Sleep quality in cancer patients: a common metric for several instruments measuring sleep quality.

PURPOSE: Sleep problems are frequently observed in cancer patients. Multiple questionnaires for assessing sleep quality have been developed. The aim of this study was to present transfer rules that allow the conversion of the patients' scores from one questionnaire to another. In addition, we anchored this common metric to the general population. METHODS: A sample of 1,733 cancer patients completed the following questionnaires: Pittsburgh Sleep Quality Index, Insomnia Sleep Index, Jenkins Sleep Scale, EORTC QLQ-C30, and the sleep scale of the EORTC QLQ-SURV100. The methods for establishing a common metric were based on Item Response Theory. RESULTS: The main result of the study is a figure that allows the conversion from one of the above-mentioned sleep scales into another. Furthermore, the scores of the questionnaires can be transferred to theta scores that indicate the position within the group of cancer patients and also to T scores that indicate the position in relation to the general population. The correlations between the sleep scales ranged between 0.70 and 0.85. CONCLUSIONS: The conversion rules presented in the study enable researchers and clinicians to directly compare single scores or mean scores across studies using different sleep scales, to assess the degree of sleep problems with regard to the general population, and to relate cutoff scores from one questionnaire to another.

Fear of Cancer Progression: A Comparison between the Fear of Progression Questionnaire (FoP-Q-12) and the Concerns about Recurrence Questionnaire (CARQ-4).

As cancer patients often suffer from fear of cancer progression (FoP), valid screening for FoP is of high relevance. The aims of this study were to test psychometric properties of two FoP questionnaires, to determine their relationship to other anxiety-related constructs, and to analyze the impact of sociodemographic and clinical factors on the FoP. Our sample consisted of n = 1733 patients with mixed cancer diagnoses. For measuring FoP, the Fear of Progression questionnaire (FoP-Q-12) and the Concerns About Cancer Recurrence Questionnaire (CARQ-4) were used. The mean scores of the FoP-Q-12 and the CARQ-4 were 30.0 ± 10.4 and 16.1 ± 10.8, respectively, indicating relatively high levels of FoP. Both questionnaires showed excellent internal consistency coefficients, α = 0.895 and α = 0.915, respectively. The correlation between the two FoP questionnaires was r = 0.72. Female patients reported more FoP than male patients (d = 0.84 and d = 0.54, respectively). There was a nonlinear age dependency of FoP, with an increase found in the age range from 18 to 50 years and a decrease in the older age range. Radiation, chemotherapy, and antibody therapy, but not surgery, lead to an increase in FoP. Both questionnaires show good psychometric properties and can be recommended for use in an oncological routine. Female patients and patients in the middle-age range deserve special attention from healthcare providers.

The Relationship between Supportive Care Needs and Health-Related Quality of Life in Cancer Patients.

The aim of this study was to analyze the relationship between quality of life (QoL) and supportive care needs (SCNs) in cancer patients. It is difficult to relate SCNs to detriments in QoL since SCNs and QoL assessment tools generally comprise different dimensions that cannot be directly related to each other. Therefore, we developed a short questionnaire with eight dimensions for uniformly measuring SCNs, QoL, and the subjective importance of these dimensions. A total of 1108 cancer patients with mixed diagnoses assessed eight dimensions of health-related QoL concerning SCNs, satisfaction, and importance. Among the eight dimensions of QoL, physical functioning received the highest SCN assessments (M = 3.4), while autonomy (M = 20.7) and social relationships (M = 1.88) were the dimensions with the lowest SCN mean scores on the 1-5 scale. For each of the eight dimensions, high levels of SCNs were reported by those patients who had low levels of satisfaction with that dimension (r between -0.32 and -0.66). The subjective importance of the dimensions was not consistently correlated with SCNs (r between -0.19 and 0.20). Females reported higher SCNs than males in six of the eight specific dimensions. Patients with prostate and male genital cancers reported the lowest SCNs. These results suggest gender-specific SCN patterns that warrant further exploration. This study highlights the value of a unified assessment instrument for SCNs and QoL, providing a robust basis for future cancer care strategies.

