuan, Taiwan.
| | - Young Ko
- Gachon University, School of Nursing, Incheon, South Korea.
| | - Eunice Chee
- North Carolina State University, School of Engineering, Biomedical Engineering Department, Engineering Building III, 911 Oval Drive, Campus Box 7115, Raleigh, NC 27695.
| | - Wonshik Chee
- Duke University, School of Nursing, 307 Trent Dr., Durham, NC, 27710.
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Mazor M, Cataldo JK, Lee K, Dhruva A, Cooper B, Paul SM, Topp K, Smoot BJ, Dunn LB, Levine JD, Conley YP, Miaskowski C. Differences in symptom clusters before and twelve months after breast cancer surgery. Eur J Oncol Nurs 2017; 32:63-72. [PMID: 29353634 DOI: 10.1016/j.ejon.2017.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/25/2017] [Accepted: 12/08/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Given the inter-relatedness among symptoms, research efforts are focused on an evaluation of symptom clusters. The purposes of this study were to evaluate for differences in the number and types of menopausal-related symptom clusters assessed prior to and at 12-months after surgery using ratings of occurrence and severity and to evaluate for changes in these symptom clusters over time. METHODS Prior to and at 12 months after surgery, 392 women with breast cancer completed the Menopausal Symptoms Scale. Exploratory factor analyses were used to identify the symptom clusters. RESULTS Of the 392 women evaluated, the mean number of symptoms (out of 46) was 13.2 (±8.5) at enrollment and 10.9 (±8.2) at 12 months after surgery. Using occurrence and severity, three symptom clusters were identified prior to surgery. Five symptom clusters were identified at 12 months following surgery. Two symptom clusters (i.e., pain/discomfort and hormonal) were relatively stable across both dimensions and time points. Two symptom clusters were relatively stable across both dimensions either prior to surgery (i.e., sleep/psychological/cognitive) or at 12 months after surgery (i.e., sleep). The other four clusters (i.e., irritability, psychological/cognitive, cognitive, psychological) were identified at one time point using a single dimension. CONCLUSIONS While some menopausal-related symptom clusters were consistent across time and dimensions, the majority of symptoms clustered together differently depending on whether they were evaluated prior to or at 12 months after breast cancer surgery. An increased understanding of how symptom clusters change over time may assist clinicians to focus their symptom assessments and management strategies.
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Affiliation(s)
- Melissa Mazor
- School of Nursing, University of California, San Francisco, CA, United States
| | - Janine K Cataldo
- School of Nursing, University of California, San Francisco, CA, United States
| | - Kathryn Lee
- School of Nursing, University of California, San Francisco, CA, United States
| | | | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, United States
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, United States
| | | | | | - Laura B Dunn
- School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
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Abstract
Theories and conceptual models can be thought of as broad nets that attempt to rationalize, explain, and master a phenomenon within clinical nursing and interdisciplinary care. They can be used to guide a review of the literature and to formulate and organize research variables and relationships. Gaps in the literature can be identified and opportunities for additional research revealed (Fawcett, 2005). A variety of symptom models or theories exist, including the Theory of Symptom Management (Dodd et al., 2001), Theory of Unpleasant Symptoms (Lenz, Pugh, Milligan, Gift, & Suppe, 1997), Symptoms Experience Model (Armstrong, 2003), and Symptom Experiences in Time Theory (Henly, Kallas, Klatt, & Swenson, 2003). Most recently, the National Institute of Nursing Research identified a new National Institutes of Health Symptom Science Model to guide symptom science research (Cashion & Grady, 2015).
