Kyra Whitmer

A randomized clinical trial of energy conservation for patients with cancer‐related fatigue

The efficacy of energy conservation and activity management (ECAM) for fatigue reduction and maintenance of functional performance has never been evaluated in adults with cancer who are undergoing treatment.

Psychometric testing of fatigue instruments for use with cancer patients

BACKGROUND Cancer treatment-related fatigue (CRF) is a common side effect of cancer treatment. A problem identified in most reviews of CRF is lack of sound approaches to measurement that are congruent with the conceptualization of CRF as a self-perceived state. The diversity of instruments available to measure fatigue and the lack of comprehensive testing of several promising instruments with cancer patients undergoing treatment provided the rationale for this study. The purpose of this article is to report the results of psychometric testing of several fatigue instruments in patients undergoing cancer treatment. OBJECTIVES The aims of this study were to determine the reliability, validity, and responsiveness of each instrument and to determine the ability of each instrument to capture CRF. METHODS Existing fatigue instruments with published psychometric information that indicated suitability for further testing were selected and included the Profile of Mood States Short Form fatigue subscale (F_POMS-sf), Multidimensional Assessment of Fatigue (MAF), Lee Fatigue Scale (LFS), and the Multidimensional Fatigue Inventory (MFI). Data were collected at a university-based clinical cancer center and a freestanding comprehensive cancer center. Subjects completed all study instruments, which were presented in random order, at a time when CRF was expected to be high and again when it was expected to be low. A subset of subjects completed the instruments within 48 hours of one of the data collection points when CRF was expected to be relatively unchanged to provide stability data. RESULTS Reliability estimates using Cronbachs alpha indicated that all instruments examined had good internal consistency. Test-retest correlations showed good stability for total scores on all the instruments, but some subscales of the LFS and MFI had marginal stability. Factor analysis of all instruments indicated that only the LFS and the F_POMS-sf fully supported their construct validity. All of the instruments showed responsiveness to changes in CRF related to treatment. CONCLUSIONS The results of the study provide researchers and clinicians with detailed comparisons of the performance of established fatigue measures in cancer patients undergoing treatment to use when selecting measures of CRF.

Factors influencing diabetes self‐management in Chinese people with type 2 diabetes

Patients with diabetes must incorporate a complicated regimen of self-management into their daily lives (e.g., taking medication, diet, exercise). Diabetes self-management (DSM) is the cornerstone for controlling diabetes and preventing diabetic complications. The purpose of this study was to test a model describing the effects of individual and environmental factors on DSM in a sample of patients with diabetes in Beijing, China. Survey data were gathered from a convenience sample of 201 Chinese adults with type 2 diabetes during outpatient visits. Data were analyzed using structural equation modeling. Model fit indices indicated a good fit to the data. In the final model, belief in treatment effectiveness and diabetes self-efficacy were proximate factors affecting DSM. Knowledge, social support, and provider-patient communication affected self-management indirectly via beliefs and self-efficacy. The findings provide a theoretical basis to direct the development of interventions for improving DSM in Chinese individuals with diabetes.

A pilot study examining energy conservation for cancer treatment-related fatigue.

The purpose of this pilot study was to examine the feasibility of conducting an energy conservation and activity management (ECAM) intervention for cancer treatment–related fatigue and describe patterns of cancer treatment–related fatigue for two groups undergoing active treatment, one receiving the ECAM intervention and a nonequivalent control group receiving standard care for cancer treatment–related fatigue. The ECAM group received 3 telephone sessions focusing on the provision of information about fatigue, development of an energy conservation plan, and evaluation of the plan’s effectiveness. Data for the ECAM group were collected before treatment, at an expected fatigue high point during treatment, and an expected low point of fatigue after treatment. The nonequivalent control group lacked the pretreatment measure but had equivalent follow-up measurement points. The feasibility of conducting the ECAM intervention was supported by patient adherence in receiving all 3 sessions of the intervention and by their self-reports of its usefulness and plans to continue using ECAM skills. Patterns of fatigue differed for the ECAM study group and the nonequivalent control group, suggesting that the intervention moderates the expected rise in fatigue due to cancer therapy. A full-scale clinical trial is needed to evaluate the efficacy of the ECAM intervention.

