Changes in fatigue among cancer patients before, during, and after radiation therapy: A meta-analysis.

BACKGROUND: Fatigue is a common symptom in cancer patients receiving radiotherapy. However, previous studies report inconsistent patterns of fatigue change. AIM: The aim of this study was to estimate changes in fatigue among patients with cancer before, during, and after radiotherapy. METHODS: Five databases (PubMed, SDOL, CINAHL Plus with Full Text, Medline [ProQuest], and ProQuest Dissertations) were searched for studies published from January 2006 to May 2021. Three effect sizes of fatigue change (immediate, short-term, and long-term) were calculated for each primary study using standardized mean difference. A random-effect model was used to combine effect sizes across studies. Subgroup analyses and meta-regression were performed to identify potential categorical and continuous moderators, respectively. RESULTS: Sixty-five studies were included in this meta-analysis. The weighted mean effect size for immediate, short-term, and long-term effects was 0.409 (p < .001; 95% CI [0.280, 0.537]), 0.303 (p < .001; 95% CI [0.189, 0.417]), and 0.201 (p = .05; 95% CI [-0.001, 0.404]), respectively. Studies with prostate cancer patients had a significantly higher short-term (0.588) and long-term weight mean effect size (0.531) than studies with breast (0.128, -0.072) or other cancers (0.287, 0.215). Higher radiotherapy dosage was significantly associated with a higher effect size for both immediate (ß = .0002, p < .05) and short-term (ß = .0002, p < .05) effect. LINKING EVIDENCE TO ACTION: Findings from this meta-analysis indicated that radiotherapy-induced fatigue (RIF) exist for more than 3 months after the completion of treatment. Assessment of radiation-induced fatigue in cancer patients should extend long after treatment completion, especially for patients with prostate cancer and patients receiving a higher radiation dose. Interventions to reduce fatigue tailored for different treatment phases may be developed.

Construction and evaluation of a 360 degrees panoramic video on the physical examination of nursing students.

AIM: The aim of this study was to construct and analyze the content validity and usability for a 360-degree panoramic video for physical examination. BACKGROUND: Acquiring techniques and ability on physical examination (PE) skill is often difficult. Immersion and simulation provide an opportunity for nursing students in the real situation focus on the PE techniques practice and to improve patient care. The combination of digital instructional materials and innovative teaching strategies is crucial to improving education. Therefore, effective and clear instruction of PE techniques that can enable students confidently to use their skills in clinical practice is an issue that nursing education must address. METHODS: This study used a descriptive research design and the technology acceptance model to create a 360-degree video to teach students to perform PE. Content validity and usability were analyzed by five nursing teachers and 53 nursing students who had completed a physical assessment course were invited to assess its usability. RESULTS: The results of the expert review indicated that the content validity of the video scored 0.98 in terms of content relevance, 0.95 in terms of convenience and 0.97 in terms of suitability, suggesting that the video was useful and appropriate for self-practicing. The experts' qualitative feedback indicated that the technical demonstrations in the video were clear and specific and that the video was easy to use. The video increased learning motivation and streamlined learning. The ability to change the video's perspective also increased learning interest. The results of a satisfaction survey were 8.94 points for perceived ease of use, 8.79 points for perceived usefulness, 8.56 points for user attitude toward the video and 9.02 points for continued intention to use the video, indicating that the participants were satisfied with the video. The participants' qualitative feedback indicated that each PE technique was clear and that the ability to change the video's perspective and zooming was useful and novel. CONCLUSIONS: The 360-degree panoramic videos were described as a positive learning method for physical examination of nursing students. It provides easy to use and useful to practice PE technique under realistic conditions. Among these outcomes, the 360-degree video can be learned best when teaching PE in nursing education. Accordingly, nursing educators should construct similar videos for the PE of other parts of the body as soon as possible, improve the videos convenience and usefulness and promote their ability to strengthen professional skills.

