Physical Symptom Scores Research Articles

MO951ASSESSMENT OF HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN A GREEK COHORT OF KIDNEY TRANSPLANT RECIPIENTS WITH THE KIDNEY TRANSPLANT QUESTIONNAIRE (KTQ-25)

Abstract Background and Aims Kidney transplantation is recognized as the treatment of choice for patients with End Stage Kidney Disease (ESKD). Improvement in short term patient and graft survival of kidney transplant recipients (KTRs), has shifted interest to the long-term outcomes and Health-Related Quality of Life (HRQoL) estimation is closely related. Thus, reliable evaluation of HRQoL with disease specific questionnaires is of great importance. The aim of this study was to assess the HRQoL in adult KTRs of our Transplant Unit with Kidney Transplant Questionnaire 25 (KTQ-25) and the 36-item Short Form Health Survey (SF-36). Method The Greek version of the recently translated and adapted by our team disease specific instrument KTQ-25 and the Greek SF-36 were administered in KTRs during their routine visit in the transplant outpatient clinic. Patients who met the eligibility criteria (time since transplant≥1 year, aged≥18 year old, functioning transplant) were included after providing written informed consent. Results A total of 84 KTRs (59 males; mean age 53.45±10.72; mean e-GFR 47.69±15.07; average time since transplantation 55.68±48.26 months) completed the two questionnaires. The scores in each dimension of KTQ-25 were: Physical Symptoms 3.98±1.60, Fatigue 5.30±1.36, Uncertainty/Fear 5.16±1.33, Appearance 6.31±0.94, Emotions 5.03±1.07 and Total Score 5.20±0.87. The mean SF-36 Physical Component Score (PCS) and Mental Component Score (MCS) scores were 47.98±8.70 and 46.94±9.70 respectively. Fatigue (p=0.009), Uncertainty/Fear (p=0.008) and Total Score (p<0.001) were better in male sex. Physical Symptoms (p=0.013) was better in KTRs with children than those with no children. There was positive correlation of e-GFR with Fatigue (p 0.002), Uncertainty/Fear (p=0.034) and Total Score (p=0.017). Hgb was positive correlated with Fatigue (p<0.001), Uncertainty/Fear (p<0.001), Emotions (p=0.031) and Total Score (p<0.001). KTRs who were receiving EPO for anemia had worse scores in all dimension of KTQ-25 (Physical Symptoms p=0.001; Fatigue p=0.001; Uncertainty/Fear p=0.021; Emotions p=0.010; Total Score p=0.002) except Appearance. Appearance was negative correlated with Weight (p=0.001) and BMI (p=0.001). Total number of daily taken pills was also significantly negative correlated with Fatigue (p=0.006) and Total Score (p=0.007). No differences found between different immunosuppressive therapies. Conclusion In our cohort of Greek adults KTRs maximum KTQ-25 score was obtained in Appearance dimension and the minimum in Physical Symptoms dimension. Fatigue, Uncertainty/Fear dimensions and Total Score were better for male sex and for KTRs with higher e-GFR and Hgb levels. Physical Symptoms score was better only for KTRs having children. Overweight and high BMI negatively affected A dimension. This is the first study to use a specific-disease tool for evaluating HRQoL in Greek KTRs and among our significant results is that better graft function is significantly correlated with better HRQoL.

Clusters by Menopausal Symptoms: Asian American Breast Cancer Survivors.

The purpose of this secondary analysis was to determine the clusters of Asian American breast cancer survivors by the severity scores of menopausal symptoms and to explore the characteristics associated with the identified clusters. The data from an ongoing study among 94 survivors were used. The instruments included the Perceived Isolation Scale, the Personal Resource Questionnaire, and the Memorial Symptom Assessment Scale-Short Form. The data analysis was conducted using hierarchical cluster analyses and multinomial logistic analyses. Three clusters were identified: "the cluster with high severity scores of total, psychological, physical, and psychosomatic symptoms (Cluster 1)," "the cluster with moderate severity scores of total, psychological, physical, and psychosomatic symptoms (Cluster 2)," and "the cluster with low severity scores of total, psychological, physical, and psychosomatic symptoms (Cluster 3)." The clusters had significant differences in the level of acculturation, perceived social isolation, and perceived social support (p < 0.05).

Differences by race in patient-reported symptoms during chemotherapy among women with early-stage, hormone receptor-positive breast cancer.

