Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers

Context

Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers.

Palliative Care Symptom Management in The Emergency Department: The ABC's of Symptom Management for The Emergency Physician

Background

Palliative care is a rapidly evolving area of emergency medicine. With an estimated 5,000 to 10,000 baby boomers per day reaching retirement age, emergency departments (EDs) are treating more patients with chronic and serious disease. Palliative care offers comprehensive care for patients with advanced medical illness, aims to alleviate suffering and improve quality of life, and plays an important role in caring for these patients in the ED.

需求理论下肺癌化疗患者对消化道症状群认知态度及饮食营养管理需求的质性研究

目的：探究需求理论下肺癌化疗患者对消化道症状群的真实认知态度及饮食营养管理需求的质性研究。方法：采用目的抽样方法,选取2021年10～11月南昌市某三甲医院呼吸科收治的16例肺癌化疗患者为研究对象,进行半结构式深入访谈,并运用现象学分析法进行资料分析。结果：通过访谈归纳出三个主题,分别是肺癌化疗患者普遍出现消化道症状但缺乏多渠道的正向行为;肺癌化疗患者对消化道症状群信息管理平台需求较高;肺癌化疗患者出现消化道不适症状时,对营养、饮食的信息需求较大。结论：医护人员应准确评估患者对消化道症状群的认知情况及饮食营养管理需求,实现对消化道症状群的科学管理,提高患者营养水平和生活质量。     

A Reflective Study of Symptom Management in Terminal Cancer

ABSTRACT

Perceived experiences of patients are important hallmarks of symptom control not only for physical symptoms, but also for the psychological, social, and spiritual dimensions. Listening to patients’ narratives opens window to diagnosing the patients’ symptoms. This reflection outlines the importance of this practice in managing symptoms of a terminally ill cancer patient.     

Stability of Symptom Clusters in Patients With Lung Cancer Receiving Chemotherapy

Context

Patients with lung cancer who undergo chemotherapy (CTX) experience multiple symptoms. Evaluation of how these symptoms cluster together and how these symptom clusters change over time are salient questions in symptom clusters research.

癌症患者的症状群调查研究

目的了解癌症患者疾病发展和治疗过程中的相关症状,探讨其症状群种类和数量.方法使用中文版安德森症状评估量表对155例住院癌症患者进行调查,采用探索性因子分析法统计症状群.结果癌症患者发生率高的症状依次是疲乏、口干、睡眠不安.严重程度症状依次为食欲下降、呕吐、疲乏和睡眠不安.Spearman相关分析显示,除气短与食欲下降、呕吐之间相关性无统计学意义(P>0.05)之外,其余各症状之间相关性均具有统计学意义且均存在正相关关系(P<0.05).探索性因子分析得出3个症状群,分别为疾病行为症状群、上消化道症状群、心理症状群.各症状群的Cronbach’sα系数分别为0.69、0.83、0.75.结论癌症患者存在多种症状群,对癌症患者应探索以症状群为基础的干预模式,以求能够产生更好的临床效果,提高癌症患者的生存质量.     

Web-Based Symptom Management for Women With Recurrent Ovarian Cancer: A Pilot Randomized Controlled Trial of the WRITE Symptoms Intervention

ContextLittle research has focused on symptom management among women with ovarian cancer. Written Representational Intervention To Ease Symptoms (WRITE Symptoms) is an educational intervention delivered through asynchronous web-based message boards between a study participant and a nurse.ObjectivesWe evaluated WRITE Symptoms for 1) feasibility of conducting the study via message boards, 2) system usability, 3) participant satisfaction, and 4) initial efficacy.MethodsParticipants were 65 women (mean age, 56.5; SD = 9.23) with recurrent ovarian cancer randomized using minimization with race/ethnicity (non-Hispanic white vs. minority) as the stratification factor. Measures were obtained at baseline and two and six weeks after intervention. Outcomes were feasibility of conducting the study, system usability, participant satisfaction, and efficacy (symptom severity, distress, consequences, and controllability).ResultsFifty-six (87.5%) participants were retained, and the mean usability score (range 1–7) was 6.18 (SD = 1.29). All satisfaction items were scored at 5 (of 7) or higher. There were significant between-group effects at T2 for symptom distress, with those in the WRITE Symptoms group reporting lower distress than those in the control group [t(88.4) = −2.57; P = 0.012], with a similar trend for symptom severity [t(40.4) = −1.95; P = 0.058]. Repeated measures analysis also supported a group effect, with those in the WRITE Symptoms group reporting lower symptom distress than those in the control condition [F(1, 56.7) = 4.59; P = 0.037].ConclusionParticipants found the intervention and assessment system easy to use and had high levels of satisfaction. Initial efficacy was supported by decreases in symptom severity and distress.     

