RESUMEN
OBJECTIVE: An individual's ability to effectively manage their cancer pain is influenced by knowledge and perceptions regarding the pain experience. While significance of the physician's knowledge of cancer pain management has been reported, much less is known how a patient's knowledge may influence their ability to optimally manage their pain. The purpose of this study is to determine the influence health and social factors have on the knowledge and experience of cancer pain among older adults. DESIGN: A prospective cross-sectional study of older Black and White patients presenting for outpatient cancer treatment. METHODS: Participants were surveyed on questions assessing pain severity, knowledge and experience of pain, self-efficacy for pain treatment, satisfaction with pain treatment, and additional social, health, and demographic characteristics. A series of hierarchical regression models were specified to examine predictors of cancer pain knowledge and experience. RESULTS: Education, race, and trust were significant predictors of pain knowledge, whereas self-efficacy for pain, pain interference, and pain severity were indicators of the experience of cancer pain. CONCLUSIONS: Knowledge and experience of (cancer) pain are contingent upon a myriad of social and clinical factors that are not exclusive but rather coexisting determinants of health. Understanding older adults' knowledge of pain may begin to diminish the imparities in the diagnosis and treatment of pain among this growing diverse population of older adults. It may similarly allow for programs to be tailored to fit the specific needs of the patient in the treatment and management of their cancer pain.
Asunto(s)
Atención Ambulatoria , Conocimientos, Actitudes y Práctica en Salud , Alfabetización en Salud , Neoplasias/psicología , Pacientes Ambulatorios/psicología , Manejo del Dolor/psicología , Dolor/psicología , Anciano , Población Negra/psicología , Estudios Transversales , Escolaridad , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Neoplasias/fisiopatología , Dolor/etiología , Estudios Prospectivos , Autoeficacia , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Confianza , Población Blanca/psicologíaRESUMEN
Community engagement is a process often used in developing effective health communication interventions, especially in traditionally underserved cultural contexts. While the potentially positive outcomes of community engagement are well established, the communication processes that result in engagement with cultural groups are less apparent. The focus on the outcomes of engagement at the expense of describing how engagement occurs makes it difficult for methods to be improved upon and replicated by future studies. The purpose of the current manuscript is to illustrate the process of achieving community engagement through the development of a culturally grounded health communication intervention. We offer practical suggestions for implementing community engagement principles, as well as the benefits and challenges inherent in this approach to research. Key points are illustrated using examples from the DECIDE Project, a culturally grounded intervention for improving communication about clinical trials in the medically underserved Appalachian region.
Asunto(s)
Participación de la Comunidad , Asistencia Sanitaria Culturalmente Competente/organización & administración , Comunicación en Salud , Desarrollo de Programa/métodos , Región de los Apalaches , Humanos , Estudios de Casos Organizacionales , Investigación Cualitativa , Población RuralRESUMEN
This study examines the relationship of personality traits and affect on cancer-related pain in 150 older adults receiving outpatient treatment at a comprehensive cancer center. Regression analyses revealed extraversion as a significant predictor of current pain, with openness to experience as a significant indicator of average pain. Similarly, positive affect and negative affect were significant predictors of self-efficacy for pain management. Moderation models showed that conscientiousness and extraversion were significant moderators in the relationship between self-efficacy for pain management and worst pain. These findings suggest that different personality types may influence perceptions of pain severity.
