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PURPOSE: To examine the impact of diabetes (type 2) and glycemic control on healthcare-related outcomes (healthcare utilization, adverse effects, and treatment modifications) in non-metastatic breast cancer (NMBC) patients during chemotherapy treatment. METHODS: This was a retrospective study of 243 NMBC patients (stages 1-3) with/without diabetes receiving neoadjuvant or adjuvant cytotoxic chemotherapy. The primary study endpoint was to compare healthcare utilization between NMBC patients with and without diabetes. Secondary study endpoints included adverse events and chemotherapy treatment modifications. Additional analyses were conducted to compare these health-related outcomes by glycemic control status. RESULTS: NMBC patients with diabetes had higher utilization of emergency department (ED) services (52% vs. 33%, p = 0.013) and a higher frequency of unplanned inpatient admissions (35% vs. 19%, p = 0.014). Additionally, NMBC patients with diabetes had a higher incidence of infection and treatment modifications. NMBC patients, regardless of diabetes diagnosis, who had poor glycemic control, specifically hyperglycemia (per random blood glucose), during the study period also had increased healthcare utilization, adverse effects, and treatment modifications. Patients with a baseline HbA1c ≥ 7 had a greater number of ED visits and a higher incidence of infection than those without diabetes. CONCLUSION: Diabetes and glycemic control may impact the health-related outcomes of NMBC patients. Additional studies are needed to confirm these findings and determine optimal monitoring and management strategies for NMBC patients with diabetes and/or poor glycemic control during cytotoxic chemotherapy.
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Neoplasias da Mama , Diabetes Mellitus Tipo 2 , Hiperglicemia , Humanos , Feminino , Estudos Retrospectivos , Neoplasias da Mama/patologia , Controle Glicêmico , Hiperglicemia/induzido quimicamente , Hiperglicemia/epidemiologia , Hiperglicemia/prevenção & controle , GlicemiaRESUMO
OBJECTIVE: The aim of this review was to describe how the coronavirus disease 2019 (COVID-19) lockdown affected the self-care behaviors of people living with type 2 diabetes. Methods: A systematic rapid review was conducted using four electronic databases. Studies reporting on the lockdown's impact on at least one of the self-care behaviors that were published from January 2020 through October 2021 were included. Findings were synthesized narratively, using the Association of Diabetes Care & Education Specialists ADCES7 Self-Care Behaviors as a framework. The methodological level of evidence and quality ratings of the articles were assessed using the Joanna Briggs Institute Appraisal Checklist. Results: Fifteen articles were included. Most studies reported on at least five of the self-care behaviors. There were reported increases in diabetes-related stress, as well as in increases in dietary intake and changes in the timing of meals. Physical activity was reported to decrease. Overall, taking medications and glycemic self-monitoring of blood glucose (SMBG) were unaffected by the lockdown. Of the studies reporting glycemic outcomes, the lockdown appeared to have little negative effect. None of the articles assessed all the self-care behaviors. The self-care behavior of SMBG was the least assessed. Most articles had a medium level of evidence and a medium to high quality rating (scores >60%). Conclusion: The findings from this review found the COVID-19 lockdown had a variable impact on diabetes self-care behaviors. Because the potential for future COVID-19 surges and/or other virulent transmissible diseases remains a concern, health care providers should continue to address the importance of self-care behaviors to mitigate the risk of poor health outcomes in people with diabetes.
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PURPOSE: The purpose of the study was to compare the individual and total number of symptoms and explore symptom clusters by hyperglycemia status in colorectal cancer survivors (CRCS) with diabetes (type 2). METHODS: A retrospective cohort study was conducted, whereby symptom data were extracted from clinical notes in electronic health records. CRCS (stage II or III) diagnosed between 2007 and 2017 who had diabetes and at least one HbA1c within 8 months of initial chemotherapy were included. Zero-inflated negative binomial regression analysis was used to examine total symptoms by hyperglycemia status (hyperglycemia versus no hyperglycemia). Exploratory factor analysis was conducted to identify symptom clusters. RESULTS: Two hundred forty-three CRCS met inclusion criteria. CRCS with hyperglycemia (HbA1c ≥ 6.5%) had greater individual symptoms (fatigue and depression) and total number of symptoms than those with no hyperglycemia. Two distinct symptom clusters, with five (nausea, vomiting, constipation, fatigue, and peripheral neuropathy) and two symptoms (anxiety and depression), were identified among CRCS with hyperglycemia. CONCLUSION: These findings indicate that CRCS with diabetes and hyperglycemia had more symptoms and two distinct symptom clusters compared to those with no hyperglycemia. Prospective research studies are needed to examine the role of hyperglycemia in symptoms among CRCS with diabetes. Understanding hyperglycemia's influence is important as it is a modifiable risk factor towards which prevention and intervention can be directed, potentially mitigating symptoms and symptom clusters and improving outcomes for CRCS with diabetes.
