Hsiao-Lan Wang

Predictors of cancer-related pain improvement over time

Objective To determine the predictors of pain improvement among patients being treated for cancer-related pain over 12 months. Methods A secondary analysis of the telephone care Indiana Cancer Pain and Depression trial was performed. Patients (n = 274) were interviewed at baseline and after 1, 3, 6, and 12 months. Pain improvement outcomes included both a continuous measure (Brief Pain Inventory score) and a categorical measure (pain improved versus pain not improved). Predictor variables included change in depression, age, sex, race, marital status, socioeconomic disadvantage, medical comorbidity, type of cancer, and phase of cancer. Multivariable repeated measures were conducted, adjusting for intervention group assignment, baseline pain severity, and time in months since baseline assessment. Results Factors significantly predicting both continuous and categorical pain improvement included participating in the intervention group (&bgr; = −0.92, p < .001, odds ratio [OR] = 2.53, 95% confidence interval [CI] = 1.65–3.89), greater improvement in depression (&bgr; = −0.31, p = .003, OR = 1.84, 95% CI = 1.35–2.51), higher socioeconomic status (Socioeconomic Disadvantage index; &bgr; = 0.25, p = .034; OR = 0.73, 95% CI = 0.56–0.94), and fewer comorbid conditions (&bgr; = 0.20, p = .002; OR = 0.84, 95% CI = 0.73–0.96). Patients with more severe pain at baseline or with recurrent or progressive cancer were less likely to experience continuous or categorical pain improvement, respectively. Conclusions Effective management of depression and comorbid conditions along with improvement of social services could be critical components of a comprehensive pain management. Patients with more severe pain or with recurrent or progressive cancers may require closer monitoring and adequate treatment of pain. Trial Registration clinicaltrials.gov Identifier: NCT00313573. Abbreviations BPI = Brief Pain Inventory HSCL-20 = Hopkins Symptom Checklist 20-item depression scale INCPAD = Indiana Cancer Pain and Depression MMRM = mixed-effects models for repeated measures PGRI = Pain Global Rating of Improvement SED = Socioeconomic Disadvantage T0 = baseline data collection T1 = 1-month data collection T3 = 3-month data collection T6 = 6-month data collection T12 = 12-month data collection Telecare = centralized telephone care management

Cancer-Related Pain and Disability: A Longitudinal Study

CONTEXT Although the cross-sectional association between cancer-related pain and disability is well established, their longitudinal relationship has been less studied. OBJECTIVES Data from the Indiana Cancer Pain and Depression (INCPAD) trial were analyzed to determine whether baseline cancer-related pain and changes in pain over time predict disability over 12 months. METHODS A total of 274 cancer survivors with cancer-related pain were accrued in the INCPAD trial. Data were collected at baseline, one, three, six, and 12 months by interviewers blinded to treatment arm. Disability outcomes included a continuous measure (Sheehan Disability Scale [SDS] score) and a categorical measure (≥14 days in the past four weeks with a ≥50% reduction in usual activities). Predictor variables, operationalized by the Brief Pain Inventory, included baseline pain severity and changes in pain severity scores between each time point. Multivariable analyses were conducted adjusting for treatment group, baseline disability, and selected covariates including depression. RESULTS Baseline pain severity did not predict disability outcomes at 12 months. However, improvement in pain severity predicted less disability over 12 months both in terms of SDS scores (b=-0.17, t=-5.33, P<0.001) and ≥14 disability days in the past month (odds ratio=0.85; 95% confidence interval, 0.79-0.93; P<0.001). CONCLUSION Disability over 12 months in patients with cancer-related pain is predicted by changes in pain severity over time. Results suggest that effective pain management may reduce subsequent disability among cancer survivors.

Predictors of stage of adoption for colorectal cancer screening among African American primary care patients.

Background: Compared with other racial groups, African Americans have the highest colorectal cancer (CRC) incidence and mortality rates coupled with lower screening rates. Objective: Our study examined the predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy among African American primary care patients who were nonadherent to published screening guidelines. Methods: Baseline data (N = 815) in a randomized clinical trial were analyzed. Participants were categorized into precontemplation, contemplation, and preparation stages for FOBT and colonoscopy. Predictor variables were demographics, clinical variables, CRC health beliefs and knowledge, and social support. Hierarchical modeling was to identify significant predictors of stage of adoption. Results: Older, male, Veterans Affairs participants and those with higher perceived self-efficacy, family/friend encouragement, and a provider recommendation had higher odds of being at a more advanced stage of adoption for FOBT. Patients with a history of cancer and higher perceived barriers had higher odds of being at an earlier stage of adoption for FOBT. Predictors of more advanced stage of adoption for colonoscopy included higher perceived benefits, higher perceived self-efficacy, family/friend encouragement, and a provider recommendation for colonoscopy. Higher income (>30 000 vs <15 000) was predictive of earlier stage of adoption for colonoscopy. Conclusions: Enhancing self-efficacy, encouragement from family and friends, and provider recommendations are important components of interventions to promote CRC screening. Implications for Practice: Nurses can use knowledge of the characteristics associated with stage of adoption to educate and motivate their African American primary care patients to complete CRC screening tests.

