Carol Beth Stewart

Effects of Exercise in Combination With Epoetin Alfa During High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation for Multiple Myeloma

PURPOSE/OBJECTIVES To determine the effect of aerobic and strength resistance training and epoetin alfa (EPO) therapy on transfusions, stem cell collections, transplantation recovery, and multiple myeloma treatment response. DESIGN Randomized clinical trial. SETTING A myeloma research and therapy center in the south central United States. SAMPLE 135 patients with multiple myeloma, 120 evaluable. METHODS Random assignment to exercise or usual care groups. All patients received EPO based on an algorithm. Aerobic capacity, using the six-minute walk test, was assessed prior to induction chemotherapy, prior to stem cell mobilization, and following stem cell collection for all patients and before and after transplantation for patients continuing in the study. Data analysis included analysis of variance to compare other outcome variables by groups. MAIN RESEARCH VARIABLES Number of red blood cell and platelet transfusions during transplantation, number of attempts at and total number of days of stem cell collection, time to recovery after transplantation, and response to intensive therapy for multiple myeloma. FINDINGS Recovery and treatment response were not significantly different between groups after transplantation. The exercise group had significantly fewer red blood cell transfusions and fewer attempts at stem cell collection. Serious adverse events were similar in each group. CONCLUSIONS Exercise with prophylactic EPO therapy reduces the number of RBC transfusions and attempts at stem cell collection for patients receiving intensive treatment for multiple myeloma. IMPLICATIONS FOR NURSING Exercise is safe and has many physiologic benefits for patients receiving multiple myeloma treatment.

The Effect of Telephone Social Support and Education on Adaptation to Breast Cancer During the Year Following Diagnosis

PURPOSE/OBJECTIVES To find the most effective methods of providing social support for women diagnosed with breast cancer by testing the effectiveness of a telephone social support and education intervention to promote emotional and interpersonal adaptation to breast cancer. DESIGN Multisite, two-group experimental study with repeated measures. SETTING Arkansas and New Jersey. SAMPLE The Arkansas sample consisted of 106 women who entered the study two to four weeks postsurgery for nonmetastatic breast cancer and were randomly assigned to an experimental or control group. The comparison group consisted of 91 women from New Jersey who had participated in a previously completed study that used the same interventions and found that telephone support resulted in more positive, statistically significant adaptation to the disease. METHODS The experimental group received 13 months of telephone social support and education. Both groups received educational materials via a mailed resource kit. The Profile of Mood States; Visual Analogue Scale-Worry; Relationship Change Scale; University of California, Los Angeles, Loneliness Scale-Version 3; and the modified Symptom Distress Scale provided data regarding the variables of interest. Data analysis included descriptive statistics, t tests, and multivariate analysis of variance with repeated measures. MAIN RESEARCH VARIABLES Mood, worry, relationships with significant others, loneliness, and symptoms. FINDINGS Data analysis showed no significant differences between groups, and both improved on some of the outcomes. Significant time-by-location interaction effects were found when comparing the Arkansas and New Jersey samples, thereby supporting the need to consider regional differences when developing interventions. CONCLUSIONS The mailed educational resource kit alone appeared to be as effective as the telephone social support provided by oncology nurses in conjunction with the mailed resource kit. IMPLICATIONS FOR NURSING Mailed educational resource kits may be the most efficient and cost-effective way to provide educational support to newly diagnosed patients with breast cancer, but their effect may differ according to region.

Women's Perceptions of the Effectiveness of Telephone Support and Education on Their Adjustment to Breast Cancer

