Leda L. Danao

Quality of life and meaning of illness of women with lung cancer.

PURPOSE/OBJECTIVES To describe the quality of life (QOL) of women with non-small cell lung cancer (NSCLC) and examine relationships of demographic, clinical, health status, and meaning of illness (MOI) characteristics to QOL. DESIGN Descriptive, cross-sectional survey. SETTING In-person interviews in homes or research offices. SAMPLE 217 women with NSCLC (greater than 6 months and less than 5 years since diagnosis, mean = 2 years); 19% of the women had advanced disease. The mean age was 65 years. METHODS Assessments of QOL with cancer-specific (QOL Scale-Patient Version) and generic (Short Form-36) self-reports, health status (i.e., number and type of comorbid conditions, presence of depressed mood using the Center for Epidemiologic Studies Depression Scale, smoking status), and MOI (positive and negative perceptions). MAIN RESEARCH VARIABLES QOL, health status, MOI, and demographic and clinical characteristics. FINDINGS Serious disruptions in psychological and social aspects of QOL were common. Depressed mood, negative conceptualizations of MOI, and younger age explained 37% of the variance of global QOL and were correlated with poorer physical, psychological, and social dimensions of QOL. Thirty-six percent reported negative ascriptions of MOI; 35% experienced depressed mood; more than 75% reported distress with their diagnosis, family distress, and impact of sexual function as lowering their QOL; and 67% reported comorbid conditions, the most common being chronic obstructive pulmonary disease (31%). CONCLUSIONS Women with lung cancer experience a range of disruptions in QOL, and more than a third associate lung cancer with negative meaning. Younger age, depressed mood, and number of comorbid diseases are risk factors for negative QOL. IMPLICATIONS FOR NURSING These findings support the importance of assessing the QOL, MOI, and health status of women with lung cancer even after treatment is completed. Younger women may be at higher risk for disruptions.

Challenges of Recruitment and Retention in Multisite Clinical Research

This article reviews recruitment and retention issues in a multisite, multistate (California, New York, Connecticut, Georgia, Alabama) 6-month prospective cross-sectional study focused on quality of life among 230 women with lung cancer. Recruitment of women into clinical trials and their retention are important, yet understudied. To date, few articles have described the challenges associated with recruiting women with lung cancer to participate in clinical research. Data from this trial were used to investigate the most effective strategies for recruitment across sites, to identify the most common reasons for refusal and attrition, and to identify challenges and potential solutions to recruitment and retention issues associated with multisite clinical research studies. Strategies for recruitment included letters from physicians, posters, announcements in community support groups, and newspaper and radio advertisements. Three sites allowed the researchers to contact potential participants directly, whereas 2 sites required the potential participants to contact the researchers for further information. Enrollment included 63% of the women eligible for the study (n = 230). The most common reasons for refusal were health limitations (n = 60), lack of interest (n = 46), and inconvenience (n = 16). The most common reasons for attrition (24% of the sample) were death (n = 21) and severity of illness (n = 13). Challenges related to recruitment and retention varied by geographic location.

Use of Complementary and Alternative Medicine Therapies to Control Symptoms in Women Living With Lung Cancer

Complementary and alternative medicine (CAM) use by cancer patients, especially women, is increasing. However, CAM use among patients with lung cancer, who have been reported to have the highest symptom burden, is poorly documented. This study describes types and frequencies of specific CAM therapies used by women with lung cancer to manage symptoms, and examines differences in demographic and clinical characteristics between CAM users and non-CAM users. Participants included 189 women with non-small cell lung cancer and ≥1 of 8 symptoms. Six CAM therapies, used to control symptoms, were assessed, including herbs, tea, acupuncture, massage, meditation, and prayer. Forty-four percent (84 women) used CAM therapies, including prayer (34.9%), meditation (11.6%), tea (11.6%), herbs (9.0%), massage (6.9%), and acupuncture (2.6%). Complementary and alternative medicine use was greatest for difficulty breathing and pain (54.8% each), with prayer the most commonly used CAM for all symptoms. Significant differences (P < .05) were found for age (t = 2.24), symptom frequency (t = −3.02), and geographic location (&khgr;2 = 7.51). Women who were younger, experienced more symptoms, and lived on the West Coast or South (vs Northeast) were more likely to use CAM. We found that CAM use is variable by symptom and may be an indicator of symptom burden. Our results provide important initial data regarding CAM use for managing symptoms by women with lung cancer.

