Caregivers of patients with cancer fatigue: a high level of symptom burden.

Fatigue is the problematic symptom identified by patients with cancer. However, fatigue has not been widely examined in caregivers of patients with cancer. In this study, 131 caregivers of patients diagnosed with advanced stage cancer and actively receiving radiotherapy reported experiencing the most difficulties with fatigue (mean 46.9; on a 0-100 scale, with a 10-point difference having clinical meaning) at baseline and at a 6-month follow-up (mean 48.3). This is in sharp contrast to other domains of quality of life and functioning being rated in the 60s, 70s and 80s by the caregivers of patients with cancer. Given the level of fatigue reported by the caregivers of patients with cancer, if confirmed by other investigators in larger and more diverse samples, interventions targeting caregiver fatigue should be explored.

Complementary therapies and integrative medicine in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

BACKGROUND: Physicians are often asked about complementary therapies by patients with cancer, and data show that the interest in and use of these therapies among patients with cancer is common. Therefore, it is important to assess the current evidence base on the benefits and risks of complementary therapies (modalities not historically used in modern Western medicine). METHODS: A systematic literature review was carried out and recommendations were made according to the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines development methodology. RESULTS: A large number of randomized controlled trials, systematic reviews, and meta-analyses, as well as a number of prospective cohort studies, met the predetermined inclusion criteria. These trials addressed many different issues pertaining to patients with lung cancer, such as symptoms of anxiety, mood disturbance, pain, quality of life, and treatment-related side effects. The available data cover a variety of interventions, including acupuncture, nutrition, mind-body therapies, exercise, and massage. The body of evidence supports a series of recommendations. An evidenced-based approach to modern cancer care should integrate complementary therapies with standard cancer therapies such as surgery, radiation, chemotherapy, and best supportive care measures. CONCLUSIONS: Several complementary therapy modalities can be helpful in improving the overall care of patients with lung cancer.

Physical activity level and quality of life in long term lung cancer survivors.

PURPOSE: Lung cancer is associated with a multitude of challenges, and lung cancer survivors report significantly lower quality of life (QOL) than other cancer survivors. METHODS: This study aimed to examine the relationship between physical activity level and QOL in a large sample of long term lung cancer survivors (N=1937). Average age at diagnosis was 65 years, 92% were Caucasian, and 51% male. Surveys were completed at lung cancer diagnosis and then average 4.2 years post-diagnosis. RESULTS: Most survivors reported having a sedentary lifestyle at both timepoints. However, 256 survivors reported a change in physical activity level from diagnosis to follow-up. Decreased physical activity (n=140) was associated with decreased overall, mental, physical, emotional, social, and spiritual QOL (all ps<.001) and decreased symptom control as seen in reported pain, dry coughing, coughing with phlegm, shortness of breath, and level of fatigue (all ps<.05). In contrast, increased physical activity (n=116) was associated with improved QOL (all ps<.05), and improved symptom control as seen in frequency and severity of pain (p<.01). For all participants, those engaging in regular physical activity (30 min or more per day, at least five days per week) reported significantly higher QOL scores (all ps<.001), and better symptom control than more sedentary survivors. CONCLUSIONS: Results indicate a significant association between change in physical activity and QOL and symptom control for long term lung cancer survivors, and research exploring interventions designed to improve activity level for lung cancer survivors is further warranted.

SNPs in PTGS2 and LTA predict pain and quality of life in long term lung cancer survivors.

PURPOSE: Lung cancer survivors report the lowest quality of life relative to other cancer survivors. Pain is one of the most devastating, persistent, and incapacitating symptoms for lung cancer survivors. Prevalence rates vary with 80-100% of survivors experiencing cancer pain and healthcare costs are five times higher in cancer survivors with uncontrolled pain. Cancer pain often has a considerable impact on quality of life among cancer patients and cancer survivors. Therefore, early identification, and treatment is important. Although recent studies have suggested a relationship between single nucleotide polymorphisms (SNPs) in several cytokine and inflammation genes with cancer prognosis, associations with cancer pain are not clear. Therefore, the primary aim of this study was to identify SNPs related to pain in lung cancer survivors. PATIENTS AND METHODS: Participants were enrolled in the Mayo Clinic Lung Cancer Cohort upon diagnosis of their lung cancer. 1149 Caucasian lung cancer survivors (440 surviving <3 years; 354 surviving 3-5 years; and 355 surviving >5 years) completed study questionnaires and had blood DNA samples available. Ten SNPS from PTGS2 and LTA genes were selected based on the serum-based studies in the literature. Outcomes included pain, and quality of life as measured by the SF-8. RESULTS: Of the 10 SNPs evaluated in LTA and PTGS2 genes, 3 were associated with pain severity (rs5277; rs1799964), social function (rs5277) and mental health (rs5275). These results suggested both specificity and consistency of these inflammatory gene SNPs in predicting pain severity in lung cancer survivors. CONCLUSION: These results provide support for genetic predisposition to pain severity and may aid in identification of lung cancer survivors at high risk for morbidity and poor QOL.

