Barbara F. Piper

Feasibility of a Sleep Intervention During Adjuvant Breast Cancer Chemotherapy

PURPOSE/OBJECTIVESnTo evaluate the feasibility of an intervention designed to promote sleep and modify fatigue during four cycles of adjuvant breast cancer chemotherapy.nnnDESIGNnProspective, repeated measures, quasi-experimental feasibility study.nnnSETTINGnMidwestern urban oncology clinics.nnnSAMPLEn25 women between the ages of 40-65 (mean = 54.3) with stage I-II breast cancer receiving doxorubicin-based chemotherapy.nnnMETHODSnEach woman developed, reinforced, and revised an individualized sleep promotion plan (ISPP) with four components: sleep hygiene, relaxation therapy, stimulus control, and sleep restriction techniques. A daily diary, the Pittsburgh Sleep Quality Index, a wrist actigraph, and the Piper Fatigue Scale were used to collect data two days before and seven days after each treatment.nnnMAIN RESEARCH VARIABLESnAdherence, sleep and wake outcomes, and fatigue.nnnFINDINGSnAdherence rates with the components of the ISPP varied during treatments one through four: sleep hygiene (68%-78%), relaxation therapy (57%-67%), stimulus control (46%-67%), and sleep restriction (76%-80%). Mean sleep and wake outcomes at baseline, peak, and rebound times were that (a) sleep latency remained brief (less than 30 minutes per night), (b) time awake after sleep onset exceeded the desired less than 30 minutes per night, (c) sleep efficiency scores remained stable at 85%-90%, (d) total rest time remained stable at 8-10 hours per night, (e) subjective ratings of feelings on arising were stable, and (f) nighttime awakenings were 8-10 per night. Fatigue outcomes were that fatigue was stable two days after each treatment and mean daily fatigue intensity was lower at treatment three than at treatment one but rebounded at treatment four.nnnCONCLUSIONSnThe intervention was feasible, adherence rates improved over time, and most sleep and wake patterns were consistent with normal values. Revisions will focus on decreasing nighttime awakenings.nnnIMPLICATIONS FOR NURSINGnAdopting behaviors to promote sleep may assist in maintaining sleep and managing fatigue during chemotherapy.

Biomarkers, fatigue, sleep, and depressive symptoms in women with breast cancer: a pilot study.

PURPOSE/OBJECTIVESnTo evaluate the changes in reports of fatigue, sleep disturbances, and depressive symptoms and serum cortisol, melatonin, serotonin, and bilirubin during adjuvant chemotherapy in women with breast cancer and to determine whether any correlations exist between the symptom parameters and biomarkers.nnnDESIGNnProspective longitudinal, correlational, repeated-measures pilot study.nnnSETTINGnLarge southwestern, university-based, National Cancer Institute-designated cancer center.nnnSAMPLEn22 subjects (11 women with stage II breast cancer receiving adjuvant chemotherapy and 11 cancer-free women who were matched by age, ethnicity, and menopausal status).nnnMETHODSnQuestionnaires (fatigue, sleep, depressive symptoms), wrist sleep actigraphy, and laboratory analysis of serum samples. All subjects (i.e., women with breast cancer receiving chemotherapy and a comparison group of cancer-free women who were matched by age, ethnicity, and menopausal status) were admitted to a general clinical research center for two nights during cycles 1 and 4 for data collection.nnnMAIN RESEARCH VARIABLESnBiomarkers (serum cortisol, melatonin, serotonin, and bilirubin), fatigue, sleep, and depressive symptoms.nnnFINDINGSnMean fatigue scores of the subjects with cancer were significantly higher than the healthy comparison group. Subjects with cancer had a significantly lower mean actual sleep time compared to the comparison group at cycle 1. No significant difference was found between the groups at cycle 4. Depression scores also differed significantly between the cancer group and comparison group. Select biomarkers changed over time and were associated with subjective parameters of fatigue, sleep, and depressive symptoms.nnnCONCLUSIONSnFindings suggest that fatigue, sleep, and depressive symptoms are more prevalent in women with cancer than a cancer-free comparison group. Biomarkers changed over time and provide a possible explanatory mechanism for the three related symptoms.nnnIMPLICATIONS FOR NURSINGnData help to explain a mechanism that may underlie fatigue, sleep, and depressive symptoms and provide a theoretical framework from which to establish evidence-based interventions for symptom management.

Adherence, Sleep, and Fatigue Outcomes After Adjuvant Breast Cancer Chemotherapy: Results of a Feasibility Intervention Study

