Lynn Steinbrenner

Sleep, mood, and quality of life in patients receiving treatment for lung cancer.

PURPOSE/OBJECTIVES To distinguish relationships among subjective and objective characteristics of sleep, mood, and quality of life (QOL) in patients receiving treatment for lung cancer. DESIGN Descriptive, correlational study. SETTING Two ambulatory oncology clinics. SAMPLE 35 patients with lung cancer. METHODS The following instruments were used to measure the variables of interest: Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Treatment-Lung (FACT-L), a sleep diary, and a motionlogger actigraph. MAIN RESEARCH VARIABLES Sleep, mood, and QOL. FINDINGS Significant differences were found between sleep diary and actigraph measures of sleep efficiency (p = 0.002), sleep latency (p = 0.014), sleep duration (p < 0.001), and wake after sleep onset (p < 0.001). Poor sleepers (PSQI score greater than 5) were significantly different from good sleepers (PSQI score of 5 or lower) on sleep diary measures of sleep efficiency and sleep latency and the FACT-L lung cancer symptom subscale, but not on mood or actigraphy sleep measures. CONCLUSIONS Although patients with lung cancer may report an overall acceptable sleep quality when assessed by a single question, those same patients may still have markedly increased sleep latencies or reduced total sleep time. The findings indicate the complexity of sleep disturbances in patients with lung cancer. Lung cancer symptoms had a stronger association with sleep than mood. Research using prospective methods will help to elucidate their clinical significance. IMPLICATIONS FOR NURSING Patients receiving treatment for lung cancer are at an increased risk for sleep disturbances and would benefit from routine sleep assessment and management. In addition, assessment and management of common symptoms may improve sleep and, ultimately, QOL. KNOWLEDGE TRANSLATION A high frequency of sleep disturbances in patients receiving treatment for lung cancer was evident, and poor sleepers had lower QOL. Sleep disturbances may be more related to lung cancer symptoms than anxiety or depression. Improving lung cancer symptoms such as dyspnea may improve sleep.

Sleeping with the enemy: sleep and quality of life in patients with lung cancer.

Background: Patients with lung cancer have the poorest sleep quality compared with other patients with cancer and noncancer control subjects. However, few studies have examined sleep longitudinally. Objective: The objective of this study was to characterize and correlate sleep quality, daytime sleepiness, sleep-wake actigraphy, and quality of life (QOL) before, during, and after chemotherapy for non–small cell lung cancer (NSCLC). Methods: Using a prospective repeated-measures 1-group design, patients scheduled to receive chemotherapy for NSCLC were recruited. Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Functional Assessment of Cancer Treatment–Lung (FACT-L), and Motionlogger Actigraph were used for data collection. Results: Poor nocturnal sleep and QOL were evident among 29 patients with NSCLC before treatment. The FACT-L subscale scores worsened and then improved significantly from baseline through 2 rounds of chemotherapy. Objective sleep duration and sleep efficiency were positively associated with FACT-L scores, whereas objective sleep latency and wake after sleep onset were negatively associated with FACT-L scores. Sleepy patients had significantly worse FACT-L scores than did nonsleepy patients. The FACT-L subscale items that demonstrated significant worsening and then improvement over time were shortness of breath, weight loss, coughing, and chest tightness. Lung cancer patients experience early and middle insomnia before and during treatment. Conclusion: Poor sleep quality is common in patients receiving treatment for NSCLC and is related to poorer QOL and respiratory symptoms. Implication for Practice: Patients with NSCLC require routine screening for sleep disturbances. A positive screen for sleep disturbance warrants a thorough sleep assessment using practice guidelines and, if necessary, referral to a sleep specialist for diagnosis and treatment.

Perceptions of Barriers and Facilitators to Health Behavior Change Among Veteran Cancer Survivors

OBJECTIVE This study aimed to identify barriers and facilitators to health behavior change related to body size in a sample of veteran cancer survivors. METHODS A qualitative study was conducted with a sample of 35 male and female cancer survivors receiving care at a Veterans Administration comprehensive cancer center. Participants completed individual interviews regarding barriers and facilitators to lifestyle change and responded to a brief questionnaire regarding current health behaviors. RESULTS Participants reported suboptimal adherence to recommended health behavior goals and the majority were overweight or obese (80%). Qualitative analysis revealed numerous barriers and facilitators to health behavior change across six broad categories: environmental factors, health services delivery factors, health-related factors, factors related to attitudes toward change, factors related to enacting change, and motivational factors. Veteran cancer survivors were impacted by common barriers to change affecting the general population, cancer-specific factors related to personal diagnosis and treatment history, and health service delivery factors related to the Veterans Administration health care system. CONCLUSIONS There are many barriers and facilitators that exist in diverse domains for veteran cancer survivors, each of which offers unique challenges and opportunities for improving engagement in behavior change following cancer diagnosis and treatment.