Perceptions, clinical characteristics, and other factors associated with prolonged and high daily dose of benzodiazepine use among patients with anxiety or depressive disorders.

BACKGROUND: Benzodiazepines (BZDs) have been widely used to treat anxiety; however, the risk of adverse health effects caused by their long-term use is high. This study examined the factors associated with the duration and higher daily dose of BZDs use among a population with anxiety or depressive disorders. METHODS: A cross-sectional study design was used. Patients from a psychiatric outpatient department who had been prescribed BZDs were recruited. Data were collected from 250 patients. RESULTS: Nearly 94% of patients were long-term BZDs users. The mean duration of BZDs use was 5.5 years; and mean defined daily dose (DDD) of BZDs use, converted to diazepam milligram equivalent (DDD), was 1.53 DME-DDD. Patients who knew more about alternative treatments were less prone to use BZD longer. Patients aged 65 years or older and those with difficulty falling asleep were more prone to use BZDs longer. Patients who were currently taking BZDs at higher daily dose were those who felt more depressed, prescribed second generation antipsychotics, suffered from disrupted sleep, less aware of alternative treatments, had comorbid chronic physical illness, and were current smokers. LIMITATIONS: The cross-sectional study design limited its ability to confirm causal relationships. CONCLUSIONS: Long-term and excessive daily dose of BZDs use in patients with depressive or anxiety disorders needs to be noted. Providing information or program of non-pharmacological treatment in reducing anxiety and improving specific sleep disturbance is suggested. Elderly, suffering from depressive mood, had comorbid chronic physical illness need to be targeted for further intervention.

Changes in hot flash experiences and related factors in women with breast cancer.

OBJECTIVE: Taiwanese women are younger than women in western countries when diagnosed with breast cancer, and many of them are still menstruating. One of many distressing side effects reported by premenopausal women treated for breast cancer are hot flashes (HFs). The purposes of this study were to identify: (1) the trajectories of hot flash (HF) occurrence, frequency, and interference and (2) potential factors associated with HF changes. METHODS: Peri- or premenopausal women newly diagnosed with breast cancer scheduled to receive chemotherapy and hormonal therapy were enrolled. HF frequency, HF interference, and other symptoms were measured six times from prechemotherapy to 24 months after chemotherapy. Data were analyzed using hierarchical linear modeling. RESULTS: A total of 90 women were eligible for the study. The prechemotherapy occurrence rate of HFs was 7.9%, but rapidly increased to 42.5% immediately after chemotherapy. The change curve of HF frequency and interference appeared quadratic, increasing first and slightly decreasing later. At any time point, increased body mass index (BMI) was associated with both higher HF frequency (P = 0.020) and HF interference (P = 0.002), whereas anxiety (P < 0.001) and loss of sexual desire (P = 0.038) were associated with higher HF interference. Six months after completing chemotherapy, premenopausal women reported significantly higher HF frequency than perimenopausal women (P = 0.041). CONCLUSION: A significant proportion of pre- and perimenopausal women experienced HFs after receiving breast cancer treatment. Our findings on HF trajectories can educate patients newly diagnosed with breast cancer. Special attention should be paid to those with increased body mass index changes and those still regularly menstruating.

The effect of a 12-week home-based walking program on reducing fatigue in women with breast cancer undergoing chemotherapy: A randomized controlled study.

