The Role of Inflammation in the Pain,Fatigue, and Sleep Disturbance Symptom Cluster in Advanced Cancer

Context

Symptom researchers have proposed a model of inflammatory cytokine activity and dysregulation in cancer to explain co-occurring symptoms including pain, fatigue, and sleep disturbance.

Relationships Between Financial Toxicity and Symptom Burden in Cancer Survivors: A Systematic Review

Context

Financial toxicity (FT) is used to describe the financial distress/hardship associated with cancer and its treatment.

Assessing Common Sleep Disturbances in Survivors of Childhood Cancer

The number of children, adolescents, and young adults transitioning into primary care is steadily increasing as the overall survival rates for childhood cancer improve. Survivors of childhood cancer are at significant risk for co-morbidities associated with their primary cancer and cancer therapy impacting their health-related quality of life. Sleep disturbances are now recognized as a public health concern and are common complaints among survivors of childhood cancer. This review will describe the most common sleep disturbances reported among survivors of childhood cancer, as well as appropriate evaluations to confirm sleep diagnosis and prescribed treatments.     

卵巢癌患者的症状群与其生活质量的相关性

目的调查卵巢癌患者的症状群,并探讨症状群与其生活质量的相关性。方法便利抽样法选择2012年5-10月在山东省济南市某三级甲等医院妇科病房接受治疗的卵巢癌患者130例,采用安德森症状评估表(M.D.Anderson symptom inventory,MDASI)和卵巢癌治疗功能评估量表(the functional assessment of cancer therapy scale-ovarian,FACT-O)对其进行调查。结果卵巢癌患者有较高内部一致性的4个症状群分别为情感性症状、躯体性症状、胃肠道症状及治疗不良反应,其Cronbachα系数分别为0.838、0.632、0.715和0.613。患者生活质量评分均值为(96.78±17.13)分,与4个症状群均呈负相关(均P0.01)。其中情感性症状群、躯体性症状群及胃肠道症状群被纳入回归方程。结论卵巢癌患者存在情感性症状、躯体性症状、治疗不良反应及胃肠道症状四个主要症状群,其中情感性症状群、躯体性症状群、胃肠道症状群是生活质量的重要影响因素。因此,医护人员可以进行有针对性的治疗及心理疏导,以提高患者的生活质量。     

A Longitudinal Study of PROMIS Pediatric Symptom Clusters in Children Undergoing Chemotherapy

Context

Children in treatment for cancer experience multiple, troubling, and interrelated symptoms. Analyzing the interrelatedness of symptoms and how that changes during treatment could yield clinically relevant patient profiles to guide patient care.

Prospective Longitudinal Evaluation of a Symptom Cluster in Breast Cancer

ContextSymptom cluster research expands cancer investigations beyond a focus on individual symptoms in isolation.ObjectivesWe conducted a prospective longitudinal study of sleep, fatigue, depression, anxiety, and perceived cognitive impairment in patients with breast cancer undergoing chemotherapy.MethodsPatient-reported outcome measures were administered prior to chemotherapy, at Cycle 4 Day 1, and six months after initiating chemotherapy. Participants were divided into four groups and assigned a symptom cluster index (SCI) score based on the number/severity of symptoms reported at enrollment.ResultsParticipants (N = 80) were mostly women (97.5%) with Stage II (69.0%) breast cancer, 29–71 years of age. Scores on all measures were moderately-highly correlated across all time points. There were time effects for all symptoms, except sleep quality (nonsignificant trend), with most symptoms worsening during chemotherapy, although anxiety improved. There were no significant group × time interactions; all four SCI groups showed a similar trajectory of symptoms over time. Worse performance status and quality of life were associated with higher SCI score over time.ConclusionWith the exception of anxiety, the coherence of the symptom cluster was supported by similar patterns of severity and change over time in these symptoms (trend for sleep quality). Participants with higher SCI scores prior to chemotherapy continued to experience greater symptom burden during and after chemotherapy. Early assessment and intervention addressing this symptom cluster (vs. individual symptoms) may have a greater impact on patient performance status and quality of life for patients with higher SCIs.     

Differences in the Symptom Experience of Older Oncology Outpatients

ContextThe relatively low number of older patients in cancer trials limits knowledge of how older adults experience symptoms associated with cancer and its treatment.ObjectivesThis study evaluated for differences in the symptom experience across four older age groups (60–64, 65–69, 70–74, ≥75 years).MethodsDemographic, clinical, and symptom data from 330 patients aged >60 years who participated in one Australian and two U.S. studies were evaluated. The Memorial Symptom Assessment Scale was used to evaluate the occurrence, severity, frequency, and distress of 32 symptoms commonly associated with cancer and its treatment.ResultsOn average, regardless of the age group, patients reported 10 concurrent symptoms. The most prevalent symptoms were physical in nature. Worrying was the most common psychological symptom. For 28 (87.5%) of the 32 Memorial Symptom Assessment Scale symptoms, no age-related differences were found in symptom occurrence rates. For symptom severity ratings, an age-related trend was found for difficulty swallowing. As age increased, severity of difficulty swallowing decreased. For symptom frequency, age-related trends were found for feeling irritable and diarrhea, with both decreasing in frequency as age increased. For symptom distress, age-related trends were found for lack of energy, shortness of breath, feeling bloated, and difficulty swallowing. As age increased, these symptoms received lower average distress ratings.ConclusionAdditional research is warranted to examine how age differences in symptom experience are influenced by treatment differences, aging-related changes in biological or psychological processes, or age-related response shift.     