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Neoplasias Colorretais , Diabetes Mellitus Tipo 2 , Humanos , Neoplasias Colorretais/complicações , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Fadiga/epidemiologia , Fadiga/etiologia , Hemoglobinas Glicadas , Estudos Prospectivos , Qualidade de Vida , Estudos Retrospectivos , Sobreviventes , SíndromeRESUMO
PURPOSE: To evaluate the acceptability, satisfaction, and preliminary efficacy of cognitive training for improving cognitive function and health outcomes in breast cancer survivors (BCS). PATIENTS AND METHODS: BCS enrolled in this 2-group randomized, double-masked controlled trial of cognitive training. Primary outcomes included the acceptability and satisfaction of the interventions. Secondary outcomes included examining the effect size and reliable improvement of perceived cognitive function and health outcomes, including work ability, health perception (status and change), and quality of life. Exploratory outcomes were performance on neuropsychological tests and plasma levels of brain-derived neurotropic factor (BDNF). Data were collected at baseline and immediately post-intervention. Using ANCOVA models, the intervention was compared to attention control while adjusting for covariates and baseline values. The effect sizes for differences in means and the reliable improvement percentage were reported. RESULTS: Thirty-six BCS completed the study and were on average 57.6 (SD = 8.0) years old, 59.4% Caucasian, and had some college education (74.5%). Both programs were reported to be satisfactory and acceptable. Non-significant small effect sizes were noted for the intervention on cognitive abilities (d = 0.26) and cognitive concerns (d = - 0.32), with reliable improvement noted in 32% and 28% of BCS, respectively. Small to medium effect sizes were noted in improvement in work ability (d = 0.37) and health perception status (d = 0.30) and change (d = 0.60, p < 0.05). CONCLUSIONS: Cognitive training was acceptable to BCS and resulted in improvement in perceived cognitive function and perceptions of "real-world" health benefits. A larger randomized controlled trial is warranted to determine its effectiveness for objective cognitive performance.
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Neoplasias da Mama , Sobreviventes de Câncer , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Criança , Cognição , Feminino , Humanos , Qualidade de Vida/psicologia , Sobreviventes/psicologiaRESUMO
Integration of evidence-based practice (EBP) into the culture of a healthcare organization is essential to provide safe patient care and promote a thriving culture for the nurses within the healthcare organization. Collaboration and utilization of both clinical and academic experts facilitate the removal of barriers to EBP. This article describes the successful partnership between a healthcare system and school of nursing in executing a 3-phased multimodal approach to an EBP training program.
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Fortalecimento Institucional/métodos , Enfermagem Baseada em Evidências/organização & administração , Recursos Humanos de Enfermagem Hospitalar/educação , Parcerias Público-Privadas , Humanos , Pesquisa em Administração de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/organização & administraçãoRESUMO
BACKGROUND: Implementation and sustainability of a culture of evidence-based practice (EBP) require a systematic approach. A baseline assessment of the organizational context can inform implementation efforts. AIMS: To examine organizational hospital context and provider characteristics associated with EBP readiness and to describe EBP context across hospitals. METHODS: A nonexperimental descriptive correlational design was used to conduct a web-based survey of direct-care registered nurses (N = 701) and nurse managers (N = 94) across a large Midwestern multisite healthcare system using the Alberta Context Tool (ACT). RESULTS: Many significant relationships existed among nurse characteristics and ACT domains, including age (lower age had higher Leadership, Evaluation, and Formal Interactions), education (graduate education had lower Social Capital than a bachelor's or associate degree), role (direct-care nurses had lower Culture than managers and lower Social Capital), and work status (full-time employees had lower Evaluation and Social Capital). EBP context across type of hospitals is similar, with marginal differences in Social Capital and Organizational Slack (higher in critical access hospitals). LINKING EVIDENCE TO ACTION: Assessing organizational context to support EBP is the first step in developing and enhancing a sustainable culture of inquiry. The ACT has been tested across countries, settings, and healthcare disciplines to measure perception of readiness of the practice environment toward EBP. Optimal organizational context is essential to support EBP and sustain the use of evidence in professional nursing practice. Nursing leaders can use baseline assessment information to identify strengths and opportunities to enhance EBP implementation. Enhancing organizational context across nurse characteristics (e.g., age, role, and work status) to acknowledge nurses' contributions, balance nurses' personal and work life, enhance connectedness, and support work culture is beneficial. Fostering development of Social Capital in nurses is needed to influence EBP readiness. A systematic and standardized approach to foster EBP across health systems is key to successful implementation.
