Kevin D. Stein

Efficacy and Costs of Two Forms of Stress Management Training for Cancer Patients Undergoing Chemotherapy

PURPOSEnProfessionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy. The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver.nnnPATIENTS AND METHODSnFour hundred eleven patients about to start chemotherapy were randomly assigned to receive usual psychosocial care only, a professionally administered form of stress management training, or a patient self-administered form of stress management training. Quality-of-life assessments were conducted before randomization and before the second, third, and fourth treatment cycles. Intervention costs were estimated from both payer and societal perspectives.nnnRESULTSnCompared with patients who received usual care only, patients receiving the self-administered intervention reported significantly (P < or = .05) better physical functioning, greater vitality, fewer role limitations because of emotional problems, and better mental health. In contrast, patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only. Costs of the self-administered intervention were estimated to be 66% (from a payer perspective) to 68% (from a societal perspective) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy.nnnCONCLUSIONnEvidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment.

Impact of Hot Flashes on Quality of Life Among Postmenopausal Women Being Treated for Breast Cancer

Hot flashes are among the most commonly reported symptoms among women who have completed treatment for breast cancer. Relatively little is known, however, about hot flashes among women while they are undergoing breast cancer treatment. The present study investigated the prevalence and severity of hot flashes of women during chemotherapy and radiotherapy for breast cancer. We also sought to identify the medical, demographic, and treatment correlates of hot flashes during treatment and to document the impact of hot flashes on quality of life. Seventy postmenopausal women with breast cancer completed a self-report questionnaire packet during chemotherapy and radiotherapy. Forty percent (n = 28) reported hot flashes during the week prior to assessment. Of the 28 women endorsing hot flashes, 25% (n = 7) rated them as severe, 39% (n = 11) rated them as moderate, and 36% (n = 10) rated them as mild. Women with hot flashes were significantly (p < 0.05) younger and reported significantly (p < 0.001) more fatigue, poorer sleep quality, and poorer physical health compared to women without hot flashes. Multivariate analyses revealed that, even after controlling for relevant medical, demographic, and treatment variables, the prevalence of hot flashes significantly (p < 0.05) predicted poorer sleep quality, more fatigue, and worse physical health. The results indicate that hot flashes are experienced by a sizable percentage of postmenopausal breast cancer patients as they undergo treatment. Hot flashes during cancer treatment appear to have a negative impact upon patient quality of life that may be due, in part, to fatigue and interference with sleep. Future research should seek to evaluate interventions to relieve hot flashes during breast cancer treatment as a means of improving patient quality of life.

Is Fatigue a Long-term Side Effect of Breast Cancer Treatment?

BACKGROUND: Fatigue is one of the most common and distressing symptoms experienced by breast cancer survivors. Despite its prevalence, relatively little is known about the characteristics, etiology, or treatment of fatigue in breast cancer survivors. METHODS: This report reviews studies that assessed fatigue in breast cancer patients previously treated with adjuvant radiotherapy, adjuvant chemotherapy, or autologous bone marrow transplantation. RESULTS: A review of the literature suggests that breast cancer patients who undergo adjuvant chemotherapy or autologous bone marrow transplantation experience clinically significant levels of fatigue for months or even years following the completion of active treatment. In contrast, there is little evidence that patients who receive only regional therapy (ie, surgery plus adjuvant radiotherapy) experience clinically significant fatigue as a long-term treatment side effect. CONCLUSIONS: A growing body of evidence indicates that persistent fatigue can be a long-term side effect of certain forms of breast cancer treatment. The challenges for the future will be to determine the etiology of fatigue among breast cancer survivors and to develop interventions that are effective in preventing or reducing fatigue following breast cancer treatment.

