Research Trends on Factors Influencing the Quality of Life of Cancer Survivors:Text Network Analysis and Topic Modeling Approach

Purpose@#This study aimed to identify the major keywords and the structure of the networks for each major topic to gain knowledge on factors influencing the quality of life of cancer survivors using Text Network Analysis (TNA) and topic modeling. @*Methods@#The study was conducted in four steps:(1) collecting abstracts, (2) text preprocessing in Python, (3) building a co-occurrence matrix, and (4) analyzing network features and clustering topic groups. From 2010 to 2020, 133 studies related to factors affecting the quality of life of cancer survivors were collected from several databases (PubMed, Embase, Cochrane, CINAHL RISS, KoreaMed, KISS). @*Results@#As a result of analyzing 9,968 evaluation results on “breast cancer,” “female,” “depression,” “treatment,” “age,” “questionnaire,” “symptom,” and “diagnosis,” five topics were derived after topic modeling considering coherence score and perplexity score. The main themes were breast cancer survivor, symptom experience, colon cancer survivor, psycho-social factors, and lifestyle and health management. @*Conclusion@#Based on the results of this study, symptoms such as depression, physical activity, and lifestyle and health management are significant factors affecting the quality of life of cancer survivors.

Incidence and Risk Factors of Cardio-Cerebrovascular Disease in Korean Menopausal Women: A Retrospective Observational Study using the Korean Genome and Epidemiology Study data

Purpose@#Cardio-cerebrovascular diseases constitute the most common and fatal disease among menopausal women. However, the risk of cardio-cerebrovascular diseases in menopausal women compared to men has been underestimated, with insufficient related studies. Therefore, we examined the incidence and risk factors of cardio-cerebrovascular diseases among Korean menopausal women. @*Methods@#A retrospective observational study design with secondary analysis was conducted using data from the Korean Genome and Epidemiology Study survey. We used the study’s data of 1,197 menopausal women, aged 40–64 years, who did not have cardio-cerebrovascular diseases at baseline and their related data from the biennial follow-ups over 14 years. Cardio-cerebrovascular diseases were defined as hypertension, coronary artery disease, or stroke. The incidence of cardio-cerebrovascular diseases was calculated per person-years, and multivariate Cox proportional hazards models were used to determine the predictors of cardio-cerebrovascular diseases during the follow-up period. @*Results@#Of the 1,197 cases, 264 were early or surgical menopausal women. The overall incidence of cardio-cerebrovascular diseases was 18.75 per 1,000 person-years. Early or surgical menopause (HR = 4.32, p < .001), along with family history of cardiovascular disease (HR = 1.87, p = .024), elevated blood pressure (HR = 1.79, p < .001), abdominal obesity (HR = 1.37, p = .046), or duration of menopause at the same age (HR = 1.01, p = .001), were strong predictors of cardio-cerebrovascular diseases. @*Conclusion@#Based on the results of this study, it is necessary to identify and closely monitor women with early or surgical menopause for cardiovascular and cerebrovascular diseases prevention. Also, prevention of cardio-cerebrovascular diseases through blood pressure and abdominal obesity management is vital for menopausal women.

Validity and Reliability of the Korean Version of the Menopause-Specific Quality of Life

