Self-reported Symptom Burden Research Articles

Executive dysfunction after multiple concussions is not related to cerebrovascular dysfunction

Objective. We investigated the relation between prior concussion history and working memory (WM), self-reported cognitive symptom burden, and cerebrovascular function in adolescents and young adults (14–21 years old). Approach. We recruited 59 participants, 34 clinically diagnosed with a sports-related concussion and 25 controls. Concussed subjects were studied at baseline (within 28 days of their injury) and eight weeks after, while control subjects only had one assessment. We assessed WM (n-back task up to four-back), and neurovascular coupling (cerebrovascular responses at middle cerebral artery during n-back tasks) using a transcranial Doppler ultrasonograph. Main results. There was no significant difference in WM between controls and concussed participants (p = 0.402). However, WM capacity was lower in those who had sustained ≥3 concussions (7.1% with WM capacity of four) compared to those with their first ever concussion (33.3%) and controls (28.0%, overall p = 0.025). At the sub-acute point (n = 24), self-reported cognitive symptom burden was mostly resolved in all but two participants. Despite the resolution of symptoms, WM performance was not different eight weeks post injury (p = 0.706). Neurovascular coupling was not different between controls and concussed participants regardless of prior concussion history. Significance. Up to 20% of concussed individuals experience covert sequelae lasting beyond the resolution of self-reported overt symptoms. How a prior history of concussion impacts the potential for sequelae is not well established, and the underlying mechanisms are unknown. Despite no alterations in neurovascular coupling, a history of prior concussion was associated with significant deficits in WM capacity, and lasted beyond self-reported cognitive symptom resolution.

Effects of preoperative oral carbohydrate administration combined with postoperative early oral intake in elderly patients undergoing hepatectomy with acute-phase inflammation and subjective symptom burden: A prospective randomized controlled study

BackgroundEnhanced recovery after surgery (ERAS) has received increasing attention. Preoperative oral carbohydrate and postoperative early oral feeding (POC-PEOF) as the basic nutrition administration in the ERAS program suffers from low adherence. The role and benefits of administering POC-PEOF in elderly patients with hepatocellular carcinoma (HCC) are unclear. Therefore, the randomized controlled trial evaluated the effects of POC-PEOF in elderly patients with HCC undergoing hepatectomy with inflammation and patient self-reported symptom burden compared with the corresponding outcomes of traditional fasting protocols. MethodsElderly patients with HCC (n = 126) were randomly assigned to two groups using the sealed envelope technique. Sixty-three patients were included in the intervention (POC-PEOF) group and received POC-PEOF administration, whereas the 63 patients in the control (FAST) group underwent conventional fasting. Acute-phase inflammation markers, patient self-reported symptom burdens, and postoperative outcomes were compared between the two groups. ResultsThe average age was 69.60 ± 5.00 years in the POC-PEOF group and 70.44 ± 6.15 years in the FAST group. Compared to prolonged fasting, POC-PEOF achieved significant positive results, including lower overall levels of inflammatory response mediators (CRP, IL-6) on postoperative day (POD) 1, POD 3, and POD 5 (P < 0.05), lower patient self-reported symptom burdens of thirst, hunger, anxiety and nausea (P < 0.05), faster gastrointestinal function return with shortened times to first flatus and first defecation (48.31 ± 13.24 h vs. 96.26 ± 23.12 h and 72.87 ± 21.12 h vs. 144.34 ± 23.31 h, and P = 0.034 and P = 0.013, respectively). Furthermore, the average postoperative hospitalization duration in the POC-PEOF group was shorter than that in the FAST group (6.93 ± 0.98 d vs. 8.12 ± 1.15 d, P = 0.042). There was no significant difference of total complications between the groups (25.39 % vs 36.51 %, RR 0.696, 95 % CI 0.408–0.187, P = 0.177). ConclusionPOC-PEOF helps lessen acute-phase inflammation and relieves the subjective symptom burden, which can ensure better positive postoperative outcomes in elderly HCC patients undergoing hepatectomy.

