Identifying the Complexity of Diagnosing Bipolar Disorder: A Focused Ethnography

Purpose: To identify and describe the complexity of diagnosing bipolar disorder, including the diagnostic process and patient experiences of being newly diagnosed with bipolar disorder.

Design: A mixed-methods focused ethnography was conducted, grounded in a post-positivist foundation.

Methods: Medical records (n?=?100) of patients whose diagnosis had been switched to bipolar disorder were examined. Six weeks post-hospitalization, ten outpatients with the diagnosis of bipolar disorder underwent an in-depth interview.

Findings: Four diagnostic processes were identified during the retrospective record review. Two patterns and five themes were identified from the interviews. The first pattern, living with undiagnosed bipolar disorder, demonstrated common experiences of distinguishing impulsive moods and behavior, suffering life challenges, and seeking relief. The second pattern, acclimating to a new diagnosis of bipolar disorder, demonstrated participants’ ways of understanding the diagnosis and reconciling the diagnosis. Patterns in the interviews corroborated data from the record review.

Conclusions: The rendering of an appropriate diagnosis is key. Many participants’ lives were significantly improved when diagnosis was made, and treatment recommendations for bipolar disorder (BPD) were initiated. These findings offer clinicians and researchers new ways to think about the complexity of the diagnosis of BPD including contrasting decision-making outcomes along a screening, diagnosis, and treatment continuum, as well as using the diagnostic event to instigate meaningful life change in the patient.     

Diagnoses of anxiety and depression in clinical-scenario patients: Survey of Saskatchewan family physicians

Objective

To investigate family physicians’ differential diagnoses of clinical-scenario patients presenting with symptoms of either generalized anxiety disorder (GAD) or a major depressive episode (MDE).

Design

Cross-sectional survey.

Setting

Saskatchewan.

Participants

A total of 331 family physicians practising in Saskatchewan as of December 2007.

Main outcome measures

Type and number of physicians’ differential diagnoses for a GAD-scenario patient and an MDE-scenario patient.

Results

The survey response rate was 49.7% (331 of 666 surveys returned). Most physicians suggested a diagnosis of anxiety (82.5%) for the GAD-scenario patient and a diagnosis of depression (84.2%) for the MDE-scenario patient. In descending order, the 5 most frequent differential diagnoses for the GAD-scenario patient were anxiety, hyperthyroidism, depression, panic disorder or attack, and bipolar disorder. The 5 most frequent differential diagnoses for the MDE-scenario patient were depression, anxiety, hypothyroidism, irritable bowel syndrome, and anemia. Neither a diagnosis of anxiety nor a diagnosis of depression was associated with physicians’ personal attributes (sex, age, and years in practice) or organizational setting (number of total patient visits per week, private office or clinic, solo practice, Internet access, and rural practice setting). However, physicians in solo practice suggested fewer differential diagnoses for the GAD-scenario patient than those in group practice; physicians in practice 30 years or longer suggested fewer differential diagnoses for the MDE-scenario patient than those in practice fewer than 10 years. On average, physicians suggested 3 differential diagnoses for each of the scenarios.

Conclusion

Most family physicians recognize depression and anxiety in patients presenting with symptoms of these disorders and consider an average of 3 differential diagnoses in each of these cases.     

Psychosocial and Sensory Factors Contribute to Self-Reported Pain and Quality of Life in Young Adults with Irritable Bowel Syndrome

