Hypermobility and musculoskeletal pain in children: a systematic review.

OBJECTIVE: To examine the evidence of an association between hypermobility and musculoskeletal pain in children. METHODS: A systematic review of the literature was performed using the databases PubMed, EMBASE, NHS Evidence, and Medline. Inclusion criteria were observational studies investigating hypermobility and musculoskeletal pain in children. Exclusion criteria were studies conducted on specialist groups (i.e. dancers) or hospital referrals. Pooled odds ratios (ORs) were calculated using random effects models and heterogeneity was tested using χ(2)-tests. Study quality was assessed using the Newcastle-Ottawa Scale for case-control studies. RESULTS: Of the 80 studies identified, 15 met the inclusion criteria and were included in the review. Of these, 13 were included in the statistical analyses. Analysing the data showed that the heterogeneity was too high to allow for interpretation of the meta-analysis (I(2) = 72%). Heterogeneity was much lower when the studies were divided into European (I(2) = 8%) and Afro-Asian subgroups (I(2) = 65%). Sensitivity analysis based on data from studies reporting from European and Afro-Asian regions showed no association in the European studies [OR 1.00, 95% confidence interval (CI) 0.79-1.26] but a marked relationship between hypermobility and joint pain in the Afro-Asian group (OR 2.01, 95% CI 1.45-2.77). Meta-regression showed a highly significant difference between subgroups in both meta-analyses (p < 0.001). CONCLUSION: There seems to be no association between hypermobility and joint pain in Europeans. There does seem to be an association in Afro-Asians; however, there was a high heterogeneity. It is unclear whether this is due to differences in ethnicity, nourishment, climate or study design.

Use of complementary therapies among breast and prostate cancer patients during treatment: a multisite study.

PURPOSE: The purpose of this study was to compare the use of complementary therapies (CT) among breast and prostate cancer patients during active cancer treatment. The authors compared use and beliefs about the role of CT in cancer recovery. METHODS: A self-report survey was completed by 126 breast cancer patients and 82 prostate cancer patients as part of a multisite research project. The self-report questionnaire inquired about the use of various CTs, sources of information about CT, reasons for using CT, beliefs about the benefits and risks of CT, demographic characteristics, and cancer treatment history. RESULTS: Most of the respondents were older than 50 years, Caucasian, married, had attended or completed college, and were less than 1 year post-diagnosis. Prostate cancer patients were significantly older than the breast cancer patients (P < .001). Several differences emerged between the groups. Compared to the prostate cancer patients, significantly more of the breast cancer patients reported using CT because they wanted to reduce the risk of recurrence (P < .01), play a more active role in recovery (P < .01), help manage stress (P < .01), take a more holistic approach (P < .01), or boost the immune system (P < .01). More of the prostate cancer patients reported using CT to have more control of their recovery (P < .05). The 2 groups also differed significantly (P < .01) on several beliefs about the potential benefits and risks of using CT. CONCLUSIONS: Most of the patients in this study had used some form of CT since the time of their diagnosis. Differences among breast and prostate cancer patients with regard to their use of CT during cancer treatment should be considered by oncology professionals who are discussing this topic with their patients.

Oncology professionals' communication with cancer patients about complementary therapy: a survey.

OBJECTIVE: To compare the communication practices of three groups of oncology professionals with regard to discussion of complementary therapies with cancer patients. DESIGN: A mail survey was completed by a randomly selected, nationwide sample of oncology physicians, oncology nurses, and oncology social workers in the United States. MAIN OUTCOME MEASURES: Respondents indicated how often they initiated discussion of complementary therapies, their comfort level discussing this subject, and the perceived impact on the patient-professional relationship. RESULTS: Significantly more of the social workers reported that they initiated discussion of complementary therapy compared to physicians and nurses. Physicians and social workers reported being equally comfortable with this topic and more so than nurses. More of the social workers reported believing that discussing complementary therapies can enhance the patient-professional relationship. CONCLUSIONS: Oncology social workers were more amenable to discussing complementary therapies than physicians or nurses. The impact of communication on patient outcomes is addressed.