PURPOSE/OBJECTIVESnTo evaluate outcomes of an intervention designed to promote sleep and modify fatigue after adjuvant breast cancer chemotherapy.nnnDESIGNnProspective, repeated measures, quasi-experimental, feasibility study.nnnSETTINGnMidwestern urban oncology clinics.nnnSAMPLEn21 female participants, ages 43-66 years (meanX = 55.3) with stage I or II breast cancer status post four cycles of doxorubicin chemotherapy. Eight had four additional cycles of paclitaxel, 10 also had radiation, and 18 took tamoxifen.nnnMETHODSneach woman continued to revise her Individualized Sleep Promotion Plan (ISPP), developed during her first cycle of chemotherapy, that included sleep hygiene, relaxation therapy, stimulus control, and sleep restriction components. The daily diary, Pittsburgh Sleep Quality Index, wrist actigraph, and Piper Fatigue Scale were used for seven days 30, 60, and 90 days after the last chemotherapy treatment and one year after the first chemotherapy treatment.nnnMAIN RESEARCH VARIABLESnAdherence and sleep and wake, fatigue, and ISPP components.nnnFINDINGSnAdherence to the ISPP components remained high at all times (77%-88%) except for stimulus control (36%-56%). Sleep outcome means and the actigraph revealed that (a) sleep latency remained less than 30 minutes per night, (b) the time awake after sleep onset exceeded the desired less than 30 minutes per night, (c) sleep efficiency scores ranged from 82%-92%, (d) total rest time ranged from seven to eight hours per night, (e) feelings on arising ranged from 3.7-3.8 (on a 0-5 scale), (f) nighttime awakenings ranged from 10-11 per night, and (g) daytime naps ranged from 10-15 minutes in length. Fatigue remained low, from 2.9-3.5 on a 0-10 scale.nnnCONCLUSIONSnAdherence rates remained high for most components. Sleep and wake patterns were within normal limits except for the number and duration of night awakenings. Fatigue remained low.nnnIMPLICATIONS FOR NURSINGnFuture testing using an experimental design will focus on increasing ISPP adherence and decreasing nighttime awakenings. Adopting behavioral techniques to promote sleep may result in improved sleep and lower fatigue after chemotherapy.

Effectiveness of a Clinical Intervention to Eliminate Barriers to Pain and Fatigue Management in Oncology

BACKGROUNDnPain and fatigue are recognized as critical symptoms that impact quality of life (QOL) in cancer, particularly in palliative care settings. Barriers to pain and fatigue relief have been classified into three categories: patient, professional, and system barriers. The overall objective of this study was to test the effects of a clinical intervention on reducing barriers to pain and fatigue management in oncology.nnnMETHODSnThis longitudinal, three-group, quasi-experimental study was conducted in three phases: phase 1 (usual care), phase 2 (intervention), and phase 3 (dissemination). A sample of 280 patients with breast, lung, colon, or prostate cancers, stage III and IV disease (80%), and a pain and/or fatigue of 4 or more (moderate to severe) were recruited. The intervention group received four educational sessions on pain/fatigue assessment and management, whereas the control group received usual care. Pain and fatigue barriers and patient knowledge were measured at baseline, 1 month, and 3 months post-accrual for all phases. A 3u2009×u20092 repeated measures statistical design was utilized to derive a priori tests of immediate effects (baseline to 1 month) and sustained effects (baseline or 1 month to 3 months) for each major outcome variable, subscale, and/or scale score.nnnRESULTSnThere were significant immediate and sustained effects of the intervention on pain and fatigue barriers as well as knowledge. Measurable improvements in QOL were found in physical and psychological well-being only.nnnCONCLUSIONnA clinical intervention was effective in reducing patient barriers to pain and fatigue management, increasing patient knowledge regarding pain and fatigue, and is feasible and acceptable to patients.

Cancer-Related Fatigue: Role of Oncology Nurses in Translating National Comprehensive Cancer Network Assessment Guidelines Into Practice

This article reviews the National Comprehensive Cancer Networks (NCCNs) guidelines for cancer-related fatigue (CRF) assessment and discusses many of the common barriers that hinder the translation of the CRF guidelines into practice settings. Current assessment and measurement scales validated in patients with cancer are highlighted, and case studies reflect the vital roles that oncology nurses can play in managing patients with CRF. Oncology nurses must remember to assess the gang of 7 (i.e., anemia, pain, sleep difficulties, nutrition issues, deconditioning or changes in activity patterns, emotional distress [depression or anxiety], and presence of comorbidities) that may affect workup, treatment, and supportive care referrals. Teaching patients about the importance of viewing CRF as the sixth vital sign can emphasize this symptoms importance and significance. Oncology nurses also can recognize the many patient-, provider- and system-related barriers that exist and work with others in a systematic and collaborative fashion within the system to decrease these barriers and begin to incorporate a simple intensity scale for CRF assessment and screening, documentation, and ongoing monitoring. By using available resources, oncology nurses can play significant roles in the translation of the NCCNs evidence-based practice guidelines for CRF in their practice settings.

A qualitative analysis of cancer-related fatigue in ambulatory oncology.

The purpose of this study was to describe patients perceptions of the causes, relief, related symptoms, meaning, and suffering secondary to cancer-related fatigue (CRF). In total, 252 patients with breast, lung, colon, and prostate cancers were enrolled in a quasiexperimental study to test the effects of a clinical intervention on reducing barriers to symptom management in ambulatory care. Analysis of data reported in this article was derived from the Piper Fatigue Scale-Revised. Using qualitative research methods and content analysis, written statements related to the impact of CRF were coded using the following themes: patients perceptions of CRF, causes, relief, related symptoms, meaning, and suffering. Comments were categorized and reviewed for content. Overall, CRF had a significant impact on physical, psychological, social, and spiritual well-being. CRF limited the ability of participants to function, socialize, and participate in enjoyable activities. Emotional issues as a result of CRF were common. The negative impact of CRF on patients overall well-being alters the meaning and suffering related to the cancer experience. The assessment of personal meaning and suffering related to CRF is an important component of the multidimensional assessment of CRF and will enable nurses to better understand the suffering related to CRF.