Associations between adjuvant endocrine therapy and onset of physical and emotional concerns among breast cancer survivors.

BACKGROUND: Breast cancer survivors often receive long-term adjuvant endocrine therapy (AET) to reduce recurrence risk. Adherence to AET is suboptimal, which may be due to the experience of symptoms and/or concerns. Few studies have comprehensively assessed self-reported concerns between those who currently, previously or have never received AET. The study objective is to describe self-reported physical and emotional concerns of breast cancer survivors who are current, prior, or never-recipients of AET. METHODS: Secondary analysis was performed on a subset of survey data collected in the 2010 LIVESTRONG Survey. Breast cancer survivors (n = 1,013, mean 5.4 years post-diagnosis) reported on 14 physical and eight emotional concerns that began after diagnosis and were experienced within 6 months of participation in the survey. Bivariate analyses examined the prevalence of each concern by AET status. The relationships between AET and burden of physical or emotional concerns were modeled with logistic regression. RESULTS: More than 50% of the participants reported currently experiencing cognitive issues, fatigue, fear of recurrence, emotional distress, and identity/grief issues. Thyroid dysfunction and stigma concerns were more common among participants with prior AET (p < 0.01), while fear of recurrence, emotional distress, and concern about appearance were more common among those currently receiving AET (p < 0.01). Fatigue, sexual dysfunction, and pain were more common among prior and current AET recipients (p < 0.01). In adjusted models, receipt of AET was associated with a higher number of physical, but not emotional concerns. A higher number of concerns was associated with younger age, having children, receipt of chemotherapy, longer duration of cancer treatment, and shorter time since diagnosis (p < 0.01). CONCLUSIONS: Breast cancer survivors who received AET were at risk of developing a variety of physical and emotional concerns, many of which persisted after treatment. These findings suggest the importance of developing individualized, supportive resources for breast cancer survivors.

A representational approach to patient education.

PURPOSE: To describe the theoretical basis for a representational approach to patient education and the application of this approach to the development, implementation, and preliminary evaluation of a representational intervention for pain management. ORGANIZING CONSTRUCT: Leventhal's common sense model (CSM) was a guide for this approach to patient education. The CSM is based on the idea that people have common sense beliefs, or representations, that guide how they cope with health problems. Theoretically based interventions derived from the CSM have not been reported. METHODS: Steps included: (a) designing a general approach to educational interventions, centered on illness representations; (b) specifying an intervention (RIDPAIN) to facilitate coping with cancer pain; (c) pilot-testing and revising the intervention; and (d) testing feasibility and acceptability of the intervention with 61 patients in a Midwestern American city. FINDINGS: The RIDPAIN intervention was useful in eliciting misconceptions of pain and pain management from patients experiencing cancer pain. Many patients found RIDPAIN to be meaningful and useful, and they perceived it to have an effect on pain-related beliefs and behaviors. CONCLUSIONS: This theory-driven approach should be effective and widely applicable because it includes patients as active participants in all phases of the learning continuum, from information acquisition to behavior change.

An individualized intervention to overcome patient-related barriers to pain management in women with gynecologic cancers.

Concerns about reporting pain and using analgesics ultimately can contribute to poor pain management for many individuals. A nursing intervention to address these "patient-related barriers" was developed based on Johnson's self-regulation theory. The purpose of this pilot study was to determine whether provision of individually tailored sensory and coping information about analgesic side effects and specific information to counter misconceptions would enhance pain management in a sample of 43 women with gynecologic cancers. It was hypothesized that at 1-month post-test and 2-month follow-up, those subjects randomized to the information condition would (a) have lower barriers scores; (b) use more adequate analgesic medication; (c) have lower analgesic side effect scores; (d) have lower pain intensity scores; and (e) experience less pain interference with life and better overall quality of life compared to those in the care-as-usual control group. There was no main effect for group on any of the dependent variables. Rather, all women reported a decrease in barriers between baseline and 2-month follow-up (p<.05); all subjects experienced a decrease in pain interference with life scores between baseline and 1-month post-test (p<.05); and there was a significant shift of women from unacceptable pain management at baseline to acceptable pain management at 1-month post-test (p<.05). In addition, the majority of women reported that the intervention contained novel and useful information that helped them to feel more comfortable taking pain medication, to be less concerned about addiction, and helped them talk more openly about pain with a doctor or nurse.

The impact on quality of life of patient-related barriers to pain management.

A stress-coping model of relationships between patients' beliefs about pain, coping (analgesic use), pain severity, analgesic side-effects, and three quality of life (QOL) outcomes was tested. Participants were 182 men and women with cancer who completed valid and reliable self-report measures of relevant variables. Antecedent variables (age and education) showed expected relationships with beliefs. As predicted, beliefs were significantly related to analgesic use. Analgesic use was inversely related to pain severity, but was not related to side-effect severity. Analgesic use was inversely related to impairments in QOL before controlling for pain and side-effect severity, but not after these two variables were controlled. Both analgesic side-effects and pain severity were related to impaired QOL outcomes, including difficulty performing life activities, depressed mood, and poor perceived health status.