Ada M. Lindsey

The development of an instrument to measure social support.

This article describes the development of a new instrument, the Norbeck Social Support Questionnaire, designed to measure multiple dimensions of social support. Based on Kahns (1979) conceptual definitions of social support and definitions from network theory (Barnes, 1972), the instrument has three main variables—Total Functional, Total Network, and Total Loss—each with three subscales.Graduate and undergraduate nursing students were used as subjects in this phase of testing, which established high levels of test-retest reliability and internal consistency. The social desirability response bias was ruled out, and moderate levels of concurrent validity were found. Additional work to establish construct validity is needed. Two groups of students were compared to study the normative trend for this population, and differences were minimal except for recent losses and aid, reflecting the actual situations of the two groups.

Further development of the Norbeck Social Support Questionnaire: normative data and validity testing.

This article describes the second phase of testing the Norbeck Social Support Questionnaire (NSSQ), an instrument designed to measure multiple dimensions of social support. Three studies were conducted to provide a normative data base and to further test validity. In the first study, data from 136 employed adults were obtained. The amount and type of support available for a functioning group of male and female respondents and sources of support for this sample are described. In the second and third studies, the instrument was found to be very stable over a seven-month interval and sensitive to changes within the social support networks of a group of graduate students during their first year of study. Construct validity of the instrument was established by comparing convergent and discriminant constructs to the NSSQ. Concurrent validity with another social support questionnaire was demonstrated. Predictive validity was tested in a sample of 53 graduate students through assessing the buffering effect of social support on measures of negative mood following life stress. Two NSSQ subscales, aid and duration of relationships, had significant interaction effects with life stress on the outcome of negative mood. Duration of relationships also had a significant main effect. After subtracting the main effect for life stress from the overall R2 in the multiple regression analysis, the NSSQ functional support subscales and their interactions with life stress accounted for 19 percent of the variance on negative mood, and the NSSQ network property subscales and their interactions accounted for 20 percent of the variance.

Bone mineral density in postmenopausal breast cancer survivors.

Purpose The overall purpose of this longitudinal 18‐month study was to test the feasibility and effectiveness of a multicomponent intervention for prevention and treatment of osteoporosis. The purpose of this article is to describe the baseline bone mineral density (BMD) findings for 30 postmenopausal women and to compare these BMD findings to time since menopause, body mass index, and tamoxifen use. Data Sources Baseline data of BMD findings for 30 post‐menopausal women, who have had a variety of treatments including surgery, adjuvant chemotherapy and or tamoxifen, and are enrolled in the 18‐month longitudinal study. A demographic questionnaire and a three day dietary record were used to collect baseline data. Conclusions Eighty percent of the women with breast cancer history had abnormal BMDs at baseline (t‐scores below ‐1.00 SD). Thinner women showed a greater risk for accelerated trabecular bone loss at the spine and hip. Implications for Practice These findings suggest the need for early BMD assessments and for aggressive health promotion intervention strategies that include a multifaceted protocol of drug therapy for bone remodeling, 1500 mg of daily calcium, 400 IU vitamin D and a strength weight training program that is implemented immediately following chemotherapy treatment and menopause in this high risk population of women.

Vitamin D Insufficiency and Musculoskeletal Symptoms In Breast Cancer Survivors on Aromatase Inhibitor Therapy

Breast cancer survivors (BCSs) on aromatase inhibitor (AI) therapy often experience musculoskeletal symptoms (joint pain and stiffness, bone and muscle pain, and muscle weakness), and these musculoskeletal symptoms may be related to low serum levels of vitamin D. The primary purpose of this pilot exploratory study was to determine whether serum levels of 25-hydroxyvitamin D (25[OH]D) concentration were below normal (<30 ng/mL) in 29 BCSs on AI therapy and if musculoskeletal symptoms were related to these low vitamin D levels. The mean (SD) serum 25(OH)D level was 25.62 (4.93) ng/mL; 86% (n = 25) had levels below 30 ng/mL. Patients reported muscle pain in the neck and back, and there was a significant inverse correlation between pain intensity and serum 25(OH)D levels (r = −0.422; P < .05 [2 tailed]). This sample of BCSs taking AIs had below normal levels of serum 25(OH)D despite vitamin D supplements. This is one of the few studies to document a significant relationship between vitamin D levels and muscle pain in BCSs on AI therapy. Findings from this pilot study can be used to inform future studies examining musculoskeletal symptoms in BCSs on AI therapy and relationships with low serum levels of vitamin D.