BACKGROUND: Fatigue is the most common symptom experienced by cancer patients during treatment and can last long after completing treatment. Fatigue in cancer patients who have completed treatment is well known to be reduced by exercise, but the effect of exercise on reducing fatigue in patients under treatment has been inconsistent. OBJECTIVES: The purposes of this study were to examine short-term and long-term effects of an individually tailored, home-based brisk walking program on reducing fatigue in breast cancer patients under chemotherapy. DESIGN, SETTING, PARTICIPANTS: For this randomized controlled trial, women were recruited from a medical center in northern Taiwan if they were diagnosed with stages I-III breast cancer and experienced insomnia, fatigue, pain, or depressive symptoms after their first cycle of chemotherapy. Consenting participants (N = 159) were randomly assigned to either an exercise (12-week home-based walking program) group (n = 81) or an attention-control group (n = 78). METHODS: The 12-week, home-based brisk walking program started on the first day of the third chemotherapy cycle. Fatigue was measured by the Brief Fatigue Inventory. Covariates, i.e., functional performance, sleep disturbance, anxiety, depression, and exercise-related variables, were also measured. Data were collected at baseline, two times during the exercise intervention, and five times after the exercise intervention (eight times in total). The effects of time-varying and time-invariant predictors on fatigue were analyzed by multilevel modeling. RESULTS: Fatigue levels increased over time for both groups, even after completing treatment. At the end of the 12-week exercise program, the exercise group had less fatigue than the attention-control group, and this group difference was maintained for the whole study period. At the end of exercise program, women who had spent more time exercising before diagnosis had less fatigue than those who had exercised less often. In addition, patients' fatigue levels at various time points fluctuated along with their functional performance, sleep disturbance, and depression. CONCLUSIONS: Our tailored, home-based brisk walking program effectively reduced fatigue in breast cancer patients under chemotherapy, and this effect lasted after completing treatment.

Psychological profiles of excluded living liver donor candidates: An observational study.

Living donor liver transplantation has advantages over deceased organ liver transplantation. However, the living liver donor candidates must be carefully assessed before surgery. Candidates may be excluded for various reasons. The purpose of this study was to evaluate the psychological profiles of excluded living liver donor candidates according to the reason for exclusion.A descriptive and cross-sectional study was conducted. Donor candidates were invited to participate if they were at least 20 years of age, related biologically or by marriage to the recipient (within 5 degrees), and had undergone living donor evaluation. Among the 338 participants recruited from August 2013 to December 2015, 116 were excluded for the following reasons: a medical condition (n = 35), failure to be chosen (n = 63), or withdrawal from the selection process (n = 18). The psychological profiles of these 3 exclusion groups were evaluated.There were no significant group differences in age, sex, education level, religion, marital status, and consanguinity (P > .05). The withdrawal group had fewer recipients with an hepatitis B virus infection than did the other groups (χ = 9.28, P = .01). Additionally, compared with the unchosen group, the withdrawal group had lower intimacy with the recipient (F = 5.32, P = .006) and higher ambivalence (F = 5.53, P = .005). In terms of family relationship parameters, the withdrawal group had lower family cohesion than the medical condition and unchosen groups (F = 4.44, P = .01), lower family expressiveness than the medical condition group (F = 3.76, P = .03), and higher family conflict than the medical condition and unchosen groups (F = 7.05, P = .001). The withdrawal group also had lower emotional social support than the medical condition group (F = 3.55, P = .03). There were no significant group difference in motivation, expectations, donation-related concerns, informational social support, value social support, instrumental social support, and health-related quality of life.The living donor candidates who withdrew from the selection process had obvious ambivalence, poorer family relationships, and insufficient emotional social support. The transplantation team should respect the autonomy of the candidate's decision and mitigate the impact of the donation decision on living liver donor candidates.

Taking actions to quit chewing betel nuts and starting a new life: taxi drivers' successful experiences of quitting betel nut chewing.

