Symptom Distress Scale Research Articles

Abstract 4138578: NICE-Support program effectively improves symptom and psychological distress in patients with heart failure

Background: Patients with heart failure may suffer from symptom distress, affecting their overall quality of life and psychological well-being including depression. Limited researches focused on the effects of intervention on symptoms and psychological distress for patients with heart failure. Research Hypothesis: Nutritional education and exercise intervention can significantly improve symptoms and psychological distress in patients with heart failure. Aims: To investigate the effectiveness of the Nutrition Instruction Combined Exercise and Support program (NICE-Support) on symptom and psychological distress in patients with heart failure. Methods: This randomized controlled trial recruited 240 patients with heart failure from two medical centers in Taiwan by convenience sampling. Participants were divided into two subgroups based on participation in the "Post-Acute Care Integration Program (PAC)." Each group was randomly assigned to the experimental group and control group, including PAC, PAC+NICE, N-PAC, and N-PAC+NICE groups. The experimental group received a 12-week NICE-Support intervention, encompassing nursing instruction, nutritional counseling, exercise, and support. The control group followed routine hospital care. Data were collected through a structured questionnaire, including basic information, the Heart Failure Symptom Distress Scale, Hospital Anxiety and Depression Scale at baseline, 4, 12, and 24 weeks after enrollment. Data were analyzed using SPSS 24, including descriptive, t-tests, one-way ANOVA, Pearson correlation coefficients, chi-square tests, and generalized estimating equations. Results: The overall symptom distress score was 45.02 (SD = 13.50). Anxiety and depression were reported in 23.8% and 30.9% patients, with the mean anxiety and depression score of 5.01 (SD = 4.50) and 5.98 (SD = 4.16), respectively. Compared with the N-PAC control group, the PAC+NICE group and N-PAC+NICE group exhibited significant greater improvements in symptom distress at 4, 12, and 24 weeks post-intervention, while the N-PAC+NICE group showed statistically significant greater improvement in anxiety at 12 and 24 weeks. Conclusion: The NICE-Support program effectively improves symptom and psychological distress in patients with heart failure and could implement in patients with heart failure.

Abstract C013: Racial disparities in Interpersonal Processes of Care (IPC) during early stage breast cancer chemotherapy: Associations with symptoms and the ability to receive dose-intensive chemotherapy

Abstract Purpose: Documented racial disparities exist in the dose intensity of early-stage breast cancer (ESBC) chemotherapy, partly due to chemotherapy symptom toxicity and subsequent dose modifications. Effective communication is crucial for early symptom mitigation. We explored the associations between racial differences in patient-clinician communication, symptom experience, and the ability to receive the full dose of ESBC chemotherapy. Methods - A descriptive, correlational design compared clinician communication, symptoms, and the ability to obtain dose-intensive ESBC chemotherapy by race. Multi-site - large, urban breast cancer outpatient clinics. Patients completed the 18-item Interpersonal Processes of Care (IPC) and 13-item Symptom Distress Scale (SDS) at baseline and each chemotherapy visit. The IPC assesses clarity of communication, elicitation of concerns, explaining results, shared decision-making, compassion, discrimination due to race/ethnicity, and disrespectful office staff. Mean scores for IPC and SDS were calculated for each visit, and average scores across all visits were created for each participant; chemotherapy dose intensity - Receiving 85% or more of the prescribed chemotherapy within the projected timeline, dichotomized to yes or no—Analysis - IBM® SPSS®, version 27. Descriptive statistics were generated for raw data. Pearson’s correlations were used to examine bivariate associations and univariate and multivariate logistic or linear regression models to explore associations further. Results – N = 216 women, 37% - Black and 63% - White. The mean age was 52.99 ± 12.31 years. IPC - Black patients reported significantly higher (worse) IPC scores for "lack of clarity," "discrimination," and "disrespectful office staff" compared to White patients (all ps ≤ 0.01). Associations of SDS and IPC - Patients with higher IPC subscale scores for "lack of clarity," "discrimination," and "disrespectful office staff," and lower scores for "compassion and respect" experienced significantly higher levels of symptom distress (all ps < 0.05). Associations between IPC and Dose Intensity - Patients reporting higher (worse) discrimination scores were less likely to receive 85% of the prescribed chemotherapy. The IPC "discrimination" subdomain score was significantly associated with chemotherapy dose intensity (χ2(1)=6.910, p=0.009). Each one-unit increase in perceived "discrimination" subdomain score increased the likelihood of not receiving prescribed chemotherapy (B=0.985, OR=2.602, p=0.014) by approximately 160.2%. Conclusions - Black patients perceive poorer quality IPC than White patients during ESBC chemotherapy. Specific subdomains of IPC are associated with worse symptom distress and the inability to receive the full dose of ESBC chemotherapy, primarily driven by perceived discrimination. We must understand the relationship between race, communication, symptoms, and the ability to receive appropriate chemotherapy dose intensity. Citation Format: Margaret Q. Rosenzweig, Hiba Q. Abujaradeh. Racial disparities in Interpersonal Processes of Care (IPC) during early stage breast cancer chemotherapy: Associations with symptoms and the ability to receive dose-intensive chemotherapy [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C013.

