Yun-Hsiang Lee

Meta-Analysis of Cognitive Functioning in Breast Cancer Survivors Previously Treated With Standard-Dose Chemotherapy

PURPOSE Evidence is mixed regarding long-term cognitive deficits in patients treated with chemotherapy. Previous meta-analyses have not focused specifically on the postchemotherapy period and have not incorporated several recent studies. The goal of the current study was to conduct a meta-analysis of cognitive functioning in breast cancer survivors who were treated with chemotherapy ≥ 6 months previously. METHODS A search of PubMed, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library yielded 2,751 abstracts, which were independently evaluated by pairs of raters. Meta-analysis was conducted on 17 studies of 807 patients previously treated with standard-dose chemotherapy for breast cancer. Neuropsychological tests were categorized according to eight cognitive domains: attention, executive functioning, information processing, motor speed, verbal ability, verbal memory, visual memory, and visuospatial ability. RESULTS Deficits in cognitive functioning were observed in patients treated with chemotherapy relative to controls or prechemotherapy baseline in the domains of verbal ability (g = -0.19; P < .01) and visuospatial ability (g = -0.27; P < .01). Patients treated with chemotherapy performed worse than noncancer controls in verbal ability and worse than patients treated without chemotherapy in visuospatial ability (both P < .01). Age, education, time since treatment, and endocrine therapy did not moderate observed cognitive deficits in verbal ability or visuospatial ability (all P ≥ .51). CONCLUSION Results indicate that, on average, observed cognitive deficits in patients with breast cancer previously treated with chemotherapy are small in magnitude and limited to the domains of verbal ability and visuospatial ability. This information can be used to inform interventions to educate patients with breast cancer regarding the long-term impact of chemotherapy on cognitive functioning.

The unmet supportive care needs—what advanced lung cancer patients’ caregivers need and related factors

PurposeTo identify the unmet supportive care needs and related factors in caregivers of patients with advanced lung cancer.MethodsA cross-sectional study of 166 lung cancer patient-caregivers dyads was recruited at a medical center. The supportive care needs, fatigue, and sleep disturbance of caregivers were collected. Patients were assessed for symptom severity, anxiety, and depression. Logistic regression was used to reveal the related factors of unmet supportive care needs.ResultsOf the 166 dyads surveyed, the top unmet needs were information needs, health care professional/health care service needs, and daily living needs. Patients’ anxiety was positively correlated to overall caregiving needs, health care professional/health care service needs, interpersonal communication needs, and psychological/emotional needs of caregivers. The information needs and health care professional/health care service needs were related to the caregivers’ fatigue. The sleep disturbance of caregivers was associated with their overall caregiving needs, daily living needs, and psychological/emotional needs.ConclusionsFuture interventions to meet the needs of caregivers should include specific needs assessment and continuing education in caregiving.

Multidimensional Pain Inventory-Screening Chinese version (MPI-sC): psychometric testing in terminal cancer patients in Taiwan

IntroductionCancer pain is identified as a multidimensional experience, but relatively few brief instruments are available for assessing the complex pain-related experiences of terminal cancer patients in Taiwan. The purposes of this study were to (1) translate and examine the feasibility and psychometric characteristics of the eight-item Multidimensional Pain Inventory-Screening Chinese (MPI-sC) when used with patients having terminal cancer and (2) apply the MPI-sC to examine multidimensional pain-related experiences of terminal cancer patients in Taiwan.Materials and methodsThe MPI-sC was tested in 106 terminal cancer inpatients at a hospice setting in Taipei.ResultsThe results showed that the MPI-sC has satisfactory face and content validity, feasibility, acceptable internal consistency reliability (overall Cronbach’s alpha of 0.75), and overall support of theoretical assumptions. However, instead of the four-factor structure of the original instrument, we found a three-factor structure (with pain intensity and pain interference merged into one factor) that explained 76.73% of the variance. Close to half the patients (48.1%) had considerable levels of pain interference, and a majority (72.6%) reported not having control in life based on the cut-point of MPI-sC categorization.ConclusionOur results support the brief MPI-sC as a feasible and valid tool for assessing and representing multidimensional pain experiences in terminal cancer patients. The MPI-sC could help clinicians and researchers assess the complex multidimensional pain experiences of terminal cancer patients, including Chinese-speaking cancer populations.