Purpose@#This study aimed to evaluate the validity and reliability of the Korean version of Menopause-Specific Quality of Life (MENQOL). @*Methods@#The MENQOL was translated into Korean according to algorithm of linguistic validation process. A total of 308 menopausal womenwere recruited and assessed using the Korean version of MENQOL (MENQOL-K), the World Health Organization Quality of Life BriefVersion (WHOQOL-BREF), and Center for Epidemiological Studies Depression Scale (CES-D-K). In estimating reliability, internal consistencyreliability coefficients were calculated. Validity was evaluated through criterion validity and construct validity with confirmatory factor analysesusing SPSS 23.0 and AMOS 25.0 software. @*Results@#In item analyses, the “increased facial hair” symptom was excluded because of thelow contribution of MENQOL-K. The confirmatory factor analysis supported good fit and reliable scores for MENQOL-K model, and thefour-factor structure was validated (x2=553.28, p <.001, NC=1.84, RMSEA=.05, AGIF=.85, AIC=765.28). The MENQOL-K consists of 28 itemsin 4 domains, including vasomotor (3 items), psychosocial (7 items), physical (15 items), and sexual subscales (3 items). There was an acceptablecriterion validity with moderately significant correlation between MENQOL-K and WHOQOL-BREF. The Cronbach’s a for the 4subsacles ranged from .80 to .93. @*Conclusion@#The MENQOL-K is a valid and reliable scale to measure condition-specific quality of life forperimenopausal and postmenopausal women. It can be used to assess the impact of menopausal symptoms on the quality of life of Koreanwomen in clinical trials.

Menopausal Symptoms and Quality of Life Among Breast Cancer Patients with Chemotherapy-induced Amenorrhea

PURPOSE: The aim of this study was to evaluate the severity of menopausal symptoms and their impact on the quality of life (QOL) in breast cancer patients with chemotherapy-induced amenorrhea. METHODS: A cross-sectional survey design was used. Participants were 112 breast cancer patients with chemotherapy-induced amenorrhea. They completed the Menopause Rating Scale (MRS) and the Functional Assessment of Cancer Therapy-General (FACT-G). Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation coefficients, and multiple regression with SPSS/WIN 23.0. RESULTS: The prevalence of symptoms among the participants were as follows: sleep problems, 88.4%; physical and mental exhaustion, 80.4%; joint and muscular discomfort, 76.8%; and depression, 70.5%. Menopausal symptoms had a significant negative association with QOL. The results of the regression analysis showed that psychological and urogenital symptoms were statistically significant in explaining patients' QOL and accounted for 70% of the total variance. CONCLUSION: Menopausal symptoms appear to be a significant problem for premenopausal breast cancer patients. Assessment and control of menopausal symptoms played a large role in maintaining the quality of life in breast cancer patients.

Psychoeducational Approach to Distress Management of Newly Diagnosed Patients with Breast Cancer

PURPOSE: The purpose of this study was to examine the effects of integrated psychoeducational program for distress management of newly diagnosed patients with breast cancer. METHODS: A quasi-experimental trial was conducted. The participants consisted of 47 female patients with breast cancer assigned to an intervention group (n=25) and control group (n=22). The intervention group participated in integrated psychoeducational program, consisting of individual face-to-face education and telephone-delivered health-coaching sessions. Data were collected at three time points: pre-intervention (T1), post-intervention (T2), and 6-month follow-up (T3). Study instruments were Distress thermometer, Supportive Care Needs Survey Short Form 34 and Functional Assessment of Cancer Therapy-Breast. RESULTS: Compared with the control group, breast cancer patients in the intervention group reported lower distress and supportive care needs than the control group. The intervention group reported higher quality of life (QOL) overall and higher emotional well-being than the control group. CONCLUSION: These findings indicate that the integrated psychoeducational program is an effective intervention for reducing distress and supportive care needs and increasing QOL of newly diagnosed patients with breast cancer. Oncology nurses need to provide psychoeducational intervention to support patients with breast cancer in managing their distress and helping them adjust to their life.

Predictors of Psychological Distress Trajectories in the First Year After a Breast Cancer Diagnosis