AimsPsychosocial and sensory factors, including anxiety, depression, and pressure pain threshold have been used to cluster chronic symptoms in irritable bowel syndrome (IBS). This study examined the contribution of psychosocial sensory factors on pain interference and quality of life (QOL) in this population.DesignWe performed a cross-sectional analysis of baseline data from a randomized controlled trial.SettingsTwo gastrointestinal clinics, general communities, and two large campuses of a public university in the Northeastern United States.Participants/SubjectsEighty young adults with IBS aged 21 ± 2.57 years (76.25% female).MethodsDemographic and psychosocial factors including anxiety, depression, fatigue, cognition or general concerns, sleep disturbance, self-efficacy, coping, and food intake were measured as independent variables. Quantitative sensory testing was conducted to measure mechanical, thermal, and pressure pain thresholds. Self-reported pain measured by the brief pain inventory (BPI) and IBS-QOL were assessed as the outcome variables. Regression analysis and mediation analysis were conducted to determine the associated factors of IBS pain and QOL.ResultsAge, sex, and psychosocial factors including coping, self-efficacy, alcohol intake, mechanical pain sensitivity, and cold pain threshold were significantly associated with pain interference (all p < 0.05). Coping, and self-efficacy were significantly associated with IBS-QOL (all p < 0.05). In the mediation analysis, coping catastrophizing and self-efficacy were indirectly associated with IBS-QOL mediated by fatigue.ConclusionsPsychosocial factors including coping and self-efficacy, and quantitative sensory testing factors significantly correlate with self-reported pain and QOL among young adults with IBS. This preliminary research calls for further interventional studies that target personalized psychosocial and quantitative sensory factors to improve pain management and quality of life in IBS patients.     

Diagnosis and management of post-traumatic stress disorder

Although post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder that may cause significant distress and increased use of health resources, the condition often goes undiagnosed. The lifetime prevalence of PTSD in the United States is 8 to 9 percent, and approximately 25 to 30 percent of victims of significant trauma develop PTSD. The emotional and physical symptoms of PTSD occur in three clusters: re-experiencing the trauma, marked avoidance of usual activities, and increased symptoms of arousal. Before a diagnosis of PTSD can be made, the patient's symptoms must significantly disrupt normal activities and last for more than one month. Approximately 80 percent of patients with PTSD have at least one comorbid psychiatric disorder. The most common comorbid disorders include depression, alcohol and drug abuse, and other anxiety disorders. Treatment relies on a multidimensional approach, including supportive patient education, cognitive behavior therapy, and psychopharmacology. Selective serotonin reuptake inhibitors are the mainstay of pharmacologic treatment.     

Prevalence and distribution of psychological diagnoses and related frequency of consultations in Norwegian urban general practice

Objective: To investigate the prevalence and distribution of psychological diagnoses made by general practitioners (GPs) in urban general practice and the related frequency of consultations during 12 consecutive months in Norwegian general practice.Design: A cross-sectional study with data extracted from 16,845 electronic patient records in 35 urban GP practicesSetting: Six GP group practices in Groruddalen, Norway.Subjects: All patients aged 16–65 with a registered contact with a GP during 12 months in 2015.Main outcome measures: Frequency and distribution of psychological diagnoses made by GPs, and the number of patients’ consultations.Results: GPs made a psychological diagnosis in 18.8% of the patients. The main diagnostic categories were depression symptoms or disorder, acute stress reaction, anxiety symptoms or disorder and sleep disorder, accounting for 67.1% of all psychological diagnoses given. The mean number of consultations for all patients was 4.09 (95% CI: 4.03, 4.14). The mean number of consultations for patients with a psychological diagnosis was 6.40 (95% CI: 6.22, 6.58) compared to 3.55 (95% CI 3.50, 3.51) (p<0.01) for patients without such a diagnosis. Seven percent of the diagnostic variation was due to differences among GPs.Conclusions: Psychological diagnoses are frequent in urban general practice, but they are covered using rather few diagnostic categories. Patients with psychological diagnoses had a significantly higher mean number of GP consultations regardless of age and sex.Implications: The knowledge of the burden of psychological health problems in general practice must be strengthened to define evidence-based approaches for detecting, diagnosing and treating mental disorders in the general practice population.

Key Points

• Eighteen percent of patients aged 16–65 in our study of patients in urban general practice received one or more psychological diagnoses in 12 months.
• Depression was the most common diagnosis; followed by acute stress reaction, anxiety and sleep disturbance.
• Patients with psychological diagnoses had a significantly higher mean number of consultations compared to patients without such diagnoses regardless of age and sex.