Electrical cardioversion to assess the association between self-reported symptoms and rhythm status in patients with persistent atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background. Knowledge about the association between symptoms and rhythm status (symptom-rhythm correlation) has potential clinical implications as it may identify patients with atrial fibrillation (AF) who profit from rhythm control in regard to reduction in symptom burden and improvement in quality of life. However, standardized strategies to assess symptom-rhythm correlation in AF patients are currently not available. Purpose. This study aimed to assess symptom-rhythm correlation in patients with persistent AF using electrical cardioversion (ECV) as a diagnostic probe. Methods. We used ECV to examine symptom-rhythm correlation in 81 patients with persistent AF. The presence of self-reported symptoms before ECV and at the first outpatient AF clinic follow-up visit (within 1-month) was assessed to determine the prevalence of a symptom-rhythm correlation (defined as self-reported symptoms present during AF and absent in sinus rhythm or absent in AF and yet relief during sinus rhythm). The symptom-rhythm correlation was absent in patients with symptoms before ECV who remained symptomatic during sinus or in patients with symptoms prior to ECV and without symptoms in AF after ECV. Asymptomatic patients before ECV with or without symptoms in AF or sinus rhythm afterwards had no symptom-rhythm correlation as well. The symptom-rhythm correlation was unevaluable in patients who were symptomatic in AF before ECV and at the first outpatient AF clinic follow-up visit. In addition, predominant self-reported symptoms (symptoms with highest self-reported symptom burden) were assessed to evaluate the symptom patterns around ECV. Intra-individually variable symptom patterns were defined as changes in predominant self-reported symptoms within patients around ECV. Results. Symptom-rhythm correlation was assessed in all patients. Only in 18 patients (22%), a symptom-rhythm correlation could be documented. Twenty-eight patients (35%) did not show any symptom-rhythm correlation and 35 patients (43%) had an unevaluable symptom-rhythm correlation as these patients were in symptomatic AF both at baseline and at the first outpatient AF clinic follow-up visit. Importantly, self-reported symptom patterns around ECV were intra-individually variable in 10 patients (12%) without symptom-rhythm correlation (of which 9 patients (11%) had AF recurrence) and in 2 patients (2%) with an unevaluable symptom-rhythm correlation. Conclusions. In patients with persistent AF, the prevalence of a symptom-rhythm correlation around ECV is low, but ECV often changes symptom pattern. Further studies are warranted to identify more optimal strategies to assess symptom-rhythm correlation in patients with persistent AF. Abstract Figure. Symptom-rhythm correlation and patterns

Determinants of patient activation and its association with cardiovascular disease risk in chronic kidney disease: A cross-sectional study.

BackgroundPatient activation describes the knowledge, skills and confidence in managing one's own health. Promoting patient activation is being prioritized to reduce costs and adverse outcomes such as cardiovascular disease (CVD). The increasing prevalence of chronic kidney disease (CKD) presents a need to understand the characteristics that influence patient activation and the effect on health outcomes.DesignCross‐sectional study.Setting and participantsPatients with non‐dialysis CKD recruited from 14 sites (general nephrology and primary care) in England, UK.Outcome measuresPatient activation was measured using the PAM‐13. Demographic and health‐related variables, self‐reported symptom burden, health‐related quality of life (HRQOL), socioeconomic status (SES), were assessed as determinants of patient activation. Major CVD risk factors included hypertension, dyslipidaemia, obesity and hyperkalaemia.Results743 patients were included (eGFR: 32.3 (SD17.1) mL/min/1.73 m2, age 67.8 (SD13.9) years, 68% male). The mean PAM score was 55.1 (SD14.4)/100. Most patients (60%) had low activation. Those with low activation were older (P<.001), had lower eGFR (P = .004), greater number of comorbidities (P = .026) and lower haemoglobin (P = .025). Patients with low activation had a 17% greater number of CVD risk factors (P < .001). Risk factors in those with low activation were being older (P < .001) and having diabetes (P < .001).ConclusionThis study showed that only a minority of CKD patients are activated for self‐management. Our findings help better understand the level of activation in these patients, particularly older individuals with multimorbidity, and further the knowledge regarding the characteristics that influence activation.Patient or Public ContributionPatients were involved in the design of main study.

Frailty is strongly associated with self-reported symptom burden among patients with cirrhosis.