PURPOSE: Psychological distress is a significant and ongoing problem for breast cancer. These mental health problems are often neglected as they are not always properly understood. This study was performed to explore the trajectory of psychological distress over 1 year since breast cancer surgery and to identify the associated factors for the trajectory. METHODS: One hundred seventeen women who underwent surgery for breast cancer completed the psychological distress thermometer and problem lists from after surgery to 12 months after surgery. Information on their sociodemographic and clinical characteristics was also obtained. Group-based trajectory modeling was performed to identify the distinct trajectories of psychological distress. Chisquare test and logistic regression analysis were performed to determine predictors of psychological distress trajectories. RESULTS: two-group linear trajectory model was optimal for modeling psychological distress (Bayesian information criterion = −777.41). Group-based trajectory modeling identified consistently high-distress (19.4%) and low-decreasing distress (80.6%) trajectories. Old age, depression, nervousness, and pain were significant predictors of consistently high-distress trajectory. CONCLUSION: Our results indicate that distinct trajectory groups can be used as a screening tool to identify patients who may be at an increased risk of psychological distress over time. Screening for psychological distress during disease diagnosis is important and necessary to identify patients who are at an increased risk of elevated distress or at risk of experiencing psychological distress over time.

Effects of Psychoeducational Intervention for Cancer Survivors: A Systematic Review and Meta-Analysis

PURPOSE: This study was a systematic review and meta-analysis designed to investigate effects of psychoeducational intervention for cancer survivors. METHODS: Ten databases were searched. Two reviewers independently performed the selection of the studies, data extraction and assessment. The risk of bias was assessed using Cochrane Collaboration's tool. To estimate the effect size, meta-analysis of the studies was performed using Comprehensive Meta-Analysis and RevMan programs. RESULTS: Of 18,781 publications identified, 35 met inclusion criteria, and 25 studies were used to estimate effect size of psychoeducational intervention. Effect sizes (standardized mean difference [SMD]) were heterogeneous and random effects models were used in the analyses. Psychoeducational intervention was effective for quality of life (n=2,410, ES=0.23; 95% CI: 0.09~0.37), coping and self-efficacy (n=179, ES=0.68; 95% CI: 0.26~1.11), anxiety (n=1,786, ES=-0.26; 95% CI: -0.37~-0.15), depression (n=1,910, ES=-0.28; 95% CI: -0.37~-0.18), and psychological distress (n=2,242, ES=-0.31; 95% CI: -0.46~-0.17). Subgroup analysis showed that counseling was the most effective intervention for quality of life, and behavioral therapy was an effective intervention for all positive and negative outcomes. Publication bias was not detected except for psychological distress. CONCLUSION: Psychoeducational intervention appears to be effective in improving quality of life and coping and self-efficacy, and it is effective in reducing psychological symptoms in cancer survivors. Behavioral therapy, especially, is commonly effective in improving psychosocial outcomes. However, low-quality evidence, variability in the designs of existing studies, and publication bias suggest that additional high-quality trials should be conducted in the future.

Changes of Symptom Distress and Quality of Life in Breast Cancer Patients Receiving Adjuvant Therapy

PURPOSE: The purpose of this study was to identify changes of symptom distress and quality of life (QOL) in breast cancer patients receiving adjuvant therapy. METHODS: 113 patients with breast cancer were administered the Memorial Symptom Assessment Scale-Short Form and the Functional Assessment of Cancer Therapy-Breast before adjuvant therapy, both a week and 6 months after completing adjuvant therapy. 71 patients (CTx group) were treated with adjuvant chemotherapy and radiotherapy. 42 patients (RTx group) received only adjuvant radiotherapy. Data were analysed using the SPSS/Win 21.0 program. RESULTS: Compared with the RTx group, patients in the CTx group reported higher overall symptom distress and physical symptom distress. The CTx group reported lower scores in overall QOL, physical well-being and the breast cancer specific domain than the RTx group. CONCLUSION: Findings from this study support that chemotherapy results in higher risk for more severe symptoms and leads to impaired QOL for breast cancer patients. Comprehensive symptom management should be implemented for breast cancer patients receiving chemotherapy.