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Ji YB, Bo CL, Xue XJ, Weng EM, Gao GC, Dai BB, Ding KW, Xu CP. Association of Inflammatory Cytokines With the Symptom Cluster of Pain, Fatigue, Depression, and Sleep Disturbance in Chinese Patients With Cancer. J Pain Symptom Manage 2017; 54:843-852. [PMID: 28797869 DOI: 10.1016/j.jpainsymman.2017.05.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/30/2017] [Accepted: 05/25/2017] [Indexed: 02/01/2023]
Abstract
CONTEXT Pain, fatigue, depression, and sleep disturbance are common in patients with cancer and usually co-occur as a symptom cluster. However, the mechanism underlying this symptom cluster is unclear. OBJECTIVES This study aimed to identify subgroups of cluster symptoms, compare demographic and clinical characteristics between subgroups, and examine the associations between inflammatory cytokines and cluster symptoms. METHODS Participants were 170 Chinese inpatients with cancer from two tertiary hospitals. Inflammatory markers including interleukin-6 (IL-6), interleukin-1 receptor antagonist, and tumor necrosis factor alpha were measured. Intergroup differences and associations of inflammatory cytokines with the cluster symptoms were examined with one-way analyses of variance and logistic regression. RESULTS Based on cluster analysis, participants were categorized into Subgroup 1 (all low symptoms), Subgroup 2 (low pain and moderate fatigue), or Subgroup 3 (moderate-to-high on all symptoms). The three subgroups differed significantly in Eastern Cooperative Oncology Group (ECOG) performance status, sex, residence, current treatment, education, economic status, and inflammatory cytokines levels (all P < 0.05). Compared with Subgroup 1, Subgroup 3 had a significantly poorer ECOG physical performance status and higher IL-6 levels, were more often treated with combined chemoradiotherapy, and were more likely to be rural residents. IL-6 and ECOG physical performance status were significantly associated with 1.246-fold (95% CI 1.114-1.396) and 31.831-fold (95% CI 6.017-168.385) increased risk of Subgroup 3. CONCLUSION Our findings suggest that IL-6 levels are associated with cluster symptoms in cancer patients. Clinicians should identify patients at risk for more severe symptoms and formulate novel target interventions to improve symptom management.
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Affiliation(s)
- Yan-Bo Ji
- Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, China
| | - Chun-Lu Bo
- School of Nursing, Cheeloo Health Science Center, Shandong University, Jinan, Shandong Province, China
| | - Xiu-Juan Xue
- Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, China
| | - En-Ming Weng
- Yanggu No. 2 People's Hospital, Liaocheng, Shandong Province, China
| | - Guang-Chao Gao
- School of Nursing, Taishan Medical College, Tai'an, Shandong Province, China
| | - Bei-Bei Dai
- School of Nursing, Taishan Medical College, Tai'an, Shandong Province, China
| | - Kai-Wen Ding
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Cui-Ping Xu
- Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, China.
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Carrillo-González GM. Los grupos de síntomas en personas con cáncer: una revisión integrativa. AQUICHAN 2017. [DOI: 10.5294/aqui.2017.17.3.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: explorar el estado actual de desarrollo investigativo del área temática de grupos de síntomas en adultos con cáncer. Método: revisión integrativa de producción científica generada entre 2001 y 2016. Se incluyeron 61 artículos por su aporte en la comprensión del área temática. Resultados: el estudio de los grupos de síntomas en personas con cáncer se consolida como un área temática novedosa, pertinente y necesaria para la investigación y práctica de enfermería en oncología, con tendencias y retos que incluyen: (1) El desarrollo de marcos conceptuales que aporten a la fundamentación, atributos y efectos (2) La determinación de métodos y formas de crearlos y clasificarlos (3) La generación de estudios con poblaciones específicas por tipos de cáncer y tratamiento y la consolidación de intervenciones de enfermería. Conclusiones: los pacientes con cáncer experimentan múltiples síntomas de forma simultánea durante las distintas fases de la enfermedad. Es incipiente el estudio de este fenómeno, los retos para la enfermería se centran en la generación de respuestas que alivien la carga de los grupos de síntomas y mejoren la calidad de vida de estos pacientes. Es necesario validar escalas de carga del síntoma y explorar los grupos de síntomas incluyendo variables clínicas ligadas a los tratamientos oncológicos.