     

The effect of comorbid medical and psychiatric diagnoses on chronic fatigue syndrome

Abstract

Objective: To determine if presence of co-existing medically unexplained syndromes or psychiatric diagnoses affect symptom frequency, severity or activity impairment in Chronic Fatigue Syndrome.

Patients: Sequential Chronic Fatigue Syndrome patients presenting in one clinical practice.

Design: Participants underwent a psychiatric diagnostic interview and were evaluated for fibromyalgia, irritable bowel syndrome and/or multiple chemical sensitivity.

Main Measures: Structured Clinical Interview [SCID] for DSM-IV; SF-36, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Short Form; Patient Health Questionnaire-8; Multidimensional Fatigue Inventory (MFI-20), CDC Symptom Inventory

Results: Current and lifetime psychiatric diagnosis was common (68%) increasing mental fatigue/health but no other illness variables and not with diagnosis of other medically unexplained syndromes. 81% of patients had at least one of these conditions with about a third having all three co-existing syndromes. Psychiatric diagnosis was not associated with their diagnosis. Increasing the number of these unexplained conditions was associated with increasing impairment in physical function, pain and rates of being unable to work.

Conclusions: Patients with Chronic Fatigue Syndrome should be evaluated for current psychiatric conditions because of their impact on patient quality of life, but they do not act as a symptom multiplier for the illness. Other co-existing medically unexplained syndromes are more common than psychiatric co-morbidities in patients presenting for evaluation of medically unexplained fatigue and are also more associated with increased disability and the number and severity of symptoms.

• Key messages

• When physicians see patients with medically unexplained fatigue, they often infer that this illness is due to an underlying psychiatric problem.

• This paper shows that the presence of co-existing psychiatric diagnoses does not impact on any aspect of the phenomenology of medically unexplained fatigue also known as chronic fatigue syndrome. Therefore, psychiatric status is not an important causal contributor to CFS.

• In contrast, the presence of other medically unexplained syndromes (irritable bowel syndrome; fibromyalgia and/or multiple chemical sensitivity) do impact on the illness such that the more of these that co-exist the more health-related burdens the patient has.

     

Referral Patterns of Patients for Palliative Radiation Therapy in British Columbia: A Comparison Between Rural and Urban Family Physicians

BackgroundPrevious studies have shown that palliative radiation therapy (PRT) is often underused, especially in rural and remote settings despite evidence supporting its effectiveness in managing symptoms from advanced or metastatic cancer.PurposeTo identify factors which influence family physicians (FPs) in British Columbia (BC) to refer patients for PRT at the BC Cancer Agency (BCCA) and to compare referral patterns between FPs in rural and urban areas.Methods and MaterialsA total of 1,001 questionnaires were sent to all FPs practicing in rural areas and randomly to FPs in urban areas (351 and 650, respectively). Rural and urban areas were chosen based on our previous study of utilization rates of PRT in BC. The questionnaire was adapted from a previously validated survey, and was used to obtain information on referral practices of FPs in BC. FPs who did not practice family medicine or where 80% of their practice was spent with either obstetrical or pediatric patients were excluded.ResultsThe overall response rate was 33% (44% rural vs. 28% urban). Rural FPs were more involved in both palliative care and metastatic cancer management of their patients (88% vs. 74%; P = .01 and 58% vs. 39%; P = .01). No difference was observed in the FPs' awareness of the BCCA's Radiation Oncology Program. The most significant factors influencing an FP to refer a patient for PRT were: poor functional status, inconvenience to travel and life expectancy. A higher proportion of rural FPs had 10 years or less of experience in family practice than the urban FPs (P = .03). There was no significant difference in the formal training or additional training between the rural and urban FPs.ConclusionsThis study found that FPs practicing in rural areas were more involved in palliative management of their patients and participated more in the care of patients with advanced or metastatic cancer than those in urban areas. They also more commonly referred patients for palliative radiotherapy than their urban counterparts. The reported factors that influenced rural and urban FPs to refer were patients' functional status and life expectancy, combined with uncertain benefit and potential side effects of radiotherapy. More than twice as many FPs from rural compared to urban areas were influenced by perceived inconvenience to travel for palliative radiotherapy. After controlling for potential confounding factors, FP awareness of the radiotherapy program, high participation in advanced, metastatic, or palliative care of cancer patients, formal training in radiation oncology, and additional training in palliative care were all associated with an increased probability of ever referring for palliative radiotherapy.     