Pilates for breast cancer survivors.

Pilates has been advocated for rehabilitation of breast cancer survivors despite little scientific evidence. The authors of this article have examined the feasibility of a Pilates program in postmastectomy breast cancer survivors and the impact on physical and psychological parameters. Fifteen breast cancer survivors were recruited in a one-arm study of 12 weeks of Pilates exercises. The authors assessed recruitment, adherence, and attrition, and measured changes in shoulder and neck range of motion, posture, height, arm volume, quality of life, mood, and body image from pre- to postintervention. Of 26 eligible patients, 15 enrolled, 13 completed the study, and 10 performed more than 50% of the recommended sessions. Statistically significant improvements emerged for shoulder abduction and internal rotation on the affected side, neck rotation toward the unaffected side, and neck flexion. The affected side arm volume and the interlimb volume discrepancy increased. Significant improvements were reported in quality of life, mood, and body image. The improvements in physical and psychological outcomes are promising and deserve further evaluation in a randomized, controlled study. The increase in affected arm volume also warrants additional investigation.

Health behaviors among cancer survivors receiving screening mammography.

OBJECTIVES: The purpose of this study was to evaluate the prevalence of cancer-related behavioral risk factors among female cancer survivors, relative to women without a previous diagnosis of cancer. METHODS: In a large cohort of 19,948 women presenting for screening mammography, questionnaires on health behaviors were administered. RESULTS: A total of 18,510 had detailed history on health behaviors and previous cancer history. Overall 2713 (14.7%) reported a previous cancer history. We found statistically significant results indicating that cancer survivors were less likely than those with no cancer history to: report their overall health as "excellent" (13.6% vs. 21.5%), to engage in moderate or strenuous exercise (56.5% vs. 63.3%), and to use complementary and alternative medicine (57.4% vs. 60.2%). Conversely, cancer survivors were more likely to be current smokers (6.3% vs. 5.5%), rate their overall health as "poor" (15.8% vs. 9.1%), and to report more weight gain over time. Among cancer survivors, differences also emerged by the type of primary cancer. For example, cervical cancer survivors (n = 370) were most likely to report being current smokers (15.7%) and regular alcohol users (71.7%) compared with other survivors. Ovarian (n = 185) and uterine (n = 262) cancer survivors most frequently reported being obese (41% and 34.4%, respectively). Cervical cancer survivors reported the largest weight gain (4.9 lbs at 5 y and 13.4 lbs at 10 y). CONCLUSIONS: These results suggest opportunities for tailored behavioral health risk factor interventions for specific populations of cancer survivors.

Complementary and alternative medicine: use and disclosure in radiation oncology community practice.

PURPOSE: The aims of this study were to evaluate the frequency of complementary and alternative medicine (CAM) use among radiation oncology patients, the coping strategies that influenced this use, and the rates of disclosure of CAM use to their healthcare providers. METHODS: One hundred fifty-three patients undergoing radiation therapy for various neoplasms at rural cancer centers in Minnesota completed the Mayo Complementary and Alternative Medicine Use Survey and the Coping Inventory for Stressful Situations questionnaires. Data regarding CAM use was also compared with provider consultation notes in the medical record at the onset of radiation therapy to determine rates of patient disclosure of CAM use to their healthcare providers. RESULTS: A total of 153 participants completed the study with 61.4% females and 38.6% males and a mean age of 64.9 years. The two most frequent diagnoses of participants were breast cancer (43.8%) and prostate cancer (22.9%). CAM use was reported in 95% of the participants and was categorized into three domains: treatments and techniques, vitamins, and herbs and supplements. The three most frequently reported treatments and techniques were spiritual healing/prayer (62.1%), exercise (19.6%), and music (17.6%). The top three most frequently used biologically based CAM therapies were multivitamins (48.1%), calcium (37.3%), and vitamin with minerals (21.5%). The most frequently used herbs and other dietary supplements were fish oil (19.0%), flaxseed (15.0%), glucosamine (15.0%), and green tea (15.0%). The most common reason cited for CAM treatments and techniques use was previous use (26.1%), for use of vitamins and minerals was recommendation by a physician (33.0%), and for use of herbs and other supplements was previous use (19.0%). One hundred twelve participants reported taking vitamins, minerals, or supplements, and 47% of those 112 did not disclose this use to their providers. CONCLUSIONS: Consistent with previous research, our study found that the majority of cancer patients used CAM treatments. Spiritual healing/prayer was the most commonly reported, followed by multivitamins. Patients reported using CAM primarily due to previous use and physician recommendation. Unfortunately, disclosure of CAM use to healthcare providers was relatively low.