Dyspnea, anxiety, body consciousness, and quality of life in patients with lung cancer.

Dyspnea is a common symptom of lung cancer that can impact patient physical, social, and psychological well-being. Study goals were to evaluate quality of life (QOL) and dyspnea in patients with lung cancer and the relationships between QOL, dyspnea, trait anxiety, and body consciousness. Sociodemographic and cancer-related variables (stage, cell type, performance status) were evaluated. One hundred twenty outpatients with stage I-IV lung cancer participated in the study. Patients completed 5 questionnaires assessing QOL, dyspnea, trait anxiety, body consciousness, and pain. Eighty-seven percent of study participants experienced dyspnea. Patients with high dyspnea scores had lower QOL (P = 0.04). Dyspnea was worse in men than in women (P = 0.02), and there was a trend towards older patients reporting more severe dyspnea than younger patients (P = 0.06). There was no difference in dyspnea based on cancer stage, cell type, or performance status. Pain and anxiety scores were higher in patients with high dyspnea (P = 0.02, P = 0.03). Dyspnea was more severe in patients taking opioid analgesics when compared to non-opioids or no pain medications (P = 0.03). No significant association was found between dyspnea, anxiety, and private body consciousness.

Impact of hot flashes on quality of life among postmenopausal women being treated for breast cancer.

Hot flashes are among the most commonly reported symptoms among women who have completed treatment for breast cancer. Relatively little is known, however, about hot flashes among women while they are undergoing breast cancer treatment. The present study investigated the prevalence and severity of hot flashes of women during chemotherapy and radiotherapy for breast cancer. We also sought to identify the medical, demographic, and treatment correlates of hot flashes during treatment and to document the impact of hot flashes on quality of life. Seventy postmenopausal women with breast cancer completed a self-report questionnaire packet during chemotherapy and radiotherapy. Forty percent (n = 28) reported hot flashes during the week prior to assessment. Of the 28 women endorsing hot flashes, 25% (n = 7) rated them as severe, 39% (n = 11) rated them as moderate, and 36% (n = 10) rated them as mild. Women with hot flashes were significantly (p < 0.05) younger and reported significantly (p < 0.001) more fatigue, poorer sleep quality, and poorer physical health compared to women without hot flashes. Multivariate analyses revealed that, even after controlling for relevant medical, demographic, and treatment variables, the prevalence of hot flashes significantly (p < 0.05) predicted poorer sleep quality, more fatigue, and worse physical health. The results indicate that hot flashes are experienced by a sizable percentage of postmenopausal breast cancer patients as they undergo treatment. Hot flashes during cancer treatment appear to have a negative impact upon patient quality of life that may be due, in part, to fatigue and interference with sleep. Future research should seek to evaluate interventions to relieve hot flashes during breast cancer treatment as a means of improving patient quality of life.

Symptom structure of PTSD following breast cancer.

Identification of posttraumatic stress disorder (PTSD) symptoms and diagnoses in survivors of cancer is a growing area of research, but no published data exist regarding the symptom structure of PTSD in survivors of malignant disease. Findings from investigations of the PTSD symptom structure in other trauma populations have been inconsistent and have not been concordant with the re-experiencing, avoidance/numbing, and arousal symptom clusters specified in DSM-IV. The present study employed confirmatory factor analysis to evaluate the extent to which the implied second-order factor structure of PTSD was replicated in a sample of 142 breast cancer survivors. PTSD symptoms were measured using the PTSD Checklist--Civilian Version (PCL-C). Fit indices reflected a moderate fit of the symptom structure implied by the DSM-IV. These findings provide some tentative support for the DSM-IV clustering of PTSD symptoms and for the validity of cancer-related PTSD.

Measurement of fatigue in cancer patients: further validation of the Fatigue Symptom Inventory.