Longitudinal assessment of BMI in relation to ADT use among early stage prostate cancer survivors

IntroductionThe use of androgen deprivation therapy (ADT) for prostate cancer is on the rise, but its adverse side effects may include increased fat mass and decreased lean muscle mass. The net effect of ADT on BMI is unknown.MethodsPrimary, incident cases of early stage prostate cancer (n = 473) were identified from the Buffalo VA Medical Center tumor registry and matched to body size, demographic, comorbidity, and treatment exposure data from veteran medical records. Multilevel modeling was used to assess the association between ADT and changes in BMI.ResultsOn average, survivors were overweight at diagnosis and showed small, non-significant changes in BMI over time. However, among those survivors with a history of ADT, a significant decrease of 0.05 BMI units per year was associated with each additional dose of ADT (p < 0.001). When the association between BMI rate of change and ADT was allowed to vary with respect to age, additional doses of ADT predicted stronger decreases in BMI for younger survivors as compared to older survivors (p < 0.05). Neither a history of surgery nor radiation influenced the association between ADT use and BMI.ConclusionsDeclines in BMI in relation to ADT exposure may be reflective of unfavorable changes in body composition, especially decreased muscle mass, that is most pronounced in younger survivors.Implications for Cancer SurvivorsSurvivors on ADT may benefit from close monitoring of physical functioning and referral for exercise interventions to preserve muscle mass and improve health related quality of life.

Sleep in Lung Cancer: The Role of Anxiety, Alcohol and Tobacco

&NA; Lung cancer patients constitute a subgroup of cancer patients most at risk for experiencing sleep disturbances. Anxiety is not a significant problem in this population, but may be blunted by alcohol use or smoking. The purpose of this study is to describe anxiety, alcohol use, smoking, and sleep disturbances in a sample of patients with lung cancer. Guided by the classic model of insomnia by Spielman, this study describes anxiety as a predisposing factor, alcohol use and smoking as precipitating factors, and perpetuating factors that maintain or exacerbate sleep disturbances. Nurses across all specialty areas should address these modifiable factors during encounters with patients with lung cancer.

Experiences of Patients With Advanced Lung Cancer: Being Resigned to Sleep-Wake Disturbances While Maintaining Hope for Optimal Treatment Outcomes.

Background: Sleep-wake disturbances are prevalent in patients with lung cancer yet are infrequently studied over time. This article reports on the qualitative results of a mixed-methods study of newly diagnosed patients’ narratives over 6 months. Objective: The objective of this study was to gain an understanding of the treatment and illness trajectory related to sleep-wake disturbances as well as the beliefs and practices of patients while seeking optimal treatment outcomes. Methods: Longitudinal interview narratives of 26 patients’ experiences with advanced lung cancer diagnosis (at baseline, pre–second and third treatment, and 6 months) were obtained from participants recruited from Veterans Administration Hospital Center and a Comprehensive Cancer Center in Northeast United States. Analysis of illness narratives used interpretive phenomenology based on Heideggarian hermeneutic traditions. Results: At diagnosis, participants described poor sleep such as trouble falling asleep and frequent awakenings. Over time, as the treatment worsened their sleep symptoms, these participants still maintained hope for more time with treatment. This focus enabled them to tolerate the sleep-wake disturbances and treatment adverse effects. As the treatment effectiveness declined, their focus changed to spiritual meanings for the future and to keep living life with a purpose. Conclusions: By explicating lung cancer patients’ experiences with sleep-wake disturbances, nurses will gain insight into potential interventions to improve sleep and support effective outcomes as well as open a dialogue about hope. Implications for Practice: Findings offer insight for oncology nurses to provide opportunities for dialogue about treatment options and techniques to improve sleep, which will facilitate patients living their lives.

Growth curve analysis of BMI in relation to primary care utilization in prostate cancer survivors.

SUMMARY Cancer survivors are advised to maintain a healthy BMI to optimize quality of life. In the VA healthcare system, multidisciplinary primary care clinics are responsible for screening and management of overweight or obesity, but it is unclear if cancer survivors are accessing or benefiting from these services. This study aimed to determine if primary care utilization was associated with changes in BMI of prostate cancer survivors, a group with very high rates of long-term survival. Data on demographics, comorbidities, cancer treatment, body size, and number of primary care encounters (medical, behavioral health, nutrition, and weight management program) were collected from electronic medical records and the local tumor registry for 406 early stage prostate cancer survivors who were overweight or obese at diagnosis. Growth curve modeling assessed BMI trajectories in relation to primary care utilization. Results indicated that survivors averaged 18 primary care encounters over the observation period but rarely accessed behavioral health, nutrition, or weight management program services. The average BMI trajectory was non-linear, showing an increase in BMI until 3.2 years after diagnosis followed by deceleration. Primary care utilization was inversely associated with BMI growth, (β = -0.05, p < 0.01). This association was not impacted by demographic, cancer treatment, or comorbidities. Although primary medical care encounters were associated with modest reductions in BMI, overweight or obese prostate cancer survivors appear to be underutilizing the full range of primary care services that could address the motivational, informational, dietary, and physical activity barriers associated with weight loss.:

Military veteran cancer survivors’ preferences for a program to address lifestyle change and psychosocial wellness following treatment

ABSTRACT This study aimed to understand military veteran cancer survivors’ preferences regarding the delivery of post-treatment wellness services. Thirty-three military veteran cancer survivors were interviewed about their perceptions of three models of health service delivery (home-, primary care-, and oncology-based services). Conventional qualitative content analysis revealed strengths and weaknesses of each service delivery models content and structure (e.g., program location, inclusion of emotional support, access to clinical experts). All service delivery programs had strengths, with clinic-based programs offering the greatest breadth of services deemed important for wellness by cancer survivors.