Prevalence of Psychoneurological Symptoms and Symptom Clusters in Women with Breast Cancer Undergoing Treatment: Influence on Quality of Life.

OBJECTIVES: To identify subgroups of psychoneurological symptoms (PNS) and their relationship to different clinical variables in a sample of women with breast cáncer (BC) with different type of treatment, and the possible influence of these on quality of life (QoL), using a factorial principal components analysis. DATA SOURCES: Observational, cross-sectional, non-probability study (2017-2021) at Badajoz University Hospital (Spain). A total of 239 women with BC receiving treatment were included. RESULTS: 68% of women presented fatigue, 30% depressive symptoms, 37.5% anxiety, 45% insomnia, and 36% cognitive impairment. The average score obtained for pain was 28.9. All the symptoms were related between themselves, and within the cluster of PNS. The factorial analysis showed three subgroups of symptoms, which accounted for 73% of variance: state and trait anxiety (PNS-1), cognitive impairment, pain and fatigue (PNS-2), and sleep disorders (PNS-3). The depressive symptoms were explained equally by PNS-1 and PNS-2. Additionally, two dimensions of QoL were found (functional-physical and cognitive-emotional. These dimensions correlated with the three PNS subgroups found. A relationship was found between chemotherapy treatment and PNS-3, and its negative impact on QoL. CONCLUSIONS: A specific pattern of grouped symptoms in a psychoneurological cluster with different underlying dimensions has been identified which negatively influences QoL of survivors of BC. IMPLICATION FOR NURSING PRACTICE: It is important to raise awareness among professionals and patients about the existence of a cluster of PNS, the patient's profile, as well as the factors that exacerbate them. This will allow them to be treated more effectively and comprehensively.

Chemotherapy-Related Cognitive Impairment in Patients with Breast Cancer Based on Functional Assessment and NIRS Analysis.

Background: Chemotherapy-related cognitive impairment (CRCI), or "chemobrain," isdefined as a phenomenon of cognitive deficits in cancer patients after chemotherapy and is characterized by deficits in areas of cognition, including memory, attention, speed of processing, and executive function, which seriously affect quality of life. The purpose of this study is to investigate the impact of CRCI in breast cancer (BC) patients in chemotherapy treatment (CT+) or not (CT−) and to analyze their relationship with detectable objective changes in cerebral activity during the execution of a phonological and semantic verbal fluency task (PVF and SVF). Methods: An observational, cross-sectional study was carried out at Badajoz University Hospital (Spain). A total of 180 women with BC were included. We used Cognitive Scale (FACT-Cog) for neuropsychological subjective assessment, obtaining scores of perceived cognitive impairment (PCI), and near-infrared spectroscopy system (NIRS) for neuropsychological objective assessment during a verbal fluency task (PVF and SVF), determining alterations in the prefrontal cortex (PFC) assessed as changes in regional saturation index (rSO2). Results: A total of 41.7% percent of the patients in the sample had PCI. CT+ was significantly associated with a worse impact in PCI (X¯ = 50.60 ± 15.64 vs. X¯ = 55.01 ± 12.10; p = 0.005). Average rSO2 decreased significantly in CT+ (X¯ = 63.30 ± 8.02 vs. X¯ = 67.98 ± 7.80; p < 0.001), and BC patients showed a significant decrease in PVF and SVF on average (X¯ = 41.99 ± 9.52 vs. X¯ = 47.03 ± 9.31, and X¯ = 33.43 ± 11.0 vs. X¯ = 36.14 ± 10.68, respectively; p < 0.001). Conclusions: Our findings suggest that cognitive impairments in the domain of executive functioning exist among patients with BC who received CT. The results corroborate the hypothesis that CT is an important factor in cognitive impairment in patients with BC, which has been demonstrated by both subjective (PCI) and objective (PVF, SVF, and rSO2) neuropsychological measures. The combination of doxorubicin, cyclophosphamide, and docetaxel induce cognitive impairment.

Factors Related to Anxiety, Depressive Symptoms and Quality of Life in Breast Cancer.

Breast cancer (BC) is a major public health problem internationally. Although illness survival rates have improved, patients usually suffer multiple symptoms, both physical and psychological, which can affect their quality of life (QoL). The main aim of this study was to evaluate depressive symptoms, anxiety and the QoL of people with BC. An observational, cross-sectional study was carried out at Badajoz University Hospital (Spain). A total of 200 women with BC were included. EORTC QLQ-C30 and QLQ-BR23 questionnaires were used to assess QoL. Patients were screened for depressive symptoms using the Beck Depression Inventory (BDI) and for state anxiety and trait anxiety using the State Anxiety Inventory (STAI). Thirty-eight percent of the patients in the sample had moderate to severe anxiety, which was related to the time of diagnosis, advanced stage of illness and surgical treatment. We found that 28% of patients had depressive symptoms, related mainly with time of diagnosis, adjuvant therapy and number of cycles of chemotherapy (CT). Patients with the longest time since diagnosis, in stage III, and in treatment with CT, especially those with the greatest number of cycles, had the worst scores in QoL. We found a positive association between depressive symptoms and anxiety with QoL in patients with BC.