Although patients with cirrhosis often experience debilitating symptoms, few are referred for palliative care. Frailty is increasingly incorporated in liver transplantation evaluation and has been associated with symptom burden in other populations. We hypothesized that frail patients with cirrhosis are highly symptomatic and thus are likely to benefit from palliative care. Patients with cirrhosis undergoing outpatient liver transplantation evaluation completed the Liver Frailty Index (grip strength, chair stands and balance) and a composite of validated measures including the Edmonton Symptom Assessment Scale, distress and quality of life (QOL) measures. Of 233 patients (median age 61 years, 43% women), 22% were robust, 59% prefrail and 19% frail. Overall, 38% of patients reported ≥1 severe symptoms based on preestablished Edmonton Symptom Assessment Scale criteria. Higher frailty categories were associated with increased prevalence of pain, dyspnea, fatigue, nausea, poor appetite, drowsiness, depression and poor well-being (test for trend, all P < 0.05). Frail patients were also more likely to report psychological distress and poor QOL (all P < 0.01). In univariate analysis, each 0.5 increase in liver frailty index was associated with 44% increased odds of experiencing ≥1 severe symptoms [95% confidence interval (CI), 1.2-1.7, P < 0.001], which persisted (odds ratio, 1.3, 95% CI, 1.0-1.6, P = 0.004) even after adjusting for Model for End Stage Liver Disease-Sodium, ascites, hepatic encephalopathy and age. In patients with cirrhosis, frailty is strongly associated with physical/psychological symptoms, including pain and depression and poor QOL. Frail patients with cirrhosis may benefit from palliative care co-management to address symptoms and improve QOL.

P05.13 Central vs Peripheral Thoracic Malignancies Treated with SBRT: Early Outcomes of a Prospective Quality of Life Study

Thoracic malignancies in close proximity to central mediastinal structures are known to have a higher rate of treatment-related toxicity following stereotactic body radiation therapy (SBRT). Intrinsic damage secondary to tumor invasion may contribute to this increased toxicity and could be identified by pretreatment quality of life metrics. The appropriate dose fractionation schedule as well as daily treatment schedule that may mitigate the aforementioned central toxicity remains nebulous. We reviewed patients on a prospective trial assessing quality of life before and after SBRT and stratified based on central versus peripheral anatomical location. In this single institutional study, patients were enrolled on a prospective quality of life trial approved by the local Institutional Review Board. All patients were evaluated by a multidisciplinary thoracic oncology team and were diagnosed with thoracic malignancy amenable to stereotactic body radiation therapy delivered in 5 or fewer treatment fractions on an every other day schedule. Central tumors were defined as those within 2 cm of central mediastinal structures including the proximal bronchial tree. Patients underwent pre-and post-treatment quality of life questionnaires including the prospectively validated EORTC Quality of Life Core questionnaire (QLQ-C30 version 3) and Supplemental Lung Cancer module questionnaire (QLQ-LC13). Baseline differences between groups were analyzed using the Mann-Whitney U and Chi-squared tests. Score comparisons for EORTC questionnaires pre- and post- SBRT were conducted using the Wilcoxon signed-rank test. All statistics were performed in SPSS, version 24. A total of 31 patients from February 2018 to February 2020 were enrolled with a median age of 70 (59-90) years. The majority of patients had an ECOG of 1 (n = 15) and the most common histology was adenocarcinoma (n = 17). A total of 13 patients were found to have central lung tumors. There were no significant pretreatment differences in age, performance status, gender or the predefined EORTC questionnaire-specific subcategorized functional, quality of life, or symptom domains between patients diagnosed with central versus peripheral tumors. Following SBRT, there were notable, statistically significant improvements in the Emotional functioning (EF) domain (pre- and post- treatment median: 61.5 and 91.7, respectively, z=-2.01, p=.044) and the Cognitive functioning (CF) domain (pre- and post- treatment median: 75.0 and 91.7, respectively z=-2.06, p=.039) in patients treated for central lung tumors. Similar improvements were not observed in patients treated for peripheral lung tumors. There were no significant changes in any other functional, symptom, or quality of life domain following treatment for either group. Pretreatment EORTC quality of life metrics did not demonstrate significant differences in patients diagnosed with central versus peripheral thoracic malignancies in our prospective cohort. However, patients with central lung tumors experienced significant improvements in their EF and CF domains following SBRT. These findings suggest patients with central lung tumors may experience greater psychological distress from their disease independent of self-reported physical symptom burden.

