Wearable mobile health device for monitoring postoperative ambulation among patients with colorectal cancer undergoing minimally invasive surgery: A prospective comparison study.

BACKGROUND: This study aimed to evaluate the feasibility of using mHealth devices for monitoring postoperative ambulation among patients with colorectal cancer undergoing minimally invasive surgery (MIS). METHODS: Patients with colorectal cancer undergoing MIS were prospectively recruited to wear mHealth devices for recording postoperative ambulation between October 2018 and January 2021. The primary outcome was the compliance by evaluating the weekly submission rate of step counts. The secondary outcome was the association of weekly step counts and postoperative length of stay. RESULTS: Of 107 eligible patients, 53 patients wore mHealth devices, whereas 54 patients did not. The average weekly submission rate was 72.6% for the first month after surgery. The total step counts <4000 or >10 000 in the postoperative week one were negatively associated with postoperative length of stay (ß = -2.874, p = 0.038). CONCLUSIONS: mHealth devices provide an objective assessment of postoperative ambulation among patients with colorectal cancer undergoing MIS. CLINICAL TRIAL REGISTRATION: NCT03277235.

The Effect of Walking Intervention on Cognitive Function Among Patients With Non-Central Nervous System Cancer: A Systematic Review.

BACKGROUND: Cognitive impairment is one of the most frequently reported symptoms in patients with non-central nervous system (non-CNS) cancer. Walking has positive effects on cognitive function. However, the effects of walking interventions on cognitive function outcomes in patients with non-CNS cancer are not well synthesized. OBJECTIVE: The aim of this study was to explore the characteristics of walking intervention and its effects on cognitive function in patients with non-CNS cancer. METHODS: Ten databases were searched to identify eligible randomized controlled trials from each database's inception to June 7, 2021. The Physiotherapy Evidence Database Scale was used to assess the quality of the included studies. RESULTS: Five randomized controlled trials involving 242 adults with non-CNS cancer were included. Two studies involving immediate treadmill walking interventions with moderate intensity at 40% to 60% maximal heart rate reported significantly improved objective cognitive domains of processing speed and spatial working memory with small to moderate effect sizes for cancer survivors. One study delivering home-based, moderate-intensity walking intervention had borderline significantly positive effects on perceived cognitive functioning for patients with non-CNS cancer during chemotherapy. CONCLUSION: Walking intervention with moderate intensity is a beneficial approach to improve objective cognitive domains of processing speed and spatial working memory and perceived cognitive function. IMPLICATIONS FOR PRACTICE: Nurses may provide moderate-intensity walking with 40% to 60% maximal heart rate monitoring to alleviate cognitive problems during the continuous process of cancer care. The modality and dosage of intervention should be adjusted depending on this population's tolerance to better maintain training.

Role of preoperative malnutrition and symptom severity in anorexia-cachexia-related quality of life in patients with operable pancreatic cancer.

PURPOSE: This study assessed the changes in malnutrition status, symptom severity, and anorexia-cachexia-related quality of life (QoL) before and after pancreatic surgery and identified significant factors associated with changes in anorexia-cachexia-related QoL in patients with operable pancreatic cancer. METHODS: In total, 76 patients with pancreatic cancer who were scheduled to undergo surgery were recruited from a medical center in northern Taiwan. The Mini Nutritional Assessment, Symptom Severity Scale, and Functional Assessment of Anorexia-Cachexia Therapy scale were used to assess the patients' nutritional status, symptom severity, and anorexia-cachexia-related QoL, respectively. Bioelectrical impedance analysis was performed using X-Scan Plus II to assess body composition. A generalized estimating equation approach was used to identify significant factors associated with anorexia-cachexia-related QoL. RESULTS: In total, 42.1% of the patients had malnutrition or were at risk of malnutrition before surgery. Preoperative malnutrition (ß = -3.857, p = .001) and higher early satiety (ß = -0.629, p = .005), insomnia (ß = -0.452, p = .025), and pain (ß = -0.779, p < .001) were associated with lower anorexia-cachexia-related QoL. CONCLUSION: Clinicians should actively assess the nutritional status of patients with pancreatic cancer before surgery and provide symptom cluster management interventions to improve nutrition, insomnia, and pain, which is crucial for enhancing patients' anorexia-cachexia-related QoL.

