Predictors of adherence to a behavioral therapy sleep intervention during breast cancer chemotherapy.

BACKGROUND: This study's purpose was twofold: (1) to establish adherence rates to a behavioral therapy (BT) sleep intervention and (2) to identify psychological and physical symptom predictors of adherence to the intervention in women undergoing breast cancer chemotherapy. METHODS: A randomized controlled trial began 48 h before the first of four chemotherapy treatments. Women with stages I-IIIA breast cancer (n = 113) received a BT sleep intervention composed of stimulus control, modified sleep restriction (MSR), relaxation therapy (RT), and sleep hygiene counseling components. A BT plan was developed by a research nurse and each participant, reinforced on day 8, and repeated for chemotherapy cycles 2, 3, and 4. Adherence to the BT plan was measured daily; total adherence score was computed at each chemotherapy cycle by combining adherence estimates of all BT plan components. Psychological and physical symptoms over the past 7 days were measured 2 days prior to and 7 days after each chemotherapy treatment. RESULTS: Total adherence rates to the BT plan were 51-52% at all four treatments but adherence varied by component. Sleep disturbance, pain, and anxiety significantly decreased whereas depression significantly increased across chemotherapy. Structural equation modeling revealed a good model fit with decreasing sleep disturbances (0.409) and increasing depression (-0.711) contributing to lower total adherence rates. Increasing depression predicted lower MSR adherence (-0.203) and decreasing sleep disturbances predicted lower RT adherence (1.220). CONCLUSIONS: Sleep disturbance and depression significantly impacted adherence rates during chemotherapy. Results warrant attention when promoting adherence to BT sleep interventions during chemotherapy treatment.

Methodological challenges of symptom management research in recurrent cancer.

Completion of first-line treatment is an important milestone for adults newly diagnosed with cancer. However, for many adults, the cancer experience of the 21st century does not end with the completion of initial treatment. Decreased functional status, distressing symptoms, and residual effects of treatment impact the daily lives of cancer survivors. Cancer has evolved into a chronic illness, in which a disease-free period may be followed by recurrent cancer. Researchers face challenges in the design and analysis of symptom management studies in recurrent disease. Residual effects can preclude a true "baseline" measurement of the symptom(s) of interest to the researcher. In addition, as cancer survivors age, they are more likely to have comorbid conditions that increase the likelihood of developing toxicities and residual symptoms that are specific to cancer treatments. Research studies of cancer-related symptoms in adults with recurrent disease pose many methodological challenges. Selection of appropriate study design, sample inclusion and exclusion criteria, measures of comorbidity and symptoms, and advanced analysis techniques are among the strategies proposed to address these methodological challenges.

Peripheral nerve function and symptom distress during biotherapy for malignant melanoma.

Studies of biotherapy-induced physiological changes are few, and systematic monitoring for neurotoxic effects are lacking. The purpose of this exploratory pilot study was to determine the change in peripheral nerve function and symptom distress during treatment with biotherapy for malignant melanoma. A convenience sample of 11 participants with malignant melanoma receiving interferon-alpha had measures of peripheral nerve function measured at baseline, four and 12 weeks of treatment. Data were analyzed using plots and regression slopes to determine change over time in sensation, gait/balance, vision, hearing, vibratory sense, muscle strength, deep tendon reflexes, blood pressure, and symptom distress. Declines in hearing, sensation, vibration, and muscle strength were found. Changes in visual acuity, and orthostatic blood pressure were noted, while gait/balance remained stable. Additionally, neuropathy symptoms were associated with symptom distress. The characterization of such changes can increase our understanding of the nature of the physiological effects associated with high-dose biotherapy treatment and aid clinicians to better prepare patients for anticipated changes in function and subsequent lifestyle adjustments. These findings can be used to provide information in a larger study of this phenomenon regarding important outcomes and measurement time-points of therapy-induced neuropathy and decreasing symptom distress in patients receiving cancer treatment with biologic agents.