Prevalence and Characteristics of Chemotherapy-related Cognitive Impairment in Patients with Breast Cancer

PURPOSE: Evidence suggests that some patients with breast cancer experience cognitive difficulties following chemotherapy. This longitudinal study was done to examine the prevalence of cognitive impairment and trajectory of cognitive function over time in women with breast cancer, who received adjuvant chemotherapy. METHODS: Participants were 137 patients with breast cancer. They completed neuropsychological tests and the Functional Assessment of Cancer Therapy-Cognitive Function before adjuvant therapy (pretest), toward the end of adjuvant therapy (posttest), and 6 months after the completion of adjuvant therapy (follow-up test). Of the patients, 91 were treated with adjuvant chemotherapy and 46 patients who did not receive chemotherapy made up the comparison group. A reliable-change index and repeated-measure ANOVA were used for statistical analyses. RESULTS: At the posttest point, over 30% of patients showed complex cognitive impairment and reported greater difficulty in subjective cognitive function. At the follow-up test point, 22.0% of patients exhibited complex cognitive impairment and 30.8% of patients complained of subjective cognitive impairment. Repeated-measure ANOVA showed significant decreases after receiving chemotherapy followed by small improvements 6 months after the completion of chemotherapy in cognitive domains of change for attention and concentration, memory, executive function, and subjective cognitive function. CONCLUSION: These results suggest that chemotherapy in patients with breast cancer may be associated with objective and subjective cognitive impairments. Further studies are needed to explore the potential risk factors and predictor of chemotherapy-related cognitive changes. Also nursing interventions for prevention and intervention of cognitive impairments should be developed and tested.

Concept Analysis of Health Inequalities / 간호행정학회지

PURPOSE: The purpose of this study was to explore ways to define the concept of health inequality. METHODS: The concept analysis process by Walker and Avant was used to clarify the meaning of health inequality. RESULTS: Defining attributes of health inequality included differences in health status between individuals or groups, infringement of fundamental rights to health, unfair use of medical services, and social discrimination. The antecedents of health inequality included differences in demographic characteristics (age, gender, education, occupation, residential location), limitations in accessibility to health care, and social exclusion. Consequences of health inequality were increased costs for medical care, decreased health-related quality of life, and lack of ability to cope with health problems resulting in crisis situations, increases in morbidity and mortality, and shortening of life span. The concept was clarified through presentation of model, borderline, related, and contrary cases. CONCLUSION: Results of this study can be used to guide the direction of future studies through concept analysis in which conceptual attributes in the context of health inequality are examined. Also, based on the result of this study, development of standardized tools to measure health inequality is recommended as well as development of educational programs to reduce health inequalities.

Factors Influencing Elevated Distress Scores at the End of Primary Treatment of Breast Cancer

PURPOSE: The purpose of this study was to determine the prevalence of distress and to investigate the related problems in breast cancer patients at the end of primary treatment. METHODS: A sample of 118 participants was recruited among outpatients who had successfully completed primary treatment of breast cancer. Data were collected between July, 2013 and October, 2014 using the Distress Thermometer (DT) scale and problem lists. Descriptive statistics and logistic regression analysis were used to analyze data. RESULTS: Among the 118 patients that participated in this study, 34 patients (28.8%) suffered from elevated distress using the previously validated cut point > or =4 for the DT. Problems most frequently encountered were fatigue (68.8%), worry (59.3%), appearance (51.7%) and memory/concentration (48.3%). Multivariate logistic regression analysis revealed that depression (OR=9.55), worry (OR=8.34), fatigue (OR=8.19) and age (OR=1.14) were independent predictors for elevated distress scores. CONCLUSION: Utilizing the DT, onethird of breast cancer patients screened met criteria for distress at the end of the primary treatment. Breast cancer patients with depression, worry, fatigue and older age should be targeted for distress screening and management.