Results of a community-based randomized trial to increase colorectal cancer screening among Filipino Americans.

OBJECTIVES We conducted 1 of the first community-based trials to develop a multicomponent intervention that would increase colorectal cancer screening among an Asian American population. METHODS Filipino Americans (n = 548) nonadherent to colorectal cancer (CRC) screening guidelines were randomized into an intervention group that received an education session on CRC screening and free fecal occult blood test (FOBT) kits; a second intervention group that received an education session but no free FOBT kits; and a control group that received an education session on the health benefits of physical activity. RESULTS Self-reported CRC screening rates during the 6-month follow-up period were 30%, 25%, and 9% for participants assigned to intervention with FOBT kit, intervention without the kit, and control group, respectively. Participants in either of the 2 intervention groups were significantly more likely to report screening at follow-up than were participants in the control group. CONCLUSIONS A multicomponent intervention that includes an educational group session in a community setting can significantly increase CRC screening among Filipino Americans, even when no free FOBT kits are distributed.

Nurses' perspectives of smoking initiation, addiction, and cessation

Background:It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement. Objectives:To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses’ attitudes toward smoking and quitting, and to explore nurses’ preferences for smoking cessation interventions. Methods:Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes. Results:Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups. Conclusions:Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.

Women with lung cancer: quality of life after thoracotomy: a 6-month prospective study.

Background: Data about health-related quality of life (QOL) after surgical treatment for lung cancer are limited. Such information can be valuable in developing appropriate nursing interventions for follow-up care for survivors. Objectives: The purposes of this study were to describe physical and emotional QOL of disease-free female non-small cell lung cancer (NSCLC) survivors and to determine characteristics associated with greater risk for disruptions. Methods: One-hundred-nineteen women surgically treated for NSCLC completed the Short-Form 36 (as a measure of physical and mental QOL) along with health status assessments (including comorbidity, depression, Center for Epidemiologic Studies-Depression Scale, smoking status, and body mass index), dyspnea (Dyspnea Index), meaning of illness, and demographic and clinical information at baseline and 3 and 6 months. Results: On average, the women were 68 years of age, diagnosed 2 years previously, had adenocarcinoma, and were treated surgically with lobectomy. The majority (66%) had comorbid disease, 29% had depressed mood (Center for Epidemiologic Studies-Depression Scale score ≥16), 8% were current smokers, 62% were overweight, 22% had dyspnea (scores ≥2), and 24% had a negative meaning of illness. Physical and emotional QOL scores were comparable to Short-Form 36 norms for older adults and exhibited little change over time. Controlling for time since diagnosis, dyspnea, and depressed mood were strongly related to disruptions in physical and emotional QOL, respectively, across the 6-month study period, with comorbid disease contributing to both models. Conclusion: Depressed mood, comorbidities, and dyspnea were factors related to poorer physical and emotional QOL. Survivors with these characteristics might benefit from greater supportive care. Implications for Practice: Screening for dyspnea, depressed mood, and comorbid illness can identify female survivors at-risk for poorer QOL after surgery.

An English and Spanish quality of life measure for rheumatoid arthritis.

OBJECTIVE To develop a rheumatoid arthritis-specific health-related quality of life instrument, translate the English instrument into Spanish, and test the scaling assumptions, reliability, validity, and feasibility of both the English and Spanish versions. METHODS The development of the Quality of Life-Rheumatoid Arthritis Scale (QOL-RA Scale) involved literature review, consultations with experts, 40 face-to-face interviews, and 5 focus group discussions with multiethnic and multilingual women with rheumatoid arthritis (RA). Translation design facilitated conceptual and linguistic equivalence. Data for the psychometrics came from telephone interviews of a sample of 107 Caucasian/English and 80 Hispanic/Spanish women with RA. The instruments were (a) the Arthritis Impact Measurement Scales 2 (AIMS2), (b) the Lubben Social Network Scale (LSNS), (c) the Center for Epidemiologic Studies-Depression Scale (CES-D), and (d) the QOL-RA Scale. Descriptive statistics, significance tests, Cronbachs alpha technique, correlation, and factor analysis were used. RESULTS The QOL-RA Scale, an 8-item scale, took 2 to 3 minutes to administer. Psychometric analysis revealed that the psychometric attributes and constructs of both English and Spanish questionnaires are comparable (i.e., equivalent). Both versions demonstrated the following: (a) normal distribution of the QOL-RA Scale, roughly symmetrical distributions of the items, equivalent means and standard deviations across items, and less than 10% floor and ceiling effects, (b) Cronbachs alpha coefficients of 0.87-0.90, (c) significant correlations of the QOL-RA Scale with the AIMS2 subscales, LSNS, and CES-D, ranging from 0.25 to 0.66 (P < or = 0.01), and (d) extraction of 2 factors, namely physio-psychological and socio-psychological, that explained 65% to 73% of the variance in the scale scores. CONCLUSION The QOL-RA Scale, in both English and Spanish versions, appears to meet the assumptions of a summated rating scale and the criteria of relevance, reliability, validity, feasibility, and adaptability to several languages.