6528 Background: Symptom burden may contribute to racial differences in cancer treatment adherence and survival. Evidence on changes in symptom burden during chemotherapy and whether these differ by race is scarce. We used patient reported outcomes data collected before and after breast cancer chemotherapy initiation to compare symptom burden by race. Methods: Using electronic medical records of a large cancer center in the southern region of the US, we identified Black and White women diagnosed with stage I-III, hormone-receptor positive breast cancer from January 2007 to December 2015. A tablet-based platform [ConcertAI] was used to collect patient reported symptoms at the point of care. We included patients with at least one completed symptom report before and during chemotherapy. We focused on two standardized composite scores – physical symptoms and treatment side-effect (mean of 50 and standard deviation of 10), and calculated changes in symptoms using the closest report before chemotherapy and the most severe score reported during chemotherapy. Patients with a 10-point increase were classified as having a clinically meaningful increase in symptom burden. We used Oaxaca-Blinder decomposition to quantify racial differences in symptom burden change explained by baseline characteristics. These included baseline symptom scores, sociodemographic characteristics (age, regional level household income and education, state) and clinical characteristics (cancer stage and primary chemo regimen). Results: Among 1,167 included patients, Black women (30%) were younger (52 vs. 55 years old, p&lt;.001), more likely to live in areas with lower median household income and less education, and reported most severe scores about 2 weeks later than White women ( p&lt;.05). They were also more likely to report a 10-point increase in symptom burden for physical (68.5% vs. 61.2%, p=.017) and side-effects symptoms score (49.0% vs. 41.4%, p=.015). This was driven by larger increases in selected individual symptoms among Black women, such as sweating, itching, and numbness (under physical symptom score), and hair loss and taste change (under side-effect score). Decomposition analyses showed that baseline characteristics (especially primary chemo regimen) explained 79.2% ( p=.002) and 35.2% ( p=.131) of the increased probability of Black women reporting a 10-point increase in physical symptom and side-effects scores respectively. Conclusions: Black women with early-stage breast cancer were more likely to report a clinically meaningful increase in treatment side-effects and physical symptoms during chemotherapy compared to White women. Differences by race in physical symptoms scores were mostly explained by baseline characteristics. Future studies should examine whether racial differences in symptom burden translate into differences in treatment adherence and mortality.

Comprehensive TCM treatments combined with chemotherapy for advanced non-small cell lung cancer: A randomized, controlled trial.

Objective:We conducted this study to evaluate the efficacy and safety of traditional Chinese medicine (TCM) in advanced non-small cell lung cancer (NSCLC) patients who underwent chemotherapy.Design:This was a prospective, open-label, randomized controlled trial. NSCLC patients at stage IIIA, IIIB, or IV were randomly assigned to either TCM plus chemotherapy or chemotherapy alone. The comprehensive TCM treatment consisted of Kang Ai injection, herbal decoction, and Zhenqifuzheng capsules. The primary endpoint was quality of life (QOL) measured by the Functional Assessment of Cancer Therapy-Lung version 4.0. The secondary endpoints were chemotherapy completion rate, tumor response, and adverse events. All assessments were done at baseline, the third week, and the sixth week.Results:Thirty-nine participants were randomly assigned to the treatment group and 36 to the control group. The QOL scores were significantly improved in the treatment group compared with those of the control group in social well-being (cycle 1, P = .048; cycle 2, P = .015), emotional well-being (cycle 1, P = .047; cycle 2, P = 4.29E-05), and functional well-being (cycle 1, P = .030; cycle 2, P = .003), while the QOL scores in the above 3 domains declined in the control group (P < .05). Both groups had a decline in the physical well-being score (cycle 1, P = .042; cycle 2, P = .017) and lung cancer symptom score (cycle 1, P = .001; cycle 2, P = .001) after 2 courses of intervention. The deterioration in physical well-being and lung cancer symptoms was noticeably smaller in the treatment group (P < .05). There were significant differences between the 2 groups in social well-being, emotional well-being, functional well-being, lung cancer symptom domain, and the total score (P < .05). Patients in the treatment group had a significantly lower incidence of platelet reduction than the control group (P = .028) after 2 cycles of treatment. No significant difference in nonhematological adverse events (AEs) was observed.Conclusion:This study illustrated that comprehensive TCM treatment could promote the QOL of NSCLC patients, alleviate symptoms, and reduce the AEs caused by chemotherapy, verifying the synergistic and attenuating effects of TCM in NSCLC patients undergoing chemotherapy.Trial registration:Chinese Clinical Trial Registry (www.chictr.org.cn): ChiCTR-TRC-13003637