Anxiety Disorders: Differential Diagnosis and Their Relationship to Chronic Pain

ABSTRACT

Anxiety disorders are the most prevalent type of mental disorder, and they frequently co-occur with various medical conditions, including chronic pain. Anxiety disorders are associated with higher health care costs, and comorbid chronic pain and anxiety disorder leads to worse outcomes. Despite their prevalence, anxiety disorders often go unrecognized in pain care facilities, compromising clinical benefit of pain treatment. Differential diagnosis among the anxiety disorders can be very difficult, and the high comorbidity with mood disorders, unexplained physical symptoms, and medical disorder makes the precise assessment complicated. Nevertheless, a better understanding of the research and theory that has accumulated can help clinicians accurately diagnose, conceptualize, and treat the patient's symptomatology. In this paper, the authors provide comprehensive review of the diagnostic criteria, epidemiology, differential diagnosis, and relation to chronic pain.     

Predictive Validity and Psychiatric Nursing Staff's Perception of the Clinical Usefulness of the French Version of the Dynamic Appraisal of Situational Aggression

Attention deficit hyperactivity disorder (ADHD) has long been identified as a common disorder of childhood. There is increasing recognition that adults also are affected by this disorder. Many adults, however, are often undiagnosed or misdiagnosed until their child is diagnosed with the disorder. Improved recognition and treatment for parental ADHD needs to occur given the genetic and environmental etiologies of the disorder. This paper examines three areas where there is a dearth of data in extant literature: parental ADHD culture and ethnicity; parenting and undiagnosed ADHD; and professional care and ADHD, and focuses on parents from ethnic minority cultures.     

Fibromyalgia Pain and Fatigue Symptoms in Spanish and U.S. Men

Background and AimsFibromyalgia Syndrome (FMS) is a chronic centralized pain disorder characterized by widespread pain and fatigue. Of those affected by FMS, the majority are women, and minimal research exists involving men. The purpose of this paper is to describe the pain and fatigue experiences of men with FMS from two Western countries, Spain and the United States, in order to support more accurate and earlier recognition and diagnosis in men.Design and MethodsWe used individual and focus group interviews with qualitative and quantitative assessments.Settings and Participants/SubjectsTen men in Spain and seven men in the United States provided information about their symptoms, psychosocial and health-seeking behaviors, and gender experiences with FMS.ResultsMen articulated types, trends, and triggers of pain and fatigue that enrich an understanding of their symptoms. For example, men report more localized pain than generalized pain. Employment status and activities, among other contextual factors, impacted men's pain and fatigue experiences.ConclusionsMen experience distinct facets of pain and fatigue compared with women, with notable similarities and differences across the Spanish and U.S. samples. Cross-cultural comparisons highlight contextual factors that may inspire future inquiries about determinants of men's experiences with FMS.Clinical ImplicationsThe present study could be useful for anyone treating men suffering from FMS, especially care providers in nursing, medical, and psychology fields. These initial findings may prompt a closer examination of recommendations for assessment and diagnostic criteria used internationally for patients with FMS with better recognition of men's experience.     

Primary headaches in patients with generalized anxiety disorder

Although anxiety disorders and headaches are comorbid conditions, there have been no studies evaluating the prevalence of primary headaches in patients with generalized anxiety disorder (GAD). The aim of this study was to analyze the lifetime prevalence of primary headaches in individuals with and without GAD. A total of 60 individuals were evaluated: 30 GAD patients and 30 controls without mental disorders. Psychiatric assessments and primary headache diagnoses were made using structured interviews. Among the GAD patients, the most common diagnosis was migraine, which was significantly more prevalent among the GAD patients than among the controls, as were episodic migraine, chronic daily headache and aura. Tension-type headache was equally common in both groups. Primary headaches in general were significantly more common and more severe in GAD patients than in controls. In anxiety disorder patients, particularly those with GAD, accurate diagnosis of primary headache can improve patient management and clinical outcomes.     