Fatigue is one of the most common and debilitating symptoms experienced by cancer patients, yet until recent years it has received little systematic attention, due in part to the lack of adequate instruments to measure fatigue. The primary aim of this report is to further validate a recently developed measure of fatigue for use with cancer patients: the Fatigue Symptom Inventory (FSI). This 13-item self-report measure was designed to measure the intensity and duration of fatigue and its interference with quality of life. The FSI was originally validated in a sample of breast cancer patients and a sample of healthy individuals. In this study, the FSI was evaluated in an outpatient sample that included male and female cancer patients, as well as some older patients, with a variety of cancer diagnoses. A seven-item interference scale was found to have good internal consistency, with alpha coefficients above 0.90. Convergent validity was demonstrated via comparisons with an existing measure of fatigue. Construct validity was demonstrated via comparisons with measure of life satisfaction and depression as well as comparisons among subgroups of patients expected to differ in their experience of fatigue. Overall, the FSI was further established as a valid and reliable measure of fatigue in cancer patients. The potential application of this measure in psychosocial oncology research is discussed.

Patients' psychosocial concerns following stem cell transplantation.

Information regarding the nature, frequency, correlates and temporal trajectory of concerns of stem cell transplantation (SCT) recipients is critical to the development of interventions to enhance quality of life (QOL) in these individuals. This study examined psychosocial concerns in 110 SCT (87% autologous) recipients drawn from two SCT centers. Participants were a mean of 46 years of age and 17 months post-SCT (range 3-62 months). Information regarding current and past SCT-related concerns, performance status, and demographic characteristics was collected by telephone interview or questionnaire. Recipients reported a wide variety of psychosocial concerns following SCT. Recipients who were younger, female and evidenced a poorer performance status reported a larger number of post-SCT concerns. Examination of the temporal trajectory of concerns suggests that some concerns are salient throughout the course of post-SCT recovery (eg disease recurrence, energy level, 'returning to normal'), some are salient early in the course of recovery (eg quality of medical care, overprotectiveness by others), and others emerge later in the course of recovery (eg feeling tense or anxious, sexual life, sleep, relationship with spouse/partner, ability to be affectionate). Implications for the development of interventions to enhance post-SCT QOL are identified.

Massage therapy for patients undergoing autologous bone marrow transplantation.

The purpose of the current study was to examine the impact of massage therapy on psychological, physical, and psychophysiological measures in patients undergoing autologous bone marrow transplantation (BMT). Patients scheduled to undergo BMT were randomly assigned to receive either (a) massage therapy, consisting of 20-minute sessions of shoulder, neck, head, and facial massage, or (b) standard treatment. Overall effects of massage therapy on anxiety, depression, and mood were assessed pretreatment, midtreatment, and prior to discharge using the State-Trait Anxiety Inventory, Beck Depression Inventory, and Brief Profile of Mood States, respectively. The immediate effects of massage were measured via the State Anxiety Inventory, Numerical Scales of Distress, Fatigue, Nausea, and Pain and indices of psychophysiological arousal (heart rate, blood pressure, and respiration rate), collected prior to and following patients' first, fifth, and final massage (on Days--7, midtreatment, and predischarge). Analysis of the data evaluating the immediate effects of massage showed that patients in the massage therapy group demonstrated significantly larger reductions in distress, fatigue, nausea, and State Anxiety than the standard treatment group at Day-7, in State Anxiety at midtreatment, and in fatigue at the predischarge assessment. The overall measures of psychological symptoms measured at pretreatment, midtreatment, and prior to discharge showed no overall group differences, although the massage group scored significantly lower on the State Anxiety Inventory than the standard care group at the midtreatment assessment. The two groups together showed significant declines through time on scores from the Profile of Mood States and State and Trait Anxiety Inventories.

Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates.

This study investigated the characteristics, course, and correlates of fatigue in women receiving adjuvant chemotherapy for breast cancer. Fifty-four patients were assessed before the start of chemotherapy and during the first three treatment cycles. An age-matched sample of women with no cancer history was assessed at similar time intervals for comparison purposes. Results indicated that breast cancer patients experienced worse fatigue than women with no cancer history. These differences were evident before and after patients started chemotherapy. In addition, fatigue worsened among patients after treatment started. More severe fatigue before treatment was associated with poorer performance status and the presence of fatigue-related symptoms (e.g., sleep problems and muscle weakness). Increases in fatigue after chemotherapy started were associated with continued fatigue-related symptoms and the development of chemotherapy side effects (e.g., nausea and mouth sores). These findings demonstrate the clinical significance of fatigue in breast cancer patients before and during adjuvant chemotherapy treatment. Results also suggest that aggressive management of common side effects, such as nausea and pain, may be useful in relieving chemotherapy-related fatigue.