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Prática Clínica Baseada em Evidências/métodos , Enfermeiros Administradores/psicologia , Enfermeiras e Enfermeiros/psicologia , Adulto , Atenção à Saúde/métodos , Atenção à Saúde/normas , Prática Clínica Baseada em Evidências/normas , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Enfermeiros Administradores/estatística & dados numéricos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Cultura Organizacional , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: The integration of these preventive guidelines with Electronic Health Records (EHRs) systems, coupled with the generation of personalized preventive care recommendations, holds significant potential for improving healthcare outcomes. Our study investigates the feasibility of using Large Language Models (LLMs) to automate the assessment criteria and risk factors from the guidelines for future analysis against medical records in EHR. MATERIALS AND METHODS: We annotated the criteria, risk factors, and preventive medical services described in the adult guidelines published by United States Preventive Services Taskforce and evaluated 3 state-of-the-art LLMs on extracting information in these categories from the guidelines automatically. RESULTS: We included 24 guidelines in this study. The LLMs can automate the extraction of all criteria, risk factors, and medical services from 9 guidelines. All 3 LLMs perform well on extracting information regarding the demographic criteria or risk factors. Some LLMs perform better on extracting the social determinants of health, family history, and preventive counseling services than the others. DISCUSSION: While LLMs demonstrate the capability to handle lengthy preventive care guidelines, several challenges persist, including constraints related to the maximum length of input tokens and the tendency to generate content rather than adhering strictly to the original input. Moreover, the utilization of LLMs in real-world clinical settings necessitates careful ethical consideration. It is imperative that healthcare professionals meticulously validate the extracted information to mitigate biases, ensure completeness, and maintain accuracy. CONCLUSION: We developed a data structure to store the annotated preventive guidelines and make it publicly available. Employing state-of-the-art LLMs to extract preventive care criteria, risk factors, and preventive care services paves the way for the future integration of these guidelines into the EHR.
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Registros Eletrônicos de Saúde , Guias de Prática Clínica como Assunto , Serviços Preventivos de Saúde , Humanos , Fatores de Risco , Processamento de Linguagem Natural , Aprendizado de MáquinaRESUMO
Objective: This study aimed to investigate symptoms and symptom clusters in breast cancer survivors (BCS) with and without type 2 diabetes across three crucial periods during the cancer trajectory (0-6 months, 12-18 months, and 24-30 months) post-initial chemotherapy. Methods: Eight common symptoms in both BCS and individuals with diabetes were identified through natural language processing of electronic health records from January 2007 to December 2018. Exploratory factor analysis was employed to discern symptom clusters, evaluating their stability, consistency, and clinical relevance. Results: Among the 4601 BCS in the study, 20% (n = 905) had a diabetes diagnosis. Gastrointestinal symptoms and fatigue were prevalent in both groups. While BCS in both groups exhibited an equal number of clusters, the composition of these clusters differed. Symptom clusters varied over time between BCS with and without diabetes. BCS with diabetes demonstrated less stability (repeated clusters) and consistency (same individual symptoms comprising clusters) than their counterparts without diabetes. This suggests that BCS with diabetes may experience distinct symptom clusters at pivotal points in the cancer treatment trajectory. Conclusions: Healthcare providers must be attentive to BCS with diabetes throughout the cancer trajectory, considering intensified and/or unique profiles of symptoms and symptom clusters. Interdisciplinary cancer survivorship models are essential for effective diabetes management in BCS. Implementing a comprehensive diabetes management program throughout the cancer trajectory could alleviate symptoms and symptom clusters, ultimately enhancing health outcomes and potentially reducing healthcare resource utilization.