Factors Influencing Human Papillomavirus Vaccination Adoption Stages Based on the Precaution Adoption Process Model

PURPOSE: This study aimed to identify the factors influencing human papillomavirus (HPV) vaccination adoption stages using the Precaution Adoption Process model. METHODS: A total of 173 female university students from B metropolitan city participated. Demographics, factors contributing to action, knowledge, health beliefs, and self-efficacy related to the HPV vaccination were measured. The collected data were analyzed using descriptive statistics and multiple logistic regression analysis using SPSS for Windows version 21.0. RESULTS: Factors that contributed to the transition from the unaware and unengaged stages to the undecided about action stage included age, economic status, experience of recommendation from doctors, perceived severity of cervical cancer, and perceived barriers. Factors that contributed to the transition from the undecided about action stage to the deciding to act stage were perceived benefit and self-efficacy of the HPV vaccination. Factors that contributed to the transition from the deciding to act stage to the acting and maintenance stages were experience of recommendation from doctors and perceived severity of cervical cancer. CONCLUSION: These results suggest that aggressive HPV vaccination campaigns increase awareness. Further studies should develop tailored strategies for promoting HPV vaccination that emphasize health beliefs and self-efficacy.

A Meta-analysis of Chemotherapy related Cognitive Impairment in Patients with Breast Cancer

PURPOSE: The purpose of this study was to evaluate the cognitive effects of chemotherapy in patients with breast cancer. METHODS: Using several databases, prospective studies were collected up to August 2011. Of 2,106 publications identified, 12 met the inclusion criteria, and 8 studies were used to estimate the effect size of chemotherapy on cognitive impairment. RESULTS: Twelve studies were done since 2005 and most of the research was performed in Europe or North America. Eight studies were used to generate effect size across the cognitive domains of attention/concentration, verbal and visual memory, executive function, visuospatial skill, language, and subjective cognitive function. Each of the cognitive domains showed small effect sizes (-0.02 ~ -0.26), indicating diminished cognitive function for the chemotherapy group compared with non-chemotherapy groups. CONCLUSION: Finding suggests that breast cancer patients who undergo chemotherapy may experience mild cognitive decline. Further study is needed to generate knowledge and guideline for interventions to address chemotherapy related cognitive impairment in these patients.

A Systematic Review of Psychological Distress as a Risk Factor for Recurrent Cardiac Events in Patients with Coronary Artery Disease

PURPOSE: The purpose of this study was to determine whether psychological distress is an independent risk factor for recurrent cardiac events in patients with coronary artery disease (CAD). METHODS: A prospective cohort of studies that measured psychological distress and the incidence of recurrent cardiac events in the adult population were included. Three computerized databases were assessed (PubMed, CINAHL, and PSYCINFO). Meta-analysis was conducted using a random-effects model to determine summary estimates of risks of major recurrent cardiac events associated with each psychological distress. Of 506 publications identified, 33 met inclusion criteria, and 24 studies were used to estimate effect size of psychological distress on recurrent cardiac events. RESULTS: Mean number in the research sample was 736 and mean time of follow-up was 4.0 years. Depression, anxiety, anger, and hostility as psychological factors were studied. According to estimation of effect size using random model effect, depression (OR=1.39, 95% CI: 1.22-1.57), anxiety (OR=1.22, 95% CI: 0.96-1.56), and anger/hostility (OR=1.29, 95% CI: 1.07-1.57) CAD patients in significantly increased risk for recurrent cardiac events. CONCLUSION: Finding suggests that psychological distress in forms of depression, anxiety, anger, and hostility impact unfavorably on recurrent cardiac events in CAD patients.

A Comparison of the Health Status and Health Promoting Behaviors between Type D Personality and Non-Type D Personality in Middle aged Women / 여성건강간호학회지

PURPOSE: The purpose of this study is to examine the impact of type D personality on health status and health promoting behaviors in middle-aged women. METHODS: A cross-sectional study design was used with 220 middle aged women. All participants completed 3 measuring tools: a 14-item Type D Personality Scale, a 12-item Short Form Health Survey Questionnaire version 2, and Health Promoting Lifestyle Profile-version II. All were completed in November 2010. RESULTS: The prevalence of type D personality was 34.5%. Type D women had significantly lower physical (p=.020) and mental health status (p<.001) compared with non-type D women. In addition Type D women reported significantly poorer performance of health responsibility (p=.015), physical activity (p=.001), nutrition (p=.027), spiritual growth (p<.001), interpersonal relations (p<.001) and stress management (p<.001) techniques in health behaviors than non-type D women. CONCLUSION: Type D personality is a vulnerability factor that affects health status and is associated with poor health promoting behaviors in middle aged women. Therefore, screening for Type D personality is important to detect women at risk for health status and quality of life in community settings in Korea.

