Psychological and Symptom Distress In Terminal Cancer Patients with Met and Unmet Needs

This study identified the needs of terminal cancer patients, investigated the factors associated with unmet needs, and assessed psychological and symptom distress associated with unsolved needs. Ninety-four patients were randomly selected from 324 patients admitted for palliative care in 13 Italian centers. Two self-administered questionnaires (the Symptom Distress Scale and the Psychological Distress Inventory) were administered to all the patients. Patients needs were identified using a semi-structured interview, aimed at exploring five areas: physiological needs, safety needs, love and belonging needs, self-esteem needs, self-fulfilment needs. A content analysis of the answers defined 11 needs, and identified patients with unmet needs. The most frequent unmet needs were symptom control (62.8%), occupational functioning (62.1%), and emotional support (51.7%). The less frequently reported needs were those related to personal care (14.6%), financial support (14.1%), and emotional closeness (13.8%). Low functional state was significantly associated with a high proportion of patients with unmet needs of personal care, information, communication, occupational functioning, and emotional closeness. Patients with unmet needs showed significantly higher psychological and symptom distress for most needs. This study provides some suggestions about the concerns that should be carefully considered during the late stage of cancer.     

Fatigue in patients with chronic heart failure — A burden associated with emotional and symptom distress

Background

The relationship between experience of fatigue and emotional and symptom distress in chronic heart failure (CHF) needs to be thoroughly explored, because fatigue has major impact on daily activities in life.

Aims

The purpose was to examine the association between fatigue, as a multidimensional experience and anxiety, depression and symptom distress, and to explore the relationships between individual symptoms and the dimensions of fatigue in patients with CHF.

Methods

A consecutive sample of 112 patients with exacerbation of symptoms of CHF answered the Multidimensional Fatigue Inventory (MFI-20), the Hospital Depression and Anxiety (HAD) Scale and the Symptom Distress Scale (SDS).

Results

Anxiety was associated with mental fatigue, whereas depression was associated with reduction of activity, low motivation and decreased functioning. Physical fatigue was affected by symptom distress, with women reporting more distress than men. With exception of breathlessness, poor agreement was found between fatigue and the most intensive reported symptoms.

Conclusions

The relationship between emotional distress and the experience of fatigue in patients with CHF may have a devastating affect on the patient's ability to cope and manage daily activities, including self-care and adherence to recommended treatment.     

Evaluation of efficacy of the perioperative administration of venlafaxine XR in the prevention of postmastectomy pain syndrome

This study aimed to examine how symptoms vary in relation to demographic characteristics (age and sex), stage of disease, histology of lung cancer, and treatment type in Korean adults with lung cancer. Symptoms were measured with the Symptom Distress Scale. A total 106 patients with a mean age of 60.9 (SD = 10.38) years participated. The results indicated that 1) overall symptom distress was more severe (mean 32.74, SD 10.75) compared to the studies reported in Western countries, and 2) among the variables, only the stage of lung cancer showed a significant relationship with total symptom distress (P < 0.05). In analyses of the individual symptoms, bowel-related symptoms showed significant relationships with sex, age, and type of treatment. The results highlight the importance of symptom management as well as the need to tailor clinical interventions according to related factors in order to maximize effective symptom management in Korean patients with lung cancer.     

维持性血液透析患者症状困扰相关影响因素分析

目的通过对301例维持性血液透析患者症状困扰现况及相关影响因素分析,找出维持性血液透析患者症状困扰的主要症状,为临床治疗提供信息。方法采用方便抽样方法,使用自设的透析患者一般情况调查表、症状困扰量表、匹兹堡睡眠质量指数评定量表、综合主观性营养评估及综合医院焦虑、抑郁量表调查广东地区三家三级甲等医院及二家二级医院301例维持性血液透析患者。结果维持性血液透析患者各症状发生率为23.3%~80.4%之间,其中发生率最高的三种症状分别为皮肤干燥(80.4%)、瘙痒(77.7%)和易醒(76.1%),而严重程度得分最高的三种症状分别为瘙痒(3.41±1.53)分、性欲减退(2.83±1.57)分和易醒(2.70±1.27)分;透析患者症状困扰的症状有无得分及症状严重程度得分与匹兹堡睡眠质量指数总分、营养状况及焦虑、抑郁得分呈正相关(P0.001)。结论血液透析患者症状困扰的发生率比国外研究的水平高,与国内研究的水平相一致,维持性血液透析患者存在诸多症状,给日常生活带来较大困扰,医务人员应重视这些问题,采取相应的措施。     