A systematic review of the effectiveness of problem‐solving approaches towards symptom management in cancer care

AIMS To investigate the evidence of problem-solving approach interventions on symptom management in cancer care. BACKGROUND Symptom-related problems are a common challenge in cancer care. The problem-solving approach is one strategy of cognitive behavioural therapy used to help patients with cancer self-manage their symptoms. However, no systematic review has investigated the effectiveness of this approach. DESIGN Systematic review. METHOD A systematic search for intervention studies using randomised controlled designs, controlled clinical trial and quasi-experimental studies designs was conducted using the following electronic databases: EBSCO host, CINAHL (1991-2008), Medline (1975-2009), Electronic Periodical Services (Chinese) and Electronic Theses and Dissertations System (Taiwan). RESULTS Seven studies published in English between 1975-2009 were included in this systematic review. All studies were randomly assigned and almost all studies demonstrated the positive effects of a problem-solving approach in reducing symptomatic problems in the target participants. Varying protocols and qualities of methodological design (14% good, 43% fair and 43% poor) were found in this review. CONCLUSIONS This systematic review highlighted the potential of a problem-solving approach in the management of symptom problems in patients with cancer. However, more rigourous studies are needed and a better evaluation of the most effective problem-solving approach protocols is required. RELEVANCE TO CLINICAL PRACTICE Cancer care nurses should explore the use of problem-solving approach interventions in their practice as the evidence base suggests the value of this approach--but caution is needed in regard to the precise structure of the problem-solving approach protocol.

Validation of the University of Washington Quality of Life Chinese Version (UWQOL-C) for head and neck cancer patients in Taiwan

BACKGROUND/PURPOSE The purposes of this three-phase study were to: (1) translate and evaluate the burden, content, and face validity of the Chinese version of the University of Washington Quality of Life Scale, version 4 (UWQOL-v4-C); and (2) examine the psychometric properties of the UWQOL-v4-C in oral cancer and laryngeal cancer patients in Taiwan. METHODS This instrument translation and validation study was part of a major research project. The first phase of this study developed and validated the content of the UWQOL-v4-C. The second phase sought to validate the internal consistency, reliability, and construct and discriminant validity in two major groups of head and neck cancer (HNC) patients: oral cavity cancers (n=109) and laryngeal cancer (n=102). Construct validity was measured using theoretically supported correlations between the UWQOL and related constructs. Discriminant validity was also assessed. In the third phase, test-retest reliability of UWQOL-v4-C was examined through the 1-week interval in another group of HNC patients (n=50). RESULTS The translated UWQOL-v4-C demonstrated satisfactory face validity, content validity, and minimal patient burden. Additionally, the UWQOL-v4-C showed excellent construct validity in patient testing, supported by significant correlations between the UWQOL-v4-C and hypothesized constructs, including generic measures of QOL and performance status. The developed scale correlated inversely with symptom severity and psychological distress. Discriminant validity was seen in patients with different cancer diagnoses, stages, and treatments. Finally, excellent stability was supported by a 1-week test-retest reliability of 0.88. CONCLUSION The UWQOL-v4-C was a brief, low-burden, and valid instrument to measure the QOL in Chinese-speaking HNC patients in Taiwan.

Promoting Post-Traumatic Growth among Taiwanese Cancer Survivors: CulturalIssues

Posttraumatic growth (PTG) is a phenomenon notable among cancer survivors who endure aggressive, lifethreatening treatment of severe illnesses. Such growth manifests through improved physical health, strengthened psycho-spiritual resilience, intensified coping skills, and better utilization of resources. Due to the scarce literature, the link between cancer survivorship and PTG remains unclear in Taiwan and further complicated by cultural issues. Presented in this article are summated findings from cross-cultural literature of PTG among cancer survivors, particularly various observations of posttraumatic stress and coping between Eastern and Western cultures. Clinical implications are followed to encourage health care providers to cogitate culture-specific meanings in survivors’ cancer-related posttraumatic experiences. There lies a cultural need to fill in the knowledge gap in order to ultimately promote PTG and improve cancer survivors’ quality of post-cancer life in Taiwan.

Trajectories of caregiver burden and related factors in family caregivers of patients with lung cancer

This study aimed to (1) identify the changes of 5 domains of family caregiver (FC) burden, overall burden, and its subtrajectories when caring for newly diagnosed advanced lung cancer patients during the first 6 months following cancer diagnosis; and (2) identify the FC‐related and patient‐related factors most associated with the overall FC burden and each of its subtrajectories.