Importance of Addressing the Psychosocial Impact of Penile Cancer on Patients and Their Families

ObjectiveIn this article we review the quality of life and the psychosocial and functional outcomes experienced by patients and their partners following penile cancer diagnosis and treatment.Data SourcesA literature search for primary articles related to patient reported outcomes following penile cancer treatment was conducted using the electronic database PubMed.ConclusionPenile cancer is a rare malignancy in the United States, and it carries an excellent prognosis if diagnosed early. However, increased survivorship carries devastating long-term consequences on the mental health of patients and their families. Factors impacting the quality of life of patients include sexual dysfunction, cosmetic changes, voiding dysfunction, depression, and anxiety. Treatment modalities vary depending on the extent of the cancer but include medical, interventional, and surgical options.Implications for Nursing PracticeThe multidisciplinary team can support patients and their partners to develop, test and deliver posttreatment survivorship interventions to optimize psychosocial well-being and quality of life outcomes for this rare disease.     

Psychological and social profile of family caregivers on commencement of palliative care

ContextPalliative care services are required to support patients who have advanced, life-threatening, noncurable disease, and their family caregivers. Comprehensive psychological and social support for bereaved family members also is expected. However, recent systematic reviews have demonstrated significant gaps in evidence-based approaches for such support. Furthermore, a comprehensive understanding of the psychological and social response to the family caregiver role is required for support to be optimized.ObjectivesWe sought to examine the psychological and social profile of family caregivers on commencement of receiving palliative care services.MethodsA self-report questionnaire was administered to primary family caregivers of patients within two weeks of admission to three palliative care services in Melbourne, Australia. The questionnaire incorporated six instruments that measured 11 family caregiver-related psychosocial factors; four instruments that measured caregiver psychological distress factors; 14 mental health lifetime risk factors; and a sociodemographic questionnaire.ResultsThree hundred and two family caregivers participated. Nearly half (44%) of the caregivers had a probable anxiety and/or depressive disorder, with 40% scoring more than the cutoff score for probable anxiety and 20% scoring more than the cutoff score for probable depression. Additionally, approximately 15% of caregivers met the criteria for pre-loss grief, and around 10% reported moderate to severe levels of demoralization. Caregivers who had a probable anxiety and/or depressive disorder also reported higher levels of pre-loss grief.ConclusionThis study provides further evidence of the prevalence of poor psychosocial well-being in this population. The results reinforce the need to develop suitable strategies for psychological and social support for family caregivers.     

Mental health and the relationship between health promotion counseling and health outcomes in chronic conditions: Cross-sectional population-based study

Objective

To explore the relationship between health promotion counseling (HPC) provided by FPs and health-related quality of life (HRQL) and the use of health care services among patients with chronic conditions, while assessing the effect of mental health on these relationships.

Design

Telephone survey using random-digit dialing.

Setting

Alberta.

Participants

A total of 1615 participants with chronic conditions.

Main outcome measures

Health promotion counseling provided by FPs, which was assessed using 4 questions; HRQL using the Euro quality of life 5-dimensions (EQ-5D) questionnaire; and the use of health care services assessed with self-reported emergency department (ED) visits and hospitalizations.

Results

Of the 1615 participants with chronic conditions, 55% were female and more than two-thirds were older than age 45 years. Less than two-thirds of participants received HPC from their FPs. In patients without anxiety or depression, those who needed help from their FPs in making changes to prevent illness had a 0.05 lower EQ-5D score than those who did not (P < .001); and those who received diet counseling had a 0.03 higher EQ-5D score than their counterparts did (P = .048). However, these associations were not observed in patients with anxiety or depression. Patients were more likely to have visited EDs if they needed their physicians’ help in making changes to prevent illness (odds ratio 1.43, 95% CI 1.08 to 1.89) and less likely to visit EDs if they had been encouraged by their physicians to talk about their health concerns (odds ratio 0.69, 95% CI 0.52 to 0.91). None of the HPC items was associated with hospitalizations.