Muscle Sympathetic Nerve Activity is Elevated in Females with Physical Menopause Symptoms

Introduction Multiple symptoms accompany menopause, including vasomotor symptoms (VMS), physical symptoms, psychosocial symptoms and sexual dysfunction. Previous studies show that experiencing VMS may increase the risks for hypertension and cardiovascular disease (CVD); however, it is unclear whether physical menopausal symptoms, such as weight gain, lack of energy, or reduced muscular strength, contribute to CVD risk. Furthermore, muscle sympathetic nerve activity (MSNA) is elevated with CVD, but the relationship between menopause symptoms and MSNA is unknown. Thus, the aim of our study was to determine if physical menopausal symptoms are correlated with MSNA in postmenopausal females. Methods Eight postmenopausal females (age 63±1yr; menopause age 53±2yr) attended two study visits. The first visit included written informed consent, completion of the Menopause-Specific Quality of Life (MENQOL) and Minnesota Leisure Time Physical Activity (MLTPAQ) Questionnaires, and blood draws to measure sex hormone levels. The MENQOL asks participants to rate how bothered they feel in four areas of symptoms: vasomotor (i.e., VMS), psychosocial, physical, and sexual. The absence of a symptom corresponds with a score of 1 point, whereas a present symptom is rated according to how bothersome it is and is scored from 2-8 points. The MLTPAQ estimates caloric expenditure based on reported habitual physical activity. The second visit was conducted in the morning after an overnight fast and abstinence of alcohol, caffeine and exercise for 12 hours and included measurements of continuous noninvasive BP, heart rate via a 3-lead electrocardiography (ADInstruments, Colorado Springs, CO) and MSNA of the peroneal nerve via microneurography during a 10-minute period of quiet rest. Results Total MENQOL scores ranged from 1.3-2.4 on a 1-8 scale; physical symptom scores ranged from 1.1 to 3.4; and VMS ranged from 1.0-1.7. Body mass index (BMI, kg/m2) was 24±2. Levels of estradiol, total estrogens, testosterone, total estrogens: testosterone ratio, and MLTPAQ were not different between the females. Average mean arterial pressure was (101±5mmHg) and MSNA burst frequency was 29 bursts/min). In addition, MSNA burst frequency correlated with the MENQOL scores for physical symptoms (r=0.73, p=0.04), but not other menopausal symptoms, including VMS (p>0.05), indicating that females with more severe physical symptoms had greater MSNA. Conclusion Although females with VMS have greater CVD risk than those without VMS, data from this small sample of females suggests that reported physical symptoms rather than VMS were elevated with resting MSNA and were strongly associated with MSNA. These findings suggest that females who experience physical menopause symptoms may demonstrate autonomic dysregulation which could contribute to CVD risk.

Association Between Preinjury Symptoms and Postconcussion Symptoms at 4 Weeks in Youth.

To investigate whether preinjury physical, emotional, cognitive, and sleep symptoms on the Post-Concussion Symptoms Inventory (PCSI) are associated with persistent postconcussion symptoms (PPCS) at 4 weeks and whether any associations are moderated by sex or age. A total of 3063 participants with acute concussion, presenting to 9 Canadian pediatric emergency departments, were enrolled from August 2013 to June 2015. A planned secondary analysis of a prospective, multicenter cohort study (Predicting Persistent Post-concussive Problems in Pediatrics or 5P). Primary outcome was PPCS at 4 weeks, defined as 3 or more new or worsening individual symptoms compared with the preinjury score at 28 days on the PCSI. The association between preinjury scores and PPCS was analyzed with a multivariable logistic regression analysis that included preinjury, sex, age, sex × preinjury, and age × preinjury interactions as predictors. Missing baseline covariates were imputed. A total of 2123 (n = 844 [39.8%] girls; median [IQR] age = 12.9 [10.7, 15.0] participants were included in the analysis. Preinjury physical symptom score was associated with PPCS at 4 weeks (χ2 = 13.87, df = 6, P = .031). The preinjury emotional score also contributed to the variability in PPCS (χ2 = 11.79, df = 6, P = .067). While girls reported higher preinjury physical, emotional, and cognitive scores than boys, neither sex nor age interacted with preinjury to predict PPCS at 4 weeks. Independent of age and sex, preinjury physical symptoms were associated with PPCS at 4 weeks (OR = 1.40; 95% CI, 1.15-1.70). Preinjury physical symptoms are associated with the probability of having PPCS at 4 weeks postconcussion independent of age and sex. Providers should consider preinjury symptoms to inform prognosis and recovery management.