Sense of coherence, resilience, and habitual optimism in cancer patients.

Background/Objective: The aim of this study was to investigate whether the three resource variables sense of coherence, resilience, and dispositional optimism become impaired when people are ill with cancer, whether there are sex and age differences in these variables, and how these variables are associated with quality of life (QoL). Method: A sample of 1108 patients with mixed cancer diagnoses were examined using the Sense of Coherence Scale-3 (SOC-3), the Brief Resilience Scale (BRS), the Life Orientation Test (LOT-R), and the QoL questionnaire EORTC QLQ-C30. Results: The three resource variables showed somewhat lower levels in the patients' sample in comparison with general population controls, with effect sizes between -0.10 and -0.23. While there were only small sex differences in the resource variables, significant age differences were found in these variables, with stronger detriments in younger patients. The correlations among the resource variables ranged between .53 and .61. Sense of coherence was more strongly correlated with QoL than resilience and optimism. Conclusions: Cancer patients with low levels of personal resources adapt to their disease more poorly than patients with high levels. In addition to limitations in QoL, health care professionals should also consider patients' resources for coping with the disease. Special attention should be given to young cancer patients.

Importance of and Satisfaction with Domains of Health-Related Quality of Life in Cancer Rehabilitation.

Instruments for measuring health-related quality of life (HRQoL) generally do not consider the subjective importance of the dimensions they comprise. The aims of this study were to analyze the subjectively perceived importance of the dimension of HRQoL and to investigate their relationship to the satisfaction ratings with these dimensions. A total of 1108 participants enrolled in a cancer rehabilitation program were surveyed. Patients rated eight dimensions of HRQoL (physical functioning, autonomy, emotional stability, cognitive functioning, social relationships, vitality, absence of pain, and sleep quality), as well as global health in terms of how important those dimensions are to them, and how satisfied they are with them. The dimensions with the highest importance ratings were autonomy and social relationships. There were only small sex differences in the importance ratings, but younger patients rated health as being more important than older patients did. The correlations between the importance ratings and the satisfaction ratings of the specific HRQoL dimensions ranged from -0.06 to 0.40, and the correlation between importance and satisfaction for global health was 0.01. Importance ratings provide relevant information for health care professionals in addition to the HRQoL assessments in the context of cancer rehabilitation.

Decreased mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs: A longitudinal analysis.

BACKGROUND: Cancer patients' mental health and quality of life can be improved through professional support according to their needs. In previous analyses of the UNSAID study, we showed that a relevant proportion of cancer patients did not express their needs during the admission interview of inpatient rehabilitation. We now examine trajectories of mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs. METHODS: We enrolled 449 patients with breast, prostate, and colon cancer at beginning (T0) and end (T1) of a 3-week inpatient rehabilitation and 3 (T2) and 9 (T3) months after discharge. We explored depression (PHQ-2), anxiety (GAD-2), emotional functioning (EORTC QLQ-C30), fear of progression (FoP-Q-SF), and global quality of life (EORTC QLQ-C30) using structuring equation models. Furthermore, we evaluated self-reports about expressing needs and utilization of professional help at follow-up. RESULTS: Patients with unexpressed needs (24.3%, n = 107) showed decreased mental health compared to other patients (e.g., depression: d T0 = 0.32, d T1-T3 = 0.39). They showed a significant decline in global quality of life at discharge and follow-up (d = 0.28). Furthermore, they had a higher need for support (Cramer's V T2 = 0.10, T3 = 0.15), talked less about their needs (Cramer's V T2 = 0.18), and made less use of different health care services at follow-up. CONCLUSION: Unexpressed needs in cancer patients may be a risk factor for decreased mental health, quality of life, and non-utilization of professional help in the long term. Further research should clarify causal relationships and focus on this specific group of patients to improve cancer care.

The association between sleep problems and general quality of life in cancer patients and in the general population.