Measurement of symptom distress in women with early-stage breast cancer

While symptom distress can alter the cancer experience, it is difficult to define and measure. This study's aims were (1) to determine whether the McCorkle Symptom Distress Scale (SDS) or the Rhodes Adapted Symptom Distress Scale (ASDS) was the more accurate measure of symptom distress in women with breast cancer; (2) correlate both scales with a visual analogue scale (VAS) measuring anxiety, a symptom frequently reported clinically; (3) determine tool preference; and (4) establish when during the first cycle of chemotherapy the highest levels of symptom distress were experienced. One hundred twenty women were recruited and measurement of symptom distress (SDS and ASDS) and anxiety (VAS) taken at the start of chemotherapy (Time 1), at the nadir (Time 2), and at the end of the cycle (Time 3). Both instruments were highly correlated and detected change over time; none was correlated with the VAS anxiety scale. Symptom distress scores were generally low, with fatigue, appearance, insomnia, and concentration causing the greatest distress. Other factors like functioning, body image, and menopausal symptoms cited as contributors to symptom distress levels were not measured and could account for low scores and perhaps suggest that symptom distress may not be accurately measured in today's women with early-stage breast cancer.     

Symptom prevalence, characteristics, and distress in AIDS outpatients.

Symptom distress is an important but poorly characterized aspect of quality of life in AIDS patients. To assess and characterize the symptoms and symptom distress associated with AIDS, 504 ambulatory patients with AIDS were evaluated between December, 1992 and December, 1995. The assessment included measures of symptom distress, physical and psychosocial functioning, and demographic and disease-related factors. Patients described symptoms during the previous week using the Memorial Symptom Assessment Scale Short Form (MSAS-SF), a validated measure of physical and psychological symptom distress. The mean age was 38.6 years (range 18-69); 56% were male. African-Americans comprised 40% of the sample, Caucasians 35%, and Hispanics 23%. Ninety-three percent had CD4+ T-cell counts below 500, and 66% had counts below 200; 69% were classified in CDC category C (history of AIDS-defining conditions). Fifty-two percent reported intravenous drug use. Karnofsky performance status was > or = 70 in 80% of the patients. No patients were taking protease inhibitors. The mean (+/- SD) number of symptoms was 16.7 +/- 7.3. The most prevalent symptoms were worrying (86%), fatigue (85%), sadness (82%), and pain (76%). Patients with Karnofsky performance scores < 70 had more symptoms and higher symptom distress scores than patients with scores > or = 70 (21.2 +/- 6.5 vs. 15.6 +/- 7.1 symptoms/patient; 2.3 +/- 0.8 vs. 1.6 +/- 0.8 on the Global Distress Index [GDI] of the MSAS-SF; P < 0.0001 for both). Patients who reported intravenous drug use as an HIV transmission factor reported more symptoms and higher overall and physical symptom distress than those who reported homosexual or heterosexual contact as their transmission factor (17.8 +/- 7.5 vs. 15.4 +/- 6.9 symptoms/patient, P = 0.0002; 1.9 +/- 0.9 vs. 1.6 +/- 0.8 on the MSAS-GDI, P = 0.002). Both the number of symptoms and symptom distress were highly associated with psychological distress and poorer quality of life; for example, r = -0.69 (P < 0.0001) between GDI scores and scores on a validated measure of quality of life. Neither gender nor CD4+ T-cell count was associated with symptom number or distress. Responses from this self-referred sample of AIDS outpatients indicate that AIDS patients experience many distressing physical and psychological symptoms and a high level of distress. Both the number of symptoms and the distress associated with them are associated with a variety of disease-related factors and disturbances in other aspects of quality of life. Symptom assessment provides information that may be valuable in evaluating AIDS treatment regimens and defining strategies to improve quality of life.     