Conclusion

Not all patients with chronic conditions are receiving HPC from their FPs. Also, there is an association between HPC and important health outcomes (ie, HRQL and ED visits), but this association is not apparent for those with anxiety or depression.     

Adult emergency department referrals from urgent care centers

BackgroundAlthough urgent care centers (UCCs) can often evaluate and treat minor injuries/illnesses, patients may present with life threatening conditions that require immediate recognition, stabilization, and transfer to a higher level of care, beyond the capabilities of most UCCs.ObjectiveTo describe adult ED referrals from UCCs and to determine the percentage of referrals considered critical, complex, and simple.MethodsA prospective study was conducted between 8/2016–8/2017 on patients >18 years referred directly to our ED from surrounding UCCs. Referrals were categorized based on investigations/procedures performed or medications/consultations received in the ED.ResultsWe analyzed 317 patient encounters; 23 (7.3%) considered critical, 254 (80.1%) complex, and 40 (12.6%) simple. The most common chief complaints for all ED referrals were abdominal pain (62 encounters), chest pain (28), shortness of breath (16), eye pain/injury (16), and leg pain/swelling (15). 68% of patients received laboratory diagnostic investigations and 69% received radiologic investigations. 37% of patients required consultation from a subspecialist. 78% of patients were discharged home. The most common primary diagnoses for all ED referrals were nonspecific abdominal pain (27 encounters), laceration (22), fracture (20), nonspecific chest pain (12), cellulitis (12), and pneumonia (12). The most common primary diagnoses for critical referrals were appendicitis (7) and fracture (3).ConclusionMany adult ED referrals in our sample were considered complex and few were considered critical. Individual UCCs should evaluate their current states of ED referrals, and develop educational and preparedness strategies based on the epidemiology of adult emergencies that may occur.     

Forecast modeling to identify changes in pediatric emergency department utilization during the COVID-19 pandemic

ObjectiveTo identify trends in pediatric emergency department (ED) utilization following the COVID-19 pandemic.MethodsWe performed a cross-sectional study from 37 geographically diverse US children's hospitals. We included ED encounters between January 1, 2010 and December 31, 2020, transformed into time-series data. We constructed ensemble forecasting models of the most common presenting diagnoses and the most common diagnoses leading to admission, using data from 2010 through 2019. We then compared the most common presenting diagnoses and the most common diagnoses leading to admission in 2020 to the forecasts.Results29,787,815 encounters were included, of which 1,913,085 (6.4%) occurred during 2020. ED encounters during 2020 were lower compared to prior years, with a 65.1% decrease in April relative to 2010–2019. In forecasting models, encounters for depression and diabetic ketoacidosis remained within the 95% confidence interval [CI]; fever, bronchiolitis, hyperbilirubinemia, skin/subcutaneous infections and seizures occurred within the 80–95% CI during the portions of 2020, and all other diagnoses (abdominal pain, otitis media, asthma, pneumonia, trauma, upper respiratory tract infections, and urinary tract infections) occurred below the predicted 95% CI.ConclusionPediatric ED utilization has remained low following the COVID-19 pandemic, and below forecasted utilization for most diagnoses. Nearly all conditions demonstrated substantial declines below forecasted rates from the prior decade and which persisted through the end of the year. Some declines in non-communicable diseases may represent unmet healthcare needs among children. Further study is warranted to understand the impact of policies aimed at curbing pandemic disease on children.     