Symptom Burden Clusters: A Challenge for Targeted Symptom Management. A Longitudinal Study Examining Symptom Burden Clusters in Breast Cancer

ContextAlthough there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters.ObjectivesTo explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer.MethodsIn this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups.ResultsThree clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with “change in the way food tastes” as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden.ConclusionThis study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients.     

A Randomized Trial of Weekly Symptom Telemonitoring in Advanced Lung Cancer

ContextLung cancer patients experience multiple, simultaneous symptoms related to their disease and treatment that impair functioning and health-related quality of life (HRQL). Computer technology can reduce barriers to nonsystematic, infrequent symptom assessment and potentially contribute to improved patient care.ObjectivesTo evaluate the efficacy of technology-based symptom monitoring and reporting in reducing symptom burden in patients with advanced lung cancer.MethodsThis was a prospective, multisite, randomized controlled trial. Two hundred fifty-three patients were enrolled at three sites and randomized to monitoring and reporting (MR) or monitoring alone (MA). Patients completed questionnaires at baseline, 3, 6, 9, and 12 weeks and symptom surveys via interactive voice response weekly for 12 weeks. MR patients' clinically significant symptom scores generated an e-mail alert to the site nurse for management. The primary endpoint was overall symptom burden; secondary endpoints included HRQL, treatment satisfaction, symptom management barriers, and self-efficacy.ResultsThis randomized controlled trial failed to demonstrate efficacy of symptom monitoring and reporting in reducing symptom burden compared with monitoring alone in lung cancer. HRQL declined over 12 weeks in both groups (P < 0.006 to P < 0.025); at week 12, treatment satisfaction was higher in MA than MR patients (P < 0.012, P < 0.027). Adherence to weekly calls was good (82%) and patient satisfaction was high.ConclusionFeasibility of using a technology-based system for systematic symptom monitoring in advanced lung cancer patients was demonstrated. Future research should focus on identifying patients most likely to benefit and other patient, provider, and health system factors likely to contribute to the system's success.     

Adherence to Medication Guideline Criteria in Cancer Pain Management

The medication-assessment tool for cancer pain management (MAT-CP) is a novel tool for measuring the quality of drug use in chronic pain management in relation to guideline standards. MAT-CP has recently been revised and validated for use in the U.K. clinical setting. This article presents a measure of the adherence of current practice to specific cancer pain guideline criteria in two palliative care settings. Adult patients with malignant disease experiencing pain and/or receiving analgesics were identified by clinical pharmacists at two hospitals and five hospices in Scotland, United Kingdom. The MAT-CP was applied to data extracted from case notes. Results were quantified in terms of applicability and adherence to guideline criteria and the presence of insufficient data. MAT-CP was applied to 192 cancer patients experiencing pain; 103 (54%) were males and the mean (standard deviation) age was 68.5 (13.0) years. Overall guideline adherence was 75% (confidence interval [CI]: 74%, 77%; n = 3460 applicable criteria). Low adherence (<50%) was seen for nine criteria, whereas 21 criteria were considered high-adherence criteria (>75%). Overall adherences for 56 (29%) hospitalized patients and 136 (71%) hospice patients were 65% (CI: 62%, 68%) and 79% (CI: 78%, 81%), respectively. Although good overall guideline adherence was found, there were gaps in both the hospice and hospital palliative care settings in the implementation of certain treatment recommendations, particularly in relation to pain assessment. The application of the tool has highlighted issues for feedback to health care providers and for further study.     

肺癌患者化疗期间的症状体验及相关因素研究

目的描述肺癌患者化疗期间的症状体验特点,探讨其影响因素.方法运用安德森症状评估量表,便利抽取西安市3家三级甲等医院的123例肺癌化疗患者,调查分析其化疗期间的症状体验及相关因素.结果本组的主要症状依次为:疲乏(6.26±1.62)分、苦恼(4.25±1.88)分、胃口差(4.96±2.07)分、睡眠不安(4.48±2.01)分,发生率均在90%以上;给患者的工作、一般活动、生活乐趣带来较大的困扰,其得分分别是(7.03±1.85)分、(5.42±1.69)分、(4.64±1.60)分.症状体验受在职与否、家庭人均月收入、性别、疾病临床分期4个因素的影响(P<0.05).结论肺癌患者化疗期间症状发生频率均高于50%,处于轻中度水平,受疾病的临床分期、性别等的影响,给患者带来较大的症状困扰.提示临床护士应对肺癌化疗患者进行症状评估,并给予管理和控制.     