Cognitive Function in Patients at Different Stages of Treatment for Colorectal Cancer: A Comparative Cross-Sectional Study.

OBJECTIVES: To compare subjective and objective cognitive functions among patients at the following three stages of treatment for colorectal cancer (CRC): new diagnosis (Group A), ≤2 years since chemotherapy completion (Group B), and >2 years since chemotherapy completion (Group C). DATA SOURCES: A comparative cross-sectional approach was used in this study. The Functional Assessment of Cancer Therapy-Cognitive Function questionnaire and neuropsychological assessments were used to assess patients' subjective cognitive function, attention, memory, and executive functions. A total of 63 patients with stage I to III CRC were recruited from a medical center in northern Taiwan. We performed one-to-one-to-one propensity score matching to identify 36 individuals as eligible for this study. A generalized estimating equation was used to compare subjective and objective cognitive functions. CONCLUSION: We observed no significant between-group differences in subjective cognitive function and objective performance in overall cognition and memory. Group B had significantly longer reaction time in attention and processing speed than did Group A. Adjuvant chemotherapy had significantly deleterious effects on attention and processing speed in patients with CRC. These cognitive symptoms last for approximately 2 years after the completion of chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: The early detection of cancer-related cognitive impairment is necessary for managing symptom distress. Future studies with a large sample size and longitudinal design may elucidate the trajectory of specific cognitive functions. Developing nursing interventions aimed at improving attention and executive function in patients with CRC are needed.

Resilience process in individuals with colorectal cancer: a qualitative study.

PURPOSE: Resilience is a positive outcome in giving individuals strength to adapt to cancer and have better various aspects of health-related quality of life. However, research focusing on resilience in relation to colorectal cancer (CRC) is limited. Therefore, the aim of this study was to explore the process of resilience in individuals with CRC. METHOD: Sixteen individuals diagnosed with stage Ι to III CRC within the last five years were recruited from a CRC surgical outpatient department in a medical center in Northern Taiwan. Semi-structured interviews were used to explore the resilience process of living with CRC. Recorded interviews were transcribed verbatim and were analyzed using modified grounded theory. FINDINGS: Resilience is a dynamic three-phase process, including impact of CRC, adaptation or maladaptation following CRC, and growth from CRC experience. Resilience strategies (i.e., attitude adjustment, developing personal strategies to conquer CRC and side effects, setting new goals in life, and viewing death as a normal process), avoidance behaviors, and passive waiting strategy were shown across the resilience process. CONCLUSIONS: All individuals showed negative impacts during CRC diagnosis and treatments, but some individuals used the resilience strategies in helping to promote positive adjustment and redirect to develop their resilience process. Furthermore, resilient and maladaptive individuals may change the situation depending on which strategies are used and on the progression of CRC because resilience is dynamic. Oncology clinicians should help individuals use resilience strategies to smoothly go through the resilience process.

A pilot study of metabolomic pathways associated with fatigue in patients with colorectal cancer receiving chemotherapy.

PURPOSE: The aim of this pilot study was to evaluate for differences in metabolomic profiles between fatigued and non-fatigued patients with colorectal cancer (CRC) during chemotherapy (CTX). METHOD: Patients were recruited from the department of surgery in a large medical center in Taiwan. In this longitudinal pilot study, the Fatigue Symptom Inventory and fasting blood samples were collected at three assessments (i.e., prior to surgery (T0), three months (T1) and six months (T2) after surgery). Metabolomic profile analysis was used. Multilevel regression and pathway analyses were performed to identify differences in metabolomic profiles between the fatigued and non-fatigued groups. RESULTS: Of the 49 patients, 55.1% (n = 27) were in the fatigue group. All of the 15 metabolites that had statistically significant group × time interactions in the differential metabolite analysis were entered into the pathway analysis. Two pathways were enriched for these metabolites, namely galactose metabolism and phenylalanine, tyrosine, and tryptophan biosynthesis. CONCLUSIONS: The results from this pilot study suggest that pathways involved in galactose metabolism and phenylalanine, tyrosine, and tryptophan biosynthesis are associated with cancer-related fatigue (CRF) in patients with CRC during CTX. These findings are consistent with the hypotheses that alterations in energy metabolism and increases in inflammation are associated with the development and maintenance of CRF.