Objective: It is well-known that patients with cancer frequently experience sleep problems, and that sleep quality is associated with general quality of life (QoL). The aims of this study were to analyze the relationship between sleep problems and other components of QoL in more detail and to investigate sex and age differences in sleep quality in cancer patients in comparison with the general population. Method: This study comprised one general population sample (n = 4,476) and eight samples with cancer patients (n between 323 and 4,020). Sleep Quality was measured using the QoL questionnaire EORTC QLQ-C30. Results: All of the cancer patient groups reported more sleep problems than the general population. Sleep problems were associated with all facets of QoL both in cancer patients and in the general population. The highest associations were found in cancer patients for fatigue (r = 0.52) and emotional functioning (r = -0.47). The association between sleep quality and general QoL was lower in the cancer samples (r = -0.37) than in the general population (r = -0.46). Female cancer patients reported markedly more sleep problems than male patients did (d = 0.45), while this sex difference was lower in the general population (d = 0.15). In contrast to the general population, younger cancer patients had greater trouble sleeping than older patients did (d = -0.17). Conclusion: The results underline the significance of the role mental factors play in sleep problems. Health care providers should pay special attention to female patients and younger patients concerning this issue.

Why Do Our Cancer Patients Sleep So Badly? Sleep Disorders in Cancer Patients: A Frequent Symptom with Multiple Causes.

INTRODUCTION: On the one hand, sleep disorders in cancer patients are reported in 30-50% of cancer patients. On the other hand, specific causes for these sleep disorders are little known. This study was done to evaluate factors which may affect sleep of cancer patients. To our knowledge, this is the first study which includes return to work as one factor of sleep disturbance. METHODS: 107 patients with various types of cancer treated in 2 hospitals were interviewed with a battery of questionnaires after having given informed consent. The questionnaires intended to detect abnormalities of sleep and related pain, breathing disorders, restless legs syndrome, depression, rumination, medication, and psychosocial distress. The study was approved by the ethics committee of the University of Marburg. RESULTS: The analysis of the 6 sleep-related questionnaires indicated a sleep disorder of any kind in 68% of all patients. Insomnia symptoms were present in 48 patients (44.9%). Pain, depression, anxiety, and worries about the workplace were significantly related to sleep disorders. CONCLUSION: Sleep disorders are common in cancer patients. The causes are manifold and should be considered by caregivers during diagnosis, therapy, and aftercare of cancer patients. Tumour patients should actively be asked about sleep disorders. If these are present, they should be addressed, and as they have a large impact on quality of life, treatment options should be offered in cooperation with sleep specialists.

Assessment of sleep problems with the Insomnia Severity Index (ISI) and the sleep item of the Patient Health Questionnaire (PHQ-9) in cancer patients.

OBJECTIVE: The objectives of this study were to examine sleep problems in cancer patients, to test the psychometric properties of the Insomnia Sleep Index (ISI) in comparison with the sleep item of the Patient Health Questionnaire-9 (PHQ-9), and to analyze disrupting factors which might cause the sleep problems. METHODS: A sample of 1026 mixed-site cancer patients in treatment at a German oncological rehabilitation clinic was examined. RESULTS: The reliability of the ISI was very good (Cronbach's alpha = 0.92), and the results of the confirmatory factor analysis were acceptable. Females reported worse sleep quality (ISI mean: 13.7 ± 6.6) than males (10.7 ± 6.4). Sleep problems as measured with the PHQ-9 sleep item were markedly higher than those in the general population (effect size d = 1.15). Patients reported that, of the factors that disrupted their sleep, psychological factors (brooding, worries) were more relevant than symptom factors (pain, nocturnal urination, or restless legs). CONCLUSIONS: The ISI is effective in detecting sleep problems in cancer patients. Normative studies with the ISI would be helpful for assessing ISI mean scores. Sex differences should be taken into account when groups of patients are compared. The sleep item of the PHQ-9 can be used in epidemiological studies.

[The Impact of Health literacy on Health Outcomes in Cancer Patients Attending Inpatient Rehabilitation]. / Health literacy bei onkologischen Rehabilitanden und deren Relevanz für den subjektiven Rehabilitationsverlauf.