Evaluation of Prehospital Use of Furosemide in Patients with Respiratory Distress

Objective. To evaluate the appropriateness of prehospital use of furosemide. Methods. All patients over 18 years old receiving prehopsital furosemide were retrospectively identified, andcases were matched to subsequent hospital records. Data collected included ED andhospital primary andsecondary diagnoses, brain-type natriuretic peptide (BNP) levels andfinal disposition. Furosemide was considered appropriate when the primary or secondary ED or hospital diagnoses included congestive heart failure (CHF) or pulmonary edema, or the BNP was > 400. Furosemide was considered inappropriate when none of the diagnoses included CHF, when the BNP was < 200, or when an order for IV fluid hydration was given. Furosemide was considered potentially harmful when the diagnoses included sepsis, dehydration or pneumonia, without a diagnosis of CHF or BNP > 400. Results. Of the 144 included patients, a primary or secondary diagnosis of CHF was reported in 42% and17% patients, respectively. The initial BNP was > 400 in 44% of the 120 patients in which this lab test was obtained. Sixty patients (42%) did not receive a diagnosis of CHF, 30 (25%) patients had a BNP < 200, and33 (23%) had an order for IV fluid hydration. A diagnosis of sepsis, dehydration or pneumonia without a diagnosis of CHF or a BNP > 400 occurred in 17% of patients. Seven of the 9 deaths did not receive a diagnosis of CHF. Furosemide was considered appropriate in 58%, inappropriate in 42% andpotentially harmful in 17% of patients. Conclusions. In this EMS system, prehospital furosemide was frequently administered to patients in whom its use was considered inappropriate, andnot uncommonly to patients when it was considered potentially harmful. EMS systems should reconsider the appropriateness of prehospital diuretic use.     

Impact of Self-Reported Exercise on Recounted Levels of Fatigue and Anxiety in Early-Stage Breast Cancer Radiation Therapy Patients

PurposeExercise may be an alternative strategy to helping early-stage breast cancer (ESBC) patients manage their cancer-related fatigue and anxiety during radiation therapy. This observational study aims to investigate the impact of self-reported exercise on fatigue and anxiety levels pre (T0), mid (T1), and post (T2) radiation therapy in patients with ESBC.MethodsFollowing informed consent, subjects completed three standardized questionnaires measuring physical activity, fatigue/quality of life, and anxiety at T0, T1, and T2.ResultsA total of 58 female patients (57 ± 9 years) completed this study. Mean activity level at T0 was 2548 (3292) metabolic equivalent units (METs), T1 was 3072 (3974) METs, and T2 was 2963 (2442) METs. There was no significant change between the three time points with measures of physical activity. Many patients moved from the moderately active group at T0 to the active group at T1. The mean T0 score using the quality of life questionnaire was 38.97 (11.30), T1 was 36.93 (11.69), and T2 was 35.36 (11.18). There was no significant change between the three time points with measures of quality of life (P = .211). There was statistical significance at P = .025 at T1 for lower quality of life compared to T0 across all exercise types. There was also statistical significance at P = .026 at T1 for the active group with higher quality of life compared to the inactive one. All three physical activity categories showed a decline in quality of life scores over time. Anxiety decreased between the three time point measurements. Mean T0 score for anxiety was 47.33 (5.95), T1 was 43.16 (6.49), and T2 was 38.48 (8.46). The interaction of exercise level and time is not significant for anxiety (P = .91). There was statistical significance (P = .015) for anxiety at T2 compared to T1 across exercise types.DiscussionThis study demonstrated that ESBC patients showed signs of fatigue and anxiety while undergoing radiation therapy regardless of self-reported exercise measured by a physical activity questionnaire. Several trends were observed that showed improved outcomes for patients consistent with previously published studies. The present study highlights a nonsignificant change in fatigue. As fatigue is one of the main side effects from radiation, it may be difficult to demonstrate significance. There are some studies in the field that demonstrate significance between fatigue and exercise with larger sample sizes. The results also highlight a decrease in anxiety from the baseline to the end of treatment. It is postulated that patients become less anxious as treatment progresses due to familiarity of a routine. The present study is limited by several factors including sample size and the study not being a randomized controlled one.ConclusionsExercise may reduce anxiety during radiation treatment for ESBC patients. Further investigation is required to assess the impact of fatigue.