A Resilience Model for Patients With Colorectal Cancer: A Structural Equation Modeling Analysis.

BACKGROUND: Patients with colorectal cancer (CRC) experience multiple symptoms. Resilience is a positive health outcome that can assist patients to face and adapt to their disease. OBJECTIVE: The purpose of this study was to evaluate a proposed resilience model for patients with CRC. METHODS: Patients (n = 416), who were given a diagnosis of stage Ι to III CRC within the past 5 years, were recruited from 2 medical centers in Northern Taiwan. Symptom Severity Scale, Fatigue Symptom Inventory, and Center for Epidemiological Studies Depression scale were used to assess the risk factors of symptom severity, fatigue, and depressive symptoms, respectively. Cancer Behavior Inventory and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale were used to assess the protective factors of self-efficacy for coping with cancer and spiritual well-being, respectively. Resilience was assessed using the Resilience Scale. Structural equation modeling was used to evaluate the proposed resilience model for patients with CRC. RESULTS: The initial structural equation modeling fit indices did not support the proposed model. In the revised model, depressive symptoms was a partial mediator between protective factors and resilience with an acceptable model fit (comparative fit index, 0.968; root mean square error of approximation, 0.085; standardized root mean square residual, 0.034). CONCLUSIONS: Patients with CRC who had higher levels of protective factors had higher levels of resilience. This study provides new information on the role of depressive symptoms as a partial mediator between protective factors and resilience. IMPLICATIONS FOR PRACTICE: Oncology nurses need to evaluate for depressive symptoms as well as protective factors and resilience in patients with CRC.

The Relationship Between Muscle Strength and Body Composition Measures and Cancer-Related Fatigue: A Systematic Review and Meta-Analysis.

PROBLEM IDENTIFICATION: Cancer-related fatigue (CRF) substantially affects daily living and quality of life, but objective CRF measures remain limited. This review aimed to identify the correlation between muscle strength and body composition measures and CRF, as well as potential objective indicators for assessing CRF. LITERATURE SEARCH: PubMed®, MEDLINE®, CINAHL®/PsycINFO®, and Embase® were searched for studies published from January 2000 to January 2021. DATA EVALUATION: Study selection and quality assessment were conducted using the Critical Appraisals Skills Programme checklist and the Strengthening the Reporting of Observational Studies in Epidemiology statement. Comprehensive Meta-Analysis software was used to perform meta-analysis. SYNTHESIS: 25 studies were selected, and 19 measures were analyzed. CRF negatively correlated with hand grip strength, knee extensor strength, and the sit-to-stand test. No significant correlation was found between body composition measures and CRF. IMPLICATIONS FOR NURSING: The evidence suggests that muscle strength measures may be potential indicators for CRF assessment. Combining objective and subjective CRF assessments could assist clinicians in evaluating the effectiveness of CRF interventions more accurately.

Determinants of Quality of Life in Individuals With a Dual Diagnosis of Resectable Pancreatic Cancer and Diabetes Mellitus.

OBJECTIVES: To explore the associations among clinical characteristics, fatigue, diabetes mellitus (DM) self-care activities, and quality of life (QOL) in individuals with resectable pancreatic cancer and DM. SAMPLE & SETTING: 57 individuals with resectable pancreatic cancer and DM from an outpatient pancreatic surgical department in Taiwan were included in the final analysis. METHODS & VARIABLES: A cross-sectional, correlational design was used. QOL, fatigue, and DM self-care were measured by the European Organisation for Research and Treatment of Cancer QOL Questionnaire-Core 30, the Fatigue Symptom Inventory, and the Summary of Diabetes Self-Care Activities. RESULTS: Participants who had a shorter duration of DM and higher levels of fatigue (including intensity, duration, and interference) reported lower QOL scores. Participants who performed more DM self-care activities and physical activity per week had higher QOL scores. Fatigue, DM self-care activities, and DM duration were significant factors related to QOL. IMPLICATIONS FOR NURSING: Shorter DM duration, increased fatigue, and fewer DM self-care activities were determinants of worse QOL in individuals with resectable pancreatic cancer and DM.