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BACKGROUND: Older cancer survivors in general are at greater risk for cancer-related cognitive impairment (CRCI), yet few studies have explored its association with health outcomes. This study examined the association between subjective and objective measures of cognitive function and physical function, frailty, and quality of life (QoL) among older breast cancer survivors. MATERIALS AND METHODS: Older breast cancer survivors who reported cognitive concerns completed surveys on patient-reported cognitive function, physical function, frailty, and QoL as well as objective tests of visuospatial working memory and sustained attention. Data were analyzed using descriptive statistics and separate linear regression models. RESULTS: A total of 219 female breast cancer survivors completed the study. Perceived cognitive abilities were associated with better physical function, frailty, and QoL (p ≤ 0.001) while cognitive concerns were negatively related with these metrics (p ≤ 0.001). Poorer visuospatial working memory and sustained attention were linked to increased frailty (p ≤ 0.001-0.01), whereas poorer sustained attention was associated with poorer physical function (p < 0.01). CONCLUSIONS: Older breast cancer survivors with perceived cognitive impairment and poorer cognitive performance reported poorer physical functioning, increased frailty, and poorer QoL. These findings underscore the importance of assessing cognitive concerns and their associated outcomes in older breast cancer survivors.
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PURPOSE: To characterize and identify trends in current practices for ordering, handling, dispensing, administering, and disposing of oral antineoplastics. METHODS: An electronic survey was designed and sent to pharmacists and nurses via professional society listservs. RESULTS: One hundred and twenty-three practitioners responded to the survey. Of those responding, 76% described having an official policy regarding the handling of oral antineoplastics. Prescribing was limited to attending physicians or oncologists the majority of the time (42% and 98%, respectively), with 11% accepting telephone orders for oral antineoplastics. Personal protective equipment was required by many of the respondents; 70% required gloves be worn. Patient contact precautions were utilized by 79% of practitioners, of which 81% followed similar precautions for targeted therapies. Compounding was required to be performed in a biological safety cabinet by 88% of respondents, and 83% required decontamination of supplies and equipment after exposure to oral antineoplastics. CONCLUSION: Although practices varied slightly, the majority of respondents follow available guidance when handling oral antineoplastics.
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Patients with cancer or other chronic diseases often experience different symptoms before or after treatments. The symptoms could be physical, gastrointestinal, psychological, or cognitive (memory loss), or other types. Previous research focuses on understanding the individual symptoms or symptom correlations by collecting data through symptom surveys and using traditional statistical methods to analyze the symptoms, such as principal component analysis or factor analysis. This research proposes a computational system, SymptomGraph, to identify the symptom clusters in the narrative text of written clinical notes in electronic health records (EHR). SymptomGraph is developed to use a set of natural language processing (NLP) and artificial intelligence (AI) methods to first extract the clinician-documented symptoms from clinical notes. Then, a semantic symptom expression clustering method is used to discover a set of typical symptoms. A symptom graph is built based on the co-occurrences of the symptoms. Finally, a graph clustering algorithm is developed to discover the symptom clusters. Although SymptomGraph is applied to the narrative clinical notes, it can be adapted to analyze symptom survey data. We applied Symptom-Graph on a colorectal cancer patient with and without diabetes (Type 2) data set to detect the patient symptom clusters one year after the chemotherapy. Our results show that SymptomGraph can identify the typical symptom clusters of colorectal cancer patients' post-chemotherapy. The results also show that colorectal cancer patients with diabetes often show more symptoms of peripheral neuropathy, younger patients have mental dysfunctions of alcohol or tobacco abuse, and patients at later cancer stages show more memory loss symptoms. Our system can be generalized to extract and analyze symptom clusters of other chronic diseases or acute diseases like COVID-19.