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.     

乳腺癌术后患者的症状困扰及其与生活质量的相关性

目的探讨乳腺癌术后患者的症状困扰及其与生活质量的相关性,为进行有针对性的症状管理提供依据。方法于2010年1月至2011年1月以便利抽样法选取哈尔滨医科大学附属第一医院行乳腺癌手术的患者126例,采用症状困扰量表（the symptom distress scale,SDS）、欧洲癌症研究与治疗组织生活质量问卷（ European Organization for Researchand Treatment of Cancer quality of life questionnaire, EORTC QLQ-C30）调查乳腺癌患者术后l周内的症状困扰和生活质量,进行多元逐步回归分析和Pearson相关分析。结果乳腺癌术后1周内患者普遍存在症状困扰（97．6％）,困扰程度最高的症状依次为外表的改变、对前景的担忧、手臂活动受限、胸壁紧张感、疼痛频率;年龄、疾病阶段、手术方式是症状困扰的影响因素;症状困扰与生活质量之间呈负相关（r=-0．31,P〈0．01）。结论护理过程中应重视疾病和治疗带给患者的症状困扰,对年轻、中晚期和乳房全切患者应给予更多关注,加强症状管理,进而提高乳腺癌术后患者的生活质量。     

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.     

An instrument to measure symptom experience. Symptom occurrence and symptom distress

This article describes the development of an instrument that measures symptom experience (symptom occurrence and symptom distress). The Adapted Symptom Distress Scale-2 (ASDS-2), adapted from the McCorkle and Young Distress Scale, is a 31-item, 5-point, self-report paper-and-pencil instrument that measures patients' perception of the occurrence and distress of 14 symptoms: nausea, vomiting, pain, eating, sleep, fatigue, bowel elimination, breathing, coughing, concentration, lacrimation, changes in body temperature, appearance, and restlessness. Use of the instrument yields a total score for symptom experience, scores for symptom occurrence, scores for symptom distress, and subscale scores for six symptom categories: gastrointestinal, fatigue/restlessness, concentration, pain/discomfort, respiratory, and appearance. Reliability and validity were determined with well adults (n = 97), medical-surgical patients (n = 82), and oncology patients (n = 175). Findings revealed a Cronbach's alpha of 0.91 for symptom experience, 0.90 for symptom occurrence, and 0.76 for symptom distress. Cronbach's alpha for the subscales ranged from 0.38 for appearance symptoms to 0.83 for gastrointestinal symptoms. Inclusion of symptoms reported by patients with cancer strengthened content validity. A contrasted groups approach was used to demonstrate construct validity.     

A Longitudinal Analysis of Symptom Clusters in Cancer Patients and Their Sociodemographic Predictors

ContextExploring the relationships between concurrent symptoms or “symptom clusters” (SCs) longitudinally may complement the knowledge gained from the traditional approach of examining individual symptoms or SCs crosssectionally.ObjectivesTo identify consistent SCs over the course of one year and determine the possible associations between SCs and demographic and medical characteristics, and between SCs and emotional distress.MethodsThis study was an exploratory longitudinal analysis of SCs in a large sample of newly diagnosed cancer patients. Patients provided symptom assessment data at baseline, three, six, and 12 months. A factor analysis was conducted (controlling for the patient over time) on pain, fatigue, anxiety, depression, sleep, weight change, and food intake items to identify clusters. A panel regression on each cluster explored associations with demographic and medical characteristics and distress.ResultsIn total, 877 patients provided baseline data, with 505 retained at 12 months. Three SCs explained 71% of the variance. The somatic cluster included pain, fatigue, and sleep; the psychological cluster included anxiety and depression; and the nutrition cluster consisted of weight and food intake. Low income and treatment with radiation or chemotherapy predicted higher somatic symptom burden. Younger age, being female, low income, and treatment with surgery predicted more psychological symptomatology. Older age and treatment with surgery predicted higher nutritional burden. Patients with higher somatic, psychological, and nutritional symptom burden reported higher distress.ConclusionThe presence of SCs across the first year of diagnosis supports the need for routine and ongoing screening for the range of symptoms that may be experienced by patients. Further work is needed to develop interventions that better target individual symptoms that cluster, as well as the entire cluster itself.     