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Avis NE, Levine B, Marshall SA, Ip EH. Longitudinal Examination of Symptom Profiles Among Breast Cancer Survivors. J Pain Symptom Manage 2017; 53:703-710. [PMID: 28042076 PMCID: PMC5373990 DOI: 10.1016/j.jpainsymman.2016.10.366] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/20/2016] [Accepted: 10/30/2016] [Indexed: 01/05/2023]
Abstract
CONTEXT Identification of cancer patients with similar symptom profiles may facilitate targeted symptom management. OBJECTIVES To identify subgroups of breast cancer survivors based on differential experience of symptoms, examine change in subgroup membership over time, and identify relevant characteristics and quality of life (QOL) among subgroups. METHODS Secondary analyses of data from 653 breast cancer survivors recruited within eight months of diagnosis who completed questionnaires at five time points. Hidden Markov modeling was used to 1) formulate symptom profiles based on prevalence and severity of eight symptoms commonly associated with breast cancer and 2) estimate probabilities of changing subgroup membership over 18 months of follow-up. Ordinal repeated measures were used to 3) identify patient characteristics related to subgroup membership and 4) evaluate the relationship between symptom subgroup and QOL. RESULTS A seven-subgroup model provided the best fit: 1) low symptom burden, 2) mild fatigue, 3) mild fatigue and mild pain, 4) moderate fatigue and moderate pain, 5) moderate fatigue and moderate psychological, 6) moderate fatigue, mild pain, mild psychological, and 7) high symptom burden. Seventy percent of survivors remained in the same subgroup over time. In multivariable analyses, chemotherapy and greater illness intrusiveness were significantly related to greater symptom burden, while not being married or partnered, no difficulty paying for basics, and greater social support were protective. Higher symptom burden was associated with lower QOL. Survivors who reported psychological symptoms had significantly lower QOL than did survivors with pain symptoms. CONCLUSION Cancer survivors can be differentiated by their symptom profiles.
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Affiliation(s)
- Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | - Beverly Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sarah A Marshall
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Edward H Ip
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Miaskowski C, Barsevick A, Berger A, Casagrande R, Grady PA, Jacobsen P, Kutner J, Patrick D, Zimmerman L, Xiao C, Matocha M, Marden S. Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations. J Natl Cancer Inst 2017; 109:2581261. [PMID: 28119347 PMCID: PMC5939621 DOI: 10.1093/jnci/djw253] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/25/2016] [Accepted: 09/28/2016] [Indexed: 12/17/2022] Open
Abstract
An overview of proceedings, findings, and recommendations from the workshop on "Advancing Symptom Science Through Symptom Cluster Research" sponsored by the National Institute of Nursing Research (NINR) and the Office of Rare Diseases Research, National Center for Advancing Translational Sciences, is presented. This workshop engaged an expert panel in an evidenced-based discussion regarding the state of the science of symptom clusters in chronic conditions including cancer and other rare diseases. An interdisciplinary working group from the extramural research community representing nursing, medicine, oncology, psychology, and bioinformatics was convened at the National Institutes of Health. Based on expertise, members were divided into teams to address key areas: defining characteristics of symptom clusters, priority symptom clusters and underlying mechanisms, measurement issues, targeted interventions, and new analytic strategies. For each area, the evidence was synthesized, limitations and gaps identified, and recommendations for future research delineated. The majority of findings in each area were from studies of oncology patients. However, increasing evidence suggests that symptom clusters occur in patients with other chronic conditions (eg, pulmonary, cardiac, and end-stage renal disease). Nonetheless, symptom cluster research is extremely limited and scientists are just beginning to understand how to investigate symptom clusters by developing frameworks and new methods and approaches. With a focus on personalized care, an understanding of individual susceptibility to symptoms and whether a "driving" symptom exists that triggers other symptoms in the cluster is needed. Also, research aimed at identifying the mechanisms that underlie symptom clusters is essential to developing targeted interventions.
