Catherine M. Bender

Symptom clusters in breast cancer across 3 phases of the disease.

The purpose of this exploratory, secondary analysis was to compare the prevalence of symptoms attributable to breast cancer or its treatment and to identify and describe symptom clusters across 3 phases of the disease. A pooled analysis was conducted by combining existing symptom data collected at the baseline assessment from 3 independent studies of women with breast cancer. Study I had 40 women with early-stage breast cancer following primary surgery for their disease and prior to the initiation of adjuvant therapy. Study II had 88 women with stage I, II, or III breast cancer who had completed surgery and adjuvant chemotherapy and may have been receiving hormonal therapy. Study III had 26 women with metastatic breast cancer (stage IV). Three symptom clusters were identified corresponding to 3 different phases of the breast cancer experience. Each cluster was composed of symptoms related to fatigue, perceived cognitive impairment, and mood problems. Future studies are needed to prospectively examine whether these symptoms cluster across 3 phases of breast cancer and the effect of these clusters on the functional ability and quality of life in women with breast cancer.

Mechanisms and Management of Toxicities Associated With High-Dose Interferon Alfa-2b Therapy

PURPOSE The toxicity associated with adjuvant high-dose interferon-alfa-2b therapy (HDI) for high-risk melanoma can lead to premature discontinuation. It is important to understand the expected adverse events and their underlying mechanisms and to anticipate and aggressively manage toxicity during treatment in order to ensure that patients receive the maximum therapeutic benefit. METHODS The toxicity profile of HDI was reviewed by examining data from the United States cooperative group trials. Available published data related to the potential mechanisms responsible for the observed adverse events are discussed, and comprehensive recommendations for managing side effects are presented. RESULTS The HDI regimen is associated with acute constitutional symptoms, chronic fatigue, myelosuppression, elevated liver enzyme levels, and neurologic symptoms. The majority of patients tolerate 1 year of therapy with an understanding of the anticipated toxicities in conjunction with appropriate dose modifications and supportive care. Ongoing monitoring for liver dysfunction and hematologic toxicity is critical to ensure safety. Many of the toxicities associated with interferon-alfa (IFN-alpha) seem to be the result of endogenous cytokines and their effects on the neuroendocrine system. Recent data have also demonstrated that IFN-alpha suppresses the activity of specific CYP450 isoenzymes and that this correlates with discrete toxicities. Pharmacologic interventions are under study for fatigue and depression. An increased understanding of the mechanisms of IFN-alpha-associated toxicity will lead to more rational and effective supportive care and improved quality of life. CONCLUSION Continued research in this area should lead to improvements in the safety and tolerability of adjuvant therapy for melanoma.

The Impact of Cognitive Function on Medication Management: Three Studies

OBJECTIVE Medication nonadherence has been a persistent problem over the past three decades; forgetting and being distracted from regular routines are the barriers most frequently cited by patients. Prior research on cognitive function and medication adherence has yielded mixed results. DESIGN This report compares findings of three studies: All were longitudinal, two were randomized controlled intervention trials, and one was descriptive. Samples of adult patients taking once daily lipid-lowering medication, diabetic patients with comorbid conditions on complex regimens, and early stage breast cancer patients on hormonal therapy completed similar batteries of standardized, valid, neuropsychological tests at baseline. MAIN OUTCOME MEASURES Adherence to medication regimens, over time, was tracked with electronic event monitors. RESULTS Medication nonadherence was prevalent in all studies. Deficits in attention/mental flexibility and/or working memory predicted nonadherence in all studies; impaired executive function was related to poor adherence in one study. CONCLUSION These findings suggest that better mental efficiency may be the key to better medication adherence with any regimen, and that targeted cognitive functions, which can be easily and quickly assessed, may identify patients at risk of poor adherence regardless of diagnosis or regimen.

Memory impairments with adjuvant anastrozole versus tamoxifen in women with early-stage breast cancer

Objective: Hormones have been implicated as modulators of cognitive functioning. For instance, results of our previous work in women with breast cancer showed that cognitive impairment was more severe and involved more memory domains in those who received adjuvant tamoxifen therapy compared with women who received chemotherapy alone or no adjuvant therapy. Recently aromatase inhibitors such as anastrozole have been used in lieu of tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor-positive, early-stage breast cancer. Plasma estrogen levels are significantly lower in women who receive anastrozole compared with those who receive tamoxifen. We hypothesized, therefore, that anastrozole would have a more profound effect on cognitive function than tamoxifen, a mixed estrogen agonist/antagonist. Design: To test this hypothesis we compared cognitive function in women with early-stage breast cancer who received tamoxifen with those who received anastrozole therapy in a cross-sectional study. We evaluated cognitive function, depression, anxiety, and fatigue in 31 postmenopausal women with early-stage breast cancer who were between the ages of 21 and 65 years and treated with tamoxifen or anastrozole for a minimum of 3 months. Results: The results showed that women who received anastrozole had poorer verbal and visual learning and memory than women who received tamoxifen. Conclusions: Additional, prospective studies are needed to validate and confirm the changes in cognitive function associated with hormone therapy for breast cancer.

