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ABSTRACT: Objective: Recent research suggests that sleep disturbance, fatigue, and depressed mood form a symptom cluster in patients treated with chemotherapy. To date, however, no studies have examined lagged relationships among these symptoms during chemotherapy, a time when symptom variability is high. The aim of the current study was to examine lagged changes among daily symptoms during platinum-based chemotherapy. Method: Participants were 78 women with gynecologic cancer (mean age 63 years, SD = 11; 91% Caucasian, 97% non-Hispanic). Sleep disturbance was assessed via wrist actigraphy, whereas fatigue and depressed mood were assessed via daily diary in the week after participants' first chemotherapy infusion. Latent change score models (LCS) were used to examine lagged relationships between symptom pairs. Results: High levels of sleep disturbance (i.e., minutes awake at night) were associated with earlier subsequent peaks in fatigue, and high levels of fatigue were associated with higher subsequent levels of depressed mood. Conclusions: These findings suggest that sleep disturbance, fatigue, and depressed mood occur in a cascade pattern during chemotherapy, in which increases in sleep disturbance contribute to fatigue, which, in turn, contributes to depressed mood. Interventions targeting symptoms early in the cascade, such as sleep disturbance, may provide benefits across multiple downstream symptoms. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Health Psychology 02/2013; · 3.87 Impact Factor
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Kristin M Phillips,
Javier Pinilla-Ibarz,
Eduardo Sotomayor,
Morgan R Lee, Heather S L Jim,
Brent J Small,
Lubomir Sokol,
Jeffrey Lancet,
Sara Tinsley,
Kendra Sweet,
Rami Komrokji,
Paul B Jacobsen
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ABSTRACT: PURPOSE: Tyrosine kinase inhibitors (TKIs) are now standard treatment for chronic myeloid leukemia (CML). While TKIs have less toxicity than previous treatments, they have side effects that can impact quality of life (QOL). METHODS: This study compared CML patients taking a TKI for an average of 4.01 years (range 0.50-9.79 years) to age- and gender-matched controls with no history of cancer on measures of symptom burden, depression, fatigue, sleep, and health-related QOL. RESULTS: Compared to controls (n = 62), CML patients (n = 62) taking a TKI (imatinib 55 %, nilotinib 31 %, and dasatinib 14 %) reported significantly worse fatigue severity (p < .001), fatigue interference (p < .001), depression (p = .007), symptom burden (p < .001), and physical QOL (p < .001). TKI patients were also more likely meet established cutoffs for clinically meaningful fatigue (p values < .001) and depression (p = .004). There were no differences in mental QOL or sleep (p values > .010). Regarding specific symptoms, TKI patients were more likely to report nausea, diarrhea, itching, skin changes, swelling of arms or legs, and not looking like themselves (p values < .001). CONCLUSIONS: These data suggest the need for interventions to address QOL in CML patients taking TKIs.
Supportive Care in Cancer 11/2012; · 2.09 Impact Factor
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ABSTRACT: CONTEXT: Fatigue, one of the most common side effects of chemotherapy, is typically assessed via retrospective recall (e.g., over the past week). It is unknown how such retrospective recall of fatigue correlates with daily ratings among people receiving chemotherapy. OBJECTIVES: The current study compared fatigue recorded in daily diaries with retrospective ratings using the Fatigue Symptom Inventory (FSI) in patients receiving chemotherapy for gynecologic cancer. METHODS: During the week before and the week after their first infusion of chemotherapy, patients completed daily diaries at 10 AM, 2, and 6 PM and the FSI at the end of each week. RESULTS: FSI and diary ratings of peak, lowest, and average fatigue were significantly correlated (P < 0.001). When peak, end, average, and variance diary ratings were regressed separately on the average FSI item, each was significant pre-chemotherapy (P < 0.01) and post-chemotherapy (P < 0.05). However, when entered into a stepwise regression model, only the average fatigue diary rating was retained, explaining 52% of the variance pre-chemotherapy and 54% of the variance post-chemotherapy average FSI item (P < 0.001). CONCLUSION: The FSI keyed to the past week accurately reflects daily ratings of fatigue among patients receiving chemotherapy. This study has important implications, as completing retrospective ratings of fatigue may be less burdensome for cancer patients than daily assessments.