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BACKGROUND: Diabetes (type 2) is a risk factor for developing peripheral neuropathy (PN) symptoms in breast cancer survivors (BCS). Because PN symptoms are associated with deficits in physical functioning and quality of life, more information is needed about the effects of PN symptoms on the lives of BCS with diabetes. OBJECTIVE: The aim of this study was to describe the experiences of PN among BCS with diabetes from their own perspectives. INTERVENTIONS/METHODS: This substudy is part of a larger investigation examining factors associated with cancer-related cognitive impairment in cancer survivors. Female early-stage (stage I-III) BCS with diabetes and PN symptoms were eligible to participate. A qualitative descriptive approach using purposive sampling and semistructured interviews was used. Participant narratives were summarized using standard content analytic techniques. RESULTS: Eleven BCS with diabetes and PN symptoms were interviewed. Participants described PN symptoms that were varied, were often persistent, and had troublesome effects on their physical functioning and quality of life. Participants used a variety of self-management strategies and prescription and over-the-counter medications to manage their PN symptoms. Some said that having both cancer and diabetes exacerbated the PN symptoms and complicated symptom management. CONCLUSION: Peripheral neuropathy symptoms can have a profound effect on the lives of BCS with diabetes and should be addressed by healthcare providers. IMPLICATIONS FOR PRACTICE: Clinical care for this population should include ongoing assessment of PN symptoms, conversations about the effects of these symptoms on everyday life, evidence-based treatment for the symptoms, and support for symptom self-management.
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BACKGROUND: Although the cancer-related cognitive impairment (CRCI) is a common symptom incurred by the breast cancer survivors (BCS), more emphasis is needed in identifying acceptable interventions for survivors. PURPOSE: The purpose of this qualitative descriptive study was to examine the acceptability of cognitive programs by identifying the facilitators and barriers for implementing computerized cognitive training (BrainHQ) and computerized global cognitive stimulating-based games (e.g., computerized word-find, puzzles, etc.) comparator delivered remotely to improve CRCI from the perspective of BCS. METHODS: BCS (n = 35) who enrolled and completed a randomized controlled trial of computerized cognitive training: 19 cognitive training (BrainHQ) and 16 global cognitive stimulating-based games (crosswords, puzzles, etc.) were interviewed post-training. Semi-structured questions were used, recorded, and transcribed verbatim. Qualitative data were analyzed using standard content analytic procedures for each intervention. RESULTS: Facilitators of training varied by intervention with cognitive training seen as challenging, engaging, and gave a sense of accomplishment whereas global stimulating games were seen as a way of taking mind off issues, enjoyable, and easy to navigate. Barriers of cognitive training included an awareness of failing whereas global stimulating games were deemed to be too repetitive. Both groups endorsed the convenience/flexibility of online training and common concerns of time constraints and fatigue to complete the training. Each group also provided recommendations for improvement. CONCLUSIONS: Cognitive training and global stimulating games were generally well received by BCS. Designing more support elements to promote engagement may be key to successful long-term implementation.
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Neoplasias da Mama , Sobreviventes de Câncer , Disfunção Cognitiva , Humanos , Feminino , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Treino Cognitivo , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/terapia , Sobreviventes/psicologia , CogniçãoRESUMO
OBJECTIVES: To examine symptoms and symptom clusters in patients with colorectal cancer (CRC) with or without diabetes at three key periods (0-6 months, 12-18 months, and 24-30 months) post-initial chemotherapy. SAMPLE & SETTING: Patients with CRC from a cancer center in the midwestern United States between January 2007 and December 2017. METHODS & VARIABLES: Eight of the most common symptoms (fatigue, gastrointestinal issues, depression, anxiety, peripheral neuropathy, physical function, cognition, and sleep disturbance) reported by patients with CRC and patients with diabetes were extracted from electronic health records. Exploratory factor analysis was used to identify symptom clusters, which were assessed for patterns and clinical relevance. RESULTS: Gastrointestinal issues and fatigue were the most prevalent symptoms in patients with CRC at each period. Across the three periods, patients with CRC and diabetes had more symptom clusters (n = 7) compared to patients with CRC without diabetes (n = 4). No stable symptom clusters were identified for either group. IMPLICATIONS FOR NURSING: Oncology clinicians must recognize that patients with CRC and diabetes may present with exacerbated symptoms or symptom clusters. Ongoing assessment and monitoring of patients with CRC and diabetes for symptoms and symptom clusters is important because they may be at an increased risk for higher symptom burden.