Adaptation and testing of instruments to measure diabetes self-management in people with type 2 diabetes in mainland China.

Purpose: The purpose of this study was to test the psychometric properties of instruments used to measure diabetes self-management (DSM) that were modified and translated into Chinese. Method: A convenience sample of 30 people with type 2 diabetes in Beijing, China, completed a questionnaire consisting of six instruments that had been translated and modified for use with a Chinese population. The reliability and validity were examined. Results: The Cronbachs alpha for the six instruments varied from .62 to .87. Factors analysis was performed, with variances explained by factors ranging from 61.6% to 97.9%. Conclusions: The findings of the psychometric testing of the modified and translated instruments support the use of these tools to assess DSM and its influencing factors in Chinese people with type 2 diabetes.

C-reactive protein and cardiovascular disease in people with diabetes: high-sensitivity CRP testing can help assess risk for future cardiovascular disease events in this population.

Having both diabetes and an elevated C-reactive protein (CRP) level compounds ones risk of developing cardiovascular disease, for which people with diabetes are at particularly high risk. CRP is both a biomarker for infectious and noninfectious disorders associated with inflammation and a risk factor for such conditions. Many researchers now believe that the protein also plays a role in the disease processes. The American Heart Association and the Centers for Disease Control and Prevention recently defined three cardiovascular risk categories relative to CRP levels. This article reviews the relevant literature and explores how CRP levels can be used in cardiovascular disease risk assessment, prevention, and treatment.

Exercise intervention for fatigue-related symptoms in Thai women with breast cancer: A pilot study

The purpose of this pilot study was to preliminarily examine the effects of an exercise program on the symptoms of fatigue, sleep disturbance, mood disturbance, symptom distress, and physical fitness for Thai women with breast cancer. Twenty-three eligible women were randomly assigned to either an experimental group (n = 11) or to a control group (n = 12). Data were collected and analyzed at baseline and again at 4, 7, and 10 weeks. At each time point, fatigue was measured at an expected high point during treatment. Participants in the exercise group demonstrated a trend toward improving the symptoms with mean score changes. Using generalized estimating equations analysis, a significant decrease in mood disturbance was found in the exercise group compared with control at 10 weeks (β = 0.03, P = 0.04). The participants exhibited significantly longer 12-minute walk distance at 10 weeks than those in the control group (t = 2.28, P = 0.04). These results indicate that exercise during adjuvant chemotherapy may be beneficial for Thai women with breast cancer.

Strategies for maintaining integrity of a behavioral intervention.

The purpose of this article is to address issues in maintaining the integrity of a behavioral intervention. Examples are provided from a recently completed study on how to train research staff and monitor the integrity of the intervention. In this exemplar, the integrity of the behavioral intervention was addressed by the design of the study and research staff training. Throughout the study, the integrity of the behavioral intervention was monitored by delineating a checklist of topics that must be addressed, critiquing audiotapes of the intervention, and discussing incomplete or missing elements with the research staff.

Digital image analysis of facial erythema over time in persons with varied skin pigmentation

Background/purpose: Selected chemotherapeutic agents used for the treatment of cancer are known to cause skin toxicities. One group of agents, epidermal growth factor receptor (EGFR) inhibitors, characteristically precipitates an acneform rash. Currently, no standard of care exists for the management of the rash resulting from EGFR inhibitors. In order to objectively evaluate any management strategy, a method to quantify the rash is required. The purpose of this paper is to describe a method to quantify the erythema of a facial rash through the use of digital photography and image analysis.

Development of an Outpatient Oncology Symptom Management Clinic

The Symptom Management Clinic (SMC) at University Hospital in Cincinnati, OH, was established to meet identified needs of patients with cancer seen in an outpatient setting. The initial step in the formation of the SMC consisted of the development of a business plan and the presentation of that business plan to the hospital administration. The development of clinic procedures using the creation of a guideline for pain management as an example is presented, as are medication reconciliation and patient teaching. Implications for clinical practice include the essential nature of collaborative relationships among medical oncologists, nursing, pharmacy, and administrative staff members. Interdisciplinary collaboration among the staff of the SMC facilitated referral to appropriate services within the institution and community.