Diane Von Ah

Predictors of cancer-related fatigue in women with breast cancer before, during, and after adjuvant therapy.

The purpose of this longitudinal study was to examine potential predictors of cancer-related fatigue (CRF) before, during, and after adjuvant therapy in women with breast cancer. A convenience sample of 44 women postsurgery (M = 18) aged 38 to 77 years (M = 52) were recruited from a Southern breast clinic. Based on Pipers Integrated Fatigue Model, the women (1) completed questionnaires assessing innate host factors (age, income, and education level), disease and treatment patterns (disease stage, surgery type, and adjuvant therapy), psychological patterns (perceived stress, mood disturbance, and optimism), social patterns (type and satisfaction with social support) and (2) provided a blood sample to examine regulation patterns (morning cortisol levels, interleukin-1&bgr;, tumor necrosis factor alpha, and natural killer cell activity) before adjuvant therapy. The Piper Fatigue Scale-Revised was completed at all 3 time points. Mood disturbance was the most significant predictor of CRF at all time points. Interleukin-1&bgr; predicted CRF levels before adjuvant therapy and morning cortisol before adjuvant therapy predicted CRF during and after adjuvant therapy. These findings suggest that interventions to reduce mood disturbances might be effective in decreasing CRF. Further research regarding the physiological mechanisms underlying the relationships between CRF, mood disturbance, interleukin-1&bgr;, and cortisol is needed.

Quality of life of African American breast cancer survivors: how much do we know?

Women affected by breast cancer experience an array of quality-of-life issues that affect their daily living in both short-term and long-term survivorship. Because African American women experience disparities in breast cancer survival, their quality-of-life concerns may paint a different picture from those of other racial and ethnic groups. To gain a better understanding of quality of life in African American women breast cancer survivors, we conducted a review, using an adaptation of Brenners quality-of-life proximal-distal continuum, of studies that have investigated these womens experiences and associated variables. Twenty-six studies, qualitative and quantitative, were reviewed that identified both deficits and positive outcomes of breast cancer treatment and sequelae, including physical, emotional, social, and patient-provider problems as well as heightened spirituality and positive growth. Although overall global quality of life was favorable in both African American and white survivors, differences existed in the nature and extent of deficits between these 2 survivor groups. Nursing implications of this review point to the need for further rigorous research and wide dissemination of results. Recommendations for practice include tailoring assessments and interventions within the context of the lives of African American women breast cancer survivors.

Perceived Cognitive Function in Breast Cancer Survivors: Evaluating Relationships With Objective Cognitive Performance and Other Symptoms Using the Functional Assessment of Cancer Therapy—Cognitive Function Instrument

CONTEXT Perceived cognitive impairment (PCI) has been shown to be one of the most common symptoms after breast cancer treatment. However, this symptom does not always correlate with objective cognitive performance and is often highly associated with other patient-reported symptoms. OBJECTIVES Using a sample of breast cancer survivors (BCS), this study examined relationships among the Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) scale, a self-report questionnaire that measures PCI; impact on quality of life (QoL); comments from others (other); perceived cognitive ability (PCA); objective cognitive performance on tests of verbal memory, speed of processing, and executive functioning; and other symptoms (fatigue, depression, anxiety, and sleep disturbance). METHODS The BCS who were aged 40 years or older and at least one year post-chemotherapy treatment were enrolled. Participants completed questionnaires and a brief neuropsychological assessment. RESULTS A total of 88 BCS who were on average 56.7 (SD 8.5) years old and 5.3 (SD 4.1) years post-treatment participated; 94% reported clinically significant PCI. The PCI was significantly correlated with some objective measures of immediate and delayed verbal memory and executive function, whereas PCA was associated with all these measures. The PCI and PCA were both significantly associated with depressive symptoms, fatigue, and anxiety, but only PCI was related to poor global sleep quality. CONCLUSION The PCA was highly correlated with objective neuropsychological performance and may be clinically useful in identifying problems with verbal memory and executive functioning in BCS.

Factors related to cigarette smoking initiation and use among college students.

The purpose of this cross-sectional study was to examine the impact of personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness), cognitive factors (sense of coherence and self-efficacy), coping resources (family and friend social support) and demographic factors (gender and ethnicity) on cigarette smoking behaviors (initiation, frequency, and amount of cigarette smoking) among college students. A total of 161 U.S. college students, aged 18–26, who enrolled in an introductory psychology course completed self-report questionnaires. The majority of the students had tried smoking (55%); among those who had tried, 42% were current smokers. The majority (77%) who had smoked a whole cigarette did so at age 16 years or younger. Students who reported lower levels of conscientiousness and self-efficacy had a greater likelihood to had tried cigarette smoking. Also, students who had lower levels of self-efficacy reported smoking more frequently and greater quantities of cigarettes than students with higher levels of self-efficacy. Self-efficacy was the most significant predictor of smoking behaviors. Health promotion programs focused on self-efficacy may be an effective tool for reducing the initiation, frequency, and amount of cigarette smoking among college students.

Cognitive Function in Breast Cancer Survivors Compared to Healthy Age- and Education-Matched Women

The cognitive function of breast cancer survivors (BC, n = 52) and individually matched healthy controls (n = 52) was compared on a battery of sensitive neuropsychological tests. The BC group endorsed significantly higher levels of subjective memory loss and scored significantly worse than controls on learning and delayed recall indices from the Rey Auditory Verbal Learning Test (AVLT). Defining clinically significant impairment as scores at or below the 7th percentile of the control group, the rate of cognitive impairment in the BC sample was 17% for total learning on the AVLT, 17% for delayed recall on the AVLT, and 25% for either measure. Findings indicate that a sizeable percentage of breast cancer survivors have clinically significant cognitive impairment.

