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Depressive symptoms are common in women with breast cancer. This study evaluated how ratings of depressive symptoms changed from the time of the preoperative assessment to 6 months after surgery and investigated whether specific demographic, clinical, and symptom characteristics predicted preoperative levels of and/or characteristics of the trajectories of depressive symptoms. Characteristics that predicted higher preoperative levels of depressive symptoms included being married/partnered; receipt of adjuvant chemotherapy; more fear of metastasis; higher levels of trait anxiety, state anxiety, sleep disturbance, problems with changes in appetite; more hours per day in pain; and lower levels of attentional function. Future studies need to evaluate associations between anxiety, fears of recurrence, and uncertainty, as well as personality characteristics and depressive symptoms.

The purposes of this study were to identify distinct subgroups of patients based on self-reported sleep disturbance prior to through 6 months after breast cancer surgery and evaluate for differences in demographic, clinical, and symptom characteristics among these latent classes. Women (n = 398) who underwent unilateral breast cancer surgery were enrolled prior to surgery. Patients completed measures of functional status, sleep disturbance (i.e., General Sleep Disturbance Scale (GSDS); higher scores indicate higher levels of sleep disturbance), fatigue, attentional fatigue, depressive symptoms, and anxiety prior to surgery and monthly for 6 months. Three distinct classes of sleep disturbance trajectories were identified using growth mixture modeling. The high sustained class (55.0%) had high and the low sustained class (39.7%) had low GSDS scores prior to surgery that persisted for 6 months. The decreasing class (5.3%) had high GSDS score prior to surgery that decreased over time. Women in the high sustained class were significantly younger, had more comorbidity and poorer function, and were more likely to report hot flashes compared to the low sustained class. More women who underwent mastectomy or breast reconstruction were in the decreasing class. Decreasing and high sustained classes reported higher levels of physical fatigue, attentional fatigue, depressive symptoms, and anxiety compared to the low sustained class. A high percentage of women has significant sleep disturbance prior to surgery that persists during subsequent treatments (i.e., radiation therapy and chemotherapy). Clinicians need to perform routine assessments and initiate appropriate interventions to improve sleep prior to and following surgery.

Purpose In a sample of family caregivers (FCs) of patients with prostate cancer who were to begin radiation therapy (RT), the purposes were to determine the prevalence and severity of depression, anxiety, pain, sleep disturbance, and fatigue; determine the relationships among these symptoms and between these symptoms and functional status and quality of life (QOL); evaluate for differences in functional status and QOL between FCs with low and high levels of these symptoms; and determine which factors predicted FCs’ functional status and QOL. Patients and Methods FCs were recruited before patients initiated RT and completed self-report questionnaires that evaluated demographic characteristics, symptoms, functional status, and QOL. Results Sixty female FCs participated in the study. On the basis of established cut point scores for each symptom questionnaire, 12.2% of the FCs had clinically meaningful levels of depression, 40.7% anxiety, 15.0% pain, 36.7% sleep disturbance, 33.3% morning fatigue, and 30.0% evening fatigue. FCs who were older and who had lower levels of state anxiety and higher levels of depression, morning fatigue, and pain reported significantly poorer functional status (R2 = 38.7%). FCs who were younger, had more years of education, were working, and who had higher levels of depression, morning fatigue, sleep disturbance, and lower levels of evening fatigue reported significantly lower QOL scores (R2 = 70.1%). Conclusion A high percentage of FCs experienced clinically meaningful levels of a variety of symptoms. These symptoms have a negative impact on the FCs’ functional status and QOL.

While chronic pain is experienced by approximately 50-90% of patients with metastatic cancer, little is known about sex differences in chronic cancer pain. Therefore, the purposes of this study, in a sample of oncology outpatients (n=187) who were experiencing pain from bone metastasis, were: 1) to determine if there were sex differences in various pain characteristics, including pain intensity, and 2) to determine if there were sex differences in the prescription and consumption of analgesic medications. No significant sex differences were found in any of the baseline pain characteristics. In addition, no significant sex differences were found in analgesic prescriptions or intake of analgesic medications. Of note, men reported significantly higher pain interference scores for sexual activity than women. The study findings are important because they suggest that, unlike in acute pain, sex may not influence patients' perceptions of and responses to chronic cancer pain.