Challenges of Recruitment of Breast Cancer Survivors to a Randomized Clinical Trial for Osteoporosis Prevention

Recruitment of participants was a challenging issue for a statewide, 4-site, randomized, longitudinal trial for osteoporosis prevention. The accrual goal was 273 healthy breast cancer survivors. This federally funded study included a home-based followed by a fitness center-based 24-month intervention with follow-up at 36 months. In this report, recruitment planning, monitoring, and modifications are described, and the cost per enrolled participant is identified. Monthly monitoring of accrual numbers per recruitment strategy at each of 4 catchment areas allowed for early identification of necessary changes in recruitment strategies. Modifications were necessary when only 39% of the overall accrual goal had been attained at the 66% time point into the 18-month recruitment phase. Successful recruitment strategies were intensified, and new strategies were implemented, addressing motivators and deterrents for participation in clinical trials. Because approximately 81% of women were demonstrating bone loss via free dual energy x-ray absorptiometry screening, prevalence of the bone loss problem in survivors was incorporated into the recruitment information. Of 708 women screened via telephone and laboratory/dual energy x-ray absorptiometry testing, 249 were enrolled with 67% at 2 metropolitan sites and 33% at 2 rural sites. Recruitment media costs were approximately US

Social support and health outcomes in postmastectomy women: a review

35 per enrolled participant. When combined with skeletal and laboratory screening, costs were approximately US

Comorbidity, nutritional intake, social support, weight, and functional status over time in older cancer patients receiving radiotherapy.

480 per enrolled participant. Tracking recruitment efforts in large clinical trials should be ongoing, site-specific, and cost-effective. Changes incorporated early in the recruitment phase addressed unique aspects of rural versus metropolitan areas and resulted in near achievement of accrual goals.

Facilitative strategies, psychological factors, and strength/weight training behaviors in breast cancer survivors who are at risk for osteoporosis.

Summary The concept of social support has emerged in recent years as a major psychosocial variable in health-related research. As a concept, social support has not been defined nor measured similarly in studies which have investigated the effect of social support on health outcomes. Major conceptualizations of social support are compared and studies in which some component characteristic of social support has been examined in adjustment to a mastectomy are summarized.

Postmenopausal survivors of breast cancer at risk for osteoporosis: nutritional intake and body size.

It is essential that nurses gain insight about the responses of older adults to standard anticancer therapies because there is ongoing concern about whether the elderly are affected adversely by the prescribed therapy. The purpose of this longitudinal prospective study was to describe selected outcomes and their relationships in a sample of 45 elderly (mean age 69.8 years; range 61–86) patients receiving radiotherapy for either breast (42%) or lung (58%) cancer. The outcome variables were weight and multidimensional functional status; moderator variables were co-morbidity, nutritional intake, estimated adequacy of intake, radiation dose, side effects, and social support. Data were collected at the beginning of radiation (T1), the middle of therapy (T2), the conclusion of therapy (T3), and three months post radiation (T4). Although 81.4% had some concurrent condition, those with a comorbid condition did not respond significantly differently from those without a comorbid condition on any of the major variables at any of the four times. At none of the four times was the caloric intake adequate to meet the estimated energy requirements for usual activity (range 67.9–71.5%).

Bone mineral density and bone turnover in postmenopausal women treated for breast cancer.

INTRODUCTION/PURPOSE Many women who have been treated for breast cancer are at increased risk for bone loss. Strength/weight training exercises (SWTE) may be effective in preventing bone loss and subsequent fractures. The purpose of this exploratory study was to examine psychological factors (self-efficacy, perceived benefits vs. costs, and processes of change) and their relationship to adherence and progression in use of heavier weights in breast cancer survivors (BCS). SAMPLE Twenty-three BCS with mean age of 54.8 (SD = 7.2) years, mean time since menopause of 5.8 (SD = 5.3) years, and mean time since cancer treatment completion of 4.1 (SD = 3.0) years. METHODS Exploratory one-group design with multicomponent intervention inclusive of medication, calcium with vitamin D supplement, and home-based SWTE with facilitative strategies by nurses and personal exercise trainers based on the Transtheoretical Model. FINDINGS BCS doing SWTE for 6 months: (1) maintain a high level of self-efficacy, (2) perceive increasing benefits for 6 months, (3) use cognitive processes more frequently than behavioral ones, (4) were highly adherent to the SWTE, and (5) demonstrate that behavioral processes are positively related to increase in pounds lifted. DISCUSSION/CLINICAL IMPLICATIONS Larger randomized trials studies are needed to determine the most effective strategies for assuring adherence to and progression of SWTE in this population at risk for osteoporosis.