Elizabeth Ann Coleman

Feasibility of Exercise During Treatment for Multiple Myeloma

Fatigue and insomnia are problems for patients with cancer. Research findings show that aerobic exercise decreases cancer-related fatigue. Because patients with cancer who have skeletal muscle wasting may not obtain maximum benefit from aerobic exercise training, exercise programs may need to include resistance training. Thus far, testing exercise as an intervention for fatigue has focused on patients with breast cancer and excluded patients with bone metastasis. There is a need to test the feasibility and effectiveness of exercise for patients with other types of cancer and with bone involvement. The effect of aerobic and strength resistance training on the sleep of patients with cancer has not been tested. A pilot/feasibility study with a randomized controlled design was conducted to investigate homebased exercise therapy for 24 patients receiving high-dose chemotherapy and autologous peripheral blood stem cell transplantation as treatment for multiple myeloma. None of the patients injured themselves. Because of the small sample size in the feasibility study, the effect of exercise on lean body weight was the only end point that obtained statistical significance. However, the results suggest that an individualized exercise program for patients receiving aggressive treatment for multiple myeloma is feasible and may be effective for decreasing fatigue and mood disturbance, and for improving sleep.

Fatigue, Weight Gain, and Altered Sexuality in Patients With Breast Cancer: Exploration of a Symptom Cluster

PURPOSE/OBJECTIVES To identify the symptom cluster of fatigue, weight gain, and altered sexuality caused by treatment for breast cancer. DATA SOURCES Published research and literature review articles. DATA SYNTHESIS Fatigue, weight gain, and altered sexuality commonly occur after breast cancer chemotherapy. Each symptom has a significant impact on quality of life; however, viewing them as a symptom cluster magnifies their impact. CONCLUSIONS These symptoms have yet to be studied as a cluster. Exercise appears to be an intervention common to each that may be effective in reducing the severity of these treatment side effects. IMPLICATIONS FOR NURSING Nurses should view symptoms caused by breast cancer treatment holistically, keeping in mind that a reciprocal relationship often exists among symptoms. Identification of symptom clusters with empirically derived interventions may enhance quality of care and quality of life for patients.

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.

Familial Myeloma: Study of a Unique Family

We describe a family with five cases of multiple myeloma, three cases of monoclonal gammopathy of undetermined significance (MGUS), and five cases of prostate cancer in two generations. The putative progenitor had progeny with two female partners. The progeny had prostate cancer, multiple myeloma, and MGUS.

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.

Use of a supportive care team for screening and preemptive intervention among multiple myeloma patients receiving stem cell transplantation.

Although peripheral blood stem-cell transplantation (PBSCT) has assumed a growing role in the treatment of multiple myeloma, very few studies have examined the functional and quality-of-life changes experienced by myeloma patients in the transplant setting. Multiple myeloma is characterized by a range of debilitating physical and psychosocial symptoms. However, supportive care needs for patients with this disease are often overlooked or managed only episodically. The current study pilot-tested an interdisciplinary supportive care program designed to provide screening and identify patients at risk early in the course of care. Participants in this pilot project were 61 patients with hematological disorders, predominantly multiple myeloma (85.3%), evaluated during their initial workup. Mean time since diagnosis was 7.4 months. Participants were interviewed by an advanced-practice nurse and completed standardized measures of heath-related quality of life (SF-12), fatigue (POMS-Fatigue), nutritional risk (PG-SGA), pain (Brief Pain Inventory), emotional functioning (Hospital Anxiety and Depression Scale), and sexual concerns (FACIT). Results indicated that difficulties were prevalent across multiple functional domains; 61.4% of patients displayed significant nutritional deficits. Physical functioning was below age-adjusted national norms for 53.5%. Moderate-to-severe fatigue was reported by 39.0%, and one third experienced clinically significant levels of pain, impaired daily functioning associated with pain, and emotional distress. A similar proportion of respondents (33.9%) reported disrupted sexual functioning and difficulty with body image. Findings suggest that early, systematic screening is feasible in a busy transplant center. The prevalence of symptoms highlights the importance of providing screening and proactive intervention for multiple myeloma patients early in the course of treatment and even prior to beginning protocols for high-dose therapy and transplantation.