Tobacco use in women with lung cancer

Background: Smoking cessation after a cancer diagnosis is associated with improved clinical outcomes.Purpose: The aims of this study are to determine smoking prevalence, describe patterns of smoking, identify readiness to quit and cessation strategies, identify factors associated with continued smoking among women with lung cancer, and determine smoking prevalence among household members.Methods: Data were collected through questionnaires and medical record review from 230 women. Smoking was determined through self-report and biochemical verification with urinary cotinine.Results: Eighty-seven percent of women reported ever-smoking, and 37% reported smoking at the time of diagnosis. Ten percent of women were smoking at entry to the study, 13% were smoking at 3 months, and 11% at 6 months. Fifty-five percent of smokers planned a quit attempt within the next month. One third of smokers received cessation assistance at diagnosis, and pharmacotherapy was the most common strategy. Significant factors associated with continued smoking included younger age, depression, and household member smoking. Continued smoking among household members was 21%. Twelve percent of household members changed their smoking behavior; 77% quit smoking, but 12% started smoking.Conclusions: The diagnosis of cancer is a strong motivator for behavioral change, and some patients need additional support to quit smoking. Family members should also be targeted for cessation interventions.

Behavioral mediators of colorectal cancer screening in a randomized controlled intervention trial.

BACKGROUND Understanding mediators for behavioral change is important for the optimization of intervention strategies. This report examines mediators of change in the context of a randomized controlled intervention trial (Los Angeles, 2004-2009) that successfully increased colorectal cancer (CRC) screening among Filipino Americans. METHODS The intervention, based on the Health Behavior Framework, targeted knowledge/awareness of CRC screening, communication with health care provider, health beliefs, social support and barriers to CRC screening. Health Behavior Framework variables were assessed at baseline and 6-month follow-up (N=432). Variables targeted for change were tested as potential mediators of the primary outcome, self-reported receipt of CRC screening during the follow-up period, which was previously found to have increased significantly among intervention participants. RESULTS Consistent with the Health Behavior Framework, knowledge/awareness of CRC screening and patient-provider communication mediated receipt of screening. Increase in knowledge/awareness of CRC screening accounted for 13% (95% confidence interval 2%-24%) of the total intervention effect size, while patient-provider communication accounted for 20% (5%-36%). Combined, these two variables accounted for 28% (10%-46%) of the total effect size. CONCLUSION Examining the roles of potential mediators in intervention trials may help identify constructs to target in order to enhance the effectiveness of interventions to increase screening.

Disparities in the Receipt of Fecal Occult Blood Test versus Endoscopy among Filipino American Immigrants

Background: This report examines disparities associated with the type of colorectal screening test, fecal occult blood test versus endoscopy, within a particular racial/ethnic group, Filipino American immigrants. Methods: Between July 2005 and October 2006, Filipino Americans aged 50 to 75 years from 31 community organizations in Los Angeles completed a 15-minute survey in English (65%) or Filipino (35%). Results: Of the 487 respondents included in this analysis, 257 (53%) had never received any type of colorectal cancer screening. Among the 230 subjects who had ever received a routine screening test, 78 had fecal occult blood test only (16% of the total sample), and 152 had endoscopy with or without fecal occult blood test (31% of the total sample). After controlling for access to care and key demographic variables in a multivariate analysis, only two characteristics distinguished between respondents who had fecal occult blood test only versus those who had endoscopy: acculturation, assessed by percent lifetime in the United States and language of interview, and income. Conclusions: Our data suggest a two-tier system, fecal occult blood test for less acculturated Filipino Americans with lower income versus endoscopy for Filipino immigrants with higher levels of acculturation and income. The disparity persists after adjusting for access to care. Instead of treating minority groups as monolithic, differences within groups need to be examined so that interventions can be appropriately targeted. (Cancer Epidemiol Biomarkers Prev 2008;17(8):1963–7)