Psychosocial characteristics of cancer patients who choose to attend an educational session on cancer-related fatigue

Little is known about cancer patients who seek specific educational interventions on cancer-related fatigue (CRF). The objectives of this study were (1) to describe the level of CRF, and emotional distress; social support; coping styles; and quality of life of patients who chose to attend a 1-hour educational session on CRF and (2) to examine the relationship between the selected demographic, psychosocial, and treatment-related variables and CRF. A questionnaire-based survey of 41 cancer patients who volunteered after a 1-hour education session on CRF at the Tom Baker Cancer Centre was conducted. The sample consisted mostly of married white women who lived in an urban environment. The average age was 56 years, and participants had an average of 14 years of education; 78% of the sample reported moderate to severe fatigue, 27% had significant levels of emotional distress, and 63% had a problematic coping style. Higher fatigue was associated with emotional distress, poorer quality of life, hopelessness, and reduced social support. To conclude, patients who self-refer to an educational session on CRF present a wide range of emotional difficulties and problematic coping styles. Therefore, educational sessions with patients with CRF should emphasize coping with emotional distress and building a support system.     

Levels of fatigue compared to levels of cytokines and hemoglobin during pelvic radiotherapy: a pilot study

Cancer-related fatigue (CRF) is a prevalent and distressing symptom experienced by patients during cancer therapy. One proposed mechanism for the development of fatigue is the increased secretion of proinflammatory cytokines and/or the development of anemia. The major purpose of this pilot study was to investigate the levels of fatigue and cytokines during radiation therapy and determine whether there was a correlation between the two. A secondary purpose was to explore the relationships among hemoglobin values, cytokines, and fatigue. Participants included 15 women diagnosed with uterine cancer, who received curative external radiation therapy. Fatigue was assessed by a self-report instrument (Multidimensional Fatigue Inventory [MFI-20]) and hemoglobin and cytokines (Il-1, Il-6, and TNF-alpha) were measured before, during, and after radiotherapy. The degree of fatigue increased during radiotherapy without a significant change in IL-1, IL-6, or TNF-alpha levels. There was no significant correlation between changes in general fatigue and the changes in IL-1 and TNF-alpha. There was a significant negative correlation between the change in IL-6 and general fatigue. The hemoglobin levels did decrease significantly during radiotherapy, but there was no significant correlation between general fatigue and hemoglobin after 3 weeks of therapy or after the completion of therapy. In conclusion, pelvic radiotherapy in women with uterine cancer is associated with increased fatigue. There were no significant relationships between anemia or cytokine levels and fatigue. The pathogenesis of fatigue during radiation therapy remains to be elucidated.     

Coping with recurrent breast cancer: predictors of distressing symptoms and health-related quality of life

Little is known about how postmenopausal women with recurrent breast cancer cope with distressing symptoms and which factors predict health-related quality of life (HRQOL). In the present study, 56 consecutively enrolled patients completed questionnaires measuring symptom occurrence, coping capacity, coping efforts, and HRQOL at the time of recurrence. Results from this study illustrate that women with recurrent breast cancer suffer from multiple, concurrent, and interrelated symptoms of illness, anxiety, depression, and fatigue. Highly prevalent symptoms are lack of energy, difficulty sleeping, pain, worrying, problems with sexual interest, feeling sad, and dry mouth. The most frequently occurring symptom is problem with sexual interest, and the most severe symptom is worrying. The most distressing symptom experienced is pain. The majority of the women report 10-23 symptoms. Women who experience multiple symptoms also report higher levels of symptom distress. The experience of distressing symptoms is predicted by coping capacity, and the coping efforts experienced predict HRQOL. Patients with lower coping capacity report higher prevalence of symptoms, experience higher levels of distress, and experience worse perceived health, which in turn may decrease their HRQOL. To help women manage recurrent breast cancer, it is important to use multidimensional measurement to identify, evaluate, and treat distressing symptoms, and not assess single symptoms only. Care must be based upon the awareness of critical factors that exacerbate vulnerability to distress, as well as the ability to adapt to a recurrent breast cancer disease.     