Preliminary investigations of symptom distress in two cancer patient populations: evaluation of a measurement instrument

The study reports the results of a preliminary investigation into the incidence of symptom distress in two cancer patient populations--those receiving chemotherapy and those undergoing radiotherapy--and discusses the further evaluation of a symptom distress scale. The scale is found to be both reliable and valid for use in both patient populations. The results indicate that, although overall symptom distress is similar between chemotherapy and radiotherapy patients, there is considerable individual variation in the extent of that distress and the symptoms causing distress may differ between the groups. As in previous studies, tiredness was the most common complaint. Those patients receiving chemotherapy also complained of an inability to concentrate, mood changes and alterations in appearance. Those undergoing radiotherapy most commonly reported significant distress due to pain, altered appearance, constipation and appetite change. The findings suggest that the Symptom Distress Scale may be a useful addition to the assessment of individual patients and may provide a means by which the effects of interventions, designed to alleviate physical distress, could be evaluated.     

Screening for Distress in the Radiation Therapy Department: Distress Incidence by Sex,Treatment Intent,and Ethnicity

IntroductionHealth care is moving toward personalized (person-centered) holistic care. Screening for distress is a national initiative that promotes this and will allow for better interdisciplinary collaboration between health care providers. The use of distress screening allows our cancer centers to determine trends and correlations between patient demographics and patient distress. Distress leads to increased physical complications, increased patient anxiety, decreased compliancy with treatment, and an overall negative experience in the health care system. This tool helps health care providers to identify and manage patient distress in a timely manner.MethodsA screening for distress questionnaire was completed by 119 new patients entering the department of radiation therapy at the Saskatoon Cancer Center, Saskatoon, Saskatchewan, Canada. Results were segregated by sex, treatment intent, and ethnicity and then were subjected to a Wilcoxon rank sum test to determine statistical significance between test groups.ResultsResults indicated higher distress levels in female versus male patients, palliative care versus curative intent, and Aboriginal/Métis versus non-Aboriginal/non-Métis populations. The most commonly reported symptoms of distress included recurring fatigue, poor overall well-being, and high levels of anxiety. The fears/worries portion of the distress checklist was most commonly reported.ConclusionsThe screening for distress questionnaire has been proven to be a valuable tool in the facilitation of collaborative health care and holistic patient care. Because of higher than average distress scores, further investigation should be done with Aboriginal/Métis peoples in the health care system.     

The measure of psychological distress in cancer patients: the use of Distress Thermometer in the Oncological Rehabilitation Center of Florence

Goals of work  Distress in cancer patients is common. In the last years, several studies have used the single-item Distress Thermometer (DT) as a screening tool for psychological distress in cancer patients. The primary objective of this study was to determine the optimal cutoff score on the DT for detecting psychological distress in cancer patients attending a rehabilitation center, by comparing the DT’s scores with those of the Psychological Distress Inventory (PDI). The second aim was to explore the effectiveness of the DT as a screening tool for psychological distress in rehabilitative oncological setting. Patients and methods  The sample study totaled 290 patients who were recruited from patients attending the Oncological Rehabilitation Center of Florence for the first time between January and December 2007. Patients were administered the DT along with the Problem List (PL) and the PDI as the gold standard against which the DT was compared. Main results  The area under the receiver operating characteristics curve was 0.84 [95%CI 0.80–0.89]. The optimal DT cutoff score for identifying distressed cancer patients would be at or above 7 (sensitivity = 0.73; specificity = 0.82). Patients whose DT score was 7 or above were more likely to report problems in all issues on the PL. Conclusions  The combination of DT and PL could be a practicable screening instrument for assessing the extent and the kind of distress also in rehabilitative oncological patients. On the other hand, the choice of the DT should be evaluated by clinicians.     