P32.04 Preoperative Self-Reported Symptom Burden and Quality of Life of Patients Undergoing Lung Cancer Surgery: A Cross-Sectional Study

P32.04 Preoperative Self-Reported Symptom Burden and Quality of Life of Patients Undergoing Lung Cancer Surgery: A Cross-Sectional Study

Persistent Somatic Symptom Burden and Sleep Disturbance in Patients with COVID-19 During Hospitalization and After Discharge: A Prospective Cohort Study.

BackgroundThe present study was designed to reveal the trajectory of self-reported somatic symptom burden and sleep quality over time in patients with COVID-19 and to identify prognostic factors for greater somatic symptom burden and sleep disturbance.Material/MethodsSeventy-four patients with COVID-19 were prospectively followed for longitudinal assessment of somatic symptom burden and sleep quality. We used the 8-item Somatic Symptom Scale (SSS-8) and the modified Medical Research Council (mMRC) scale for somatic symptom burden and the Pittsburgh Sleep Quality Index for sleep quality investigation. Univariate and multivariate analyses were performed to identify independent factors associated with somatic symptom burden and sleep quality.ResultsAlthough the degree of physical discomfort and sleep quality issues tended to decline during self-quarantine, patients still experienced these problems to a certain degree. Univariate and multivariate analyses showed that SSS-8 scores at admission (relative risk [RR] 1.234, 95% CI 1.075–1.417, P=0.003) and mMRC scores at discharge (RR 2.420, 95% CI 1.251–4.682, P=0.009) were 2 independent prognostic indicators of somatic symptom burden. In addition, muscle pain as a chief complaint (RR 4.682, 95% CI 1.247–17.580, P<0.022) and history of use of hypnotic drugs (RR 0.148, 95% CI 0.029–0.749, P<0.019) were 2 independent indicators of patient sleep quality during hospitalization.ConclusionsTo the best of our knowledge, the present study was the first dynamic assessment of the somatic symptom burden and sleep quality in patients with COVID-19 during hospitalization and quarantine after discharge. Patients with high somatic symptom burden at admission, especially muscle pain as the chief complaint, are prone to having a higher physical burden and more sleep disturbance at discharge.

Prevalence and Survival Impact of Self-Reported Symptom and Psychological Distress Among Patients With Multiple Myeloma

BackgroundAdvances in the management of multiple myeloma (MM) have extended survival and reduced painful skeletal-related events. As MM is evolving toward a chronic disease, we sought to determine the prevalence of self-reported symptom burden and psychological distress, and to determine the association of distress with survival. MethodsThe CPASS-7 patient-reported outcome instrument was administered to a convenience sample of MM patients at 7 outpatient cancer centers. ResultsA total of 239 patients completed the CPASS-7 between September 2015 and October 2016%; 57% of respondents were male, and median age was 67 years. Forty-eight percent were concerned that they could not do the things they wanted to do, with 33% reporting decreased performance status. Financial toxicity concerns were self-reported by 44%, with family burdens noted in 24%. Although depression was reported by only 15%, 41% noted lack of pleasure. Pain was a concern in 36%. With a median follow-up of 316 days since CPASS-7 completion, 13% of patients had died. A high total distress score was noted in 57 (24%) and trended toward an association with a decreased survival rate compared to the 182 patients (76%) with a low total distress score (P = .066). The 6-month survival rates for patients with high and low distress scores were 86% and 96%, respectively, and 12-month survival rates were 76% and 87%, respectively. ConclusionDespite dramatic improvements in survival among patients with MM, symptom, financial, and psychosocial concerns continue to be major patient concerns. As MM becomes a chronic disease, additional attention to addressing these issues is required.

High satisfaction and improved quality of life with Rock Steady Boxing in Parkinson's Disease

Objective: To compare demographics, self-reported symptom burden, Health-Related Quality of Life (HRQL), and Exercise Self-Efficacy (ESE) between Rock Steady Boxing (RSB) participants and non-participants.