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Neoplasias Colorretais , Diabetes Mellitus , Humanos , Síndrome , Diabetes Mellitus/epidemiologia , Pacientes , Fadiga/etiologiaRESUMO
Patients experience various symptoms when they haveeither acute or chronic diseases or undergo some treatments for diseases. Symptoms are often indicators of the severity of the disease and the need for hospitalization. Symptoms are often described in free text written as clinical notes in the Electronic Health Records (EHR) and are not integrated with other clinical factors for disease prediction and healthcare outcome management. In this research, we propose a novel deep language model to extract patient-reported symptoms from clinical text. The deep language model integrates syntactic and semantic analysis for symptom extraction and identifies the actual symptoms reported by patients and conditional or negation symptoms. The deep language model can extract both complex and straightforward symptom expressions. We used a real-world clinical notes dataset to evaluate our model and demonstrated that our model achieves superior performance compared to three other state-of-the-art symptom extraction models. We extensively analyzed our model to illustrate its effectiveness by examining each component's contribution to the model. Finally, we applied our model on a COVID-19 tweets data set to extract COVID-19 symptoms. The results show that our model can identify all the symptoms suggested by the Center for Disease Control (CDC) ahead of their timeline and many rare symptoms.
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COVID-19 , Mídias Sociais , Registros Eletrônicos de Saúde , Humanos , Idioma , Processamento de Linguagem NaturalRESUMO
PURPOSE: Up to 74% of breast cancer survivors (BCS) have at least one preexisting comorbid condition, with diabetes (type 2) common. The purpose of this study was to examine differences in health-related outcomes (anemia, neutropenia, and infection) and utilization of health care resources (inpatient, outpatient, and emergency visits) in BCS with and without diabetes. METHODS: In this retrospective cohort study, data were leveraged from the electronic health records of a large health network linked to the Indiana State Cancer Registry. BCS diagnosed between January 2007 and December 2017 and who had received chemotherapy were included. Multivariable logistic regression and generalized linear models were used to determine differences in health outcomes and health care resources. RESULTS: The cohort included 6851 BCS, of whom 1121 (16%) had a diagnosis of diabetes. BCS were, on average, 55 (standard deviation: 11.88) years old, the majority self-reported race as White (90%), and 48.8% had stage II breast cancer. BCS with diabetes were significantly older (mean age of 60.6 [SD: 10.34] years) than those without diabetes and were often obese (66% had body mass index of ≥33). BCS with diabetes had higher odds of anemia (odds ratio: 1.43; 95% CI: 1.04, 1.96) and infection (odds ratio: 1.86; 95% CI: 1.35, 2.55) and utilized more outpatient resources (P<0.0001). CONCLUSIONS: Diabetes has a deleterious effect on health-related outcomes and health care resource utilization among BCS. These findings support the need for clinical practice guidelines to help clinicians manage diabetes among BCS throughout the cancer trajectory and for coordinated models of care to reduce high resource utilization.
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PURPOSE: Younger breast cancer survivors (BCS) often report cognitive impairment and poor quality of life (QoL), which could be interrelated. The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with QoL, which included psychological (depressive symptoms, well-being, perceived stress, and personal growth) and physical well-being (physical functioning and fatigue). METHODS: Four hundred ninety-eight BCS (≤45 years at diagnosis) who were 3 to 8 years post-chemotherapy treatment and 394 HC completed subjective questionnaires and a one-time neuropsychological assessment, including tests of attention, memory, processing speed, and verbal fluency. For each test, cognitive impairment was defined as scoring 1.5 and 2.0 standard deviations below the mean of the HC group. Separate linear regression models for each outcome were ran controlling for known covariates. RESULTS: BCS reported significantly more memory problems than HC (p < 0.0001), with up to 23% having significant impairment. Cognitive performance did not differ significantly between BCS and HCs. BCS vs. HCs had greater depression and fatigue, yet more personal growth. Objective and subjective cognitive impairment were significantly related to greater depressive symptoms and perceived stress and lower well-being and physical functioning; whereas, objective impairment was related to less personal growth and subjective impairment was related to greater fatigue. CONCLUSIONS: Younger BCS report significant cognitive impairment years after treatment which may relate to greater decrements in QoL. IMPLICATIONS TO CANCER SURVIVORS: Assessment and interventions to address cognitive concerns may also influence QoL outcomes in younger BCS.