Journal of pain and symptom management 11/2012; · 2.42 Impact Factor
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ABSTRACT: Although exercise may be used by some to decrease distress, little is known about how it may contribute to stress management (SM) among patients receiving chemotherapy. We evaluated whether exercise separately or in combination with SM training is effective at increasing perceived ability to manage stress. Patients receiving chemotherapy (N = 391) were randomized to receive usual care only (UCO), SM, exercise (EX), or stress management and exercise (SMEX). They completed the Measure of Current Status prior to receiving chemotherapy and 12 weeks after the first infusion. We hypothesized that participants randomized to an intervention condition would report improvements in relaxation, awareness of tension, getting needs met and coping confidence compared with those receiving UCO. Results indicated significant group-by-time interactions for the following: relaxation (UCO versus SM, p = 0.008), awareness of tension (UCO versus SMEX, p = 0.029 and UCO versus EX, p < 0.001), getting needs met (UCO versus SMEX, p = 0.020) and Measure of Current Status total score (UCO versus SMEX, p = 0.007 and UCO versus EX, p = 0.016). There were no group-by-time interactions for coping confidence (p-values >0.05). This study provides support for including an exercise component in SM interventions for cancer patients receiving chemotherapy (clinicaltrials.gov identifier: NCT00740038). Copyright © 2012 John Wiley & Sons, Ltd.
Stress and Health 09/2012; · 1.23 Impact Factor
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ABSTRACT: PURPOSE Evidence is mixed regarding long-term cognitive deficits in patients treated with chemotherapy. Previous meta-analyses have not focused specifically on the postchemotherapy period and have not incorporated several recent studies. The goal of the current study was to conduct a meta-analysis of cognitive functioning in breast cancer survivors who were treated with chemotherapy ≥ 6 months previously. METHODS A search of PubMed, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library yielded 2,751 abstracts, which were independently evaluated by pairs of raters. Meta-analysis was conducted on 17 studies of 807 patients previously treated with standard-dose chemotherapy for breast cancer. Neuropsychological tests were categorized according to eight cognitive domains: attention, executive functioning, information processing, motor speed, verbal ability, verbal memory, visual memory, and visuospatial ability. Results Deficits in cognitive functioning were observed in patients treated with chemotherapy relative to controls or prechemotherapy baseline in the domains of verbal ability (g = -0.19; P < .01) and visuospatial ability (g = -0.27; P < .01). Patients treated with chemotherapy performed worse than noncancer controls in verbal ability and worse than patients treated without chemotherapy in visuospatial ability (both P < .01). Age, education, time since treatment, and endocrine therapy did not moderate observed cognitive deficits in verbal ability or visuospatial ability (all P ≥ .51). CONCLUSION Results indicate that, on average, observed cognitive deficits in patients with breast cancer previously treated with chemotherapy are small in magnitude and limited to the domains of verbal ability and visuospatial ability. This information can be used to inform interventions to educate patients with breast cancer regarding the long-term impact of chemotherapy on cognitive functioning.
Journal of Clinical Oncology 08/2012; 30(29):3578-87. · 18.37 Impact Factor
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Paul B Jacobsen,
Kristin M Phillips, Heather S L Jim,
Brent J Small,
Leigh Anne Faul,
Cathy D Meade,
Lora Thompson,
Charles C Williams,
Loretta S Loftus,
Mayer Fishman,
Rick W Wilson
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ABSTRACT: BACKGROUND: Research has shown that self-directed stress management training improves mental well-being in patients undergoing chemotherapy. The present study extends this work by evaluating separate and combined effects of stress management training and home-based exercise. METHOD: Following assessment of mental and physical well-being, depression, anxiety, exercise, and stress reduction activity before chemotherapy started, patients were randomized to stress management training (SM), exercise (EX), combined stress management and exercise (SMEX), or usual care only (UCO). Outcomes were reassessed 6 and 12 weeks after chemotherapy started. Significance testing of group-by-time interactions in 286 patients who completed all assessments was used to evaluate intervention efficacy. RESULTS: Interaction effects for mental and physical well-being scores were not significant. Depression scores yielded a linear interaction comparing UCO and SMEX (p = 0.019), with decreases in SMEX but not UCO. Anxiety scores yielded a quadratic interaction comparing UCO and SMEX (p = 0.049), with trends for changes in SMEX but not UCO. Additional analyses yielded quadratic interactions for exercise activity comparing UCO and SMEX (p = 0.022), with positive changes in SMEX but not UCO, and for stress management activity comparing UCO and SM (p < 0.001) and UCO and SMEX (p = 0.013), with positive changes in SM and SMEX but not UCO. CONCLUSION: Only the combined intervention yielded effects on quality of life outcomes, and these were limited to anxiety and depression. These findings are consistent with evidence that only the combined intervention yielded increases in both exercise and stress management activity. Future research should investigate ways to augment this intervention to enhance its benefits. Copyright © 2012 John Wiley & Sons, Ltd.