PURPOSE: Health literacy (HL) entails people's knowledge, motivation, and competences to access, understand, appraise, and apply health information. Lower HL is associated with poorer psychosocial health. However, there are no studies so far evaluating the impact of HL within oncological rehabilitation in Germany. Therefore, we explored HL in cancer patients in inpatient rehabilitation and its association with rehabilitation outcome. METHODS: We conducted a secondary data analysis of a questionnaire survey with 449 cancer patients (breast, prostate, and colon cancer) at 3 measurement occasions (end of rehabilitation, 3- and 9 months follow-up). We assessed HL with the European Health Literacy Survey (HLS-EU-Q6). We evaluated rehabilitation outcomes by measuring fear of progression (FoP-Q-SF), need for psychosocial support, physical functioning and global quality of life (EORTC-QLQ-C30), and the work ability index (WAI). To explore the impact of HL on rehabilitation outcome, we used multiple regression analyses controlling for other factors. RESULTS: At the end of rehabilitation, up to 56% of the patients reported difficulties in HL dimensions. Better HL was significantly associated with lower fear of progression (ß=- 0,33) and need for psychosocial support (OR=0,28), higher physical functioning (ß=0,22), higher global health status (ß=0,23), and higher work ability (ß=0,21). Longitudinal analyses showed that improvement in HL was significantly accompanied by improvements in all rehabilitation outcomes (0,18 ≤ ß ≤ 0,24). CONCLUSION: HL is a relevant factor within cancer rehabilitation. More than half of the patients showed problematic HL at discharge. Furthermore, HL is a predictor of psychosocial, somatic, and work-related rehabilitation outcomes up to 9 months. Effective strategies to support patients in dealing with health information are essential and should be promoted within rehabilitation.

Temporal stability of quality of life assessments in cancer patients.

Quality of life (QoL) is an important outcome criterion in cancer research and practice. Multiple studies have been performed to test the short-term temporal stability (1 day-2 weeks) of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire EORTC QLQ-C30, but its stability over longer periods of time is largely unknown. The EORTC QLQ-C30 was administered at two time points between 3 and 12 months apart in six samples of cancer patients with varying characteristics (N between 298 and 923). Averaged across the six samples, the coefficients of temporal stability (intra-class correlation coefficients ICC) were between 0.31 and 0.59 for the single scales. The 2-item global health/QoL scale showed a mean coefficient of 0.44. When the stability coefficients were calculated separately for males and females and for younger vs. older patients, no systematic gender or age differences were found in the temporal stability of the QoL scales, though the stability was slightly higher in males (vs. females) and in older subgroups (vs. younger subgroups). It is nearly impossible to predict the course a cancer patients' QoL will take over a several month period. Repeated measurements are necessary to track QoL developments.

Unexpressed psychosocial needs in cancer patients at the beginning of inpatient rehabilitation: a qualitative analysis.

OBJECTIVE: Cancer patients often need professional help to alleviate their psychosocial distress. However, not all patients express their needs. In this study, we explored possible barriers to patients' expressing needs, contents of needs difficult to express, and conditions facilitating expressing needs. METHODS: We conducted semi-structured interviews with 29 oncological inpatient rehabilitation patients, 7 members of self-help groups, and 10 health professionals. We analyzed data with structuring content analysis. RESULTS: Fear of stigmatization and difficulties in the physician-patient-relationship were the most critical expression barriers reported. Sexuality deemed to be one of the most challenging themes for patients. Changes in the physician's behavior and sufficient resources were mentioned as the main facilitating conditions. Our results indicate a wide diversity within the barriers and topics, but a general consistency between patients and health professionals. CONCLUSION: This study provides evidence for the existence of a variety of barriers to cancer patients' expressing their needs. PRACTICE IMPLICATIONS: Health professionals should be aware of the different possible expression barriers to facilitate patient communication.

Prevalence and predictors of cancer patients' unexpressed needs in the admission interview of inpatient rehabilitation.