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Affiliation(s)
- Christine Miaskowski
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Andrea Barsevick
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Ann Berger
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Rocco Casagrande
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Patricia A. Grady
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Paul Jacobsen
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Jean Kutner
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Donald Patrick
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Lani Zimmerman
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Canhua Xiao
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Martha Matocha
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
| | - Sue Marden
- Affiliations of authors: School of Nursing, University of California, San Francisco, San Francisco, CA (CM); College of Medicine, Thomas Jefferson University, Philadelphia, PA (ABa); University of Nebraska Medical Center, Center for Nursing Science-Omaha Division, Omaha, NE (ABe); Gryphon Scientific, Takoma Park, MD (RC); National Institute of Nursing Research, Bethesda, MD (PAG, MM, SM); Moffitt Cancer Center and Research Institute, Tampa, FL (PJ); School of Medicine, University of Colorado, Aurora, CO (JK); School of Public Health and Community Medicine, University of Washington, Seattle, WA (DP); University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, NE (LZ); School of Nursing, Emory University, Atlanta, GA (CX)
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The Relationship Between Inflammatory Biomarkers and Symptom Distress in Lung Cancer Patients Undergoing Chemotherapy. Cancer Nurs 2017; 40:E1-E8. [DOI: 10.1097/ncc.0000000000000369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Heinze SB, Williams PD. Symptom alleviation and self-care among breast cancer survivors after treatment completion. Clin J Oncol Nurs 2016; 19:343-9. [PMID: 26000584 DOI: 10.1188/15.cjon.343-349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This article elucidates the symptom experiences of breast cancer survivors after completion of their treatment. It also provides self reports of the types, frequency of use, and effectiveness of self-care measures to treat the symptoms they are experiencing. OBJECTIVES The purpose of this article is to describe the self-care strategies used to alleviate symptoms reported by breast cancer survivors recruited from a secure state coalition database. METHODS The Therapy-Related Symptom Checklist (TRSC) was used to identify the occurrence and severity of ongoing symptoms in breast cancer survivors who were six months or more post-treatment. Two groups were identified for further exploration of self-care. FINDINGS The self-care method category most commonly reported was diet/nutrition/lifestyle and the least common category was herbs/vitamins/complementary therapy. With few exceptions, the reported methods were perceived as effective.
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Abstract
OBJECTIVES To discuss the importance of cancer symptom clusters in clinical practice, review evidence for symptom cluster interventions, and make recommendations for symptom cluster identification, patient education, and management in clinical practice. DATA SOURCES Primary research and review articles identified through CINAHL, PubMed, and PsycINFO databases. CONCLUSION Several studies have investigated interventions for multi-symptom management or have evaluated the secondary effects of a single-symptom intervention on related symptoms. To date, only five studies have tested an intervention designed to manage a specific cancer symptom cluster. Those studies used nonpharmacologic approaches (psycho-education, cognitive-behavioral strategies, and acupressure) to address the pain, fatigue, and sleep disturbance symptom cluster, or the respiratory distress symptom cluster with some initial evidence of success. Further development and efficacy testing of symptom cluster interventions is needed. IMPLICATIONS FOR NURSING PRACTICE Clinical practice can be guided by knowledge of individual and multi-symptom management, and clinical judgment regarding possible etiologies of cancer symptom clusters. Clinicians should be aware of co-occurring symptoms in their patients, educate and involve patients in identifying symptom clusters and aggravating/alleviating factors, and coordinate treatment recommendations using strategies that are likely to be beneficial across symptoms.
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Symptom Clusters in Korean Patients With Metastatic Cancer Undergoing Palliative Chemotherapy. J Hosp Palliat Nurs 2016. [DOI: 10.1097/njh.0000000000000240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jain S, Boyd C, Fiorentino L, Khorsan R, Crawford C. Are there efficacious treatments for treating the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients? A Rapid Evidence Assessment of the Literature (REAL(©)). BREAST CANCER-TARGETS AND THERAPY 2015; 7:267-91. [PMID: 26379445 PMCID: PMC4567232 DOI: 10.2147/bctt.s25014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose While fatigue, sleep disturbance, and depression often co-occur in breast cancer patients, treatment efficacy for this symptom cluster is unknown. A systematic review was conducted to determine whether there are specific interventions (ie, medical, pharmacological, behavioral, psychological, and complementary medicine approaches) that are effective in mitigating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients, using the Rapid Evidence Assessment of the Literature (REAL©) process. Methods Peer-reviewed literature was searched across multiple databases; from database inception – October 2011, using keywords pre-identified to capture randomized controlled trials (RCT) relevant to the research question. Methodological bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) 50 checklist. Confidence in the estimate of effect and assessment of safety were also evaluated across the categories of included interventions via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. Results The initial search yielded 531 citations, of which 41 met the inclusion criteria. Of these, twelve RCTs reported on all three symptoms, and eight of these were able to be included in the GRADE analysis. The remaining 29 RCTs reported on two symptoms. Studies were of mixed quality and many were underpowered. Overall, results suggest that there is: 1) promising evidence for the effectiveness of various treatment types in mitigating sleep disturbance in breast cancer patients; 2) mixed evidence for fatigue; 3) little evidence for treating depression; and 4) no clear evidence that treatment of one symptom results in effective treatment for other symptoms. Conclusion More high-quality studies are needed to determine the impact of varied treatments in mitigating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients. Furthermore, we encourage future studies to examine the psychometric and clinical validity of the hypothesized relationship between the symptoms in the fatigue–sleep disturbance–depression symptom cluster.
