Identification of distinct depressive symptom trajectories in women following surgery for breast cancer.

OBJECTIVE: Depressive symptoms, common in breast cancer patients, may increase, decrease, or remain stable over the course of treatment. Most longitudinal studies have reported mean symptom scores that tend to obscure interindividual heterogeneity in the symptom experience. The identification of different trajectories of depressive symptoms may help identify patients who require an intervention. This study aimed to identify distinct subgroups of breast cancer patients with different trajectories of depressive symptoms in the first six months after surgery. METHOD: Among 398 patients with breast cancer, growth mixture modeling was used to identify latent classes of patients with distinct depressive symptom profiles. These profiles were identified based on Center for Epidemiological Studies-Depression (CES-D) scale scores completed just prior to surgery, and 1, 2, 3, 4, 5, and 6 months after surgery. RESULTS: Four latent classes of breast cancer patients with distinct depressive symptom trajectories were identified: Low Decelerating (38.9%), Intermediate (45.2%), Late Accelerating (11.3%), and Parabolic (4.5%) classes. Patients in the Intermediate class were younger, on average, than those in the Low Decelerating class. The Intermediate, Late Accelerating, and Parabolic classes had higher mean baseline anxiety scores compared to the Low Decelerating class. CONCLUSIONS: Breast cancer patients experience different trajectories of depressive symptoms after surgery. Of note, over 60% of these women were classified into one of three distinct subgroups with clinically significant levels of depressive symptoms. Identification of phenotypic and genotypic predictors of these depressive symptom trajectories after cancer treatment warrants additional investigation.

A pilot study of relationships among pain characteristics, mood disturbances, and acculturation in a community sample of Chinese American patients with cancer.

PURPOSE/OBJECTIVES: To describe the pain experience of Chinese American patients with cancer and to examine the relationships among pain characteristics, demographic characteristics, performance status, self-reported analgesic use, mood disturbances, and patients' acculturation levels. DESIGN: Descriptive, correlational, cross-sectional study. SETTING: Three community-based oncology facilities in the San Francisco, CA, Bay area. SAMPLE: 50 Chinese Americans who reported experiencing pain from cancer. METHODS: Participants completed in their preferred language a demographic questionnaire, the Karnofsky Performance Status Scale, the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, the Suinn-Lew Asian Self-Identity Acculturation Scale, and information about analgesic use. Descriptive and correlational statistics were used to evaluate data. MAIN RESEARCH VARIABLES: Pain intensity, pain interference, performance status, anxiety, depression, analgesic use, and acculturation level. FINDINGS: Most of the patients reported moderate to severe pain and moderate levels of interference. Lower levels of acculturation were associated with higher least and worst pain intensity scores and higher pain interference scores. Anxiety and depression scores were in the moderate range. Higher depression scores were associated with higher pain interference scores. Self-reported analgesic use for 62% of the patients was classified as inadequate. CONCLUSIONS: A significant percentage of Chinese American patients experience moderate to severe cancer pain that affects their mood and their ability to function. IMPLICATIONS FOR NURSING: Nurses should assume a proactive role in assessing the physical, emotional, and cognitive dimensions of pain in Chinese American patients. Future research should evaluate the cancer pain experience of these vulnerable patients and develop and test culturally appropriate interventions.

Changes in sexual function on mood and quality of life in patients undergoing radiation therapy for prostate cancer.

PURPOSE/OBJECTIVES: To describe the percentages of men with and without changes in sexual function from the beginning to end of radiation therapy and evaluate for differences in demographic and clinical characteristics, mood states, and quality of life (QOL) among patients who did and did not experience changes in sexual function. DESIGN: Descriptive, longitudinal. SETTING: Two radiation therapy departments in northern California. SAMPLE: 70 men with prostate cancer who underwent primary or adjuvant radiation therapy. METHODS: Self-report questionnaires, medical record reviews, and repeated measures analysis of variance. MAIN RESEARCH VARIABLES: Changes in sexual function; depression, anxiety, and QOL. FINDINGS: Patients were categorized into one of four sex groups (No Problem X 2, Problem-No Problem, No Problem-Problem, and Problem X 2) based on their responses to "Is your sexuality impacted by your illness?" at the beginning and end of radiation therapy. About 50% had a problem with sexual function either at the beginning or end of radiation therapy. Overall, men without sexual problems at both the beginning and end of radiation therapy had significantly less anxiety and depression and higher QOL scores than patients who developed a problem at the end and patients who had a problem at both time points. CONCLUSIONS: Changes in sexual function during the course of radiation therapy affect patients' mood and QOL. IMPLICATIONS FOR NURSING: Clinicians should evaluate the effects of radiation therapy on sexual function and monitor patients with prostate cancer for depression and anxiety as well as for changes in QOL.