Quality of life during clinical trials: conceptual model for the Lung Cancer Symptom Scale (LCSS)

To appreciate the full benefits of treatment for lung cancer, especially in trials that fail to show improvements in survival, data recording the quality of life must be captured and refined to produce meaningful information. A conceptual model for quality of life for lung cancer patients was tested to obtain information about the dimensions of the quality-of-life construct for ongoing development and testing of a subjective measure for clinical trials. Using a longitudinal study design, the stability of predictive factors of the physical and functional dimensions of quality of life were examined using regression analysis. A patient-rated quality-of-life measure, the Lung Cancer Symptom Scale (LCSS), was administered to 144 non-smallcell lung cancer patients at baseline, day 29, and day 71 of a chemotherapy trial. The range of explained variance for all three components of the lung cancer model over three assessment points was as follows: symptomatic distress 41%–53%, activity status 48%–52%, and overall quality of life 35%–53%. The three dimensions fluctuated slightly during intervention, but were relatively stable factors across all three times of evaluation. The LCSS model explained nearly half of the variance for quality of life experienced by lung cancer patients during therapy with a new chemotherapeutic agent. These findings provide support that the physical and functional dimensions are important predictors of quality of life for individuals with lung cancer. Meaningful subjective quality-of-life data can be obtained to evaluate an intervention by using a disease-and sitespecific quality-of-life measure for individuals with lung cancer, based on a reproducible conceptual model such as the LCSS, which is suitable for serial measurement for the progressive disease of lung cancer.     

Stability and Impact of Symptom Clusters in Patients With End-Stage Renal Disease Undergoing Dialysis

ContextPatients with end-stage renal disease undergoing dialysis experience multiple concurrent symptoms. These symptoms cluster together and have negative impacts on patient outcomes. However, information on changes in symptom clusters over time is limited.ObjectivesThis longitudinal study examined the stability of symptom clusters and their impacts on health-related quality of life and functional status over a period of one year.MethodsEligibility criteria were patients diagnosed with end-stage renal disease; had received dialysis consecutively for at least three months; and had given written informed consent. Dialysis Symptom Index, Kidney Disease Quality of Life 36, and Karnofsky Performance Status Scale were used to evaluate the impacts of symptom clusters and outcomes. Exploratory factor analyses and multiple regression analyses were used to determine symptom clusters and their associations with patient outcomes.ResultsAmong the 354 recruited patients, 271 completed the 12-month assessment. Four symptom clusters were identified across the three assessments, namely, uremic, gastrointestinal, skin, and emotional. Within each cluster, the specific symptoms were varied. The uremic symptom cluster accounted for the largest amount of variability. Across the three assessments, a higher uremic cluster factor score was associated with poorer physical well-being, whereas a higher emotional cluster factor score was consistently associated with poorer mental well-being.ConclusionSymptoms in patients on dialysis clustered in relatively stable patterns. The four symptom clusters identified had consistent negative effects on various aspects of patients' well-being. Our findings suggest the need for ongoing symptom assessment and early recognition of symptoms that may contribute to adverse patient outcomes.     

药盒植入肺动脉治疗肺癌的护理

目的 探讨将药盒植入肺动脉对肺癌患进行化疗的护理。方法 在数字减影血管造影(DSA)透视下或手术过程中在肺动脉上植入化疗药盒治疗晚期或无法施行手术的肺癌患。结果 11例植入化疗药盒的患能明显减轻痛苦，达到有效的治疗目的。结论 积极有效的护理措施，能减少药盒植入肺动脉后的并发症，从而延长肺癌患的生存期。     

结直肠癌患者术后症状体验与希望水平的相关性研究

目的了解结直肠癌术后患者症状体验与希望水平的状况,探讨两者的相关性。方法对98例术后结直肠癌患者应用MD Anderson消化道癌症症状调查量表和Herth希望量表进行调查。结果本组症状强度最为显著的5个症状依次是:疲乏(6.38±2.15)分、疼痛(6.03±1.73)分、口干(5.89±1.92)分、睡眠不安(5.85±1.24)分、胃口差(5.12±1.33)分,给患者的一般活动、工作、走路、生活乐趣造成中度及以上水平的困扰;本组患者希望总均分为(37.01±4.91)分,中等希望水平组36例(36.7%),高等希望水平组62例(63.3%);结直肠癌术后患者希望水平各维度与症状体验均呈负相关(P0.01)。结论结直肠癌术后患者症状体验强烈,给患者造成较大困扰;患者症状体验与希望水平负相关,提示临床护理工作应及时正确地评估患者出现的症状,并进行有效的干预,以提高患者希望水平,促进康复。