Asunto(s)
Afecto/fisiología , Neoplasias/psicología , Dolor/psicología , Personalidad/fisiología , Autoeficacia , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Dolor/etiología , Manejo del Dolor , Dimensión del DolorRESUMEN
PURPOSE: The most effective dietary pattern for breast cancer prevention has been greatly debated in recent years. Studies have examined hypocaloric diets, with particular emphasis on macronutrient composition, yielding inconclusive data. The objective of this study was to examine the effects of calorie-restricted low-fat and low-carbohydrate diets (LFD and LCD, respectively) on circulating adipokines among overweight and obese premenopausal women. METHODS: Seventy-nine overweight and obese premenopausal women were randomized to either LFD or LCD, with increased physical activity, for 52 weeks. Serum adiponectin, leptin and the adiponectin-to-leptin ratio (A/L) were measured at baseline, and at weeks 34 and 52 to assess intervention effects. RESULTS: While there were no significant changes in serum adiponectin concentrations following the LCD and LFD interventions, leptin concentrations significantly decreased by week 34 of the intervention period (LCD: 35.3%, P = 0.004; LFD: 30.0%, P = 0.01), with no difference by intervention arm. At week 52, these reductions were statistically non-significant, indicating a return to baseline levels by the end of the intervention. While there were non-significant increases in the A/L ratio following the LCD and LFD intervention arms, the overall trend, across groups, was marginally significant (P = 0.05) with increases of 16.2% and 35.1% at weeks 34 and 52, respectively. CONCLUSIONS: These findings suggest that caloric-restricted LCD and LFD dietary patterns favorably modify leptin and possibly the A/L ratio, and lend support to the hypothesis that these interventions may be effective for obesity-related breast cancer prevention through their effects on biomarkers involved in metabolic pathways. CLINICAL TRIAL REGISTRATION NUMBER: NCT01559194.
RESUMEN
Practical methods to reduce the risk of obesity-related breast cancer among high-risk subgroups are lacking. Few studies have investigated the effects of exercise on circulating adipokines, which have been shown to be associated with obesity and breast cancer. The aim of this study was to examine the effects of a walking intervention on serum adiponectin, leptin, and the adiponectin-to-leptin ratio (A/L). Seventy-one overweight and obese postmenopausal women at increased risk of developing breast cancer were stratified by BMI (25-30 kg/m(2) or >30 kg/m(2)) and randomized to a 12-week, two-arm walking intervention administered through interactive voice response (IVR) and mobile devices. The intervention arms were IVR + coach and IVR + no-coach condition. Pre-post changes in serum adiponectin, leptin, and the A/L ratio were examined using mixed regression models, with ratio estimates (and 95 % confidence intervals [CI]) corresponding to postintervention adipokine concentrations relative to preintervention concentrations. While postintervention effects included statistically significant improvements in anthropometric measures, the observed decreases in adiponectin and leptin (ratio = 0.86, 95 % CI 0.74-1.01, and ratio = 0.94, 95 % CI 0.87-1.01, respectively) and increase in A/L ratio = 1.09, 95 % CI 0.94-1.26) were not significant. Thus, these findings do not support significant effects of the walking intervention on circulating adipokines among overweight and obese postmenopausal women. Additional studies are essential to determine the most effective and practical lifestyle interventions that can promote beneficial modification of serum adipokine concentrations, which may prove useful for obesity-related breast cancer prevention.
Asunto(s)
Adiponectina/sangre , Neoplasias de la Mama/sangre , Promoción de la Salud/métodos , Leptina/sangre , Posmenopausia/sangre , Caminata/fisiología , Índice de Masa Corporal , Neoplasias de la Mama/fisiopatología , Neoplasias de la Mama/prevención & control , Teléfono Celular , Femenino , Humanos , Persona de Mediana Edad , Obesidad/sangre , Obesidad/fisiopatología , Sobrepeso/sangre , Sobrepeso/fisiopatología , Posmenopausia/fisiología , Factores de Riesgo , Telemedicina/métodos , Factores de Tiempo , Resultado del TratamientoRESUMEN
CONTEXT: Breast cancer risk among postmenopausal women increases as body mass index increases. Practical preventive methods to reduce risk of breast cancer are lacking. Few studies have investigated the effects of carotenoids and isoflavones on circulating adipokines in postmenopausal women. OBJECTIVE: The aim was to examine the effects of lycopene- and isoflavone-rich diets on serum adipokines. DESIGN: This was a 26-week, two-arm, longitudinal crossover trial. SETTING: Participants were recruited from clinics at The Ohio State University Comprehensive Cancer Center. PARTICIPANTS: Seventy postmenopausal women at increased breast cancer risk participated in the study. The mean age and body mass index of participants was 57.2 years and 30.0 kg/m(2), respectively; the study was comprised of 81.4% whites. INTERVENTIONS: The interventions included 10 weeks of consumption of a tomato-based diet (≥25 mg lycopene daily) and 10 weeks of consumption of a soy-based diet (≥40 g of soy protein daily), with a 2-week washout in between. MAIN OUTCOME MEASURES: Changes in serum adiponectin, leptin, and the adiponectin to leptin ratio were examined for each intervention through linear mixed models, with ratio estimates corresponding to postintervention adipokine concentrations relative to preintervention concentrations. RESULTS: After the tomato intervention, among all women, adiponectin concentration increased (ratio 1.09, 95% confidence interval (CI) 1.00-1.18), with a stronger effect observed among nonobese women (ratio 1.13, 95% CI 1.02-1.25). After the soy intervention, adiponectin decreased overall (ratio 0.91, 95% CI 0.84-0.97), with a larger reduction observed among nonobese women (ratio 0.89, 95% CI 0.81-0.98). Overall, no significant changes in leptin or the adiponectin to leptin ratio were observed after either intervention. CONCLUSIONS: Increasing dietary consumption of tomato-based foods may beneficially increase serum adiponectin concentrations among postmenopausal women at increased breast cancer risk, especially those who are not obese. Additional studies are essential to confirm these effects and to elucidate the specific mechanisms that may make phytonutrients found in tomatoes practical as breast cancer chemopreventive agents.