Daily intake of Lactobacillus gasseri CP2305 ameliorates psychological premenstrual symptoms in young women: A randomized, double-blinded, placebo-controlled study

Lactobacillus gasseri CP2305 (CP2305) ameliorates stress-induced symptoms in young adults. In this study, we evaluated the effects of CP2305 on the premenstrual symptoms of healthy young women. Fifty-six women ingested CP2305 or placebo tablets over the course of six menstrual cycles. The CP2305 group reported fewer premenstrual symptoms than the placebo group, particularly psychological symptoms, such as depressed mood and anxiety. Whereas water retention-related physical symptom scores, such as those for breast tenderness and swelling, were reduced in the placebo group, they remained unchanged in the CP2305 group. In addition, significant differences were observed in the changes from baseline levels of salivary estradiol and progesterone in the luteal phase between the two groups, resulting in sustained elevated levels of reproductive hormones in the CP2305 group. Therefore, daily intake of CP2305 tablets might improve the premenstrual psychological symptoms of healthy young women in association with changes in reproductive hormone levels.

Alterations in symptoms and health-related quality of life as kidney function deteriorates: A cross-sectional study.

To compare symptoms and health-related quality of life and to examine the relationship between these as kidney function deteriorates. Chronic kidney disease is a global health problem, and while knowledge of symptom burden and health-related quality of life is understood in kidney failure (previously end-stage kidney disease), there is limited understanding about symptoms and health-related quality of life across the chronic kidney disease trajectory. Cross-sectional design reported using the STROBE guidelines. Eight hundred eighty-six adults with varying levels of kidney function (chronic kidney disease grades 3b-5 including those receiving dialysis) completed the renal version of the Integrated Palliative care Outcome Scale and the Quality of Life Short Form-36 version 2. Socio-demographic and renal characteristics were also collected. Data were analysed using descriptive and inferential statistics. Participants had a mean age of 57years and were mostly male. Regardless of chronic kidney disease grade, pain, poor mobility, weakness, anxiety and depression were the most prevalent and severe symptoms reported. Health-related quality of life was significantly associated with physical and psychological symptom scores. As kidney function deteriorated, both physical and mental health-related quality of life decreased, and prevalence and severity of symptoms increased. There is substantial symptom burden irrespective of chronic kidney disease grade, which overwhelmingly affects health-related quality of life. Early identification by nurses would enable proactive management plans to be implemented. Nurses, whether in specialist renal services or in primary healthcare, are ideally placed to regularly assess symptoms and health-related quality of life in those with chronic kidney disease. Timely assessment could assist in the targeting of earlier interventions designed to reduce symptom burden and to increase health-related quality of life.

GERIATRIC GYNECOLOGICAL DISORDERS & QOL IN MENOPAUSAL WOMEN IN URBAN POPULATION OF CENTRAL INDIA.

Objective: Assess menopausal symptoms &amp; QOL, Importance of early symptom recognition, knowledge and importance of each domain of menopausal symptom, their occurrence and relation with sociodemographic variables. Materials and Methods: Hospital-based descriptive study at Outpatient and Inpatient Department of Gynecology at Shri Mahaveer Hospital, Raipur, CG with 140 postmenopausal women (PM), from March 1-June 30, 2020, using simple random sampling &amp; structured Menopause-specic QOL (MENQOL) questionnaire. Results: Ÿ Socio-demographic - 9(6.4%) premature menopause, 113 (80.715%) natural menopause, 134 (95.71%) married, 126 (90%) housewives, 112(80%) literate. 109 (77.86%) had no co morbidities. Ÿ Mean age menopause: - natural 43.88 + 5.01, surgical 40 + 7.73 yrs. Ÿ Prevalence of classical menopausal symptoms- hot ushes 64.29% and vaginal dryness 50%, highest in 46-50 age group (17.14%, 12.14%) followed by 51-55yrs (15%, 10%). Ÿ MENQOL mean total score = 67.51 + 17.88, highest score 104. Mean physical symptom score 38.81+11.25 (95% CI 36.94, 40.66) was highest followed by psychosocial 16.21+5.12 (15.36, 17.06), vasomotor 6.81+2.91 (6.33, 7.29) and least for sexual symptoms 5.94+3.19(5.38, 6.44). Ÿ Associations between QOL scores with educational , socioeconomic &amp; marital status were statistically signicant with P &lt; 0.05 Conclusion: Postmenopause-related physical symptoms are frequently reported by middle age group. By nursing education, creating appropriate awareness and health education on management of postmenopausal symptoms to that age group could help in reducing burden of healthcare