Measuring symptom prevalence, severity and distress of cancer survivors

The purpose of this paper is to describe patients’ self-reported symptom occurrence, symptom intensity and symptom distress at post-treatment of cancer therapy. A total of 243 outpatients with heterogeneous solid tumours within 12 months following the completion of initial cancer treatment (chemotherapy or radiotherapy) were assessed using the Chinese version of the Memorial Symptom Assessment Scale (MSAS). The mean age of the sample was 54.2 ± 12 and over half (57.6%) were women. The most common diagnoses were breast cancer (26.3%) and colon cancer (23.5%). The median number of symptoms per patient was 8 (range 0–23 symptoms) and the most prevalent were dry mouth (49.8%), lack of energy (46.9%), worry (39.1%), pain (35%) and feeling drowsy (33.7%). The mean symptom severity and distress scores measured on the MSAS were 1.92 ± 0.2 (range 1.7–2.3) and 1.37 ± 0.3 (.9–2), respectively. The prevalence of certain symptoms was influenced by the primary site of cancer. Pain, worrying and difficulty in swallowing were the most clinically important symptoms. In conclusion, intense physical and psychological symptoms were highly prevalent and distressing to cancer survivors. Comprehensive symptoms assessment is a requisite toward effective symptom control.     

Measuring symptom occurrence and symptom distress: development of the symptom experience index

AIM: This paper is a report of a study to assess reliability and construct validity of revised and refined version of the Adapted Symptom Distress Scale: the Symptom Experience Index (SEI). BACKGROUND: The development of the SEI, a 41-item Likert Scale assessing 20 symptoms, was based on self-regulation theory and an integrative conceptual analysis of symptom assessment and management. The model emphasizes the difference between the occurrence of a symptom (or multiple symptoms) and the distress (emotional) response to the occurrence of a symptom. It is the distress from symptom occurrence that promotes a person to take action and use known coping strategies to prevent the symptom occurrence or alleviate the distress from the symptom. METHOD: A contrast-group and test-retest approach was used to assess construct validity and reliability with a convenience sample of 158 patients at United States of America in 2003-2004. RESULTS: The SEI demonstrated reasonable internal consistency with a Cronbach's alpha of 0.91 for symptom experience, 0.85 for symptom occurrence and 0.84 for symptom distress. Test-retest reliability was supported by high intra-class correlation coefficients (symptom experience r = 0.93; symptom occurrence r = 0.94; symptom distress, r = 0.92). Construct validity was supported by statistically significant differences between patients and healthy adults. CONCLUSION: The SEI can be used as a baseline and outcome measure to assess the impact of multiple symptoms on patients, and the effectiveness of interventions to manage these symptoms.     

Quality of life among women with breast cancer living in Wuhan,China

BackgroundQuality of life is an important indicator in patients with breast cancer. Studies here reported that the quality of life in patients with breast cancer is low and many factors contribute to this poor quality of life.PurposeTo examine the relationships among demographic characteristics, optimism, social support, illness related factors, appraisal of illness, coping strategies and the quality of life of Chinese women with breast cancer residing in Wuhan, China.MethodsA convenience sample of 156 Chinese women with breast cancer was recruited from five teaching hospitals in Wuhan, China. Participants completed the Revised Life Orientation Test, the Perceived Social Support Scale, the Symptom Distress Scale, the Appraisal of Illness Scale, the Medical Coping Modes Questionnaire, and the Functional Assessment of Cancer Therapy-Breast. Path analysis was used to examine factors influencing quality of life.ResultsSignificant relationships were found between optimism, symptom distress, social support, appraisal of illness, a give-in coping mode and quality of life. Optimism, social support, symptom distress, lymph node status, appraisal of illness, and a give-in coping mode accounted for 66.6% of the variance in quality of life.ConclusionsThe findings of this study underscore the importance of helping women reduce symptoms distress, appraise their illness positively, use less negative coping modes, and maintain optimism, maintain good social support, because all of these factors indirectly or directly affect their quality of life.     