PURPOSE/OBJECTIVES Social support is believed to be important in helping women adjust to breast cancer. Reports have suggested limited positive effects of social support on well-being, mood disturbances, and relationships with significant others for women who receive telephone support. Womens perceptions of the role of social support in recovery, however, has had limited study. The purpose of this study was to describe womens perceptions of their emotional and interpersonal adaptations to breast cancer after their involvement in a randomized clinical trial in which one group received educational materials and telephone support from oncology nurses and another group received educational materials only. RESEARCH APPROACH Content analysis was used to discover womens perceptions of their emotional and interpersonal adaptation to breast cancer following their participation in a study in which one group received educational materials and telephone support from oncology nurses and another group received educational materials only. SETTING All participants were interviewed by telephone in their homes. PARTICIPANTS 77 of 106 women with breast cancer from a randomized clinical trial were interviewed about their expectations of their adaptations and the effectiveness of the experimental and social support intervention delivered by telephone. METHODOLOGIC APPROACH Telephone interviews were recorded on audiotape and transcribed for analysis. Structured interviews were completed by a non-nurse interviewer. Frequency counts were obtained from the responses to items and comments were clustered for themes. MAIN RESEARCH VARIABLES Emotional and interpersonal adaptations to breast cancer, educational materials, and telephone support from oncology nurses. FINDINGS Fifty-four percent of the women who received the telephone support interventions reported improvement in attitude, whereas 43% of the interviewed women in the control group reported improvement. Only three participants, all in the control group, reported worsened emotional status. The percentage of those reporting improved or unchanged physical status was about equal in each group. The majority of participants in both groups indicated that their levels of involvement in activities remained the same or increased. Forty-six percent of participants in the intervention group reported improved relationships with their spouses compared to 38% in the control group. Women from both groups indicated that the diagnosis of cancer had caused them to review their lives and make changes in their relationships and activities. CONCLUSIONS Participants who received telephone support for one year, in addition to educational materials, reported improvement in their attitudes toward their breast cancer and better relationships with their significant others. INTERPRETATION The womens perceptions are consistent with quantitative results from the clinical trial. This article reports additional evidence that telephone support is an effective alternative to support groups and may be appropriate for those with limited access to such groups because of geography, work demands, or family situations.

Fatigue, sleep, pain, mood, and performance status in patients with multiple myeloma.

Background: Cancer-related fatigue and insomnia are common distressing symptoms and may affect mood and performance status. Objective: The objective of this study was to describe fatigue, sleep, pain, mood, and performance status and the relationships among these variables in 187 patients with newly diagnosed multiple myeloma (MM) and conduct an analysis using the correlates of fatigue. Methods: Data were from baseline measures from the study, using the Profile of Mood States and the Functional Assessment of Cancer Therapy-Fatigue to assess fatigue, the actigraph to measure sleep, the Wong/Baker Faces Pain Rating Scale to assess pain, the Profile of Mood States to assess mood, and the 6-minute walk test along with a back/leg/chest dynamometer to test muscle strength to assess performance status. Data analysis consisted of descriptive statistics, Pearson and Spearman &rgr; correlations, and multiple regression analysis using fatigue as the dependent variable. All P values were 2-sided, and P < .05 was considered significant. Results: Patients with newly diagnosed MM presented with fatigue, pain, sleep and mood disturbances, and diminished functional performance. The regression model, which included all of these variables along with age, sex, and stage of disease, was statistically significant with a large measure of effect. Mood was a significant individual contributor to the model. Conclusions: Among patients with MM, fatigue, pain, sleep, mood, and functional performance are interrelated. Implications for Practice: Interventions are needed to decrease fatigue and pain and to improve sleep, mood, and functional performance.

Prophylactic recombinant erythropoietin therapy and thalidomide are predictors of venous thromboembolism in patients with multiple myeloma: limited effectiveness of thromboprophylaxis

Venous thromboembolism (VTE) is a significant but poorly understood complication in patients with newly diagnosed multiple myeloma (NDMM). As a result, most patients receive thromboprophylaxis with low molecular weight heparin (LMWH). The purpose of this retrospective study was to identify risk factors for VTE in NDMM and evaluate the effectiveness of LMWH.

Effects of Exercise on Fatigue, Sleep, and Performance: A Randomized Trial

PURPOSE/OBJECTIVES To compare usual care with a home-based individualized exercise program (HBIEP) in patients receiving intensive treatment for multiple myeloma (MM)and epoetin alfa therapy. DESIGN Randomized trial with repeated measures of two groups (one experimental and one control) and an approximate 15-week experimental period. SETTING Outpatient setting of the Myeloma Institute for Research and Therapy at the Rockfellow Cancer Center at the University of Arkansas for Medical Sciences. SAMPLE 187 patients with newly diagnosed MM enrolled in a separate study evaluating effectiveness of the Total Therapy regimen, with or without thalidomide. METHODS Measurements included the Profile of Mood States fatigue scale, Functional Assessment of Cancer Therapy-Fatigue, ActiGraph® recordings, 6-Minute Walk Test, and hemoglobin levels at baseline and before and after stem cell collection. Descriptive statistics were used to compare demographics and treatment effects, and repeated measures analysis of variance was used to determine effects of HBIEP. MAIN RESEARCH VARIABLES Fatigue, nighttime sleep, performance (aerobic capacity) as dependent or outcome measures, and HBIEP combining strength building and aerobic exercise as the independent variable. FINDINGS Both groups were equivalent for age, gender, race, receipt of thalidomide, hemoglobin levels, and type of treatment regimen for MM. No statistically significant differences existed among the experimental and control groups for fatigue, sleep, or performance (aerobic capacity). Statistically significant differences (p < 0.05) were found in each of the study outcomes for all patients as treatment progressed and patients experienced more fatigue and poorer nighttime sleep and performance (aerobic capacity). CONCLUSIONS The effect of exercise seemed to be minimal on decreasing fatigue, improving sleep, and improving performance (aerobic capacity). IMPLICATIONS FOR NURSING Exercise is safe and has physiologic benefits for patients undergoing MM treatment; exercise combined with epoetin alfa helped alleviate anemia.