Left Atrial Mechanics and Integrated Calibrated Backscatter in Anthracycline-Treated Long-Term Survivors of Childhood Cancers

We tested the hypothesis that left atrial (LA) mechanics and myocardial calibrated integrated backscatter (cIB) are altered in anthracycline-treated long-term survivors of childhood cancers. Forty-nine survivors and 25 controls were studied. Survivors had significantly smaller maximal (p = 0.009) and minimal (p = 0.017) LA volumes and lower peak negative LA strains (p = 0.011). For left ventricular (LV) indices, survivors had significantly lower shortening fraction (p < 0.001), ejection fraction (p < 0.001) and mitral annular late diastolic velocity (p = 0.003). Myocardial cIB of the LA posterior wall, ventricular septum and LV posterior wall was significantly greater in survivors than controls (all p values <0.05). Peak negative LA strain was related to late diastolic mitral annular velocity (r = 0.27, p = 0.018), whereas LA cIB was related to the average of septal and LV posterior wall cIB (r = 0.54, p < 0.001). In conclusion, LA remodeling as characterized by contractile dysfunction and increased cIB suggestive of fibrosis occurs in adult survivors of childhood cancers.     

Pretreatment Psychoneurological Symptoms and Their Association With Longitudinal Cognitive Function and Quality of Life in Older Breast Cancer Survivors

Context

Symptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied.

Psychoeducational Intervention for Symptom Management of Fatigue,Pain, and Sleep Disturbance Cluster Among Cancer Patients: A Pilot Quasi-Experimental Study

Objectives

To assess the feasibility of conducting a trial of a psychoeducational intervention involving the provision of tailored information and coaching to improve management of a cancer-related symptom cluster (fatigue, pain, and sleep disturbance) and reduce symptom cluster impacts on patient health outcomes in the Vietnamese context and to undertake a preliminary evaluation of the intervention.

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.     

Symptom distress and quality of life in patients with advanced congestive heart failure

Little is known about the burden of illness associated with advanced congestive heart failure (CHF). Understanding the needs of this population requires further information about symptoms and other factors related to quality of life. We studied a convenience sample of 103 community-dwelling patients with New York Heart Association Class III/IV CHF. The primary outcome, quality of life, was measured with the Multidimensional Index of Life Quality. Potential correlates of quality of life included overall symptom burden (Memorial Symptom Assessment Scale, MSAS), including global symptom distress (MSAS Global Distress Index, GDI); psychological state (Mental Health Inventory-5); functional status (Sickness Impact Profile); spirituality (Functional Assessment of Chronic Illness Therapy-Spirituality Scale); and co-morbid conditions (Charlson Comorbidity Index). Patients had a mean age of 67.1 years (SD=12.1); were mostly white (72.8%), male (71.8%), and married (51.5%); and had a mean ejection fraction of 22.3% (SD=6.8). The most prevalent symptoms were lack of energy (66%), dry mouth (62%), shortness of breath (56%), and drowsiness (52%). Pain was reported by about one-third of patients. For each of these symptoms, high symptom-related distress was reported by 14.1%-54.1%. Quality of life was moderately compromised (Multidimensional Index of Life Quality composite, median=56, possible range 12-84). Impairment in quality of life was strongly associated with global symptom distress (MSAS GDI; r=0.74, P<0.001); burden of comorbid conditions (r = -0.32, P=0.002), female sex (r=-0.22, P=0.03), functional impairment, particularly psychological impairment (r=-0.55, P<0.001), and poorer psychological well-being (r=0.68, P<0.001). In multivariate analyses, impairment in quality of life was significantly related to high symptom distress, poorer psychological well-being, and poor functional mobility (R2=0.67; P=0.002 for all). Distressful symptoms related to impaired quality of life included lack of energy (P=0.04), irritability (P=0.03), and drowsiness (P=0.02). Community-dwelling patients with advanced CHF experience numerous symptoms, significant symptom distress, and a compromised quality of life. Overall quality of life was strongly associated with symptom distress, psychological well-being and functional status. A focus on ameliorating prevalent physical symptoms and psychological distress, along with supportive measures that promote functional mobility, may lead to an improvement in the overall quality of life in this patient population.