Reply to symptom burden in cancer survivors 1 year after diagnosis: A report from the american cancer society's studies of cancer survivors

Background nFew studies have examined risk for severe symptoms during early cancer survivorship. Using baseline data from the American Cancer Society’s Study of Cancer Survivors-I, we examined cancer survivors with high symptom burden, identified risk factors associated with high symptom burden, and evaluated the impact of high symptom burden on health-related quality of life (HRQoL) 1 year post-diagnosis.

Health-related behavior change after cancer: results of the American Cancer Society’s studies of cancer survivors (SCS)

IntroductionCancer survivors are known to make positive health-related behavior changes after cancer, but less is known about negative behavior changes and correlates of behavior change. The present study was undertaken to examine positive and negative behavior changes after cancer and to identify medical, demographic, and psychosocial correlates of changes.MethodsWe analyzed data from a cross-sectional survey of 7,903 cancer survivors at 3, 6, and 11 years after diagnosis.ResultsOf 15 behaviors assessed, survivors reported 4 positive and 1 or 0 negative behavior changes. Positive change correlated with younger age, greater education, breast cancer, longer time since diagnosis, comorbidities, vitality, fear of recurrence, and spiritual well-being, while negative change correlated with younger age, being non-Hispanic African American, being widowed, divorced or separated, and lower physical and emotional health. Faith mediated the relationship between race/ethnicity and positive change.ConclusionsCancer survivors were more likely to make positive than negative behavior changes after cancer. Demographic, medical, and psychosocial variables were associated with both types of changes.Implications for cancer survivorsResults provide direction for behavior interventions and illustrate the importance of looking beyond medical and demographic variables to understand the motivators and barriers to positive behavior change after cancer.

Validation of a Modified Rotterdam Symptom Checklist for use with cancer patients in the United States

The Rotterdam Symptom Checklist (RSCL) is a well-known instrument for the assessment of symptom-related distress among cancer patients. Despite its broad application, the utility of the RSCL with patients of some cancers is hindered by the omission of several important physical symptoms and methodological limitations of previous validation studies. The aims of the present study were to modify the RSCL through the addition of several physical symptoms and to subsequently validate the modified version of the Rotterdam Symptom Checklist (RSCL-M) with a heterogeneous sample of cancer patients from the United States. A total of 1,005 male and female cancer patients from two midwestern states completed the RSCL-M and several other self-report instruments. Results indicated that the RSCL-M is a reliable and valid instrument for use with cancer patients in the United States and is sensitive to differences in physical distress across groups expected to have distinct symptom-related distress profiles.

Body Image Dissatisfaction in Cancer Survivors

PURPOSE/OBJECTIVESnTo explore medical and psychosocial factors associated with body image dissatisfaction in male and female cancer survivors.nnnDESIGNnSecondary data analysis from the American Cancer Societys Study of Cancer Survivors-II pilot survey.nnnSETTINGnCancer survivors were identified through two state cancer registry databases.nnnSAMPLEn165 male and 234 female cancer survivors of six cancer types (bladder, female breast, colorectal, endometrial, prostate, and melanoma) who were 2, 5, and 10 years beyond diagnosis.nnnMETHODSnResearchers notified physicians prior to participant recruitment. State cancer registries contacted potential participants via mailed letters. Participants who gave their informed consent completed a written survey.nnnMAIN RESEARCH VARIABLESnCurrent body image dissatisfaction, mental and physical health, sexual functioning, and basic medical and demographic information.nnnFINDINGSnResults of multiple regression analysis indicated that male survivors of prostate cancer were more likely to express positive body images than men who had other types of cancer. A composite variable that included a history of cancer recurrence, multiple cancers, or metastatic cancer was the strongest predictor of body image dissatisfaction for female survivors. Body image was not associated with age, length of time since diagnosis, or general treatment type for either gender.nnnCONCLUSIONSnBody image was associated with various medical and psychosocial factors, and the factors differed for male and female cancer survivors.nnnIMPLICATIONS FOR NURSINGnAn understanding of factors associated with body image is essential for the nursing care of patients with cancer.