The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation

Patients with breast cancer who undergo autologous bone marrow/peripheral blood stem cell transplantation (ABMT) cope not only with a life-threatening medical treatment, but also with multiple, interrelated symptoms including pain, fatigue, psychological distress, and nausea. The purpose of this study was to determine, in a randomized controlled clinical trial, whether a comprehensive coping strategy program (CCSP) was effective in significantly reducing pain, fatigue, psychological distress, and nausea in patients with breast cancer who underwent ABMT. The CCSP was composed of preparatory information, cognitive restructuring, and relaxation with guided imagery. Randomization placed 52 patients in the CCSP treatment group and 58 patients in the control group. The CCSP was found to be effective in significantly reducing nausea as well as nausea combined with fatigue 7 days after the ABMT when the side effects of treatment were most severe. These results are important given the high incidence of nausea and fatigue in the ABMT population. The CCSP-treated group experienced mild anxiety as compared with the control group who reported moderate anxiety. The greatest effectiveness of CCSP may correspond to the time of the greatest morbidity for patients with breast cancer who have undergone ABM.     

Changes in psychological distress of women in long-term remission from breast cancer in two different geographical settings: a randomized study

Goals of work Psychological distress and coping styles in women diagnosed with stages I and II breast cancer have attracted substantial clinical and research attention over the last several decades. The contradictory and, at times, controversial findings stimulated the present randomized research whose purpose was to explore the possibility and probability of predicting which variables affect the psychological distress level of women with breast cancer 1 to 5 years after diagnosis (time period 1) and 6 to 8 months after period 1 (time period 2).Patients and methods The study was conducted in two large oncology centers in Graz, Austria, and Jerusalem, Israel, with a sample population comprising 424 patients.Main results The only variables that significantly predicted change in the psychological distress levels (Grand Severity Index, GSI; except for the GSI level during period 1) were Fighting Spirit (Mental Adjustment to Cancer, MAC) in the Graz sample and Perceived Family Support (PFS) in the Jerusalem sample. These results are discussed in relation to other findings.Conclusions In light of these findings, it is highly important to preliminarily identify women with less adaptive psychological coping mechanisms and to provide them with efficacy tools for behavioral and cognitive changes within their own network of social and health resources.     

The dyadic effects of coping and resilience on psychological distress for cancer survivor couples

Purpose

This study aimed to examine the actor and partner effects of coping and resilience characteristics on psychological distress in cancer survivors and their spouses and to examine the mediating role of resilience characteristics in the relationship between coping and psychological distress.

Methods

A total of 91 breast, colorectal, and prostate cancer survivor-spouse dyads were recruited from the University Hospital Registry in Cleveland, Ohio. Standardized questionnaires that assessed psychological distress, reframing and acquiring social support coping, and resilience characteristics were used.

Results

The actor-partner interdependence mediation model demonstrated that the resilience of the survivors and spouses was a strong predictor of their personal psychological distress. Survivors’ and spouses’ own resilience mediated the association between their reframing coping and psychological distress. However, only the survivor model confirmed the mediating effect of resilience characteristics in the relationship between social support coping and psychological distress. In addition, spouse psychological distress was influenced by survivor resilience, indicating a spouse-partner effect in the relationship between resilience characteristics and psychological distress.

Conclusions

Our findings provide insight into the relationships between coping, resilience characteristics, and psychological distress at the individual and dyadic levels. Enhancing cancer survivors’ and their spouses’ positive thoughts and available external resources can improve resilience and, in turn, reduce their psychological distress of couples coping with cancer.     

Psychological and immunological characteristics of fatigued women undergoing radiotherapy for early-stage breast cancer

Purpose

The amelioration of fatigue in radiotherapy patients is limited by an equivocal aetiology and uncertainty regarding who is likely to experience significant fatigue. The research objective was to characterise fatigue in women undergoing radiotherapy for breast cancer, in order to evaluate associations with elevations in anxiety, depression and a marker of systemic inflammation.