Patient-Reported Symptom Burden in Routine Oncology Care: Examining Racial and Ethnic Disparities

Racial and ethnic disparities are well-documented in cancer outcomes such as disease progression and survival, but less is known regarding potential disparities in self-reported symptom burden. The goal of this retrospective study was to examine differences in symptom burden by race and ethnicity in a large sample of cancer patients. We hypothesized that racial and ethnic minority patients would report greater symptom burden than non-Hispanic whites. Cancer patients completed the Edmonton Symptom Assessment Scale – revised (ESAS-r-CSS) at least once as part of clinical care in our center’s Radiation Oncology and/or Supportive Care Medicine clinics. Two indicators of symptom burden were evaluated: 1) total ESAS-r-CSS score (i.e., overall symptom burden), and 2) number of severe symptoms (i.e., severe symptomatology, defined as symptoms scores of 7 or higher). Among patients completing the ESAS-r-CSS on multiple occasions, the highest score for each indicator was used. Zero-inflated negative binomial analyses were conducted, adjusting for other sociodemographic and clinical characteristics. Included were 19,642 symptom reports made by 5,798 patients between January 2015 and June 2018. Patients who self-identified as black reported significantly higher symptom burden and more severe symptoms than self-identified white patients (p for each<0.02). Patients self-identifying their race as “other” also reported significantly more severe symptoms than white patients (p=0.03). No other racial or ethnic differences in symptom burden were observed. This study advances our understanding of racial disparities in patient-reported symptom burden during routine oncology care. Clinic-based electronic symptom monitoring may be useful to detect high symptom burden, particularly in patients who self-identify their race as black or other. Future research is needed to reduce symptom burden in racially-diverse cancer populations.

Patient-reported outcome after treatment for definite Lyme neuroborreliosis.

ObjectiveTo chart patient‐reported outcome measures (PROMs) in Norwegian patients treated for definite neuroborreliosis (NB).Material and MethodsAdult patients treated for definite NB 1–10 years earlier supplied demographics, symptoms and treatment during NB, and answered validated questionnaires; Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), health‐related quality of life questionnaire (RAND‐36), and Patient Health Questionnaire (PHQ‐15).ResultsA higher proportion of NB‐treated persons reported severe fatigue, defined as FSS score ≥ 5, than in Norwegian normative data, but when removing persons with confounding fatigue associated comorbidities (n = 69) from the analyses, there was no difference between groups. Physical health‐related quality of life (RAND‐36 PCS), mean FSS score, proportions of persons reporting moderate or severe somatic symptom burden (PHQ‐15 score ≥ 10), anxiety (HADS‐A ≥ 8), or depression (HADS‐D ≥ 8) did not differ between NB‐treated persons and reference scores. Mental health‐related quality of life (RAND‐36 MCS) was poorer than in normative data (47.1 vs. 53.3), but associated with anxiety, depression and current moderate or severe somatic symptom burden, and not with NB characteristics.ConclusionsResults on validated PROM questionnaires measuring fatigue, anxiety, depression, self‐reported somatic symptom burden, and physical health‐related quality did not differ between persons treated for definite NB 1–10 years earlier and reference scores. NB‐treated persons tended to report a slightly poorer mental health‐related quality of life than found in normative data, but when adjusting for confounders the causative connection is questionable. Overall, the long‐term prognosis of definite NB seems to be good.

QOLP-20. IMPACT OF GLIOBLASTOMA ON PATIENT-REPORTED SYMPTOM BURDEN AND PHYSICAL ACTIVITY ASSESSED BY CONVENTIONAL INSTRUMENTS AND A NOVEL DEVICE–BASED TECHNOLOGY