An Action Plan for Translating Cancer Survivorship Research Into Care

To meet the complex needs of a growing number of cancer survivors, it is essential to accelerate the translation of survivorship research into evidence-based interventions and, as appropriate, recommendations for care that may be implemented in a wide variety of settings. Current progress in translating research into care is stymied, with results of many studies un- or underutilized. To better understand this problem and identify strategies to encourage the translation of survivorship research findings into practice, four agencies (American Cancer Society, Centers for Disease Control and Prevention, LIVE STRONG: Foundation, National Cancer Institute) hosted a meeting in June, 2012, titled: Biennial Cancer Survivorship Research Conference: Translating Science to Care. Meeting participants concluded that accelerating science into care will require a coordinated, collaborative effort by individuals from diverse settings, including researchers and clinicians, survivors and families, public health professionals, and policy makers. This commentary describes an approach stemming from that meeting to facilitate translating research into care by changing the process of conducting research-improving communication, collaboration, evaluation, and feedback through true and ongoing partnerships. We apply the T0-T4 translational process model to survivorship research and provide illustrations of its use. The resultant framework is intended to orient stakeholders to the role of their work in the translational process and facilitate the transdisciplinary collaboration needed to translate basic discoveries into best practices regarding clinical care, self-care/management, and community programs for cancer survivors. Finally, we discuss barriers to implementing translational survivorship science identified at the meeting, along with future directions to accelerate this process.

Evaluation of the American Cancer Society's breast cancer-related documents by cancer survivors.

BACKGROUNDnIn an attempt to address the informational needs of female breast cancer survivors, the American Cancer Society (ACS) develops and distributes written documents. Although this educational effort has been well received, little attention has been given to the suitability of the materials themselves.nnnMETHODSnA random sample of 812 survivors was derived from callers to the ACS National Cancer Information Center (NCIC) from July to December of 2000. The participants then rated the three most commonly distributed breast cancer information documents on five dimensions 1). presentation, 2). satisfaction, 3). understanding, 4). anxiety, and 5). impact.nnnRESULTSn. Participants responded favorably to four of the five rating categories. Conclusions. The evidence suggests that the three materials had positive health outcomes and were well received by the survivors.

Developing symptom management quality improvement reports with data from a registry-based patient reported outcomes (PRO) collection method.

180 Background: Symptom management is critical to quality cancer care, affecting treatment completion, functioning and quality of life. We describe the use of the Commission on Cancers Rapid Quality Reporting System (RQRS) to ascertain cases for PRO collection, identify key PRO quality indicators, and provide actionable symptom management quality improvement (QI) reports to community cancer centers (CCC).nnnMETHODSnThe Patient Reported Outcomes Symptoms & Side Effects Study used RQRS to sample patients (pt) 4-12 months from diagnosis with locoregional breast/colon from 17 National Cancer Institute Community Cancer Centers Program centers. Surveys were mailed with web option. Pts were asked if they talked to a health professional about pain (Talk about) and, separately, if the health professional gave advice about what to do if pain started, got worse, or came back (Advice). Similar questions were asked about fatigue and emotional distress (ED). QI reports were designed with CCC staff feedback and produced for each CCC providing crude and case-mix adjusted CCC-specific rates, and study-wide rates. Direct standardization methods were used to adjust CCC-specific rates for cancer type and education.nnnRESULTSn2,487 eligible participants responded (RR=61%). This table shows overall study-wide estimates and the range of adjusted CCC-specific estimates for six key indicators. (See Table.) Conclusions: This pilot study shows the registry-based method for PRO collection was successful and has potential for wider dissemination. Study-wide, 20-45% of pts did not report discussing or getting advice about three common symptoms from their healthcare team. CCCs varied significantly on these indicators, suggesting room for improvement. Quality reports were well received by hospital staff, who report sharing them with clinicians, navigators and cancer committees. CCC-specific reports may promote efforts to improve care through professional/patient education and applying standards of care. [Table: see text].