OBJECTIVE: The admission interview in oncological inpatient rehabilitation might be a good opportunity to identify cancer patients' needs present after acute treatment. However, a relevant number of patients may not express their needs. In this study, we examined (a) the proportion of cancer patients with unexpressed needs, (b) topics of unexpressed needs and reasons for not expressing needs, (c) correlations of not expressing needs with several patient characteristics, and (d) predictors of not expressing needs. METHODS: We enrolled 449 patients with breast, prostate, and colon cancer at beginning and end of inpatient rehabilitation. We obtained self-reports about unexpressed needs and health-related variables (quality of life, depression, anxiety, adjustment disorder, and health literacy). We estimated frequencies and conducted correlation and ordinal logistic regression analyses. RESULTS: A quarter of patients stated they had "rather not" or "not at all" expressed all relevant needs. Patients mostly omitted fear of cancer recurrence. Most frequent reasons for not expressing needs were being focused on physical consequences of cancer, concerns emerging only later, and not knowing about the possibility of talking about distress. Not expressing needs was associated with several health-related outcomes, for example, emotional functioning, adjustment disorder, fear of progression, and health literacy. Depression measured at the beginning of rehabilitation showed only small correlations and is therefore not sufficient to identify patients with unexpressed needs. CONCLUSIONS: A relevant proportion of cancer patients reported unexpressed needs in the admission interview. This was associated with decreased mental health. Therefore, it seems necessary to support patients in expressing needs.

Sleep problems in cancer patients: a comparison between the Jenkins Sleep Scale and the single-item sleep scale of the EORTC QLQ-C30.

BACKGROUND: Sleep problems are frequent in cancer patients. Multiple questionnaires and one-item scales have been developed for measuring sleep quality. The aim of this study was to test the Jenkins Sleep Scale (JSS) in comparison with the one-item sleep scale of the quality of life questionnaire (EORTC QLQ-C30), and to examine the relationship between sleep quality and age, gender, clinical variables, and several domains of quality of life. METHODS: A sample of 1216 cancer patients who were treated in an oncological rehabilitation clinic were examined with the JSS, the EORTC QLQ-C30, and several other questionnaires (t1). Participants' sleep quality was then assessed a second time six months later (t2). RESULTS: The cancer patients reported severe sleep problems, with t1 mean scores of 11.6 (JSS) and 51 (EORTC QLQ-C30 Sleep item). The reliability of the JSS was good (Cronbach's alpha = 0.84). Sleep problems were associated with gender (more problems in females), with several cancer treatment methods, and with all domains of quality of life. The JSS performed only marginally better than the EORTC QLQ-C30 Sleep item in detecting sleep problems. CONCLUSIONS: Because of the high prevalence and the strong associations with all quality of life dimensions, sleep problems should be taken into account in cancer care. The one-item sleep instrument of the EORTC QLQ-C30 is sufficient for investigations conducted on a group level.

Screening Properties of the Diagnostic Criteria for Cancer-Related Fatigue.

BACKGROUND: Within the theoretical framework of the ICD diagnostic criteria of cancer-related fatigue, we aim to investigate how those criteria can be used for screening purposes. METHODS: Fatigue was assessed in a mixed sample of 1,225 cancer patients during their stay in a rehabilitation clinic using four different fatigue measures and the diagnostic criteria (Criterion A; DC-A). Psychometric evaluations (e.g., acceptance, reliability, validity, item analyses) were conducted for the sum score and for all items of the diagnostic criteria. RESULTS: A total of 678 (57.1%) patients tested positive according to the DC-A. The sum score of the DC-A had good reliability (Cronbach's alpha = 0.87) and validity, corresponded closely with other fatigue scales, and, with less than 1% missing values, showed a high degree of patients' acceptance. The highest accuracy (approx. 0.80) and Youden indices (>0.55) were found for the items "Difficulties completing daily tasks" (A9), "Struggle to overcome inactivity" (A7), "Decreased motivation or interests" (A4), and "Unrefreshing sleep" (A6). CONCLUSION: The DC-A proved to be a well-accepted, easy to use, and reliable tool for measuring the severity of fatigue. In this paper, we make suggestions for the use of single items of the DC-A as a short and economical screening tool.

Measuring fatigue in cancer patients: a common metric for six fatigue instruments.