Surgical palliation of advanced gastrointestinal tumors

Patients with advanced gastrointestinal tumors suffer a spectrum of progressive symptoms that reduce their quality of life (QOL). Operative palliative strategies seeking to improve QOL and decrease symptom burden are poorly studied. This study seeks to measure the effect of operations on symptoms and QOL in patients with advanced gastrointestinal malignancies. Patients undergoing World Health Organization (WHO)-defined palliative operations for gastrointestinal cancers were prospectively followed with monthly QOL and Distress Thermometer surveys until 6 months post-operatively. Comparisons were made between preoperative and 3-month postoperative data. Parameters of physical, psychological, social, and spiritual QOL were measured on a scale of 0 (worst) to 5 (best). Frequency of occurrence and degree of distress caused by that specific symptom were scored from 0 (rarely/not at all) to 5 (most of the time/severely). Thirty-five patients had gastrointestinal cancer. The median age was 55.3 years. The most common symptoms were pain and obstruction. Thirty-three operations were abdominal. Ultimately, 34 patients (97%) were discharged home. When preoperative data were compared to 3 months postoperative, the frequency of the primary symptom improved by 2.22 (p = 0.001) and the distress it caused decreased by 1.82 (p = 0.004). Physical QOL decreased by 0.61 (p = 0.009), psychological QOL decreased by 0.50 (p = 0.015), social QOL decreased by 0.48 (p = 0.017), spiritual QOL decreased by 0.42 (p = 0.008), and overall QOL decreased by 0.50 (p = 0.012). Because of the unrelenting nature of gastrointestinal tumors, QOL over time will inevitably decrease. Palliative operations effectively improve symptom frequency and distress without greatly affecting the expected decline in QOL and its parameters.     

Women with breast cancer: their quality of life following a course of radiation therapy

The study assessed the quality of life of 53 women who had a lumpectomy or other breast-conserving surgery for breast cancer followed by radiation therapy. The women were interviewed a mean of 7 weeks after the course of radiation therapy regarding their functioning, emotional distress, and symptoms. Functioning was measured by the Sickness Impact Profile, emotional distress by the Profile of Mood States, and symptoms by the Symptom Distress Scale. Although the women were not experiencing many changes in their usual activities, were not distressed emotionally, and were experiencing very few symptoms, they were experiencing fatigue. Those who experienced the most fatigue had the most symptoms and the poorest level of functioning.     

Symptom distress, catastrophic thinking, and hope in nasopharyngeal carcinoma patients

The purposes of this study were to explore symptom distress, catastrophic thinking (catastrophizing) and hope, and factors predicting hope in Taiwanese nasopharyngeal carcinoma (NPC) patients within 3 years of receiving radiation therapy (RT). Instruments used were the modified Symptom Distress Scale, disease catastrophizing scale (modified from Coping Strategies Questionnaire), and Herth's Hope Index. Adult NPC patients (N = 115; 33 undergoing RT, 44 who completed RT within 1 year, and 38 who completed RT more than 1 year but less than 3 years) were recruited from an outpatient RT center in Northern Taiwan. Although participants' overall symptom distress was mild to moderate, they scored moderate level for several distressful symptoms: dry mouth, fatigue, hearing difficulty, loss of appetite, insomnia, and pain. Patients undergoing RT had greater symptom distress than subjects in the other 2 groups. Regression analysis revealed that catastrophizing was the only predictor of hope. Patients who engaged in catastrophizing reported much lower levels of hope. Particular care and attention are recommended to help NPC patients deal with the top distressful symptoms listed. Nursing interventions to reduce catastrophic thinking and enhance hope are discussed.