Abstract Glioblastoma (GBM) is a rapidly progressing disease associated with significant deterioration in quality of life. This study evaluated clinical patient-reported outcomes (PROs) and the physical activity of patients with GBM. Adults with GBM (n=180) were stratified across 4 groups representing specific stages in the disease course: Group 1=newly diagnosed; 2=postradiation; 3=stable disease; 4=recurrence. Self-reported physical function (EORTC-QLQC30), motor dysfunction (BN20), symptom burden and interference (MDASI-BT), and objective physical activity level (via Fitbit®) were compared across groups by ANOVA. Associations between outcomes were assessed with a Pearson correlation (r) test. Patients were highly symptomatic, with overall mean (MDASI-BT) symptom severity (1.7–2.4; P=0.23) and interference (2.3–3.2; P=0.68) scores similar across groups. Patients with recurrent disease experienced the numerically greatest symptom severity and interference. Self-reported activity-related interference scores (2.7–3.6, P=0.48) were highest in patients with newly diagnosed or recurrent disease. Motor dysfunction (BN20) mean scores were highest in postradiation (22) and recurrent (22) disease groups (P=0.95). Mean physical function (EORTC-QLQC30) scores were worse in patients with recurrent disease (67) than in those with stable disease (79; P=0.38). Newly diagnosed patients and those with stable disease were the most active (≈4000 and ≈4500 mean steps/day, respectively), whereas those with recurrent disease were least active (≈2300 mean steps/day; P=0.032). Greater physical activity (via Fitbit®) correlated with better self-reported physical function (EORTC-QLQC30) for all groups (Group 1, r=0.0292; Group 2, r=0.0211; Group 3, r=0.0008; Group 4, r=0.0002). Greater motor dysfunction was correlated with lower physical activity in patients with stable (r=0.0003) and recurrent (r=0.0441) disease. Patients in this study were highly symptomatic throughout the disease stages with disease recurrence associated with worse motor and physical function. Future studies exploring these findings in a longitudinal cohort are needed to assess this relationship.

Dental insurance, dental care utilization, and perceived unmet dental needs in women living with HIV: Results from the Women's Interagency HIV Study.

Dental care is the most commonly cited unmet health-care service due to cost. Previous research has highlighted the unmet dental needs of people living with HIV (PLWH). Understanding associations among dental insurance availability, dental care utilization, and the presence of unmet dental needs among PLWH is a public health priority. Oral health surveys were collected cross-sectionally (April-October 2016) among 1,442 women living with HIV (WLWH) in the Women's Interagency HIV Study. Logistic regression models were used to analyze the association between having versus not having dental insurance by type (Ryan White, private, Medicaid/Medicare) and two primary outcomes: a) typical frequency of dental visits (at least annually, less than annually) and b) reporting an unmet dental need in the past 6 months. All dental insurance types were associated with higher odds of receiving annual dental care and, for those with either Medicare/Medicaid or private insurance, lower odds of having an unmet dental need. When WLWH were asked to describe their oral health, poor self-reported condition was associated with both an unmet dental need (odds ratio [OR]: 4.52, 95 percent Confidence Interval [CI] [3.29-6.20]) and lower odds of annual dental care utilization (OR: 0.44, 95 percent CI [0.34-0.57]). Self-reported depressive symptom burden was also linked to having an unmet dental need (OR: 2.10, 95 percent CI [1.46-3.01]). Dental insurance coverage increases dental care utilization and is associated with better oral health among WLWH. In the era of health-care reform, dental insurance coverage may be instrumental for enhancing treatment outcomes.

A phase 2 study of brentuximab vedotin in patients with CD30-positive advanced systemic mastocytosis

AbstractThere is an unmet need for effective therapies for advanced systemic mastocytosis (advSM). CD30 is expressed on the surface of neoplastic mast cells (MC) in more than 50% of patients with advSM. Brentuximab vedotin (BV) is a CD30-directed antibody-drug conjugate with preclinical evidence supporting both an antineoplastic effect and an attenuation of immunoglobulin E-associated mediator release. These observations are the basis for this phase 2 trial of BV monotherapy (1.8 mg/kg IV every 3 weeks up to 8 cycles) in patients with CD30-positive advSM. The primary objective was to determine the efficacy of BV according to International Working Group-Myeloproliferative Neoplasms Research and Treatment-European Competence Network on Mastocytosis (IWG-MRT-ECNM) response criteria. Secondary objectives included evaluation of safety, changes in bone marrow (BM) MC burden, serum tryptase level, flow cytometric quantification of MC surface expression of CD30, and self-reported symptom burden. The trial enrolled 10 patients with a diagnosis of CD30+ advSM (aggressive SM, SM with an associated hematologic neoplasm [SM-AHN], or mast cell leukemia [MCL]) with 1 or more signs of SM-related organ damage. According to IWG-MRT-ECNM criteria, none of the patients demonstrated better than stable disease with BV. In addition, there were no significant reductions in BM MC burden, serum tryptase levels, or MC surface expression of CD30. Self-reported symptom scores showed no durable improvement with BV treatment. We conclude that BV is not active as a single agent in CD30+ advSM. This trial was registered at www.clinicaltrials.gov as #NCT01807598.