Electronic cigarettes\u2019 withdrawal severity symptoms among users during intermittent fasting: a cross-sectional study

BackgroundRecently, electronic cigarette (e-cig) usage has increased significantly, making it a potentially effective smoking cessation tool. In Muslim countries, most people who use e-cigarettes fast the month of Ramadan, which results in intermittent fasting. This study aims to reveal the severity of e-cig withdrawal symptoms among users during this intermittent fasting period.MethodsA self-administered survey was developed and validated to solicit anonymous responses from e-cig users living in Jordan, through a cross-sectional study design. Participants were recruited through social media resources. Severity scores of physical (out of 11) and psychological (out of 8) withdrawal symptoms for each participant were assessed and calculated for each participant, depending on the symptoms reported.ResultsA convenience sample (n = 523) of e-cig adult users were recruited. The majority of the participants were males (96.4%) aged between 18 and 40 years (86.4%). Many participants replaced tobacco smoking with e-cig (53.5%) in order to help them stop smoking. More than half of the participants experienced relatively weak physical (0.82 ± 1.78) and psychological (1.24 ± 1.89) withdrawal symptoms during the month of fasting. Most of the participants (63.2%) preferred to engage themselves with a busy schedule to tolerate the related withdrawal symptoms they experienced.ConclusionE-cigs could play a vital role in smoking cessation among tobacco smokers during intermittent fasting. Ramadan offers a good opportunity for smokers to quit, as the reported physical and psychological e-cig withdrawal symptoms were found to be relatively weak. Awareness and behavioral interventions would help clarify the effect of e-cigs and help determine alternative ways to cease smoking.

MPS-specific physical symptom score (PSS) and adaptive functions in MPS IVA: A cross sectional study

MPS-specific physical symptom score (PSS) and adaptive functions in MPS IVA: A cross sectional study

The Relationship between Self-Compassion and the Experience of Memorial Symptoms in Patients with Gastrointestinal Cancer.

Background:Patients with Gastrointestinal (GI) cancer experience a range of physical and psychological memorial symptoms after developing cancer and beginning to receive medical care. The present study was conducted to investigate the relationship between self-compassion and the experience of memorial symptoms in patients with GI cancer.Materials and Methods:This descriptive-correlational study was conducted in July to August 2019. The study sample included 190 patients admitted to Seyed Al-Shohada Hospital, with GI cancer who entered the study by convenience sampling. Data were collected using a patient demographic information form, Neff's Self-Compassion Scale (SCS), and the Memorial Symptoms Assessment Scale (MSAS) and then analyzed by Pearson correlation coefficient in SPSS-20.Results:The mean (SD) total score of self-compassion was 86.67 (16.65) out of 130, and the mean (SD) total score of memorial symptoms was 1.40 (0.64) out of 4 in patients with GI cancer. The most frequently reported physical symptom was lack of energy, with an 86.84% prevalence, and the most frequently reported psychological symptoms included worrying and feeling nervous, with 70.52% prevalence rates. The total score of self-compassion was inversely correlated with the total score of memorial symptoms, the score of psychological symptoms, and the score of physical symptoms. Furthermore, the total score of the memorial symptoms was inversely correlated with the scores of all the self-compassion components (p < 0.001).Conclusions:Cancer patients had memorial symptoms in both physical and psychological domains. These symptoms decrease with an increase in self-compassion, so compassion-based educational interventions by nurses can be used to reduce these symptoms.