Methods

Participants comprised 100 women, diagnosed with stages 0?CIIA breast cancer and prescribed with 40?Gy in 15 fractions over 3?weeks. Fatigue was assessed at baseline between 10 and 22?days before radiotherapy, after 10 and 15 fractions of radiotherapy and 4?weeks after the completion of radiotherapy, using the Functional Assessment of Chronic Illness Therapy Fatigue Subscale. Psychological status was self-reported using the Hospital Anxiety and Depression Scale. Sera concentrations of interleukin-6-soluble receptor were established via enzyme-linked immunosorbent assay. The contributions of pretreatment factors to fatigue were analysed using multivariable regression.

Results

Thirty-eight percent of participants experienced significant fatigue during radiotherapy, with the remainder little are affected. After controlling for baseline fatigue, anxiety before treatment was the strongest unique predictor of subsequent fatigue. During radiotherapy, interleukin-6-soluble receptor was significantly elevated in the fatigued group compared to the non-fatigued group (p?=?0.01). This association was not mediated by depression.

Conclusions

The data are consistent with the concept that psychological distress prior to radiotherapy relates to a distinct immunological and behavioural response during radiotherapy. Patients reporting elevated anxiety should benefit from interventions that appropriately address the underlying psychological distress and have the potential to ameliorate disabling treatment-related fatigue.     

Psychological health in cancer survivors

OBJECTIVES: The prevalence of both negative (distress) and positive responses (growth, well-being) to the cancer experience is examined and difficulties in establishing the prevalence of these responses discussed. A conceptual framework for understanding factors associated with psychological health in cancer survivors is presented. Finally, strategies for promoting psychological health in cancer survivors are examined. DATA SOURCES: Review of the literature. CONCLUSION: Psychological health in cancer survivors is defined by the presence or absence of distress as well as the presence or absence of positive well-being and psychological growth. Furthermore, psychological health in cancer survivors is determined by the balance between two classes of factors: the stress and burden posed by the cancer experience and the resources available for coping with this stress and burden. IMPLICATIONS FOR NURSING PRACTICE: In general, promotion of psychological health is based on the prevention or treatment of distress as well as the encouragement of growth and well-being. Periodic screening for psychological distress across the cancer trajectory is critical to appropriate management of distress.     

Counseling Implications in a Client's Choice of Anesthesia During a First or Repeat Abortion

Deciding to have an abortion is a process that causes most women a great deal of distress. This study addresses the question of whether a difference exists in psychological distress between women having abortions under local and general anesthesia. A two-factor analysis of variance design was utilized. The level of psychological distress among four groups of women was measured: Those experiencing a first-time and a repeat abortion under local anesthesia and those experiencing a first-time and repeat abortion under general anesthesia. A main effect for anesthesia was found for the variables of somatization, depression, hostility, psychotocism, global severity index, and positive symptom total. Specifically, women experiencing abortions under general anesthesia experienced more psychological distress in the above variables. Data suggest an association between psychological distress concerning the procedure and choice of anesthetic method may provide clues to the women's counseling needs.     

Trajectories of Fatigue,Psychological Distress,and Coping Styles After Mild Traumatic Brain Injury: A 6-Month Prospective Cohort Study

ObjectiveTo analyze fatigue after mild traumatic brain injury (TBI) with latent class growth analysis (LCGA) to determine distinct recovery trajectories and investigate influencing factors, including emotional distress and coping styles.DesignAn observational cohort study design with validated questionnaires assessing fatigue, anxiety, depression, posttraumatic stress, and coping at 2 weeks and 3 and 6 months postinjury.SettingThree level 1 trauma centers.ParticipantsPatients with mild TBI (N=456).InterventionsNot applicable.Main Outcome MeasuresFatigue was measured with the fatigue severity subscale of the Checklist Individual Strength, including 8 items (sum score, 8-56). Subsequently, 3 clinical categories were created: high (score, 40-56), moderate (score, 26-38), and low (score, 8-25).ResultsFrom the entire mild TBI group, 4 patient clusters with distinct patterns for fatigue, emotional distress, and coping styles were found with LCGA. Clusters 1 and 2 showed favorable recovery from fatigue over time, with low emotional distress and the predominant use of active coping in cluster 1 (30%) and low emotional distress and decreasing passive coping in cluster 2 (25%). Clusters 3 and 4 showed unfavorable recovery, with persistent high fatigue and increasing passive coping together with low emotional distress in cluster 3 (27%) and high emotional distress in cluster 4 (18%). Patients with adverse trajectories were more often women and more often experiencing sleep disturbances and pain.ConclusionsThe prognosis for recovery from posttraumatic fatigue is favorable for 55% of mild TBI patients. Patients at risk for chronic fatigue can be signaled in the acute phase postinjury based on the presence of high fatigue, high passive coping, and, for a subgroup of patients, high emotional distress. LCGA proved to be a highly valuable and multipurpose statistical method to map distinct courses of disease-related processes over time.     