Is symptom prevalence and burden associated with HIV treatment status and disease stage among adult HIV outpatients in Kenya? A cross-sectional self-report study

ABSTRACTPeople with HIV experience a high prevalence and burden of physical and psychological symptoms throughout their disease trajectory. These have important public and clinical health implications. We aimed to measure: the seven-day period prevalence of symptoms, the most burdensome symptoms, and determine if self-reported symptom burden is associated with treatment status, clinical stage and physical performance. We conducted a cross-sectional study among adult (aged at least 18 years) patients with HIV, attending HIV outpatient care in Kenya. Data was gathered through self-report using the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), file extraction (sociodemographic data, treatment status, CD4 count, clinical stage) and through observation using the Karnofsky Performance Scale (KPS). Multivariable ordinal logistic regression assessed the association of symptom burden (MSAS-SF) controlling for demographic and clinical variables. Of the 475 participants approached, 400 (84.2%) participated. Ordinal logistic regression showed that being on HIV treatment was associated lower global distress index (in quartiles) (odds ratio .45, 95% CI .23 to .88; p = 0.019). Pain and symptom burden still persist in the era of antiretroviral therapy. Routine clinical practice should incorporate assessment and management of pain and symptoms irrespective of disease stage and treatment status in order to achieve the proposed fourth “90” in the UNAIDS 90-90-90 targets (that is good quality of life).

The Positive Effect of Mindfulness Rivals the Negative Effect of Neuroticism on Gastrointestinal Symptoms

The current study evaluated a theoretically-derived model of the relationships between psychological traits (neuroticism and mindfulness) and gastrointestinal (GI) symptom burden with indirect effects via general dispositional cognitions and health-related cognitions. A sample of women (N = 210, Mage = 22.83, SDage = 9.78) completed an online questionnaire battery consisting of self-reported GI symptom burden, neuroticism, mindfulness, general cognitions (emotional intelligence, reappraisal, suppression, rumination), and health-related cognitions (gastrointestinal-specific anxiety, pain catastrophizing). Our hypotheses were tested using multiple regression, latent variable, and structural equational modeling. Both mindfulness (Beta = − .220, p = .011) and neuroticism (Beta = .234, p = .001) significantly independently predicted GI symptom burden. Additionally, these relationships were completely accounted for via indirect effects of general cognitions and health-related cognitions, supporting our hypotheses: Indirect effect of neuroticism on GI symptom burden: Beta = .228, p = .007; Indirect effect of mindfulness on symptom burden: Beta = − .308, p = .011. The findings from the current study highlight the important role of both general and health-related cognitions in the experience of GI symptom burden and support theoretical models that posit mechanisms of mindfulness via adaptive coping strategies. Given the subjective nature of symptom experience, these findings may help to explain the efficacy of psychological therapies in reducing GI symptom burden.

Twelve weeks of supervised exercise improves self-reported symptom burden and fatigue in chronic kidney disease: a secondary analysis of the 'ExTra CKD' trial.

BackgroundChronic kidney disease (CKD) patients experience a high symptom burden including fatigue, sleep difficulties, muscle weakness and pain. These symptoms reduce levels of physical function (PF) and activity, and contribute to poor health-related quality of life (HRQoL). Despite the gathering evidence of positive physiological changes following exercise in CKD, there is limited evidence on its effect on self-reported symptom burden, fatigue, HRQoL and physical activity.MethodsThirty-six patients [mean ± SD 61.6 ± 11.8 years, 22 (61%) females, estimated glomerular filtration rate: 25.5 ± 7.8 mL/min/1.73 m2] not requiring renal replacement therapy underwent 12 weeks (3 times/week) of supervised aerobic exercise (AE), or a combination (CE) of AE plus resistance training. Outcomes included self-reported symptom burden, fatigue, HRQoL and physical activity.ResultsExercise reduced the total number of symptoms reported by 17% and had favourable effects on fatigue in both groups. AE reduced the frequency of ‘itching’, ‘impotence’ and ‘shortness of breath’ symptoms, and the intrusiveness for symptoms of ‘sleep disturbance’, ‘loss of muscular strength/power’, ‘muscle spasm/stiffness’ and ‘restless legs’. The addition of resistance exercise in the CE group saw a reduction in ‘loss of muscular strength/power’. No changes were seen in subjective PF or physical activity levels. AE increased self-efficacy for physical activity.ConclusionsSupervised exercise had favourable effects on symptom frequency and intrusiveness, including substantial improvements in fatigue. Although the intervention did not improve self-reported physical activity levels, AE increased patients’ self-efficacy for physical activity. These favourable changes in self-reported outcomes support the important role of exercise in CKD.