Relationship between cytokine gene single nucleotide polymorphisms and symptom burden and quality of life in lung cancer survivors.

BACKGROUND: Previous research has demonstrated that many lung cancer survivors report difficulties with symptom control and experience a poor quality of life (QOL). Although recent studies have suggested a relationship of single nucleotide polymorphisms (SNPs) in several cytokine genes with cancer susceptibility and prognosis, associations with symptom burden and QOL have not been examined. The current study was conducted to identify SNPs related to symptom burden and QOL outcomes in lung cancer survivors. METHODS: All participants were enrolled in the Mayo Clinic Lung Cancer Cohort following diagnosis of lung cancer. A total of 1149 Caucasian lung cancer survivors completed questionnaires and had genetic samples available. The main outcome measures were symptom burden as measured by the Lung Cancer Symptom Scale and health-related QOL as measured by the Short-Form General Health Survey. RESULTS: Twenty-one SNPs in cytokine genes were associated with symptom burden and QOL outcomes. Our results suggested both specificity and consistency of cytokine gene SNPs in predicting outcomes. CONCLUSIONS: These results provide support for genetic predisposition to QOL and symptom burden and may aid in identification of lung cancer survivors at high risk for symptom management and QOL difficulties.

A randomized clinical trial of alternative stress management interventions in persons with HIV infection.

Research in psychoneuroimmunology suggests that immunosuppression associated with perceived stress may contribute to disease progression in persons with HIV infection. While stress management interventions may enhance immune function, few alternative approaches have yet been tested. This randomized clinical trial was conducted to test effects of three 10-week stress management approaches--cognitive-behavioral relaxation training (RLXN), focused tai chi training (TCHI), and spiritual growth groups (SPRT)--in comparison to a wait-listed control group (CTRL) among 252 individuals with HIV infection. Using repeated measures mixed modeling, the authors found that in comparison to the CTRL group, (a) both the RLXN and TCHI groups used less emotion-focused coping, and (b) all treatment groups had augmented lymphocyte proliferative function. Despite modest effects of the interventions on psychosocial functioning, robust findings of improved immune function have important clinical implications, particularly for persons with immune-mediated illnesses.

Motivational readiness for physical activity and quality of life in long-term lung cancer survivors.

Little is known about the relationship between motivational readiness for physical activity and quality of life (QOL) in long-term lung cancer survivors. Long-term survivors are considered those who are living 5 years or more following a cancer diagnosis. This project examined the relationship between a self-report measure of motivational readiness for physical activity and QOL in a sample of 272 long-term lung cancer survivors. Participants (54% male, average age 70 years old) completed the mailed survey an average of 6 years after being diagnosed with lung cancer. Survey measures included the stage of change for physical activity and a set of single item QOL and symptom scales. Thirty-seven percent of respondents reported they currently engaged in regular physical activity (a total of 30 min or more per day, at least 5 days per week). Kruskal-Wallis tests revealed that those who reported engaging in regular physical activity reported a better overall QOL, better QOL on all five domains of QOL functioning (mental, physical, social, emotional, and spiritual), and fewer symptoms compared to those with a sedentary lifestyle. Physical activity level may have important QOL and symptom management benefits for long-term lung cancer survivors.

Sleep disturbances in caregivers of patients with end-stage congestive heart failure: Part II--assess and intervene.