Measurement of depressive symptoms in cancer patients: evaluation of the Center for Epidemiological Studies Depression Scale (CES-D).

The Center for Epidemiological Studies Depression Scale (CES-D) is commonly used to measure depressive symptomatology in cancer patients, yet there is little known about the psychometric properties of the measure when applied to a cancer population. The aim of this study was to examine the psychometric properties of the CES-D with cancer patients. For purposes of comparison, the psychometric properties of the CES-D were assessed both in women undergoing treatment for breast cancer and women with no history of cancer. The CES-D and other study measures were administered to women undergoing treatment for breast cancer on two occasions: prior to treatment and midway through treatment. The measures were also administered to a group of women similar in age to the cancer patients who had no history of any type of cancer. These healthy comparison subjects were also assessed on two separate occasions. The CES-D was found to have good internal consistency, with alpha coefficients > 0.85 for both groups, as well as adequate test-retest reliability in both groups. Construct validity was demonstrated in two ways, via comparisons between the groups and by comparing the CES-D with measures of fatigue, anxiety, and global mental health functioning. The CES-D was established as a valid and reliable measure of depressive symptomatology in this sample of breast cancer patients. This measure may be appropriate for use in clinical psychosocial research with cancer patients, yet further research is needed to evaluate its usefulness in other cancer populations. The importance of measuring psychological symptoms with standard measures that have been validated with cancer patients is highlighted.

Fatigue and quality of life in breast cancer patients undergoing autologous stem cell transplantation: a longitudinal comparative study.

As more individuals are being treated for cancer with high-dose therapy and autologous stem cell rescue (ASCR), there is growing interest in treatment side effects and their impact on quality of life. The primary aim of this study was to determine if the severity of fatigue and its impact on quality of life is significantly greater in women undergoing ASCR for breast cancer than in women of similar age with no history of cancer. A group of women being treated with ASCR for breast cancer (n = 31) and a group of women of similar age with no history of cancer (n = 49) participated in this study. Patients completed measures of fatigue and psychosocial functioning prior to treatment, midway through treatment, and toward the end of treatment. Healthy comparison subjects completed the same measures three separate times. Breast cancer patients undergoing ASCR reported significantly more frequent fatigue and more severe fatigue than women with no cancer history. In addition, fatigue had a significantly greater impact on daily functioning and quality of life in patients than in women with no cancer history. Fatigue during ASCR for breast cancer was related to both medical factors (i.e., time since transplant) and psychosocial factors. During ASCR for breast cancer, women experience fatigue which is worse than what is "normally" experienced and which interferes with daily functioning and quality of life. Future research should focus on identifying the biological correlates of fatigue, psychological and physiological mechanisms by which fatigue is produced, and interventions to alleviate fatigue.

A multidimensional measure of fatigue for use with cancer patients.

PURPOSE: The purpose of this study was to develop and validate a multidimensional measure of fatigue for use with cancer patients. DESCRIPTION OF STUDY: Items for the Multidimensional Fatigue Symptom Inventory (MFSI) were generated through literature review, discussion with healthcare providers, and a survey of currently available measures of fatigue. The 83-item MFSI was designed to assess global, somatic, affective, cognitive, and behavioral symptoms of fatigue. The instrument was administered on three occasions to 275 women who had received or were undergoing treatment for breast cancer and 70 women with no history of cancer. Reliability, validity, and factorial structure of the MFSI were analyzed. RESULTS: The factor analysis produced five empirically derived scales that correspond generally to the five rationally derived scales. Reliability of the rationally and empirically derived scales was excellent (alpha coefficients .87 to .96). Estimates of test-retest reliability were also favorable. Other results support the validity of both the rationally and empirically derived scales. The MFSI appears to be sensitive to fatigue, accurately discriminating cancer patients from control subjects and between patients with varying levels of performance status. CLINICAL IMPLICATIONS: The MFSI may be useful in identifying patterns of fatigue within individual patients and across treatment modalities. Such specificity may allow the clinician to develop, implement, and evaluate interventions that are targeted for differing patterns of fatigue. Because the measure is keyed to a 1-week time frame, it may be useful during the course of cancer treatment. The MFSI appears to be a valid and reliable tool to assess the full spectrum of symptoms that characterize the construct of fatigue.

