Lillian Nail

Fatigue in Parkinson's disease: A review

Fatigue is a common problem in Parkinsons disease (PD), often the most troubling of all symptoms. It is poorly understood, generally under‐recognized, and has no known treatment. This article reviews what is known about the symptom, putting it into the context of fatigue in other disorders, and outlines a program for developing better understanding and therapy.

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.

CERVICAL CANCER BELIEFS AND PAP TEST SCREENING PRACTICES AMONG CHINESE AMERICAN IMMIGRANTS

PURPOSE/OBJECTIVES To examine beliefs and Pap test utilization among Chinese American women, the largest Asian female population in the United States. RESEARCH APPROACH Cross-sectional descriptive, correlational study. SETTING Metropolitan areas of Portland, OR. PARTICIPANTS 100 foreign-born Chinese women aged 40 years and older. METHODOLOGIC APPROACH Three questionnaires were modified, translated, combined, and pretested. Participants completed the self-administered questionnaire in a group setting. MAIN RESEARCH VARIABLES Utilization of Pap test screening, health beliefs, and cultural and sociodemographic variables. FINDINGS Sixty-eight percent reported having a Pap test within the prior three years (adherence), and 84% reported ever having a Pap test. The odds of Pap test use and adherence decreased with increasing age. Women with insurance or a regular healthcare provider had better odds of Pap test use and adherence. Older age, older age when a participant moved to the United States, and increased modesty were negatively associated with ever having had a Pap test. CONCLUSIONS Age and cultural beliefs influence Pap test use and adherence. The strength of provider recommendation and healthcare access as predictors suggest areas for interventions designed to increase screening for cervical cancer. INTERPRETATION Nurses play a vital role in preventive health care, especially with the growing number of advanced practice nurses delivering primary care. Primary healthcare providers should be reminded of their influential role in increasing adherence to cancer screening. Further health policy action is necessary to extend screening coverage to those who do not have adequate health insurance.

Strength, Physical Activity, and Age Predict Fatigue in Older Breast Cancer Survivors

PURPOSE/OBJECTIVES To determine whether clinical characteristics, physical fitness, or physical activity predict fatigue in older, long-term breast cancer survivors. DESIGN Cross sectional. SETTING National Cancer Institute-designated cancer center in Portland, OR. SAMPLE 47 women (X age = 69 years) who were at least one year beyond treatment completion, including surgery, radiation, chemotherapy, or hormone therapy, for early-stage breast cancer. METHODS Participants completed one two-hour testing session to determine fatigue ratings, clinical information, submaximal aerobic fitness, lower-extremity muscle strength, body composition, and physical activity levels. MAIN RESEARCH VARIABLES Self-reported fatigue assessed by the Schwartz Cancer Fatigue Scale, cancer and treatment history obtained by self-report, submaximal aerobic fitness assessed by 12-minute walk distance, lower-extremity muscle strength assessed by number of chair stands completed in 30 seconds, body composition assessed as percentage of body fat, and physical activity levels assessed by self-reported hours per week. FINDINGS Fatigue was significantly correlated with all independent variables, with the exception of aerobic fitness. Fatigue was higher with lower age, greater percentage of body fat, fewer years after diagnosis, more adjuvant treatments, poorer lower-extremity muscle strength, and less physical activity. In regression analyses, lower-extremity muscular strength, physical activity levels, and age each were significant independent predictors of fatigue. Lower-extremity muscle strength, physical activity, and age all were inversely related to fatigue and accounted for 15%, 7%, and 15% of the variance in fatigue scores, respectively. CONCLUSIONS In this sample of older breast cancer survivors, fatigue was linked to physical activity and muscle strength; women with better lower-extremity muscle strength, higher physical activity levels, and advanced age reported less fatigue. IMPLICATIONS FOR NURSING A physical activity program aimed at improving lower body strength could mitigate persistent fatigue in older, long-term breast cancer survivors.

A telephone-only motivational intervention to increase physical activity in rural adults: a randomized controlled trial.

