Symptoms, Cytokines, and Quality of Life in Patients Diagnosed with Chronic Graft-Versus-Host Disease Following Allogeneic Hematopoietic Stem Cell Transplantation.

PURPOSE/OBJECTIVES: To describe associations among symptoms, cytokines, and quality of life (QOL) of patients with chronic graft-versus-host disease (cGVHD). DESIGN: Prospective, cross-sectional, cohort. SETTING: The bone marrow transplantation unit at a National Cancer Institute-designated cancer center in Virginia.
 SAMPLE: 24 adults diagnosed with cGVHD. METHODS: Data were collected for demographic factors, symptoms, and QOL from medical record and validated questionnaires. Serum was analyzed for cytokine levels. MAIN RESEARCH VARIABLES: cGVHD, symptoms, cytokines, C-reactive protein, and QOL.
 FINDINGS: Participants reported multiple, concurrent symptoms. Cytokine levels were higher in participants with symptoms versus those without symptoms. Cytokine interleukin-6 correlated with lack of energy and dry mouth. Negative correlations were noted between QOL and symptoms. CONCLUSIONS: Findings demonstrated multiple concurrent symptoms present in this sample and significant relationships among symptoms, cytokines, and QOL. IMPLICATIONS FOR NURSING: cGVHD is a serious condition affecting QOL in many individuals after bone marrow transplantation for many different cancers. Results from this pilot study indicate that patients experience multiple symptoms, including sexual dysfunction, that adversely affect QOL. Better understanding of the interrelated symptoms of cGVHD and the biomarkers associated with these symptoms may lead to targeted symptom management interventions.

Perceptions of Distress in Women with Ovarian Cancer.

PURPOSE/OBJECTIVES: To explore women's experience of distress by asking "What do women with ovarian cancer want their spouse or significant other, family, friends, and healthcare providers to know about their experience of distress during diagnosis and treatment?" RESEARCH APPROACH: Modified Glaserian grounded theory. SETTING: An urban setting in the Mid-Atlantic region of the United States. PARTICIPANTS: 12 women, aged 21-71 years, diagnosed with and treated for ovarian cancer. METHODOLOGIC APPROACH: Constant comparative analysis of data obtained by audio recorded interviews. FINDINGS: Although individual experiences differed, abstraction and conceptualization of the data supported a theory of existential assault. Participants found that the diagnosis was shocking and came "out of the blue like lightning." Their responses included seeking the best physician and treatment available, described as "no stone left unturned." Information about the disease was welcomed and unwelcomed as they shared the experience of "knowing what I don't want to know and not knowing what I want to know," and then had the added experience of sharing that information with those in their social network. Interpersonal interactions were described as "watching you watching me--we are both afraid," and "talking yet not talking about death," resulting in relationship changes and the realization that "now I have to take care of me." CONCLUSIONS: Participants experienced diagnosis with and treatment for ovarian cancer as an existential assault that, with the potential for an early death, affected the individual and her relationships. INTERPRETATION: Previous studies have suggested that women diagnosed with and treated for ovarian cancer experience distress. This study reports women's perceptions of their own distress.