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Affiliation(s)
- Shamini Jain
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Lavinia Fiorentino
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Langford DJ, Paul SM, Cooper B, Kober KM, Mastick J, Melisko M, Levine JD, Wright F, Hammer MJ, Cartwright F, Lee KA, Aouizerat BE, Miaskowski C. Comparison of subgroups of breast cancer patients on pain and co-occurring symptoms following chemotherapy. Support Care Cancer 2015; 24:605-614. [DOI: 10.1007/s00520-015-2819-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/15/2015] [Indexed: 01/17/2023]
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Chen ML, Liu LN, Miaskowski C, Chen SC, Lin YC, Wang JS. Presurgical symptom profiles predict quality of life 2 years after surgery in women with breast cancer. Support Care Cancer 2015; 24:243-251. [PMID: 26014617 DOI: 10.1007/s00520-015-2784-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/17/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Higher symptom burden in oncology patients is associated with poorer quality of life (QOL). However, the long-term predictive relationship between pre-treatment symptom profiles and QOL is unknown. The aim of this study was to identify subgroups of breast cancer patients based on their presurgical symptom profiles and to examine the predictive effect of group membership on QOL 2 years after surgery. METHODS Data were analyzed from a longitudinal study of women's (N = 198) symptoms after breast cancer surgery. Patient subgroups were identified by latent class analysis based on presurgical severity of five symptoms (i.e., attentional and physical fatigue, sleep disturbance, depression, and anxiety). Among these 198 women, quality of life 2 years after surgery was available for 97. Group differences in QOL were examined by general linear models. RESULTS We identified four distinct patient groups. Group A (All Low) had low levels of all symptoms. Group B (Low Fatigue and Moderate Mood) was characterized by low attentional and physical fatigue but moderate sleep disturbance, depression, and anxiety. Group C (All Moderate) was characterized by moderate levels of all five symptoms. Group D was characterized by moderate attentional and physical fatigue and severe sleep disturbance, depression, and anxiety (Moderate Fatigue and High Mood). Group D had significantly lower overall QOL scores 2 years after surgery than Group A (p = 0.002). CONCLUSIONS Breast cancer patients' presurgical symptom profile had a long-term predictive effect on QOL. Routine assessment of patients' pre-treatment symptom is suggested to identify high risk group.
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Affiliation(s)
- Mei-Ling Chen
- Graduate Institute of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan.
| | - Li-Ni Liu
- Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Shin-Cheh Chen
- Department of Surgery, Chang Gung Memorial Hospital and School of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yung-Chang Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital and School of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Jong-Shyan Wang
- Department of Rehabilitation Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Transitions in Symptom Cluster Subgroups Among Men Undergoing Prostate Cancer Radiation Therapy. Cancer Nurs 2015; 39:3-11. [PMID: 25730597 DOI: 10.1097/ncc.0000000000000236] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prostate cancer is a common type of cancer worldwide and in the United States. However, little information has been reported on the symptoms of men over time who receive radiation therapy. OBJECTIVE The objectives of this study were to identify subgroups of men at pre- and post-radiation therapy on general and treatment-related symptoms and to determine transitions in subgroup membership over time. METHODS Men (n = 84) receiving radiation therapy completed questionnaires on fatigue, insomnia, pain, depression, anxiety, and sexual, urinary, and bowel problems at pretreatment and posttreatment. Latent class analysis identified subgroups. One-way analyses of variance determined subgroups differed on symptoms, participant characteristics, and quality of life. Latent transition analysis examined subgroup transitions over time. RESULTS At pretreatment, 4 subgroups were identified: resilient group, with little to no symptom reporting; adjusted group, with moderately high treatment-related symptoms, low insomnia, depression, and anxiety; distressed group, consistently high on most symptoms; and emerging group, with moderately high fatigue, depression, and anxiety with few treatment-related symptoms. At posttreatment, similar results were seen in groups to those at pretreatment: resilient, adjusted. and distressed groups with an impacted group having high pain, insomnia, depression, and urinary and bowel symptoms. Quality of life and participant characteristics further distinguished groups at pretreatment and posttreatment. Income level predicted a transition in group membership. CONCLUSIONS Men can be classified into distinctly different subgroups over time. IMPLICATIONS FOR PRACTICE Assessment and intervention with men in subgroups such as distressed and emerging before and during treatment may lessen potential for remaining distressed or moving into impacted group where symptom severity is high at posttreatment. Interventions to reduce multiple symptoms are vitally needed.