Feasibility of the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program for symptom improvement among breast cancer survivors

The purpose of this pilot study was to test the feasibility of delivering the mobile mindfulness‐based stress reduction for breast cancer (mMBSR(BC)) program using an iPad and to evaluate its impact on symptom improvement.

Development and Evaluation of a Lung Cancer Screening Decision Aid.

Lung cancer is the second most common cancer; however, it often is not diagnosed until the advanced stages. Early-stage lung cancer is curable, but screening tools are not usually implemented in practice because of a lack of provider awareness. A lung cancer screening decision aid may increase screening use and, ultimately, reduce lung cancer deaths.


Exergame Grading Scheme: Concept Development and Preliminary Psychometric Evaluations in Cancer Survivors

The challenge of using exergames to promote physical activity among cancer survivors lies in the selection of the exergames that match their fitness level. There is a need for a standardized grading scheme by which to judge an exergames capacity to address specific physical fitness attributes with different levels of physical engagement. The study aimed to develop an Exergame Grading Scheme and preliminarily evaluate its psychometric properties. Fourteen (14) items were created from the human movement and exergame literature. The content validity index (CVI) was rated by content experts with two consecutive rounds (N = 5 and N = 3 independently). The interrater reliability (IRR) was determined by two raters who used the Exergame Grading Scheme to determine the grading score of the five exergames performed by two cancer survivors (N = 10). Each item had a score of 1 for item-level CVI and 1 for k. For IRR, 9 items had rho values of 1, 1 item had 0.93, and 4 items had between 0.80 and 0.89. This valid and reliable Exergame Grading Scheme makes it possible to develop a personalized physical activity program using any type of exergame or fitness mobile application in rehabilitation practice to meet the needs of cancer survivors.

Stress-related biobehavioral responses, symptoms, and physical activity among female veterans in the community: An exploratory study

BACKGROUND Female veterans experience multiple stresses during their lifetime. Some of them seek care in the civilian community. Common physical and psychological symptoms among female veterans include pain, fatigue, sleep quality, and depression. Physical activity has the potential to improve their well-being. OBJECTIVES This study was guided by the concept of allostasis. The purpose of the study was to determine the associations among stress-related biobehavioral responses and symptoms as well as to determine if physical activity moderated these associations among female veterans. DESIGN/SETTINGS/PARTICIPANTS/METHODS A cross-sectional and exploratory design was implemented among 82 female veterans (46±10.57years old) at a community event. Self-reported questionnaires and blood and hair samples were collected. Descriptive statistics and multivariate analyses were applied in this secondary data analysis. FINDINGS Female veterans experienced moderate perceived stress and greater body mass index, C-reactive protein, and hair cortisol levels at the same time as they reported moderate levels of pain and fatigue, poor sleep quality, and considerable depressive symptoms. The findings showed that greater body mass index was significantly associated with more severe pain and poor sleep quality. Physical activity negatively moderated the relationship between perceived stress and pain. CONCLUSION Female veterans need services to manage body weight and help them engage in physical activity. Nurse educators are responsible for instructing nurses to properly identify female veterans in the civilian community facility and to provide care in a respectful manner.

Abstract B65: Colorectal cancer screening in nonadherent black Americans

Background: Compared with other racial groups, Black Americans have higher incidence and mortality from colorectal cancer (CRC) and lower screening rates. Theory-based tailored interventions to increase screening are more likely to be successful, especially those tailoring on stage of adoption. The purpose of our study was to examine predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy screening among non-adherent Black Americans. Methods: We analyzed baseline data from 817 Black primary care patients enrolled in a randomized clinical trial. Participants were categorized into precontemplation, contemplation, or preparation groups. Predictor variables examined included: demographics (age, gender, education, employment, income, health insurance, and clinical site), clinical variables (body mass index, family history of CRC, and personal history of cancer), CRC health beliefs and knowledge (perceived risk, perceived benefits, perceived barriers, self-efficacy, cancer fatalism, and knowledge), and social support (marital status, family/friend encouragement, and doctor recommendation). Hierarchical modeling was used to identify significant predictors with p value equal to or less than 0.01. Results: Participants who: were older (OR = 1.04, p = .003); male (OR = 1.70, p = .007); seen at a VA site (OR = 2.80, p Conclusion: Enhancing self-efficacy and encouragements from family and friends may be important components of interventions to promote CRC screening among Black Americans. Healthcare providers can utilize knowledge of the characteristics associated with stage of adoption to educate and motivate their primary care Black American patients to complete CRC screening tests. Citation Format: Hsiao-Lan Wang, Shannon M. Christy, Celette S. Skinner, Victoria L. Champion, Victoria L. Champion, Jeffrey K. Springston, Susan M. Perkins, Susan M. Perkins, Yan Tong, Connie Krier, Netsanet Gebregziabher, Susan M. Rawl, Susan M. Rawl. Colorectal cancer screening in nonadherent black Americans. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B65. doi:10.1158/1538-7755.DISP13-B65