Intervención psicoterapéutica grupal intensiva realizada en un entorno natural para el tratamiento del burnout en un equipo de enfermería oncológica / No disponible

Este estudio piloto tiene como objetivo valorar la influencia que tiene la intervención psicoterapéutica grupal sobre el estrés y el burnout en un equipo de enfermería oncológica. La intervención psicológica consistió en la aplicación de un paquete para la inoculación al estrés, utilizando principalmente técnicas cognitivo-conductuales, llevándose a cabo de forma intensiva, a través de la convivencia del grupo durante tres días en un alojamiento situado en un entorno natural de montaña. Utilizamos un diseño cuasi-experimental de dos grupos (experimental y control) con medidas pre y post-tratamiento. El grupo experimental estaba compuesto por los nueve miembros del equipo de enfermería que recibió el tratamiento psicológico y el grupo control estuvo compuesto por once profesionales de otros equipos de enfermería oncológica. Las variables dependientes consideradas fueron, de un lado, ansiedad y depresión (evaluadas con la Escala Hospitalaria de Ansiedad y Depresión) y, de otro lado, cansancio emocional, despersonalización y realización personal (evaluadas con el Maslach Burnout Inventory). Los resultados muestran que transcurrido un mes de la intervención psicoterapéutica grupal, en el grupo de tratamiento se había producido una mejoría significativa de la ansiedad (Z=-2,44; p=0,015; d=0,71) y de la realización personal (Z=-2,54; p=0,011; d=-1,29), igualmente se produjo en este período un gran efecto positivo sobre el cansancio emocional (Z=-2,08; p=0,037; d=0,94). En el pre-tratamiento el grupo experimental manifestaba mayores signos de desgaste profesional que el grupo control, principalmente en lo referido a la falta de realización personal (U=14; p= 0,006; d=-1,61), de hecho había demandado la intervención psicológica. Tras la experiencia terapéutica se produjo una equiparación en los valores de las variables dependientes consideradas entre los grupos, respecto a la situación pre-tratamiento. Al año de la intervención, en el grupo tratado sigue habiendo un efecto positivo importante sobre la realización personal (Z=-2,24; p=0,025; d=-1,15) y sobre la despersonalización (Z=-2,23; p=0,026; d=0,52). Concluimos que el tratamiento cognitivo-conductual grupal, intensivo realizado en un medio natural, ajeno al hospital, puede tener notables ventajas para el tratamiento del desgaste profesional en personal de enfermería oncológica. (AU)

This pilot study aims to test the influence of a group psychotherapeutic intervention on stress and burnout in an oncology nursing team. The psychological intervention consisted of implementing a package for stress inoculation, mainly using cognitive-behavioral techniques. The intervention is carried out intensively, through the coexistence of the group for three days in an accommodation located in a natural mountain environment. We used a quasi-experimental design of two groups (experimental and control) with pre and post-treatment measures. The experimental group was composed of nine members of the nursing team that received the psychological treatment and the control group was composed of eleven professionals from other teams of oncology nursing. The dependent variables considered were, on one hand anxiety and depression (evaluated by the Hospital Anxiety and Depression Scale) and, on the other hand, emotional exhaustion, depersonalization, and personal fulfilment (evaluated by the Maslach Burnout Inventory). The experimental group improved significantly in anxiety (Z = -2.44, P = 0.015, d = 0.71), personal fulfilment (Z =-2.54, P= 0.011, d=-1.29) and emotional exhaustion (Z=-2.08; p=0.037; d=0.94) one month post -treatment. In the pre-treatment, The experimental group showed burnout levels higher than the control group, particularly with regard to the lack of personal personal fulfilment (U=14, P = 0.006, d = -1.61), mainly regarding the lack of personal fulfillment (U=14; p=0.006; d=-1.61). in fact the experimental group had requested psychological intervention. In fact, the experimental group had requested psychological intervention. fter the therapeutic experience, the values of the dependent variables were equal in both groups. One year after the intervention, the treated group is still having a significant positive effect on the personal fulfilment (Z=-2.24; p=0.025; d=-1.15) and on the depersonalization (Z=-2.23; p=0.026; d=0.52). We conclude that an intensive program of group cognitive behavioral therapy in a natural setting outside the hospital can be an effective strategy of burnout treatment in oncology nurses. (AU)