PURPOSE: Fatigue is one of the most disabling symptoms in cancer patients. Many instruments exist to measure fatigue. This variety impedes the comparison of data across studies or to the general population. We aimed to estimate a common metric based on six different fatigue instruments (EORTC QLQ-C30 subscale fatigue, EORTC QLQ-FA12, MFI subscale General Fatigue, BFI, Fatigue Scale, and Fatigue Diagnostic Interview Guide) to convert the patients' scores from one of the instruments to another. Additionally, we linked the common metric to the general population. METHODS: For n = 1225 cancer patients, the common metric was estimated using the Item Response Theory framework. The linking between the common metric of the patients and the general population was estimated using linear regression. RESULTS: The common metric was based on a model with acceptable fit (CFI = 0.94, SRMR = 0.06). Based on the standard error of measurement the reliability coefficients of the questionnaires ranged from 0.80 to 0.95. The common metric of the six questionnaires, also linked to the general population, is reported graphically and in supplementary crosswalk tables. CONCLUSIONS: Our study enables researchers and clinicians to directly compare results across studies using different fatigue questionnaires and to assess the degree of fatigue with respect to the general population.

Cancer-Related Fatigue and Associated Factors in Young Adult Cancer Patients.

Purpose: Cancer-related fatigue (CRF) is a highly burdensome and long-lasting symptom of cancer and its therapy. This study aims to examine the severity of CRF in its different dimensions and to assess medical and sociodemographic factors associated with CRF in young adults with cancer (adolescents and young adults [AYAs]). Methods: Patients with malignant cancer (diagnosed within the last 4 years) aged 18-39 years at diagnosis were assessed. CRF was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Fatigue Module (EORTC QLQ-FA12) Questionnaire. Sociodemographic and medical data were collected with self-report questionnaires. Descriptive analyses, cluster analysis, and multiple regression analysis were used to examine CRF in AYAs. Results: In total, n = 577 patients were included. Respondents' fatigue scores were highest for the physical subscale (mean = 45.6; standard deviation [SD] = 28.2), followed by the emotional (mean = 26.7; SD = 28.8) and cognitive dimensions (mean = 19.7; SD = 22.7). Female participants, patients with an additional disease, and patients with financial problems resulting from having cancer reported significantly higher fatigue scores for all three of the subscales (R2 range: 0.10-0.22). Testicular cancer patients had the lowest CRF scores for every dimension. Breast and gynecological cancer patients had the highest emotional and cognitive fatigue scores. Conclusion: Medical variables such as cancer site and therapy scheme seem to have little influence. Caregivers should assess CRF in AYAs independent of their medical characteristics. Reducing additional burdens may represent a way of reducing CRF in AYA cancer patients.

Financial Considerations of an Anesthesia Consult Service.

Surgical patients with complex cardiac disease often require noncardiac surgery. There have been recent articles written concerning the role of the cardiothoracic anesthesiologist as a consultant in the operating room as well as outside the operating theatre.1,2 With the evolution of the cardiothoracic anesthesia consult service (CACS), there are many issues regarding medical billing, financial reimbursement, and Medicare rules that anesthesiologists may not be familiar with. This paper will discuss the financial implications of starting a CACS.

The influence of self-efficacy and resilient coping on cancer patients' quality of life.

The objective of this study was to analyse whether general self-efficacy and resilient coping are negatively impacted when people are sick with cancer (compared with people from the general population), and whether these resource variables predict quality of life outcomes in that patient group. A sample of 959 patients recruited in an oncologic rehabilitation clinic was examined once while hospitalised and once again six months thereafter. The outcome variables were quality of life (EORTC QLQ-C30) and distress (PHQ-4). The resource variables were self-efficacy (General Self-Efficacy Scale) and resilient coping (Brief Resilient Coping Scale). Representative samples of the general population served as controls. Self-efficacy (d = 0.08) and resilient coping (d = 0.28) were only slightly lower in the patients' sample than in the general population. Both resource variables were associated with quality of life, but self-efficacy (and not resilient coping) was the only independent predictor of quality of life functioning scales and distress scores when the baseline values of the dependent variables were also taken into account. Strengthening patients' belief in their own ability to cope with the disease may help them retain and/or regain a higher level of quality of life.