Background: Both urban and rural adults are likely to be inactive, but rural adults have less access to exercise classes or facilities to increase physical activity. Objectives: To evaluate whether a telephone-only motivational interviewing (MI) intervention would increase daily physical activity of rural adults. Methods: This randomized controlled trial enrolled 86 physically inactive adults living in rural communities (mean age = 58 years, range = 30-81 years) who stated that they were ready to increase physical activity during the next 6 months. Participants were assigned randomly to MI intervention (n = 43) or control (n = 43) groups. The MI group participants received a pedometer and monthly MI telephone calls over 6 months from a counselor. Control group participants received an equal number of telephone calls without MI content. Physical activity was measured by self-report using the Community Healthy Activities Model Program For Seniors Physical Activity Questionnaire for Older Adults. Data were collected by mailed surveys and analyzed using analysis of variance. Results: Seventy-two participants completed the study (35 in the intervention group and 37 in the control group). The telephone-only MI intervention increased self-efficacy for exercise (p = .019) but did not increase levels of physical activity (p = .572) compared with controls. Discussion: The intervention increased self-efficacy for exercise but did not increase physical activity, possibly due to seasonal effects, the control condition, or the length of the MI intervention. Even so, future studies are warranted because telephone-only MI has potential as a practical, relatively inexpensive method to provide health counseling to rural adults in a broad geographic area. This study produced an effect size on physical activity that will be useful to guide future studies.

Differences in Symptom Occurrence, Frequency, Intensity, and Distress in Adolescents Prior to and One Week After the Administration of Chemotherapy

Purpose/objectives: The purpose of this study was to describe differences in occurrence, frequency, intensity, and distress of symptoms prior to (T1) and one week following (T2) the administration of intravenous chemotherapy. Design: Longitudinal, descriptive. Settings: Two regional children’s cancer centers in the Pacific Northwest. Sample: A total of 51 adolescents 10 to 19 years old receiving cancer chemotherapy. Methods: Memorial Symptom Assessment Scale (MSAS 7-12). Findings: No significant differences were found in symptom occurrence rates between T1 and T2. Fatigue was the only symptom with significantly greater frequency and intensity, and nausea was the only symptom with significantly greater distress at T2 compared with T1. Conclusions: Adolescents receiving chemotherapy experience multiple symptoms that persist over time. Implications for nursing: In monitoring for symptoms, nurses need to be aware of the extent to which symptoms are present throughout treatment, as evidenced by these findings that symptom occurrence was significant even prior to receiving a subsequent course of chemotherapy.

A review of exercise interventions to improve bone health in adult cancer survivors

IntroductionCancer-treatment induced bone loss and associated fracture risk is a growing concern for cancer survivors. Exercise offers a non-pharmacologic strategy for preserving bone health during and after treatment, but only until recently has it been studied for its efficacy and safety in cancer survivors. The purpose of this review is to provide an early qualitative evaluation of exercise trials in adult cancer survivors with bone health as a primary or secondary endpoint.MethodsDatabases were searched for exercise trials in adult cancer survivors that reported data on bone health (bone mineral density (BMD) and/or bone remodeling markers) as an outcome measure and were published and indexed prior to January 1st, 2010. Data relevant to evaluation of study design, sample, exercise protocol, bone health assessment, statistical approach and findings were extracted, summarized and interpreted.ResultsEight trials were identified that met criteria for inclusion in the review. While most studies were conducted in breast cancer survivors, remaining study attributes including rigor, design, exercise program characteristics and length varied considerably across studies. Only three of the eight studies were controlled exercise trials with usual care control groups. Of these, two reported significant group × time interactions where aerobic exercise preserved BMD at the spine or whole body compared to losses in controls and none reported exercise benefits at the hip.ConclusionsThe recent emergence of exercise studies in cancer survivors with bone outcomes highlights the importance of this area of cancer survivorship. Collectively, the studies are limited in number and are too varied to warrant conclusions regarding the skeletal benefits of exercise during or after cancer treatment, though early results are encouraging and more rigorous study should follow.

Identifying factors associated with falls in postmenopausal breast cancer survivors: a multi-disciplinary approach

OBJECTIVE To identify neuromuscular, balance, and vision factors that contribute to falls in recently treated breast cancer survivors (BCS) and explore links between fall risk factors and cancer treatment. DESIGN Case-control plus prospective observation. SETTING Comprehensive cancer center. PARTICIPANTS BCS (N=59; mean age, 58y) within 2 years of chemotherapy completion and/or on adjuvant endocrine therapy. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Objective measures of postural control, vision, and neuromuscular function included: (1) a sensory organization test (SOT), (2) a visual assessment battery, (3) muscle mass by dual energy x-ray absorptiometry, and (4) neuromuscular function with strength by repetition maximum, power by timed stair climb, and gait speed by 4m walk. Falls were self-reported for the past year (retrospective) and monthly for 6 months (prospective). RESULTS Fifty eight percent of BCS reported falls in the past year. BCS with a history of falls had lower SOT scores with a vestibular deficit pattern in postural control (P<.01) and took longer to read letters on the contrast sensitivity chart (P<.05). Vestibular score on the SOT mediated the relationship between treatment and falls among BCS who received chemotherapy only, but not adjuvant endocrine therapy. CONCLUSIONS Results of this project suggest that balance disturbances of vestibular origin and delays in detecting low contrast visual stimuli are associated with falls in BCS. Future studies that track falls and fall risk factors in BCS from diagnosis through treatment are warranted, as are studies that can identify treatment-related vestibular dysfunction and altered visual processing.