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Neoplasias da Mama , Sobreviventes de Câncer , Disfunção Cognitiva , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Fadiga/epidemiologia , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Qualidade de Vida/psicologiaRESUMO
Patients with cancer, such as breast and colorectal cancer, often experience different symptoms post-chemotherapy. The symptoms could be fatigue, gastrointestinal (nausea, vomiting, lack of appetite), psychoneurological symptoms (depressive symptoms, anxiety), or other types. Previous research focused on understanding the symptoms using survey data. In this research, we propose to utilize the data within the Electronic Health Record (EHR). A computational framework is developed to use a natural language processing (NLP) pipeline to extract the clinician-documented symptoms from clinical notes. Then, a patient clustering method is based on the symptom severity levels to group the patient in clusters. The association rule mining is used to analyze the associations between symptoms and patient attributes (smoking history, number of comorbidities, diabetes status, age at diagnosis) in the patient clusters. The results show that the various symptom types and severity levels have different associations between breast and colorectal cancers and different timeframes post-chemotherapy. The results also show that patients with breast or colorectal cancers, who smoke and have severe fatigue, likely have severe gastrointestinal symptoms six months after the chemotherapy. Our framework can be generalized to analyze symptoms or symptom clusters of other chronic diseases where symptom management is critical.
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Registros Eletrônicos de Saúde , Neoplasias , Fadiga , Humanos , Processamento de Linguagem Natural , Náusea , Neoplasias/tratamento farmacológico , VômitoRESUMO
This research extracted patient-reported symptoms from free-text EHR notes of colorectal and breast cancer patients and studied the correlation of the symptoms with comorbid type 2 diabetes, race, and smoking status. An NLP framework was developed first to use UMLS MetaMap to extract all symptom terms from the 366,398 EHR clinical notes of 1694 colorectal cancer (CRC) patients and 3458 breast cancer (BC) patients. Semantic analysis and clustering algorithms were then developed to categorize all the relevant symptoms into eight symptom clusters defined by seed terms. After all the relevant symptoms were extracted from the EHR clinical notes, the frequency of the symptoms reported from colorectal cancer (CRC) and breast cancer (BC) patients over three time-periods post-chemotherapy was calculated. Logistic regression (LR) was performed with each symptom cluster as the response variable while controlling for diabetes, race, and smoking status. The results show that the CRC and BC patients with Type 2 Diabetes (T2D) were more likely to report symptoms than CRC and BC without T2D over three time-periods in the cancer trajectory. We also found that current smokers were more likely to report anxiety (CRC, BC), neuropathic symptoms (CRC, BC), anxiety (BC), and depression (BC) than non-smokers.
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Neoplasias da Mama , Neoplasias Colorretais , Diabetes Mellitus Tipo 2 , Algoritmos , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Análise por Conglomerados , Neoplasias Colorretais/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , HumanosRESUMO
OBJECTIVES: To evaluate (a) the prevalence of genitourinary symptoms, (b) which demographic and clinical factors predict genitourinary symptoms, and (c) the association between genitourinary symptoms and sexual functioning in breast cancer survivors. SAMPLE & SETTING: A secondary analysis of cross-sectional, patient-reported outcomes data from 1,085 breast cancer survivors was conducted. METHODS & VARIABLES: Prevalence and correlations with demographics, clinical factors, and sexual functioning were identified using descriptive analysis, multivariable logistic regression analysis, chi-square tests, t tests, and Pearson correlation coefficients. RESULTS: Symptoms included vaginal/vulvar irritation, pelvic discomfort, problems with urinary control, vaginal infection, and vaginal bleeding. Younger age, more comorbidities, and taking treatment for menopausal symptoms were significantly related to reporting genitourinary symptoms. Experiencing more symptoms was associated with lower sexual functioning. IMPLICATIONS FOR NURSING: The prevalence, correlates, and relationship of genitourinary symptoms with sexual functioning supports the assessment and treatment of these symptoms as part of routine care for breast cancer survivors.