Proposed mechanisms for cancer- and treatment-related cognitive changes

OBJECTIVES To review the proposed mechanisms of cognitive changes associated with non-central nervous system cancers and cancer treatment. DATA SOURCES Review and synthesis of databased publications and review articles. CONCLUSION Proposed mechanisms include cytokine upregulation, hormonal changes, neurotransmitter dysregulation, attentional fatigue, genetic predisposition, and comorbid symptoms. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses need to understand the multiple mechanisms that may contribute to the development of cancer- and treatment-related cognitive changes so that they can identify patients at high risk and help patients understand why these changes occur.

Health-related quality of life of African American breast cancer survivors compared with healthy African American women

Background: The diagnosis and treatment of breast cancer can result in an array of late cancer-specific side effects and changes in general well-being. Research has focused on white samples, limiting our understanding of the unique health-related quality of life outcomes of African American breast cancer survivors (BCSs). Even when African American BCSs have been targeted, research is limited by small samples and failure to include comparisons of peers without a history of breast cancer. Objective: The purpose of this study was to compare health-related quality of life of African American female BCSs with that of African American women with no history of breast cancer (control group). Methods: A total of 140 women (62 BCSs and 78 controls), 18 years or older and 2 to 10 years postdiagnosis, were recruited from a breast cancer clinic and cancer support groups. Participants provided informed consent and completed a 1-time survey based on the proximal-distal health-related quality of life model of Brenner et al (1995). Results: After adjusting for age, education, income, and body mass index, results show that African American BCSs experienced more fatigue (P = .001), worse hot flashes (P < .001), and worse sleep quality (P < .001) but more social support from their partner (P = .028) and more positive change (P = .001) compared with African American female controls. Conclusions: Our results suggest that African American female BCSs may experience unique health-related outcomes that transcend age, education, socioeconomic status, and body mass index. Implications for Practice: Findings suggest the importance of understanding the survivorship experience for particular racial and ethnic subgroups to proactively assess difficulties and plan interventions.

Correlates of mood disturbance in women with breast cancer: patterns over time

AIM This study examined factors associated with mood disturbance prior to, during and after adjuvant therapy. BACKGROUND Breast cancer is the most common cancer in women worldwide. Mood disturbance affects between 20% and 30% of women with breast cancer and is associated with other debilitating symptoms. However, factors associated with mood disturbance across the breast cancer diagnosis-treatment trajectory are not clearly understood. METHOD A stress-coping framework guided this longitudinal study. A convenience sample of 49 American women with newly diagnosed breast cancer aged 37-77 years completed questionnaires assessing age, optimism, disease stage, type of adjuvant therapy, lymph node status, emotional support, aid (tangible) support, perceived stress and mood disturbance. Data were collected over an 18-month period in 2002-2003 at three time points: prior to, during and after adjuvant therapy. Descriptive statistics, Pearsons correlation and multiple regression were used. FINDINGS At all three time points, higher stress was significantly related to greater mood disturbance. Perceived stress mediated the relationship between (1) emotional support and mood disturbance prior to and after adjuvant therapy and between (2) aid support and mood disturbance during adjuvant therapy. In addition, the type of support that was most important to mood disturbance varied over time. Emotional support was related to reduced mood disturbance prior to and after adjuvant therapy, whereas aid support was most important during adjuvant therapy. CONCLUSIONS Nurses may use this information to develop interventions that bolster appropriate types of support to reduce stress and ultimately lower mood disturbance. Further research across cultures is needed.

Putting Evidence Into Practice: Evidence-Based Interventions for Cancer and Cancer Treatment-Related Cognitive Impairment

Cognitive impairment is a clinically complex symptom commonly experienced by cancer survivors. Although research in this area has grown, many questions remain regarding underlying mechanisms, trajectory, and specific interventions nurses can offer patients to prevent, treat, and manage cognitive impairment effectively. As part of the Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) initiative, a comprehensive examination of the current literature was conducted to identify effective interventions for cognitive impairment in cancer survivors. The studies were categorized into nonpharmacologic interventions, including complementary and alternative therapies and cognitive training, and pharmacologic interventions, including psychostimulants and erythropoietin-stimulating agents. Using the ONS PEP Weight of Evidence Classification Schema, the levels of evidence for these interventions were consistent with the categories of effectiveness not established or not recommended for practice. Additional research is needed to identify effective preventive and treatment strategies for cognitive impairment in cancer survivors.

COPING STRATEGIES AND INTERVENTIONS FOR COGNITIVE CHANGES IN PATIENTS WITH CANCER

OBJECTIVES To provide a comprehensive summary of the coping strategies and evidence-based interventions used to address cognitive impairment following cancer and cancer treatment. DATA SOURCES Review and synthesis of empirical articles. CONCLUSION Survivors identified a structured environment and validation of their cognitive concerns as essential to adjustment. Although interventional research is still limited, non-pharmacological approaches such as cognitive training programs show the greatest promise. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses must understand the available evidence and provide information and guidance to cancer survivors to address cognitive changes after cancer.