Psycho-Oncology 06/2012; · 3.34 Impact Factor
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ABSTRACT: Fatigue is a common and distressing side effect of androgen deprivation therapy (ADT) for prostate cancer. The goal of the current study was to examine the relationship between changes in fatigue following initiation of ADT and single nucleotide polymorphisms (SNPs) in three pro-inflammatory cytokine genes: interleukin-1 beta (IL1B), interleukin-6 (IL6), and tumor necrosis factor alpha (TNFA).
As part of a larger study, men with prostate cancer (n=53) were recruited prior to initiation of ADT. Fatigue was assessed at recruitment and 6months after initiation of ADT. DNA was extracted from blood drawn at baseline.
Patients with the IL6-174 (rs1800795) G/C or C/C genotype displayed greater increases in fatigue intrusiveness, frequency, and duration than the G/G genotype (p values ⩽0.05), although inclusion of age, race, and baseline depressive symptomatology in the model attenuated these relationships (p values ⩽0.09). Patients with the TNFA-308 (rs1800629) G/A genotype showed greater increases in fatigue severity than the G/G genotype (p=0.02). IL1B-511 (rs16944) genotype did not significantly predict changes in fatigue (p values >0.46). Patients with higher numbers of variants displayed greater increases in fatigue duration and interference (p values ⩽0.02) than patients with lower numbers of variants.
Prostate cancer patients treated with ADT who carry variant alleles of the IL6 and TNFA genes are susceptible to heightened fatigue. These preliminary data lend support for the role of genetic variation in the development of cancer-related fatigue secondary to ADT. Findings are relevant to attempts to develop personalized approaches to cancer treatment.
Brain Behavior and Immunity 03/2012; 26(7):1030-6. · 4.72 Impact Factor
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ABSTRACT: OBJECTIVE: Although many survivors continue to worry about cancer years after completing treatment, little is known about factors associated with cancer worry. This study examined associations between breast cancer worry and demographic and clinical variables, as well as fatigue, symptom burden, and risk perception in a sample of breast cancer survivors 3 years post-adjuvant treatment. We hypothesized that after controlling for demographic and treatment factors, a significant proportion of variance in cancer worry would be explained by greater fatigue severity, more symptom burden, and greater perceived risk of recurrence. METHODS: Stage 0-II breast cancer patients (N = 202) completed measures of risk perception, cancer worry (modified Lerman's Cancer Worry Scale), symptom burden (Memorial Symptom Assessment Scale), and fatigue severity (Fatigue Symptom Inventory) 3 years after completing adjuvant treatment. Multiple regression analyses were used to determine the proportion of variance in cancer worry accounted for by fatigue, symptom burden, and risk perception after controlling for demographic and clinical variables RESULTS: Age, fatigue, symptom burden, and risk perception each explained a significant proportion of variance in cancer worry (p < 0.05). Fatigue, symptom burden, and risk perception together accounted for 27% of the variance in cancer worry after controlling for demographic and clinical factors (p < 0.01) CONCLUSIONS: The hypothesis was supported that fatigue, symptom burden, and risk perception are associated with cancer worry among breast cancer survivors. It is possible that lingering fatigue and other symptoms may remind breast cancer survivors of their disease. Copyright © 2012 John Wiley & Sons, Ltd.