Dietary Soy Intake and Breast Cancer Risk

PURPOSE/OBJECTIVES To conduct a metasynthesis of the literature on human studies of the relationship between dietary soy intake and breast cancer risk. DATA SOURCES Publications in English reporting human studies were searched with the terms soy and breast cancer, using Ovid, PubMed, and EBSCO databases. Only human studies investigating the relationship of soy intake to breast cancer development in women published from January 1997 through June 2008 were included in the review. DATA SYNTHESIS A total of 364 publications were located; 18 of the studies met the inclusion criteria and 18 additional studies were located through other publications identified in the search. Because four articles reported on the same two studies, a total of 34 studies were included in the review. CONCLUSIONS The naturally occurring dietary intake of soy food or its components appears safe for women without breast cancer; however, the safety of high supplements of soy or its components is less certain. IMPLICATIONS FOR NURSING Nurses should become more knowledgeable about soy foods and supplements and include soy intake in dietary assessments. Nurses caring for women at high risk for or with a history of breast cancer should confer with dietitians on current practice recommendations. Women with health issues should avoid initiating high intake of soy dietary supplements until the possible effects are better understood.

Sleep Measured by Polysomnography in Patients Receiving High-Dose Chemotherapy for Multiple Myeloma Prior to Stem Cell Transplantation

PURPOSE/OBJECTIVES To describe the objective sleep of patients receiving chemotherapy for multiple myeloma (MM) prior to stem cell transplantation. DESIGN A descriptive study with repeated measures. SETTING An international referral center in an urban area of the southern United States. SAMPLE A convenience sample of a subset of 12 patients with MM, recruited from a randomized, controlled trial. METHODS Objective sleep was assessed using two nights of polysomnography, one obtained before and one after a second cycle of high-dose chemotherapy prior to stem cell transplantation. Demographic and clinical data were obtained through a retrospective chart review. MAIN RESEARCH VARIABLES Objective sleep including sleep characteristics, sleep-related respiratory events, and periodic limb movements (PLMs) of sleep. FINDINGS Sleep was characterized by a relatively short sleep time, excessive time spent awake after the onset of sleep, and poor sleep efficiency (objective sleep quality). Patients spent more than the expected percent of time in non-rapid eye movement sleep and less in rapid eye movement sleep. Arterial oxyhemoglobin saturation nadirs reflected episodes of low arterial oxygen saturation. PLMs during sleep were in the mildly elevated range. CONCLUSIONS Findings suggest that patients had poor sleep efficiency (objective sleep quality) and were slightly better sleepers after receiving a second cycle of high-dose chemotherapy. A number of patients also demonstrated obstructive sleep apnea and frequent PLMs. IMPLICATIONS FOR NURSING Findings support the need for additional investigation of sleep in patients with MM, particularly poor sleep efficiency and PLMs. Improving sleep may improve quality of life by decreasing associated symptoms such as pain, fatigue, and depression. KNOWLEDGE TRANSLATION Oncology nurses should consider assessing patients with MM for insomnia symptoms, excessive daytime sleepiness, obstructive sleep apnea, and a history of jerking or kicking their legs when asleep. Those symptoms may suggest the need for additional investigation of a possible sleep disorder, which may negatively influence mood and function.

Obtaining Family Histories From Patients With Cancer

Information obtained from family history data can provide valuable insight into the biologic and environmental etiologies of an individuals personal and family history of disease. The purpose of this article is to provide a brief introduction to cancer genetics and discuss ways to obtain accurate family histories in a time-efficient manner to identify families with a hereditary cancer syndrome. The focus is on gathering family history information, which should be a standard component of the initial intake for any patient and updated regularly to keep the information current.