Measurement of fatigue in cancer patients: development and validation of the Fatigue Symptom Inventory.

Although fatigue is one of the most common and debilitating symptoms experienced by cancer patients, it has received little systematic attention. This situation is due in large part to the lack of adequate instruments to measure fatigue. The primary aim of this study was to validate a newly developed measure of fatigue for use with cancer patients: the Fatigue Symptom Inventory (FSI). This 13 item self-report measure was designed to measure the intensity and duration of fatigue and its impact on quality of life. The psychometric properties of the FSI were assessed in women undergoing treatment for breast cancer, women who had completed treatment for breast cancer and women with no history of cancer. A seven-item interference subscale was found to have good internal consistency, with alpha coefficients above 0.90 in all three groups. The complete FSI was found to have rather weak to moderate test-retest reliability among patients in active treatment and healthy comparison subjects assessed on three separate occasions. Convergent validity was demonstrated using comparisons with existing measures of fatigue. Construct validity was demonstrated using comparisons between and within groups as well as comparisons with measures of anxiety and depression. Overall, the FSI was established as a valid and reliable measure of fatigue in cancer patients and healthy individuals. Suggestions are made for the potential application of the measure in clinical research.

Posttraumatic stress disorder symptoms after bone marrow transplantation for breast cancer.

OBJECTIVE: On the basis of revisions of DSM criteria, questions have been raised concerning the occurrence of posttraumatic stress disorder (PTSD) symptoms among adults who have been diagnosed and treated for life-threatening illnesses. The present study examined the prevalence and correlates of PTSD symptoms among women who had undergone autologous bone marrow transplantation (ABMT) for breast cancer. METHODS: Participants were 43 women who had undergone ABMT for breast cancer an average of 19 months previously (range = 2 to 62 months) and had no clinical evidence of disease at their most recent follow-up visit. PTSD symptoms and quality of life were assessed using standardized self-report instruments. RESULTS: Between 12% and 19% of participants were likely to meet DSM-IV criteria for the current diagnosis of PTSD. Women who were less well educated, had more advanced disease at the time of the transplantation and had longer hospital stays for the transplantation reported more symptoms of PTSD. Greater PTSD symptomatology was associated with reports of poorer physical health, mental health, and sleep quality. CONCLUSION: Comparisons with previous research suggest that rates of PTSD are higher among women who undergo ABMT as opposed to less intensive forms of breast cancer treatment. These findings are consistent with the view that development of PTSD symptoms is associated with the degree of life threat. The clinical significance of PTSD in this patient population is underscored by findings indicating that greater PTSD symptoms are associated with poorer health-related quality of life.

Comparison of psychological symptoms of women requesting removal of breast implants with those of breast cancer patients and healthy controls.

Concern about the safety of silicone breast implants has led many women with numerous physical and psychological symptoms to seek breast implant removal. This retrospective group comparison study describes the psychological profile of women requesting breast implant removal compared with two control groups. The Brief Symptom Inventory was used to compare psychological symptoms of three groups of women: a preoperative breast implant group requesting removal of implants (n = 78), a postoperative breast cancer group without breast implants (n = 64), and a control group with no known breast disease and unknown breast implant status (n = 68). Scores were compared on the Global Severity Index of the Brief Symptom Inventory as well as on nine subscales: somatization, obsessive-compulsiveness, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. The breast implant group had significantly elevated Global Severity Index scores, as well as somatization, obsessive-compulsiveness, depression, hostility, and anxiety subscale scores, when compared with the other groups. Post hoc data analysis revealed that women who had implants after subcutaneous mastectomy as prophylaxis for breast cancer (n = 18) had a significantly different symptom profile and higher Global Severity Index scores than women who had cosmetic augmentation (n = 53). Additionally, women who had subcutaneous mastectomy and implants had significantly higher subscales of interpersonal sensitivity, phobic anxiety, paranoid ideation, and psychoticism than the cosmetic implant subjects. Women requesting removal of silicone breast implants had greater psychological distress than women who were recently diagnosed with breast cancer or controls with no known breast disease and unknown implant status. Within the implant group, however, women who had subcutaneous mastectomy showed greater psychological disturbance than those who had augmentation mammaplasty.

