Anxiety, depression and quality of life among Chinese breast cancer patients during adjuvant therapy.

PURPOSE: The aim of the study was to examine anxiety and depression and their effects on the quality of life (QOL) of patients with breast cancer undergoing chemotherapy or radiotherapy. METHODS: A cross-sectional descriptive design was used. Data were collected from a self-report survey derived from the Hospital Anxiety and Depression Scale (HADS)-Cantonese/Chinese version, the Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B)-Chinese version, and from demographic and clinical characteristics. Chi-square tests and the General Linear Model (GLM) were used for secondary data analysis. SAMPLE: The study group consisted of 218 women (> or = 18 years old) who were midway through chemotherapy or radiotherapy for stage I-III breast cancer. All subjects were recruited from the outpatient sections of the Departments of Clinical Oncology or Breast Centers of the four Hong Kong public hospitals. RESULTS: The percentage of participants with anxiety (chi2=6.56, p=0.01) or depression (chi2=7.26, p=0.007) was higher in the chemotherapy group. More participants in the chemotherapy group had both anxiety and depression than those in the radiotherapy group, though no statistically significant difference was reported. Anxiety and depression had detrimental effects on the overall and other domains of QOL of these women undergoing adjuvant therapy for breast cancer. CONCLUSION: This study should increase nurses' awareness of the importance of integrating psychological symptom assessment into nursing assessment procedures, and enhance their clinical sensitivity in identifying high-risk groups of patients undergoing specific cancer treatments.

The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study.

PURPOSE/OBJECTIVES: To examine the symptom cluster of fatigue, pain, anxiety, and depression and its effect on the quality of life (QOL) of women receiving chemotherapy or radiotherapy for breast cancer. DESIGN: Descriptive. SETTING: Oncology outpatient sections of four public hospitals in Hong Kong. SAMPLE: 215 ethnic Chinese women who were midway through treatment for breast cancer. METHODS: Chinese versions of the Brief Fatigue Inventory, Hospital Anxiety and Depression Scale, Brief Pain Inventory, Functional Assessment of Chronic Illness Therapy for Breast Cancer, and Medical Outcomes Study Social Support Survey were used. Spearman rho correlation and structural equation modeling were used to examine the relationships among the study variables. MAIN RESEARCH VARIABLES: Breast cancer, fatigue, pain, anxiety, depression, and QOL. FINDINGS: Most participants reported mild-to-moderate levels of fatigue and pain. Twenty-one percent and 36% of patients might have had an anxiety or depression disorder, respectively. Significant correlations among the four symptoms supported the existence of the symptom cluster. The participants receiving chemotherapy had inadequate social support, experienced higher levels of symptoms, and were more likely to have a poorer QOL. CONCLUSIONS: The findings supported the existence of the symptom cluster that had detrimental effects on QOL. IMPLICATIONS FOR NURSING: This study shed light on a contemporary approach of grouping several related symptoms together. The findings enhance nurses' clinical sensitivity when identifying patients in high-risk groups and provide useful information for designing and prioritizing symptom-management strategies to meet patients' needs.

A model to identify direct costs of nursing education: the Colorado experience.

During spring 2003, national, state, and local economic factors converged in a manner that propelled us to better identify the costs of the educational programs offered within the University of Colorado Health Sciences Center School of Nursing (SON). Two factors prompted analysis of direct costs of the nursing education programs: a shrinking state appropriation and a 36.7% rescission of state funds during that academic year. The SON supports 618 students in four programs (baccalaureate, master of science, doctor of nursing, and doctor of philosophy). During summer 2003, the SON leadership team met numerous times in an iterative process to clarify assumptions and make recommendations in an attempt to cost out academic programs. Data were obtained from a variety of sources. The SON Office of Budget and Finance provided revenue and expense data. The Office of Academic Affairs provided course schedules, the course offering plan, and projected student enrollment in courses. The Division Chairs provided data concerning faculty workload and faculty areas of expertise. The data were compiled in Access tables and arrayed in a series of Excel spreadsheets that captured course data and faculty data. A "what-if" analysis was completed to determine cost of a pilot accelerated baccalaureate program. This method provides a dynamic analytic system shown to be prospectively and retrospectively effective. As a result of this analysis, the following metrics are available: direct cost per student per course/program; revenue per student per course/program; faculty teaching FTE; and faculty-to-student ratio.