Bone Health and Falls: Fracture Risk in Breast Cancer Survivors With Chemotherapy-Induced Amenorrhea

Purpose/Objectives: To describe risk factors for fracture-bone health and falls-among breast cancer survivors with chemotherapy-induced amenorrhea.Design: Cross-sectional and prospective cohort.Setting: National Cancer Institute-designated cancer center in the Pacific northwest region of the United States.Sample: Breast cancer survivors with chemotherapy-induced amenorrhea (N = 35; X age = 46 years; one year after chemotherapy) compared to cancer-free controls (N = 26; X age = 41 years).Methods: One two-hour testing session at baseline, 12-month follow-up, monthly postcards.Main Research Variables: Clinical characteristics and number of falls, leg strength, bone mineral density (BMD), body composition, and bone turnover.Findings: No significant differences between groups for BMD at either time point. Significantly more breast cancer survivors had low-spine BMD based on T scores and elevated bone turnover versus controls at baseline and follow-up. Breast cancer survivors with low-spine BMD have significantly lower body mass index, lean mass, and leg strength, and had stage II disease more often than breast cancer survivors with normal BMD. Significantly more breast cancer survivors (75%) experienced at least one fall compared to 46% of controls. Among breast cancer survivors, those who had fallen had significantly lower leg strength and calcium intakes than those who had not.Conclusions: Breast cancer survivors with chemotherapy-induced amenorrhea, particularly those with muscle weakness, may be at increased risk of fracture.Implications for Nursing: Breast cancer survivors with chemotherapy-induced amenorrhea should be evaluated for low bone mass and fall risk and considered for therapeutic intervention to lower fracture risk.

Frailty in Older Breast Cancer Survivors: Age, Prevalence, and Associated Factors

PURPOSE/OBJECTIVES To describe frailty and associated factors in breast cancer survivors (BCSs) and evaluate whether BCSs are frail at an earlier age than female participants from in two large epidemiological studies. DESIGN Descriptive, cross-sectional. SETTING School of Nursing at Oregon Health and Science University. SAMPLE 216 BCSs aged 53-87 years who were a mean 5-7 years post-treatment and not currently participating in exercise. METHODS Performance tests, clinical measures, and self-reported questionnaires provided baseline data on five criteria for frailty. MAIN RESEARCH VARIABLES Frailty was defined as meeting three of the five criteria of the frailty phenotype: shrinking, exhaustion, low activity, slowness, and weakness. Data were compared to published data from women in the Cardiovascular Health Study (CHS) and Womens Health and Aging Study (WHAS). FINDINGS Eighteen percent of BCSs aged 70-79 years were frail compared to 11% of women of the same age in the CHS and WHAS. Frailty was more common at a younger age in BCSs, and more BCSs were frail in all age groups compared to women in the CHS study until about age 80 years, when prevalence of frailty was similar in the two groups. Fifty percent of BCSs were classified as prefrail because they met one or two of the five frailty criteria. Higher body mass index increased the odds of frailty, and higher physical activity decreased the odds of frailty (odds ratio [OR] = 1.12, p = 0.003, and OR = 0.99, p = 0.000, respectively). CONCLUSIONS Frailty and prefrailty may be common in BCSs and may occur at an earlier age than in adults without a history of breast cancer. IMPLICATIONS FOR NURSING Nurses should be alert to prefrailty or frailty at a younger age in BCSs. Awareness and early intervention may delay or prevent frailty. KNOWLEDGE TRANSLATION BCSs may be frail even when they are not yet considered older adults. Prefrailty in BCSs is important to recognize because it suggests impending frailty that could lead to reduced physical functioning or poor health. Prefrailty and frailty could be assessed in BCSs aged 50 years and older in a clinical setting using a few questions about weight, fatigue, and activity levels, in addition to simple tests of walking speed and grip strength, if warranted.