Psychological distress among women with newly diagnosed breast cancer

PurposePsychological distress is common in the cancer continuum. Our objectives were to determine the prevalence of distress and to investigate the related problems and the characteristics of women with breast cancer who experienced psychological distress at the time of diagnosis.MethodsWe used cross-sectional data from a questionnaire study. Women with newly diagnosed breast cancer were consecutively invited to respond before breast surgery. Between October 2008 and October 2009, a total of 357 responded out of 426 (84%) invited. Among these, 343 patients completed the ‘distress thermometer’ to measure psychological distress and the accompanying ‘problem list’ to identify related problems. Logistic regression models with 95% confidence intervals were used to estimate the associations between psychological distress, age, social support and domains on the problem list.ResultsWith a cut-off of 3 on the distress thermometer, 77% of women with breast cancer reported distress, whereas when the cut-off was 7, 43% were distressed. The mean distress score was 5.4 (SD, 3.1). The most frequently reported problems were worry (77%) and nervousness (71%). Distress was significantly associated with the total score and three domains on the problem list. Younger women (<50 years) reported higher levels of distress than older (≥50 years). We found no significant association between distress and having a partner or someone outside the family to rely on.ConclusionsDistress was reported by 77% of patients. Age and problem list were significantly associated with distress. No significant association between psychological distress and social support was observed.     

Perceptions and Experiences of Hematopoietic Cell Transplantation Patients During the COVID-19 Pandemic

ObjectivesSince March 2020, the severe acute respiratory syndrome coronavirus-2 pandemic has affected the global community, but poses unique challenges for individuals with cancer. Patients diagnosed with hematologic malignancies undergo aggressive therapies followed by hematopoietic cell transplantation (HCT) as a potential curative treatment. HCT recipients can be immunocompromised for extended periods of time, and even pre-pandemic, transplant patients reported depression and anxiety due to restrictions and infection prevention measures they had to adhere to as part of transplant precautions. This study aimed to understand psychological distress and capture perspectives on coping strategies and access to healthcare in the HCT population during the COVID-19 pandemic.Data SourcesAdult patients who received a transplant or were awaiting transplant and had a scheduled appointment at the transplant clinic were eligible to participate in this cross-sectional study. Participants completed an online survey that included questionnaires, clinical data and demographic information.ConclusionFifty-four participants completed the survey. HCT participants reported relatively high psychological distress during the initial phase of the COVID-19 pandemic, but indicated use of healthy coping mechanisms to deal with stress.Implication for Nursing PracticeStudy data informs healthcare providers that psychological distress and mental health warrants increased attention during periods of heightened stress. Education and resources on healthy, beneficial coping strategies should be provided to support HCT patients. Nurses and advanced nurse practitioners are well poised to interact with HCT patients and provide necessary support or appropriate referral during routine clinical interactions, preparing patients for prolonged effects of the pandemic and similar future events.     

Performance status 1 predicts psychological response in female, but not male, ambulatory cancer patients

This study aimed to identify gender differences in the impact of performance status (PS) 1, that is, of physically mild impairment, on psychological distress and coping in ambulatory cancer patients. The subjects were 260 male and 242 female cancer outpatients who participated in a structured interview and completed the Profile of Mood States and the Mental Adjustment to Cancer scale. Multivariate analyses controlling for confounding biomedical and psychosocial variables revealed a significant impact of PS 1 on helplessness/hopelessness and a trend toward an impact on fighting spirit in women alone, whereas a trend was observed in regard to psychological distress in both genders. The results of this study suggest that PS 1 may be a risk factor for negative ways of coping in female, but not male, cancer outpatients.     