Factors Influencing Learning Achievement of Nursing Students in E-learning

PURPOSE: This study was done to identify self-directed learning readiness, achievement goal orientations, learning satisfaction and learning achievement, and to evaluate the factors affecting learning achievement for nursing students using a web-based Health Assessment e-Book. METHODS: The research design was a cross-sectional study with a structured questionnaire and data were collected before using the web-based Health Assessment e-Book and 1 week after finishing. The participants were 80 nursing students who were taking the Health Assessment class from March to June 2009. RESULTS: Mean score for subjective learning achievement was 31.26 and for objective learning achievement, 69.25. Subjective and objective learning achievement were positively correlated with self-directed learning readiness, mastery goal, attitude toward distance education, and learning satisfaction. In subjective learning achievement, learning satisfaction and mastery goal were significant predictive factors and explained 64% of the variance. Objective learning achievement was significantly predicted by learning satisfaction and self-directed learning readiness, which explained 24% of the variance. CONCLUSION: Learning satisfaction, mastery goal and self-directed learning readiness were found to be very important factors associated with learning achievement for nursing students using a web-based Health Assessment e-Book. To provide high quality and effective web-based courses and to improve nursing students' learning achievement and learning satisfaction, educators should consider the learner's characteristics from the initial stages of lecture planning.

Factors Influencing Relocation Stress Syndrome in Patients Following Transfer from Intensive Care Units

PURPOSE: The purpose of this study was to identify the levels of relocation stress syndrome (RSS) and influencing the stress experienced by Intensive Care Unit (ICU) patients just after transfer to general wards. METHODS: A cross-sectional study was conducted with 257 patients who transferred from the intensive care unit. Data were collected through self-report questionnaires from May to October, 2009. Data were analyzed using the Pearson correlation coefficient, t-test, one-way ANOVA, and stepwise multiple linear regression with SPSS/WIN 12.0. RESULTS: The mean score for RSS was 17.80+/-9.16. The factors predicting relocation stress syndrome were symptom experience, differences in scope and quality of care provided by ICU and ward nursing staffs, satisfaction with transfer process, length of stay in ICU and economic status, and these factors explained 40% of relocation stress syndrome (F=31.61, p<.001). CONCLUSION: By understanding the stress experienced by ICU patients, nurses are better able to provide psychological support and thus more holistic care to critically ill patients. Further research is needed to consider the impact of relocation stress syndrome on patients' health outcomes in the recovery trajectory.

Relations among Health Behaviors, Health Symptoms and Physical Fitness of People in the Same Community

PURPOSE: This study was conducted to identify relations among health behaviors, health symptoms and physical fitness of people in the same community. METHOD: The study was designed as a descriptive survey and the participants were 1,621 healthy people. Data were collected from March to December, 2003 using a structured questionnaire on health behaviors, health symptoms and physical fitness. Data were analyzed by descriptive statistics, chi2-test, t-test, two-way ANOVA, Pearson correlation coefficients and multiple regression using SPSS/PC. RESULTS: The result of multiple regression showed that sex, age, and BMI were related to physical fitness. In health-related physical fitness, regular exercise was related to cardiorespiratory endurance and flexibility, and daily caffeine intake was related to muscular endurance. In performance-related physical fitness, having breakfast regularly was related to power, daily caffeine intake was related to agility, and regular lifestyle and health symptoms were related to balance. CONCLUSION: In conclusion, this study suggests that for better physical fitness, nursing strategies and intervention programs should include physical fitness-related factors, and education programs should be developed based on the above parameters to promote positive perception of physical fitness.