Relationship of self-reported food insecurity and symptom burden in patients with cancer.

e18771Background: One in eight residents in Maine are food insecure, higher than the national average of one in six. NECS is partnered with a local food bank to help identify food insecure patients...

PSYCHOLOGICAL FACTORS ASSOCIATED WITH SELF-REPORTED SYMPTOM BURDEN, QUALITY OF LIFE AND HEALTH CARE USAGE AMONG PAROXYSMAL ATRIAL FIBRILLATION PATIENTS

Atrial fibrillation (AF) is associated with distressing symptoms, impaired quality of life (QoL) and hospital readmissions. Anxiety sensitivity (AnxS), a cognitive trait, predisposes individuals to interpret autonomic changes as harmful. AnxS measured with the Anxiety Sensitivity Index (AnxSI), has been associated with AF symptoms independently of objective disease variables. The more recently developed AnxSI-R provides dimensional scores including fear of cardiovascular/somatic reactions. We report from an ongoing study, to: 1) describe clinician- and self-reported AF symptom burden, self-reported health care usage, QoL, anxiety and depression among AF patients at differing care stages; 2) determine whether AnxSI-R scores were associated with AF symptom burden, health-care usage and QoL, independently of age, sex and left atrial diameter from echocardiogram (echo-LAD). To date, 59 eligible consenting subjects (24 females; mean age=57.6 years) with paroxysmal AF, LVEF>55%, no documented stroke/TIA, recruited from an outpatient arrhythmia clinic between Sept/13-April/17, have been categorized as: 1) non-candidates for catheter ablation, n=20; 2) ablation candidates, n=19, mean anticipated time to ablation= 5.6 weeks; 3) ablation, n=20, mean post-ablation interval =20.1 weeks. Measurement included: Canadian Cardiovascular Society Severity of Atrial Fibrillation Scale (SAF; 0-5 mild-severe; clinician-completed); Atrial Fibrillation Severity Scale (AFSS: burden 0-5 low-high; health-care usage 0-6 low-high; well-being/QoL 1-10 low-high), Hospital Anxiety and Depression Scale (HADS; anxiety, depression each 0-21 mild-severe), and AnxSI-R (0-168 mild-severe), patient-completed. Echo-LAD was available for 23 subjects. Parametric and non-parametric statistics were used to analyze continuous and categorical variables, respectively. Stepwise multiple regression with covariates age, sex echo-LAD and the AnxSI-R cardiovascular/somatic score was used to predict subjective (AFSS) symptom burden, well-being and health-care usage. The ablation group had significantly lower CCS-SAF arrhythmia symptom ratings (table) compared to each of the other groups (p < .001). Mean subjective symptom burden (figure) was higher in the ablation candidates vs. each of the other groups (p < .001). Health-care usage was significantly lower among non-candidates compared to ablation (p < .049). None of mean well-being/QoL, anxiety or depression varied significantly between groups. From regression (n=23): AnxS cardiovascular/somatic score (R=.55, p=.006) predicted symptom burden; sex (R=.45, p=.031) predicted well-being; AnxS cardiovascular/somatic score (R=.44, p=.038) predicted health-care usage. AF symptom burden, highest in ablation candidates, may be affected by AnxS independently of objective disease severity. As symptom burden influences treatment decisions, psychological factors may warrant consideration. The AnxSI-R has potential for identifying high-AnxS patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)