Lack of marital support and poor psychological responses in male cancer patients

A total of 272 men and 252 women with cancer participated in a study of the impact of being married and the presence of spousal support on psychological distress and coping with cancer. All participants underwent a structured interview and completed the Profile of Mood States and the Mental Adjustment to Cancer scale. Multivariate analysis controlling for potentially confounding biomedical and psychosocial variables revealed that unmarried men had significantly higher levels of psychological distress and lower levels of fighting spirit than married men, and that men with spousal support showed higher levels of fighting spirit than men without spousal support. However, no such difference was observed between unmarried and married women or between women with and without spousal support. These findings suggest that being married may play an important role in reducing psychological distress and enhancing fighting spirit of men with cancer, and that being unmarried may be a risk factor for psychological distress and lower fighting spirit for men with cancer.     

Tiredness as a ticket of entry. The role of patients' beliefs and psychological symptoms in explaining frequent attendance. General Practice Fatigue Group.

OBJECTIVES: To test when patients presented with fatigue whether their beliefs about its cause was related to their frequency of attending; and to measure the association between their fatigue and psychological symptoms and their frequency of attendance during the study year. DESIGN: A cohort study. SETTING: Primary health care. PATIENTS: Patients presenting with fatigue as their main symptom. MAIN OUTCOME MEASURES: A fatigue questionnaire, the general health questionnaire (GHQ), an attribution scale, and measurement of consulting frequency during the 6 months before and after the patient presented. RESULTS: Patients who believed their fatigue was due to a physical or costly physical cause consult for any reason significantly more frequently than patients who reported that psychological as well as physical problems might have caused their fatigue. Patients' psychological distress measured with the GHQ was more closely associated with frequent attendance than their level of fatigue was. CONCLUSIONS: When patients present with fatigue it is important to inquire about their beliefs and psychological symptoms; these factors may be more important than the fatigue itself in explaining their help-seeking behaviour.     

Assessment of fatigue in and care needs of Turkish women with breast cancer

Using Piper's Integrated Fatigue Model, this research project was planned to determine the level of fatigue experienced by Turkish women with breast cancer undergoing adjuvant chemotherapy, to discover the factors affecting fatigue, and to provide a reference by means of which an effective nursing care for such patients could be planned. In assessing the level of fatigue and factors affecting it, a patient information form, the Piper Fatigue Scale, and the Rotterdam Symptom Checklist were used. The reliability tests performed afterwards showed that the scales are appropriate tools for use in Turkish women with breast cancer. Before treatment, psychological symptoms' distress was higher than physical symptoms' distress. However, following treatment, the latter was found to be closer to the former. When pretreatment and posttreatment physical and psychological symptoms were compared, it was noticed that fatigue, nausea, anorexia, vomiting, constipation, depression, and loss of hope for the future were among the symptoms observed to increase the most in the posttreatment period. Different from the other studies, we determined that all of the patients experienced fatigue 7 to 10 days after the chemotherapy cycle and the sensory/affective fatigue scores were high. Breast cancer patients undergoing chemotherapy experienced a moderate level of fatigue, which was influenced by level of income, stage of disease, and symptoms related to chemotherapy, showing compliance with similar studies. Following up patients individually and keeping the treatment-related symptoms under control were noticed to help prevent fatigue.     

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.     

The experience of fatigue, other symptoms and global quality of life during radiotherapy for uterine cancer

This paper reports on how patients with uterine cancer, receiving radiotherapy, experience fatigue, other symptoms and global quality of life. The results showed that fatigue increased significantly during the therapy. Also the other symptoms; loss of appetite, nausea/vomiting and diarrhoea increased significantly and were significantly correlated to general fatigue. Global quality of life decreased significantly during treatment compared to baseline. The variation of the level in general fatigue after completed therapy was only explained by the level of general fatigue experienced at baseline. The result can lead to a better understanding of the severity of symptoms experienced by patients with uterine cancer treated with radiotherapy.