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Aktas A, Walsh D, Hu B. Cancer symptom clusters: an exploratory analysis of eight statistical techniques. J Pain Symptom Manage 2014; 48:1254-66. [PMID: 24747226 DOI: 10.1016/j.jpainsymman.2014.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 02/13/2014] [Accepted: 03/10/2014] [Indexed: 11/20/2022]
Abstract
CONTEXT Statistical methods to identify symptom clusters (SC) have varied between studies. The optimal statistical method to identify SC is unknown. OBJECTIVES Our primary objective was to explore whether eight different statistical techniques applied to a single data set produced different SC. A secondary objective was to investigate whether SC identified by these techniques resembled those from our original study. METHODS We reanalyzed a symptom data set of 1000 patients with advanced cancer. Eight separate cluster analyses were conducted on both prevalence and severity of 38 symptoms. Hierarchical cluster analysis identified clusters at r-values of 0.6, 0.5, and 0.4. For prevalence and severity, the Spearman correlation and Kendall tau-b correlation, respectively, measured the similarity (distance) between symptom pairs. Sensitivity analysis of the prevalence data was done with Cohen kappa coefficient as a similarity measure. The K-means clustering method validated clusters. RESULTS Hierarchical cluster analysis identified similar cluster configurations from the 38 symptoms using an r-value of 0.6, 0.5, or 0.4. A cutoff point of 0.6 yielded seven clusters. Five of them were identical at all three r-values used: (1) fatigue/anorexia-cachexia: anorexia, dry mouth, early satiety, fatigue, lack of energy, taste changes, weakness, and weight loss (>10%); (2) gastrointestinal: belching, bloating, dyspepsia, and hiccough; (3) nausea/vomiting: nausea and vomiting; (4) aerodigestive: cough, dysphagia, dyspnea, hoarseness, and wheeze; (5) neurologic: confusion, hallucinations, and memory problems. Regardless of the threshold, there were always some symptoms (e.g., pain) that did not cluster with any others. Seven clusters were validated by K-means analysis. CONCLUSION Seven SC identified from both prevalence and severity data were consistently present irrespective of the statistical analysis used. There were only minor variations in the number of clusters and their symptom composition between analytical techniques. All seven clusters originally identified were confirmed. Four consistent SC were found in all analyses: aerodigestive, fatigue/anorexia-cachexia, nausea/vomiting, and upper GI. Our results support the clinical importance of the SC concept.
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Affiliation(s)
- Aynur Aktas
- Department of Solid Tumor Oncology, Section of Palliative Medicine and Supportive Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Declan Walsh
- Department of Solid Tumor Oncology, Section of Palliative Medicine and Supportive Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Bo Hu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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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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Fulcher CD, Kim HJ, Smith PR, Sherner TL. Putting evidence into practice: evidence-based interventions for depression. Clin J Oncol Nurs 2014; 18 Suppl:26-37. [PMID: 25427607 DOI: 10.1188/14.cjon.s3.26-37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression is a distressing emotion that occurs during various times of the cancer trajectory. Depression often goes unrecognized and untreated, which can significantly affect cost, quality of life, and treatment adherence. The Oncology Nursing Society's Putting Evidence Into Practice depression project team reviewed current literature to identify evidence-based interventions to reduce depression in people with cancer. Pharmacologic and nonpharmacologic interventions were evaluated, and opportunities for nurses to integrate recommendations into practice are offered in this article.
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Affiliation(s)
| | - Hee-Ju Kim
- College of Nursing, Catholic University of Korea, Seoul
| | - Patsy R Smith
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City
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The experience of cognitive change in women with breast cancer following chemotherapy. J Cancer Surviv 2014; 9:375-87. [DOI: 10.1007/s11764-014-0387-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022]
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