A Pilot Study of Metabolomic Pathways Associated With Fatigue in Survivors of Colorectal Cancer.

BACKGROUND: Over 30% of cancer survivors experience chronic fatigue. An alteration in energy metabolism is one of the hypothesized mechanisms for cancer-related fatigue (CRF). No studies have evaluated for changes in metabolic profiles in cancer survivors with CRF. The purpose of this pilot study was to evaluate for differences in metabolic profiles between fatigued and non-fatigued survivors of colorectal cancer (CRC). METHODS: Survivors were recruited from the surgical outpatient department and the oncology clinic of a medical center in northern Taiwan. Fatigue was assessed using the Fatigue Symptom Inventory. Fasting blood samples were collected on the day the fatigue questionnaire was completed. Metabolomic profile analysis was performed using non-targeted, liquid chromatography/time-of-flight mass spectrometry. Fold change analyses, t-tests, and pathway analyses were performed to identify differences in metabolomic profiles between the fatigued and non-fatigued survivors. RESULTS: Of the 56 CRC survivors in this study, 28.6% (n = 16) were in the fatigue group. Statistically significant differences in carnitine, L-norleucine, pyroglutamic acid, pyrrolidonecarboxylic acid, spermine, hydroxyoctanoic acid, and paraxanthine were found between the two fatigue groups. In addition, two pathways were enriched for these metabolites (i.e., glutathione metabolism, D-glutamine and D-glutamate metabolism). CONCLUSIONS: Findings from this pilot study provide preliminary evidence that two pathways that are involved with the regulation of ATP production and cellular energy (i.e., glutathione metabolism, D-glutamine and D-glutamate metabolism) are associated with fatigue in CRC survivors. If these findings are confirmed, they may provide new therapeutic targets to decrease fatigue in cancer survivors.

Comparison of Fatigue and Quality of Life in Individuals With Pancreatogenic Diabetes After Total or Partial Pancreatectomy.

OBJECTIVES: To compare fatigue and quality of life (QOL) between individuals with pancreatogenic diabetes after total pancreatectomy (TP) and pancreaticoduodenectomy (PD). SAMPLE & SETTING: 50 individuals (14 after TP and 36 after PD) were recruited from a pancreatic surgical outpatient department. A final sample of 39 matched individuals (13 after TP and 26 after PD) were included in the final analysis. METHODS & VARIABLES: A comparative cross-sectional approach was used. Variables were fatigue and QOL. The Fatigue Symptom Inventory and European Organisation for the Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 were used. Data went through propensity score one-to-two matching. Generalized estimating equation was used to compare fatigue and QOL. RESULTS: The groups showed no statistically significant difference in fatigue intensity and overall QOL. The TP group had significantly longer fatigue duration, perceived higher interference of functioning, lower physical function, and a higher level of insomnia. IMPLICATIONS FOR NURSING: Future studies with a larger sample and longitudinal design will help identify the trajectory of fatigue and QOL in individuals with pancreatogenic diabetes post-TP and PD.

Cancer Prehabilitation Programs and Their Effects on Quality of Life

PROBLEM IDENTIFICATION: Cancer prehabilitation programs have been reported as effective means of improving quality of life (QOL) in people with cancer, but research is lacking. The aim of this systematic review is to explore the characteristics of cancer prehabilitation programs and their effects on QOL in people with cancer. LITERATURE SEARCH: A systematic review of databases (PubMed, MEDLINE®, Cochrane Library, EMBASE, CINAHL®, Scopus®) was performed using key terms. DATA EVALUTION: Data were extracted, and the Physiotherapy Evidence Database scale was used to assess the quality of the studies. SYNTHESIS: 12 randomized, controlled trials with a total of 839 people with cancer were included in this review. Of these, seven cancer prehabilitation programs focused on physical interventions, three focused on psychological interventions, and two focused on multimodal interventions. IMPLICATIONS FOR NURSING: Oncology nurses could provide various cancer prehabilitation programs to patients who decide to undergo cancer-related treatment. Additional research on this subject should involve careful consideration of QOL instruments and sample size when designing the intervention.

Change of Uncertainty in Illness and Unmet Care Needs in Patients With Recurrent Hepatocellular Carcinoma During Active Treatment.