A randomized clinical trial of the effectiveness of photon stimulation on pain, sensation, and quality of life in patients with diabetic peripheral neuropathy.

CONTEXT: Peripheral neuropathy is one of the most common complications of diabetes. OBJECTIVES: The purpose of this study was to evaluate the effects of photon stimulation on pain intensity, pain relief, pain qualities, sensation and quality of life (QOL) in patients with painful diabetic peripheral neuropathy. METHODS: In this randomized, placebo-controlled trial, patients were assigned to receive either four photon stimulations (n=63) or four placebo (n=58) treatments. Pain intensity, pain relief, and pain qualities were assessed using self-report questionnaires. Sensation was evaluated using monofilament testing. QOL was measured using the Medical Outcomes Study Short Form-36 (SF-36). Multilevel regression model analyses were used to evaluate between-group differences in study outcomes. RESULTS: No differences, over time, in any pain intensity scores (i.e., pain intensity immediately post-treatment, average pain, worst pain) or pain relief scores were found between the placebo and treatment groups. However, significant decreases, over time, were found in some pain quality scores, and significant improvements in sensation were found in patients who received the photon stimulation compared with placebo. In addition, patients in the treatment group reported significant improvements in SF-36 social functioning and mental health scores. Findings from a responder analysis demonstrated that no differences were found in the percentages of patients in the placebo and treatment groups who received 30% or more or 50% or more reduction in pain scores immediately post-treatment. However, significant differences were found in the distribution of the changes in pain relief scores, with most of the patients in the photon stimulation group reporting a slight (28.6%) to moderate (34.9%) improvement in pain relief from the beginning to the end of the study compared with no change in pain relief (43.1%) in the placebo group. CONCLUSION: Four treatments with photon stimulation resulted in significant improvements in some pain qualities, sensation, and QOL outcomes in a sample of patients with a significant amount of pain and disability from their diabetes. A longer duration study is needed to further refine the photon stimulation treatment protocol in these chronically ill patients and to evaluate the sustainability of its effects.

Barriers to pain management in a community sample of Chinese American patients with cancer.

Barriers to cancer pain management can contribute to the undertreatment of cancer pain. No studies have documented barriers to cancer pain management in Chinese American patients. The purposes of this study in a community sample of Chinese Americans were to: describe their perceived barriers to cancer pain management; examine the relationships between these barriers and patients' ratings of pain intensity, pain interference with function, mood disturbances, education, and acculturation level; and determine which factors predicted barriers to cancer pain management. Fifty Chinese Americans with cancer pain completed the following instruments: Brief Pain Inventory (BPI), Karnofsky Performance Status (KPS) Scale, Barriers Questionnaire (BQ), Hospital Anxiety and Depression Scale (HADS), Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA), and a demographic questionnaire. The mean total BQ score was in the moderate range. The individual barriers with the highest scores were: tolerance to pain medicine; time intervals used for dosage of pain medicine; disease progression; and addiction. Significant correlations were found between the tolerance subscale and least pain (r=0.380) and the religious fatalism subscale and average pain (r=0.282). These two subscales were positively correlated with anxiety and depression levels: (tolerance: r=0.282, r=0.284, respectively; religious fatalism: r=0.358, r=0.353, respectively). The tolerance subscale was positively correlated with pain interference (r=0.374). Approximately 21% of the variance in the total BQ score was explained by patients' education level, acculturation score, level of depression, and adequacy of pain treatment. Chinese American cancer patients need to be assessed for pain and perceived barriers to cancer pain management to optimize pain management.

A review of the literature on the pain experience of Chinese patients with cancer.

Over 2 million new cases of cancer are diagnosed annually in China. In addition, cancer is the leading cause of death in China. Because cancer is often diagnosed in more advanced stages in China, a higher percentage of patients will experience pain related to their disease or treatment. This article presents a review and critique of the studies that examined the experience of pain in Chinese cancer patients. Because pain is a subjective experience with multiple dimensions, this review used the multiple dimensions of cancer pain to describe the pain experience in adult Chinese patients with cancer. The results from 24 studies of cancer pain in Chinese patients are summarized. Most of these descriptive correlational studies evaluated the physiologic and sensory dimensions of the pain experience. Most of the patients reported moderate to severe pain and that pain interfered with their normal activities and mood. In contrast, little information is available about the impact of cancer pain on the cognitive and sociocultural dimensions of the pain experience for Chinese patients.

No evidence for sex differences in the severity and treatment of cancer pain.

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.