Cognitive Function and Reproductive Hormones in Adjuvant Therapy for Breast Cancer: A Critical Review

Deterioration in cognitive function-particularly learning, memory, and attention-has been reported by women with breast cancer who receive adjuvant chemotherapy. Deficits in cognitive function reported by women with breast cancer are similar to those experienced by women as a consequence of natural or surgical menopause. The basis of these deteriorations may include reductions in reproductive hormone levels, particularly estrogens and progesterones, that occur as a result of adjuvant chemotherapy. This paper critically examines the literature related to the impact of adjuvant chemotherapy and reproductive hormone changes on cognitive function in women with breast cancer and suggests direction for future research in this area. The paper proposes a framework for investigation of the problem and discusses the challenges associated with the conduct of this research.

An introduction to oxygen free radicals

Oxygen free radicals are byproducts from the fundamental metabolic activities within the body. Normally, radicals are neutralized by enzymatic activity or natural antioxidants. Thus the generation of free radicals poses no problem so long as the balance between oxygen radical production and eradication remains in balance. There are multiple medical conditions, such as myocardial infarction, carcinogenesis, and neurologic trauma, to name a few, that may be aggravated by the presence of oxygen free radicals. This article will present an overview of oxygen free radicals: their normal formation and control and how they might further injure tissue in particular diseases. The implications for health care professionals are highlighted.

Guiding research in family care: a new approach to oncology caregiving.

Objective: Much research has documented both negative emotional and physical health conditions that may result from providing care to a family member with an illness. However, little has been done in family caregiving, particularly in oncology, to evaluate pathways in which biological and behavioral responses to stress may interact. The purpose of this article is to describe how a mind‐body (biobehavioral) model can be adapted to study family caregivers of persons with a brain tumor.

I could lose everything: understanding the cost of a brain tumor

Although studies have quantified the costs of cancer treatment, few have evaluated the widespread impact of cancer costs on the family unit. Specifically, little is known regarding how cancer affects patients and their families financially, and how they cope with these costs. The purpose of this descriptive study was to explore the financial impact of cancer care in neuro-oncology. Content analysis was used to examine data from interviews with 20 adults receiving treatment for a primary malignant brain tumor. Participants were recruited from across the United States through an advertisement in a national support group newsletter. Four major themes were identified -“paying for medication/healthcare”, “strategies to offset costs”, “impact of cancer costs”, and “fear/uncertainty”. Within the major themes several sub-themes were also recognized. In the theme of paying for medication/healthcare, participants emphasized sub-themes such as frustrations over “not qualifying/red tape” and being “thankful” for what was covered. Some of the strategies used to offset cancer costs included “cashing in” and relying on “family/friends” for financial support. When describing the impact of cancer costs, participants mentioned sub-themes including the “cost to their family”, the “cost of their disability”, and the impact of a “change in income/job”. Results elucidate the financial concerns and coping strategies of persons undergoing treatment for cancer. These data help target patients’ support needs during treatment, such as providing for their family and navigating their insurance policies, and suggest more efficient implementation of financial interventions are needed to alleviate the emotional burden of cancer costs.

Cognitive Dysfunction Following Adjuvant Chemotherapy for Breast Cancer: Two Case Studies

PURPOSE/OBJECTIVES To describe the cognitive dysfunction experienced by two women after they received adjuvant chemotherapy for breast cancer and to discuss the potential role of changes in reproductive status and depression in the development of cognitive dysfunction. DATA SOURCES Journal articles, research data, and clinical experience. DATA SYNTHESIS Following chemotherapy, 17%-50% of women with breast cancer experience cognitive dysfunction that may include decrements in memory, attention, and psychomotor efficiency. One mechanism that may contribute to cognitive dysfunction involves changes in reproductive status resulting from chemotherapy. Additionally, the presence of depression may confound the experience of cognitive dysfunction. CONCLUSIONS A comprehensive description of cognitive dysfunction and improved understanding of the interrelationships among cognitive dysfunction, reproductive hormone levels, and depression in women with breast cancer receiving adjuvant chemotherapy may hasten the development of interventions for the management of cognitive dysfunction. IMPLICATIONS FOR NURSING Nurses should teach women with breast cancer and their families about the potential for cognitive dysfunction after chemotherapy so the problem can be recognized and interventions can be implemented to help women compensate for the dysfunction.

Symptom clusters in adults with chronic health problems and cancer as a comorbidity.

PURPOSE/OBJECTIVES To identify and compare symptom clusters in individuals with chronic health problems with cancer as a comorbidity versus individuals with chronic health problems who do not have cancer as a comorbidity and to explore the effect of symptoms on their quality of life. DESIGN Secondary analysis of data from two studies. Study 1 was an investigation of the efficacy of an intervention to improve medication adherence in patients with rheumatoid arthritis (RA). Study 2 was an investigation of the efficacy of an intervention for urinary incontinence (UI) in older adults. SETTING School of Nursing at the University of Pittsburgh. SAMPLE The sample for study 1 was comprised of 639 adults with RA. The sample for study 2 was comprised of 407 adults with UI. A total of 154 (15%) subjects had a history of cancer, 56 (9%) of the subjects with RA and 98 (25%) of the subjects with UI. METHODS Analysis of existing comorbidity and symptom data collected from both studies. MAIN RESEARCH VARIABLES Symptom clusters, chronic disease, and cancer as a comorbidity. FINDINGS Individuals with chronic health problems who have cancer may not have unique symptom clusters compared to individuals with chronic health problems who do not have cancer. CONCLUSIONS The symptom clusters experienced by the study participants may be more related to their primary chronic health problems and comorbidities. IMPLICATIONS FOR NURSING Additional studies are needed to examine symptom clusters in cancer survivors. As individuals are living longer with the disease, a comprehensive understanding of the symptom clusters that may be unique to cancer survivors with comorbidities is critical.