Asunto(s)
Adiponectina/sangre , Neoplasias de la Mama/prevención & control , Leptina/sangre , Posmenopausia/sangre , Solanum lycopersicum , Proteínas de Soja , Adulto , Anciano , Índice de Masa Corporal , Neoplasias de la Mama/sangre , Estudios Cruzados , Dieta , Femenino , Humanos , Persona de Mediana Edad , RiesgoRESUMEN
How satisfied a patient is with their medical treatment may influence compliance and adherence to medical regimens. While a number of studies have examined patient satisfaction among younger populations, few have determined the impact social factors have on satisfaction with pain treatment among older adults. This study aimed to determine the influence discrimination, trust, communication, and other health characteristics have on satisfaction with pain treatment among older adults receiving outpatient services from a comprehensive cancer center. Participants were surveyed on questions assessing pain symptomatology, and identified social (discrimination, trust, and communication), physical (comorbidities, pain interference), behavioral (self-efficacy), and demographic characteristics. Analyses were calculated to determine the total and indirect effects of trust, communication, and self-efficacy as mediators on the perceived discrimination-patient satisfaction with pain treatment relationship. Data showed a significant relationship of communication and discrimination on patient satisfaction. However, none of the mediating effects were significant. It must be recognized that patient satisfaction is contingent upon a myriad of social factors that are not exclusive, but rather coexisting determinants of health. Particularly among the elderly, perceived discrimination and incidences of poor communication may be significant influences on health and the lived day-to-day experiences of this adult population.
RESUMEN
BACKGROUND: Communication problems impede effective symptom management during chemotherapy. The primary aim of this pilot randomized controlled trial was to test the effects of a personal digital assistant-delivered communication intervention on pain, depression, and fatigue symptoms among breast cancer patients undergoing chemotherapy. Secondary aims included assessment of 1) study feasibility, 2) patient and clinician responses to study participation, and 3) intervention effects on health-related quality of life (HRQoL) and communication self-efficacy. METHODS: Intervention group participants (n = 27) completed symptom inventories at baseline, once per week during treatment, and at posttreatment. Depending on symptom severity, they viewed race-concordant videos on how to communicate about pain, depression and/or fatigue, using the personal digital assistant. Symptom records were tracked and shared with clinicians. Control group participants (n = 23) received usual care. Longitudinal random effects modeling assessed the changes in average symptom scores over time. Descriptive statistics assessed study feasibility and intervention effects on HRQoL and communication self-efficacy. Postintervention focus groups, interviews, and surveys assessed responses to study participation. RESULTS: Mean age of the participants was 51.0 years; 42 participants (84%) were white. In comparison with control, intervention group participants reported lower average pain severity over time (P = .015). Mean pain interference scores over time were marginally different between groups (P = .07); mean depression and fatigue scores over time were statistically nonsignificant. Feasibility outcomes and perspectives about study participation were positive. Mean pre-post decreases in HRQoL were generally higher among intervention group participants; pre-post changes in communication self-efficacy were equivalent. CONCLUSION: Mixed findings of the study indicate the need for future research.