Sleep disturbances in caregivers of patients with congestive heart failure is common. The consequences of sleep disturbances are dire and have potential to seriously impact caregiver health and patient outcomes. Therefore, it is imperative that the health care team, especially nurses, assess and intervene. Basic assessment of caregiver sleep disturbance can be quick and simple and can be performed while assessing the congestive heart failure patient's health. If a more complex sleep disorder is suspected, other assessments can be conducted if time and money permit. The benefits to properly assessing sleep disturbance and subsequent treatment far outweigh the minimal time spent by the health care team or caregiver.

Sleep disturbances in caregivers of patients with end-stage congestive heart failure: Part I--The problem.

Up to 90% of caregivers report sleep disturbances, particularly congestive heart failure (CHF) caregivers. Sleep disturbances have numerous consequences that can negatively impact a wide domain of outcomes in both the caregiver and the patient for whom they care. Ultimately, these disturbances can lead to caregiver morbidity and CHF patient morbidity, readmission, and mortality. Nurses play a central role in patient education, especially with caregivers. Therefore, nurses can help to educate caregivers on the consequences of stress-related sleep disturbances, which are very prevalent in CHF caregivers.

Subglottic secretion viscosity and evacuation efficiency.

Ventilator-associated pneumonia (VAP) is a common nosocomial pneumonia that occurs in critically ill patients and results in mortality rates as high as 71%. Subglottic secretions (SSs) are a known risk factor. Several clinical trials have shown that continuous aspiration of subglottic secretions (CASS) reduces the risk of VAP by nearly half. Optimal suction pressure levels needed to efficiently evacuate viscous SSs are unknown. The purpose of this study was to describe SSs and the effective suction pressure (20 mmHg, 30 mmHg, 40 mmHg, and 50 mmHg) needed to maximize evacuation efficiency based on SS volume (2 ml, 4 ml, and 6 ml) and viscosity (watery, thick, and gel-like). A laboratory model was designed to replicate a human trachea. Thick secretions had the highest percentage of mean recovery representative of evacuation efficiency of SSs (mean recovery of 86%). The suction pressure of 30 mmHg had the highest overall mean of secretion recovery (83%) across all viscosity types and amounts. This study demonstrated that higher viscosity secretions were easier to evacuate than lower viscosity secretions when 30-mmHg suction pressure was applied. Management of secretion viscosity may assist in secretion removal and delay VAP development. With increased understanding of the molecular structure of SSs, there is the potential that clinicians will be able to manipulate secretion viscoelastic properties to maximize evacuation efficiency of the secretions. Further research is needed to identify safe suction pressures for optimal evacuation of SSs in human subjects.

Innovative interventions for disordered eating: evaluating dissonance-based and yoga interventions.

OBJECTIVE: Eating-disordered behavior is prevalent among college women. Few interventions have successfully reduced risk factors for these behaviors, however. The most promising interventions are both selective and interactive. This study compared two newer types of interventions that meet these criteria: cognitive dissonance and yoga programs. METHOD: This study advertised programs for women who were dissatisfied with their bodies. Participants (N = 93) were randomly assigned to dissonance, yoga, or control groups. RESULTS: Hierarchical regression analyses revealed that there were no significant post-intervention differences between the yoga and control groups. Dissonance group participants had significantly lower scores than the scores of both other groups on measures of disordered eating, drive for thinness, body dissatisfaction, alexithymia, and anxiety. CONCLUSION: These findings have important implications for interventions on college campuses. In particular, dissonance interventions appear to be an efficient and inexpensive approach to reducing eating disorder risk factors. Additional research regarding the value of yoga interventions is needed.

Factor structure of the Smith irrational beliefs inventory: results of analyses on six independent samples.

This study reports the results of six factor analyses (alpha factoring, direct oblimin rotation, Delta= .4) on six items from the Smith Irrational Beliefs Inventory. Six independent samples of 1851 college students (521 men, 1,280 women, 50 sex unstated) were tested. Three factors emerged with identical content for each analysis. Distorted Egocentrism was defined by two items reflecting feelings of entitlement and the naive assumption that events should always turn out favorably the way one desires; Task Exaggeration/Catastrophizing was defined by two items directly depicting a tendency to view challenges as overwhelming and catastrophic; and Isolated Low Self-esteem was defined by two items expressing the feeling that one has unacceptable feelings that could lead to isolation or rejection. Previous research on other irrational belief inventories has yielded inconsistent results, with multifactorial solutions emerging for clinical samples and unifactoral solutions for student samples. That the present six factor analytic studies yielded a consistent multifactoral set of irrational beliefs for a very large student sample suggests that factors do emerge when items are initially screened and the subject population is carefully defined.