Psycho-Oncology 03/2012; · 3.34 Impact Factor
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ABSTRACT: Data are scarce about whether past history of major depressive disorder in the absence of current depression places breast cancer patients at risk for worse quality of life.
The current study prospectively examined quality of life during chemotherapy in breast cancer patients with a history of resolved major depressive disorder (n = 29) and no history of depression (n = 144).
Women with Stages 0-II breast cancer were assessed prior to and at the completion of chemotherapy. Major depressive disorder was assessed via structured interview and quality of life with the SF-36.
Patients with past major depressive disorder displayed greater declines in physical functioning relative to patients with no history of depression (p ≤ 0.01).
Findings suggest that breast cancer patients with a history of resolved major depressive disorder are at increased risk for declines in physical functioning during chemotherapy relative to patients with no history of depression.
Annals of Behavioral Medicine 12/2011; 43(3):402-8. · 4.20 Impact Factor
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ABSTRACT: Studies suggest that patients with cancer who undergo hematopoietic cell transplantation (HCT) are at risk for cognitive deficits. To date, little research has investigated the cumulative effects of clinical risk factors on cognitive function in patients who undergo HCT.
Patients (N = 278) who were scheduled to undergo HCT for hematologic disease completed neuropsychological assessments before HCT and at 6 months and 12 months after HCT. A time-varying cumulative clinical risk variable was examined as a predictor of total neuropsychological performance (TNP). Cumulative clinical risk was calculated from pre-HCT neuropsychological risk factors (eg, history of cranial irradiation, intrathecal chemotherapy), HCT-related risk factors (eg, allogeneic transplantation, unrelated donor), and post-HCT complications (eg, severity of mucositis and enteritis, graft-versus-host disease).
Patients with greater cumulative clinical risk displayed worse TNP at baseline and at 6 months after HCT and less neuropsychological recovery over time than patients who had less risk (Ps < .05). Greater cumulative clinical risk predicted worse performance on tasks assessing executive function at baseline and 6 months after HCT and assessing memory at 6 months and 12 months after HCT (Ps < .05). Among risk variables, length of hospital stay was the only significant predictor of neuropsychological function (P < .05).
Findings from this study indicated that clinical risk factors may have a cumulative effect on cognitive function in patients who undergo HCT. Patients who have a complicated clinical course should be referred for evaluation and management of cognitive deficits.
Cancer 12/2011; 118(13):3407-16. · 4.77 Impact Factor
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ABSTRACT: Quality of life assessment has a number of important applications in research on cancer survivors. These applications include use in observational studies to characterize the nature and extent of problems patients experience as well as use in randomized controlled trials to evaluate the relative impact of different cancer treatments or to evaluate the efficacy of interventions designed to improve patient well-being. The aims of this article are to provide an overview of the construct of quality of life and describe strategies commonly used to measure quality of life in adult cancer survivors. In addition, several priorities for future research are identified that involve how quality of life is measured, in whom it is measured, and what uses are made of quality of life data in the clinical care of cancer survivors.
Cancer Epidemiology Biomarkers & Prevention 10/2011; 20(10):2035-41. · 4.12 Impact Factor
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ABSTRACT: Previous research suggests that cancer patients frequently experience multiple symptoms during chemotherapy; however, relationships among symptom changes are largely unknown.
The aim of the current study was to examine daily and intraday changes and interrelationships among fatigue, depression, and objectively measured disruptions in sleep and activity during chemotherapy.
Participants were 78 women with gynecologic cancer. Fatigue, depression, sleep, and activity were assessed the week before and the week after the participants' first three infusions.
Significant changes in fatigue, depression, sleep, and activity were observed over time. Before infusions, increases in fatigue were associated with increases in depression. After infusions, increases in fatigue were associated with increases in depression and minutes awake at night, as well as decreases in daytime activity and regularity of sleep/activity patterns (ps < .05).
This study is among the first to track daily and intraday changes in symptoms and interrelationships during chemotherapy. Results indicate that symptoms are interrelated and return to baseline levels after infusions.