Generalized Anxiety and Major Depressive Symptoms of General Public in South Korea during the Early COVID-19 Pandemic

The extent of viral spread and strategies in dealing with the COVID-19 pandemic have been different in each country. There are overall increased mental health concerns in many countries but it is unclear what the general public individuals who do not have heighten vulnerability to stressors for existing mental diseases or significant physical illnesses were experiencing during the pandemic. We evaluated the stressors and mental health of general public in South Korea that has a relatively low confirmed cases and deaths. Responses on the on-line survey questions were used to assess the mental and physical symptoms in association with individuals’ reported stressors. Individuals with the symptoms of the generalized anxiety disorder (GAD) were reported in 58.9%, and major depression (MD) in 23.2%, mostly in minimal to mild degrees, cut-off scores of 5 and 10, respectively by the validated screening tools, GAD-7 and PHQ-9. Both GAD and MD symptoms were in 21.5% of the respondents. The total number of stress had significant association with the scores of GAD-7, PHQ-9, physical symptoms, sleep difficulties and resilience (p < 0.01). GAD scores were also associated with sleep difficulties (p < 0.01) and raising young children (p < 0.05). MD scores were associated with sleep difficulties, job-dissatisfaction, and educational level (p < 0.05). The limitations of the study include small sample size, usage of smartphone or email, potential under-reporting by stigma in the socio-cultural context and evolving nature of pandemic. We conclude that keeping careful watch for mental symptoms, stressors, sleep difficulties and other physical symptoms are important even for the individuals without previous mental illnesses during the pandemic era.

Intake of 25-Hydroxyvitamin D3 May Reduce the Severity of Upper Respiratory Tract Infection: Post hoc Analysis of a Randomized, Double-Blind, Placebo-Controlled, Parallel Group Comparison Study.

To evaluate the effects of 25-hydroxyvitamin D3 (25OHD) on symptoms at the onset of the upper respiratory tract infection (URTI) in subjects with insufficient or deficient serum 25-hydroxyvitamin D levels, we conducted a post hoc analysis of data from a randomized, placebo-controlled study; the subjects received 10 μg of 25OHD per day or a placebo for 16 weeks. The Wisconsin Upper Respiratory Symptom Survey-21 was used to determine URTI. The study endpoints included WURSS-21 scores, number of URTI events, and proportion of medication (antibiotics, antipyretic analgesics) usage. We found that the physical symptom scores for “Runny nose,” “Sneezing,” and “Head congestion” were significantly lower in the 25OHD group than in the placebo group; for all items except “Breathe easily, “the quality of life” scores were significantly improved in the 25OHD group. There was no significant difference in the number of URTI events or the proportion of medication use between the groups. Collectively, the findings of this study indicate that a sufficient 25OHD intake can reduce physical symptoms at the onset of upper respiratory tract infection, particularly nasal symptoms, and may improve the quality of life at the time of onset.

Symptom burden in patients with common cancers near end-of-life and its associations with clinical characteristics: a real-world study.

Patients dying with cancer can experience various physical and psychological symptoms. We aimed to determine the type and severity of symptoms within the last 6months of life in a large real-world cohort of patients with cancer. We examined prospectively collected patient-reported outcomes of patients with lung, colorectal, breast, prostate or pancreatic cancer using the revised Edmonton Symptom Assessment System (ESASr) questionnaire from a large province in Canada from 2016 to 2017. The ESASr was categorized into physical and psychological symptom subscores and total symptom score, and each was classified as none to mild (0-3) or moderate to severe (4-10) based on intensity. Multivariable logistic regression analyses were performed to evaluate the relationship between clinical characteristics and symptom scores. We identified 1159 patients eligible for analysis, of whom 52.2% were men and median age was 68years. There were 613, 192, 149, 111 and 94 patients with lung, colorectal, breast, prostate and pancreatic cancer, respectively. While approximately half of patients reported moderate to severe physical symptom subscores and total symptom scores, only one-third reported moderate to severe psychological subscores. On multivariable logistic regression analyses, women were more likely to report moderate to severe physical (odds ratio [OR], 1.52; 95% confidence interval [CI], 1.08-2.12; P = 0.016), psychological (OR, 1.60; 95% CI, 1.14-2.26; P = 0.006) and total symptom scores (OR, 1.80; 95% CI, 1.28-2.51; P = 0.001). Patients with lung cancer were also more likely to report moderate to severe physical and psychological subscores (OR, 1.95; 95% CI, 1.28-2.96; P = 0.002 and OR, 1.78; 95% CI, 1.13-2.81; P = 0.013) and total symptom scores (OR, 1.83; 95% CI, 1.20-2.81; P = 0.005). Finally, those closer to death were more likely to report moderate to severe physical symptom subscores (OR, 2.07; 95% CI, 1.33-3.23; P = 0.001) and total symptom scores (OR, 2.29; 95% CI, 1.46-3.60; P < 0.001), but not psychological symptom scores (OR, 1.34; 95% CI, 0.84-2.14; P = 0.210). There is significant symptom burden in patients with cancer near the end-of-life. Further, physical symptoms appear to be more intense than psychological symptoms. Symptom-directed care is still needed to improve the quality of end-of-life.