BACKGROUND: Uncertainty about or related to cancer-related treatment and prognosis is commonly experienced by patients with hepatocellular carcinoma and might be associated with unmet care needs. However, their dynamic associations have not been examined in this population. OBJECTIVE: The aim of this study was to explore change in unmet care needs and uncertainty under different levels of uncertainty (low vs high) before discharge and the significant factors related to change of uncertainty in patients with recurrent hepatocellular carcinoma after treatment. METHODS: A set of questionnaires was used to collect data including symptom distress, supportive care needs, and uncertainty of illness before discharge (T0), 1 month after discharge (T1), and 2 months after discharge (T2). The significant factors related to uncertainty were identified by generalized estimating equations. RESULTS: The patients with high uncertainty, who were younger in age, had significantly higher levels of symptom distress and unmet care needs. Before discharge, the patients' highest levels of unmet needs were psychological in the high-uncertainty group. Patients with jobs, higher unmet care needs, and high uncertainty before discharge had higher levels of uncertainty over time. CONCLUSIONS: The changes in uncertainty were significantly associated with unmet care needs over time, and the baseline level of uncertainty was a significant factor related to the change of uncertainty. IMPLICATIONS FOR PRACTICE: Healthcare providers should take into account each individual's age, levels of psychological need, and symptom distress and should offer personalized information related to psychological needs and symptom management to decrease levels of uncertainty before discharge.

The Role of Age in Change in Unmet Supportive Care Needs in Hepatocellular Carcinoma Patients During Transition From Hospital to Home.

BACKGROUND: Age might affect the change in care needs in patients with hepatocellular carcinoma after treatment during their transition process from hospital to home. However, there have been no studies that focus on this. OBJECTIVE: The aim of this study is to examine changes in unmet supportive care needs in young (<65 years old) and elderly (≥65 years old) groups of patients with hepatocellular carcinoma from before discharge to 2 months after discharge. METHODS: A longitudinal prospective study design was used with recruited participants at a teaching hospital in Taiwan. Data were collected 3 times: within 3 days before discharge and at 1 and 2 months after discharge. A set of questionnaires was used to assess participants' levels of supportive care needs, symptom distress, anxiety, and depression. RESULTS: A total of 104 patients completed the data collection process. Supportive care needs decreased monthly after discharge, with health system and information being the domain with the highest level of unmet needs in the 2 groups. The young group had a higher level of overall unmet needs before discharge, but they had a lower level of overall needs compared with the elderly group after 2 months of discharge. CONCLUSIONS: Age could be a significant potential factor to affect change in unmet needs during transition. IMPLICATIONS FOR PRACTICE: Comprehensive assessment in care needs especially in the health system and information and physical and daily living domains before discharge is recommended to design personalized education programs before discharge.

Factors Influencing Amount of Weekly Exercise Time in Colorectal Cancer Survivors.

BACKGROUND: Performing regular exercise of at least 150 minutes weekly has benefits for colorectal cancer survivors. However, barriers inhibit these survivors from performing regular exercise. OBJECTIVES: The aim of this study was to explore exercise behaviors and significant factors influencing weekly exercise time of more than 150 minutes in colorectal cancer survivors. METHODS: A cross-sectional study design was used to recruit participants in Taiwan. Guided by the ecological model of health behavior, exercise barriers were assessed including intrapersonal, interpersonal, and environment-related barriers. A multiple logistic regression was used to explore the factors associated with the amount of weekly exercise. RESULTS: Among 321 survivors, 57.0% of them had weekly exercise times of more than 150 minutes. The results identified multiple levels of significant factors related to weekly exercise times including intrapersonal factors (occupational status, functional status, pain, interest in exercise, and beliefs about the importance of exercise) and exercise barriers related to environmental factors (lack of time and bad weather). No interpersonal factors were found to be significant. CONCLUSIONS: Colorectal cancer survivors experienced low levels of physical and psychological distress. Multiple levels of significant factors related to exercise time including intrapersonal factors as well as exercise barriers related to environmental factors should be considered. IMPLICATIONS FOR PRACTICE: Healthcare providers should discuss with their patients how to perform exercise programs; the discussion should address multiple levels of the ecological model such as any pain problems, functional status, employment status, and time limitations, as well as community environment.