AIMS AND OBJECTIVES: To understand taxi drivers' successful experiences of quitting betel nut chewing. BACKGROUND: Previous studies verified that betel nut chewing significantly increases the risk of oral cancer. In Taiwan, taxi drivers work for approximately 10-13 hours per day, and 31·7-80% of them choose to chew betel nuts for their invigorating qualities, which enable them to work more hours and receive more income. DESIGN: A qualitative research design was used. METHODS: This study used the grounded theory method with purposive sampling to perform in-depth interviews with male taxi drivers who had successfully quit betel nut chewing for more than six months. RESULTS: The interviewed participants were 25 taxi drivers aged 45-67 who had chewed betel nuts for an average of 30·9 years. A constant comparative analysis of the 25 interviews revealed six categories, namely the first experience of chewing betel nuts, a part of work and life, perceiving the impact of betel nuts, trying to change, acting to quit betel nut chewing and starting a new life. CONCLUSIONS: During the cessation process, taxi drivers tended to be affected by their addiction to chewing betel nuts and the temptation of friends' invitations to chew betel nuts. However, their recognition of the physical effects of betel nut chewing and their sense of responsibility and commitment to family were the critical factors affecting their determination to quit betel nut chewing. Their willpower to not to chew betel nuts and the source of their motivation to exercise self-control also contributed to their success. RELEVANCE TO CLINICAL PRACTICE: Healthcare personnel should understand the experiences and perceptions of betel nut chewers, strengthen their understanding of the effects of betel nut chewing on physical health during the cessation period and support their self-efficacy and quitting behaviours with the assistance of significant others.

Effects of an aerobic exercise programme on fatigue for patients with breast cancer undergoing radiotherapy.

AIMS: This study was designed to evaluate the efficacy of an aerobic exercise programme on fatigue for Taiwanese breast cancer women under radiotherapy (RT). BACKGROUND: Cancer-related fatigue has been widely reported by patients undergoing radiotherapy as strongly and profoundly interfering with their quality of life. Evidence has shown that exercise can be beneficial to patients with breast cancer. DESIGN: A quasi-experimental design was used. METHODS: Patients with early-stage breast cancer scheduled for radiotherapy were invited to participate. The first 28 women who agreed to participate were assigned to the intervention group with a six-week mild- to moderate-intensity aerobic exercise training programme during their radiotherapy. The next 30 women were assigned to the routine care control group without special exercise intervention. Fatigue was measured at pre-radiotherapy and weekly after starting radiotherapy for six weeks using the Taiwanese version of the Brief Fatigue Inventory. RESULTS: The mean age of these 47 women was 50·3 years (standard deviation = 9·5). The baseline fatigue severity for the intervention group and control group were 3·04 and 2·95 respectively; and the baseline fatigue interference for the intervention group and the control group were 3·48 and 3·55 respectively. The student t-test showed no group differences in baseline fatigue severity, fatigue interference, or haemoglobin levels. Multivariate analyses showed a significant group-by-time-interaction effect for fatigue severity and interference (p ≦ 0·001); the fatigue severity and interference decreased significantly over time for women in the intervention group but increased over time for women in the control group. CONCLUSIONS: The mild- to moderate-intensity aerobic exercise programme reduces the fatigue of Taiwanese women with breast cancer undergoing radiotherapy. The issues of cancer-related fatigue should also be discussed as they relate to other treatment modalities. RELEVANCE TO CLINICAL PRACTICE: Aerobic exercise intervention should be offered as an option for women with breast cancer to alleviate cancer-related fatigue when undergoing radiotherapy.

The effect of self-efficacy, depression and symptom distress on employment status and leisure activities of liver transplant recipients.

AIM: To examine the effect of self-efficacy, subjective work ability, depression and symptom distress on and to provide a description of, the employment and leisure activities of liver transplant recipients. BACKGROUND: Return to work and leisure activities have become an important aspect of life for liver transplant recipients worldwide. An investigation of the factors that influence the employment status and leisure activities has been recommended as a means to help transplant recipients restore their productivity. DESIGN: This was a cross-sectional, descriptive and correlational study in 2010. METHODS: A convenience sampling method was used. Data were collected using a set of questionnaires that were administered retrospectively. A total of 106 liver transplant patients were included in this study. RESULTS: The post-transplantation employment rate was 45.2%. The positive predictors of employment were higher subjective work ability and higher symptom distress. Gender (female), monthly family income (