Effects of forehead cooling and supportive care on menopause-related sleep difficulties, hot flashes and menopausal symptoms: a pilot study

ABSTRACT Objective/Background This pilot study explored the efficacy of a novel forehead cooling device for perceived sleep difficulties and hot flashes in menopausal-age women. Participants 20 women (55.1 ± 4.2 years; 19 post-menopausal) with insomnia symptoms and self-reported two or more hot flashes per day. Methods Participants completed daily assessments of sleep and hot flashes (via diaries) across 1 baseline week and 4 weeks of open-label, in-home, nightly treatment with a forehead cooling device (15–18°C) along with sleep hygiene instructions. They also completed ratings of insomnia and menopausal symptoms using standardized questionnaires. Results Women reported reductions in sleep onset latency (SOL), wakefulness after sleep onset (WASO), and nocturnal hot flash severity during the first week of treatment (SOL: 25.7 ± 18.4 min; WASO: 36.3 ± 27.3 min; hot flash severity: 3.0 ± 2.8) compared with baseline (SOL: 38 ± 26.3 min; WASO: 52.2 ± 35.6 min; hot flash severity: 6.8 ± 3.7), with further improvements after 2–4 weeks of use (p < .001). There were also clinically meaningful reductions in insomnia severity and hot flash-related daily interference and lower psychological and physical symptom scores on the Greene climacteric scale after treatment (all p’s<0.001). Conclusions This exploratory, naturalistic, pilot study shows that nightly use of a forehead cooling device produces improvements in self-reported sleep and reductions in insomnia, hot flash, and other menopausal, symptoms. Controlled studies are warranted to determine the role of this therapy in the management of sleep difficulties and menopausal symptoms in women. Further mechanistic studies are needed to understand the physiological impact of forehead cooling on sleep and menopausal symptoms.

Cognitive–behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a randomised controlled trial

BackgroundCognitive–behavioural therapy (CBT) is effective in chronic fatigue (CF) syndrome. However, CBT has not been investigated in postinfectious CF, nor is it known whether addition of therapeutic elements from other...

Pilot study for the Psychometric Validation of the Sheffield Profile for Assessment and Referral to Care (SPARC) in Korean Cancer Patients.

PurposeThis study aimed to validate the Sheffield Profile for Assessment and Referral to Care (SPARC) as an effective tool for screening palliative care needs among Korean cancer patients.Materials and MethodsThe English version of the SPARC was translated by four Korean oncologists and reconciled by a Korean language specialist and a medical oncologist fluent in English. After the first version of the Korean SPARC (K-SPARC) was developed, back-translation into English was performed by a professional translator and bilingual oncologist. The back-translated version was reviewed by the original author (S.H.A.), and modifications were made (ver. 2). The second version of the K-SPARC was tested against other questionnaires, including the Functional Assessment of Cancer Therapy-General (FACT-G) and the Edmonton Symptom Assessment System (ESAS).ResultsThirty patients were enrolled in the pilot trial. Fifteen were male, and the median age was 64.5 years. Six patients had an Eastern Cooperative Oncology Group performance status of 2 or more. All patients except one were receiving chemotherapy. Regarding internal consistency, the Cronbach’s α scores for physical symptoms, psychological issues, religious and spiritual issues, independency and activity, family and social issues, and treatment issues were 0.812, 0.804, 0.589, 0.843, 0.754, and 0.822, respectively. The correlation coefficients between the SPARC and FACT-G were 0.479 (p=0.007) for the physical domain and –0.130 (p=0.493) for the social domain.ConclusionThis pilot study indicates that the K-SPARC could be a reliable tool to screen for palliative care needs among Korean cancer patients. A further study to validate our findings is ongoing.