Annals of Behavioral Medicine 07/2011; 42(3):321-33. · 4.20 Impact Factor
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ABSTRACT: Recent attention has focused on the negative effects of chemotherapy on the cognitive performance of cancer survivors. The current study examined modification of this risk by catechol-O-methyltransferase (COMT) genotype based on evidence in adult populations that the presence of a Val allele is associated with poorer cognitive performance.
Breast cancer survivors treated with radiotherapy (n = 58), and/or chemotherapy (n = 72), and 204 healthy controls (HCs) completed tests of cognitive performance and provided saliva for COMT genotyping. COMT genotype was divided into Val carriers (Val+; Val/Val, Val/Met) or COMT-Met homozygote carriers (Met; Met/Met).
COMT-Val+ carriers performed more poorly on tests of attention, verbal fluency, and motor speed relative to COMT-Met homozygotes. Moreover, COMT-Val+ carriers treated with chemotherapy performed more poorly on tests of attention relative to HC group members who were also Val+ carriers.
The results suggest that persons treated with chemotherapy for breast cancer who also possess the COMT-Val gene are susceptible to negative effects on their cognitive health. This research is important because it strives to understand the factors that predispose some cancer survivors to more negative quality-of-life outcomes.
Cancer 04/2011; 117(7):1369-76. · 4.77 Impact Factor
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ABSTRACT: BACKGROUND:The current study was performed to determine whether neuropsychologic functioning differs in breast cancer survivors 6 months after the completion of adjuvant treatment compared with women without cancer.METHODS:Participants were 187 women who were diagnosed with ductal carcinoma in situ or stage I or stage II breast cancer and 187 age-matched and geographically matched women without cancer. Of the survivors, 97 had been treated after surgery with chemotherapy only or chemotherapy plus radiotherapy and 90 had been treated after surgery with radiotherapy only (grading determined according to the American Joint Committee on Cancer grading system).RESULTS:Small but statistically significant differences in cognitive functioning and cognitive impairment were observed in those survivors who were treated with chemotherapy and their matched controls, as well as in survivors treated with radiotherapy only and their matched controls. No group differences were observed with regard to cognitive symptoms.CONCLUSIONS:Data from the current study suggest that cognitive deficits are subtle and likely the result of the general effects of cancer diagnosis and treatment rather than systemic treatment. Cancer 2009. Published 2009 by the American Cancer Society.
Cancer 04/2009; 115(8):1776 - 1783. · 4.77 Impact Factor
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ABSTRACT: The current study was performed to determine whether neuropsychologic functioning differs in breast cancer survivors 6 months after the completion of adjuvant treatment compared with women without cancer.
Participants were 187 women who were diagnosed with ductal carcinoma in situ or stage I or stage II breast cancer and 187 age-matched and geographically matched women without cancer. Of the survivors, 97 had been treated after surgery with chemotherapy only or chemotherapy plus radiotherapy and 90 had been treated after surgery with radiotherapy only (grading determined according to the American Joint Committee on Cancer grading system).
Small but statistically significant differences in cognitive functioning and cognitive impairment were observed in those survivors who were treated with chemotherapy and their matched controls, as well as in survivors treated with radiotherapy only and their matched controls. No group differences were observed with regard to cognitive symptoms.
Data from the current study suggest that cognitive deficits are subtle and likely the result of the general effects of cancer diagnosis and treatment rather than systemic treatment.
Cancer 03/2009; 115(8):1776-83. · 4.77 Impact Factor
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ABSTRACT: Cancer survivors report that cancer can elicit symptoms of traumatic stress, but also personal growth. Although most survivors do not meet criteria for posttraumatic stress disorder, traumatic stress symptomatology in the form of intrusive thoughts about the disease, avoidance of reminders of cancer, and hyper-vigilance are commonly reported by survivors after treatment completion. Posttraumatic growth resulting from cancer is also frequently reported by survivors. This review examines theory and evidence for posttraumatic stress and posttraumatic growth related to cancer. Predictors, temporal course, and interventions to reduce traumatic stress and enhance growth are described. The review concludes with recommendations for addressing posttraumatic stress and posttraumatic growth in the clinical setting.
The Cancer Journal 14(6):414-9. · 3.26 Impact Factor