Quality of life following bone marrow transplantation for breast cancer: a comparative study.

As more women are treated with bone marrow transplantation (BMT) for breast cancer, there is growing interest in quality of life (QOL) following treatment. Although there have been some clinical studies of QOL following BMT, this area has received little systematic attention. In particular, it is unclear how QOL for women treated with BMT for breast cancer differs from that which might be expected for 'healthy' women of about the same age. To address this issue, we compared QOL reported by women treated with autologous BMT for breast cancer with that of a group of women of similar age with no history of cancer. In addition, we examined the relationship of demographic factors, medical factors, and self-reported symptom prevalence, severity, and distress to QOL in post-BMT patients. All participants completed the SF-36 Health Survey developed from the Medical Outcomes Study (SF-36). Post-BMT patients also completed the ECOG Performance Status Rating Scale (PSR) and the Memorial Symptom Assessment Scale (MSAS). Results indicated that, compared to the women with no cancer history, post-BMT patients reported significantly impaired physical functioning, physical role functioning, general health, vitality, social functioning, and emotional role functioning. Impaired QOL following BMT was significantly associated with lower income, a longer time to engraftment, longer hospital stay, poor performance status, and greater symptom prevalence, severity, and distress. The problems identified in this study may be important targets for intervention when trying to improve QOL following BMT.

Fatigue in women treated with bone marrow transplantation for breast cancer: a comparison with women with no history of cancer.

As more individuals undergo autologous bone marrow transplantation (BMT), there is growing interest in the impact of treatment side effects on quality of life. Fatigue is a potentially disruptive treatment side effect that has not been systematically assessed following BMT. The primary aim of this study was to determine whether the severity of fatigue and its impact on quality of life is significantly greater in women who had undergone BMT for breast cancer than in women of similar age with no history of cancer. Another aim was to identify the medical and psychosocial correlates of fatigue in women who had completed BMT. A group of women treated with autologous BMT for breast cancer (n = 43; mean age = 44; mean time since BMT = 20 months) and a group of women of similar age with no history of cancer (n = 43; mean age = 46) participated in this study. Subjects completed measures of fatigue, anxiety, depression, and sleep habits. Medical data were obtained from computerized patient records. Women who had completed BMT for breast cancer reported significantly more frequent and severe fatigue than women with no cancer history. In addition, fatigue had a significantly greater impact on daily functioning and quality of life in BMT recipients than in women with no cancer history. Fatigue following BMT for breast cancer was related to both medical factors (i.e., time since BMT) and psychosocial factors (i.e., anxiety, depressive symptoms and sleep difficulties). Following BMT for breast cancer, women may experience fatigue that is worse than might "normally" be expected and can interfere with daily functioning and quality of life. Future research should focus on identifying the biological correlates of fatigue, psychological and physiological mechanisms by which fatigue is produced, and interventions to alleviate fatigue.

Children of adolescent mothers: attachment representation, maternal depression, and later behavior problems.

Underlying the responses of 34 44-month-old children of adolescent mothers to five attachment narratives were two factors--departure and reunion. The departure factor included disorganized and insecure responses to parents' departure as well as disorganized responses to narratives about children's misbehavior and fear. Scores predicted children's externalizing behavior problems 10 months later and discriminated children in the clinical from those in the normal range for externalizing problems. Maternal depression explained significant additional variance in children's externalizing problems.