The Efficacy of Web and Mobile-Based Interventions to Alleviate Physical Symptoms in People with Advanced Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (GP750)

• Describe how web and mobile-based symptom management interventions may alleviate physical symptoms in patients with advanced, life limiting illness.• Describe the inclusion criteria, search strategy and analysis used in a meta-analysis of web and mobile-based symptom management interventions of physical symptoms in patients with advanced, life limiting illness. Web and mobile-based interventions are promising modalities in which patients with advanced, life-limiting diagnoses can attain symptom-focused care as part of comprehensive palliative care. Systematically review and meta-analyze studies to summarize evidence on the effectiveness of web or mobile-based interventions impacting physical symptoms in patients with advanced, life-limiting diagnoses. Titles and abstracts published from 2004-2019 were identified using PubMed, PsycINFO, and CINAHL. RCTs involving adults with advanced, life-limiting diagnoses using a web or mobile-based intervention to manage their disease or symptoms were included. Interventions must have reported physical symptom outcomes. Risk of bias was assessed using the ROBINS-I tool. Studies that reported mean scores for physical symptoms using validated tools for the intervention and control groups were analyzed. These scores were pooled using a random effects model, and standardized mean difference (SMD) and 95% confidence intervals were reported. Heterogeneity was assessed using the I2 statistic. Eleven of the 1177 screened studies met the inclusion criteria. Interventions focused on five diagnoses (Cancer n=7, COPD n=3, Parkinson’s Disease n=1, Multiple Sclerosis n=1, Post-Polio Syndrome n=1). Intervention components included: general information, messaging a provider, tracking/monitoring, and feedback/tailored information. Eight studies evaluated physical symptoms using a multi-symptom tool and three evaluated specific symptoms (e.g. pain or fatigue). Web or mobile-based interventions significantly improved physical symptoms (SMD -0.34, -0.64 to -0.03, I2=88%). A subgroup analysis including studies using a multi-symptom tool observed a similar trend in improvement of physical symptoms (SMD -0.48, -0.86 to -0.09, I2=91%). This meta-analysis demonstrated that web and mobile-based symptom management interventions are effective modalities to alleviate physical symptoms in adults living with advanced, life-limiting diagnoses. Significant heterogeneity was noted among included studies.

1033 Sleep and Patient-Reported Outcomes in Persons With Heart Failure With Preserved Ejection Fraction

Abstract Introduction Sleep quality has a significant bearing on disease. A better understanding of sleep quality may help identify opportunities to improve patient-reported outcomes (PROs) in persons with heart failure with preserved ejection fraction (HFpEF). We aimed to explore the association between sleep and PROs in patients clinically diagnosed with HFpEF. Methods Cross-sectional study of 22 participants (71.2±7.2 years, 95% male, 86.4% white) with HFpEF, recruited from a heart failure (n=14) and sleep clinic (n=8). Sleep disordered breathing was measured objectively using one-night in-home obstructive sleep apnea (OSA) testing (ApneaLink). Actigraphy (7 days) was used to assess sleep duration, efficiency, and wake after sleep onset (WASO). Subjective sleep measures included the Insomnia Severity Index (ISI), Epworth Sleepiness scale (ESS), and Pittsburgh Sleep Quality Index (PSQI). PROs included functional status (Functional Outcomes Sleep Questionnaire [FOSQ]), depression (PROMIS Depression), fatigue (PROMIS Fatigue), and heart failure specific quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]; overall summary score [KCCQ-os] and clinical summary score [KCCQ-cs]). The KCCQ-cs includes physical function and symptom scores to corresponds with NYHA Classification. Results Fifty percent of the participants had poor sleep quality (PSQI &amp;gt;5) and 2 (9.1%) had ISI scores &amp;gt;14. The majority (64%; n=14) had OSA; 10 currently on OSA therapy. Mean oxygen desaturation index (ODI) was 20.8±17.8. Mean actigraphy data indicated poor sleep (sleep duration 302±116 minutes, sleep efficiency 70.0±18.6%, and WASO 52±28 minutes) despite only 5 (22.7%) participants reporting excessive daytime sleepiness (ESS&amp;gt;10). Greater insomnia symptom severity was associated with lower heart failure specific quality of life (KCCQ-os) and functional status, and, greater fatigue and depression (all p-values &amp;lt;.05). FOSQ was negatively associated with PSQI (r= -.710, p= &amp;lt;.001) and positively with sleep efficiency (r=.496, p=.026). The KCCQ-cs was positively associated with sleep duration (r=.496, p=.026) and negatively but not significantly associated with ODI (r= -.453, p=.07). Conclusion Impaired sleep and OSA are highly prevalent in patients with HFpEF and both are adversely associated with PROs. Goals to improve sleep is important for effective symptom management and for potential improvements in PROs. Support American Nurses Foundation, Preventative Cardiovascular Nurses Association