Around-the-clock (ATC) dosing of opioid analgesics is the established approach for the management of chronic cancer pain. The purposes of this study were to determine whether there were differences in pain intensity scores and pain duration between oncology outpatients who were taking opioid analgesics on an around-the-clock (ATC) compared with an as needed (PRN) basis and to determine differences in opioid prescription and consumption between the 2 groups during a period of 5 weeks. Oncology patients (n = 137) with pain from bone metastasis were recruited from 7 outpatient settings. Patients completed a demographic questionnaire and on a daily basis recorded pain intensity scores and medication intake in a diary. No significant differences in average, least, or worst pain intensity scores or number of hours per day in pain were found between the 2 groups. However, the average total opioid dose, prescribed and taken, was significantly greater for the ATC group than for the PRN group. These findings suggest the need for further investigations in the following areas: the appropriate treatments for pain related to bone metastasis, the use of various pain measures to evaluate the effectiveness of analgesic medications, and the need to evaluate how analgesics are prescribed and titrated for patients with cancer-related pain. © 2002 by the American Pain Society

Evidence for chemotherapy-induced cognitive impairment remains inconclusive. This study was designed to determine the trajectory of cognitive function over time in women with breast cancer, who received doxorubicin and cyclophosphamide (AC) alone or followed by a taxane. Associations between changes in cognitive function and potential covariates including anxiety, depression, fatigue, hemoglobin level, menopausal status, and perception of cognitive function were evaluated. The Repeatable Battery for the Assessment of Neuropsychological Status, Stroop Test, and Grooved Pegboard were used to assess cognitive function in a group of 71 women prior to chemotherapy, a week after completing the last cycle of AC, as well as 1 week and 6 months after the completion of all chemotherapy. Cognitive impairment was found in 23% of women prior to chemotherapy. Hierarchical linear modeling showed significant decreases after receiving chemotherapy followed by improvements 6 months after the completion of chemotherapy in the cognitive domains of visuospatial skill (p

Goals of workThe goals of the study were to determine the occurrence rates for and the severity of symptoms at the middle, end, and 1 month after the completion of radiation therapy (RT), to determine the number and types of symptom clusters at these three time points, and to evaluate for changes over time in these symptom clusters.Materials and methodsSymptom occurrence and severity were evaluated using the Memorial Symptom Assessment Scale (MSAS) in a sample of patients (n = 160) who underwent RT for breast or prostate cancer. At each time point, an exploratory factor analysis was done to determine the number of symptom clusters (i.e., symptom factors) based on the MSAS symptom severity ratings.Main resultsThe majority of the patients were male and married with a mean age of 61.1 years. The five symptoms with the highest occurrence rates across all three time points were lack of energy, pain, difficulty sleeping, feeling drowsy, and sweats. Although the number of symptoms and the specific symptoms within each symptom cluster were not identical across the three time points, three relatively similar symptom clusters (i.e., "mood-cognitive" symptom cluster, "sickness-behavior" symptom cluster, "treatment-related", or "pain" symptom cluster) were identified in this sample. The internal consistency coefficients for the mood-cognitive symptom cluster and sickness-behavior symptom cluster were adequate at > or =0.68.ConclusionsThree relatively stable symptom clusters were found across RT. The majority of the symptom cluster severity scores were significantly higher in patients with breast cancer compared to patients with prostate cancer.

20671 Background: Oral mucositis is a major side effect of radiation therapy (RT) to the head and neck. Few studies have reported the correlations of prevalent symptoms, quality of life (QOL), and functional status in this population. The purpose of this study is to increase our understanding of these issues. Methods: In this clinical trial testing an innovative mouthwash, symptoms (Symptom Checklists), functional status (Karnofsky Functional Status [KPS]), quality of life (QOL-CA), and the Oral Mucositis Assessment Scale (OMAS) subjective pain score were measured at four times (beginning of RT [T1], onset of mucositis [T2], end of RT [T3], and healing of mucositis [T4]) over an approximate 10-12 week period. Results: Forty-three head and neck cancer patients were enrolled at T1: 78% male, 62% white, 67% married; 15.3 mean education years; 44% employed full time; 58% squamous cell carcinoma; 98% received IMRT, 6463.9 cGY mean total radiation dose, 56% received concurrent CTX. Mean days to onset of mucosit...

Little is known about how cancer patients manage the side effects of chemotherapy, so 48 cancer patients in chemotherapy were randomized into four groups to determine their self-care behaviors. The first group received drug information only; the second group received information on side-effect management techniques (SEMT); the third group received combined drug and SEMT information; the fourth group were controls. Pre- and postintervention scores on chemotherapy knowledge, self-care behavior, and general affective state were evaluated by analysis of covariance. Patients who received drug information alone or in combination with other information had higher chemotherapy knowledge scores. Patients who received SEMT information alone or in combination with other information performed more self-care behaviors. Although an additive effect of combined information was noted, i.e., patients who received both types of information showed improved chemotherapy knowledge and self-care behaviors, the combined information did not produce a significantly improved affective state.