Early Change as a Predictor of Treatment Outcome in Patients with a Personality Disorder

A significant proportion of patients with a personality disorder do not benefit from treatment. Monitoring treatment progress can help adjust ineffective treatments. This study examined whether early changes in symptoms and personality dysfunction during the first phase of therapy could predict treatment outcomes. Data from 841 patients who received specialized treatment for personality disorders were analyzed. The study focused on whether changes in the Outcome Questionnaire-45.2 (OQ-45.2) symptom distress scale (SD), the General Assessment of Personality Disorder (GAPD), and Severity Indices of Personality Problems (SIPP) in the early phase of therapy predicted post-treatment personality dysfunction, as measured by the SIPP and GAPD. Early changes within a specific SIPP domain were the strongest predictors of post-treatment outcomes in that same domain. Early changes in symptoms significantly predicted outcomes in Self-Control, Relational Functioning, and Identity Integration, while the GAPD predicted outcomes in Self-Control and Social Attunement on the SIPP. For the GAPD, early changes on the GAPD itself, followed by early changes on the OQ-45 SD and the SIPP domain Social Attunement, were significant predictors. Thus, when it comes to personality dysfunction, early changes in a specific domain or measure are the best predictors of outcomes in that same domain. While the OQ-45 predicted some aspects of personality dysfunction, it should not replace disorder-specific measures. Additionally, the SIPP domains and the GAPD should not be used interchangeably to predict each other. In sum, considering these factors, monitoring early change can be useful in assessing progress in the treatment of patients with personality disorders.

Post-Cancer Treatment-Related Symptom Distress and Fear of Cancer Recurrence in Colorectal Cancer Survivors

Colorectal cancer (CRC) is a primary cause of cancer-related mortality, and, after treatment, cancer survivors often worry that disease recurrence may worsen their health. Nevertheless, limited research on fear of cancer recurrence (FCR) and treatment-related symptoms has been conducted on survivors of CRC. This study was designed to explore (1) symptom distress severity and post-treatment FCR in CRC survivors and (2) the predictors of FCR. A cross-sectional correlational research design and convenience sampling approach were used to recruit patients at the colorectal surgery outpatient department of a medical center in central Taiwan. Basic demographic data, the Symptom Distress Scale - Chinese Modified Form, and Fear of Progression Questionnaire - Short Form were used as monitoring tools. Pearson's product-moment correlation analysis, independent t-tests, one-way ANOVA, and stepwise linear regression analysis were used for statistical analysis. One hundred fourteen survivors of CRC with an average age of 63.44 were enrolled as participants. The top five symptoms of distress were numbness, bowel patterns, fatigue, insomnia, and dry mouth, and the average FCR score was 18.09. Gender, educational level, monthly disposable income, and symptom distress were identified as significant predictors of FCR, with an overall explanatory power of 41.4%. Level of post-treatment FCR in survivors of CRC is influenced by symptom distress severity. Early intervention by healthcare providers to control or alleviate physical symptoms can help prevent the emergence of negative emotions and improve quality of life in this patient group.

Factors associated with loneliness in middle-aged and older patients with breast cancer

ObjectiveLoneliness is associated with adverse mental and physical health conditions and increased mortality. In this study, we identified significant factors associated with loneliness in middle-aged and older patients with breast cancer (BC). MethodsFor this cross-sectional study, we enrolled 200 patients (aged from 20 to 60 years) with BC from two hospitals in Indonesia through convenience sampling. Demographic characteristics, distress symptoms (Symptom Distress Scale), social support (Multidimensional Scale of Perceived Social Support), frailty (Groningen Frailty Indicator), and loneliness (UCLA Loneliness Scale, version 3) were measured. Multivariate logistic regression was performed to identify significant factors associated with loneliness in our cohort. ResultsLoneliness risk was negatively correlated with social support but positively correlated with unemployment and frailty. Thus, the patients received a high level of social support (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92–0.99) and had a low risk of severe loneliness. By contrast, patients who were unemployed (OR: 4.00; 95% CI: 1.65–9.66) and those who had frailty (OR: 5.79; 95% CI: 2.50–13.42) had an elevated risk of severe loneliness. ConclusionsUnemployment, social support, and frailty may significantly influence the risk of loneliness in patients with BC. Early and regular assessments of loneliness should be integrated in the care of these patients. Suitable strategies aimed at increasing social support and mitigating frailty may benefit middle-aged and older patients with BC, particularly unemployed patients, by reducing their risk of loneliness.

Symptom Distress, Social Support, Spiritual Well-Being, and Quality of Life Among Women With Gynecologic Cancer

Women with gynecological cancers experience physical and mental distress due to their diagnosis, surgery, adjuvant chemotherapy, and radiotherapy, all of which have adverse physical, mental, social, and spiritual impacts on their quality of life. This study was designed to examine the correlations among symptom distress, social support, spiritual well-being, and quality of life as well as the predictors of quality of life in women with gynecological cancers. This was a cross-sectional correlational study. A total of 91 women with gynecologic cancer were recruited from a medical center in central Taiwan. A demographic characteristics questionnaire, the World Health Organization Quality of Life Brief Questionnaire Taiwanese version, the Chinese Modified Symptom Distress Scale, the Chinese Simplified Social Support Scale, and the Spiritual Well-Being Scale were used for data collection. Correlation and multiple regression analyses were performed on the data. Symptom distress was found to correlate negatively with spiritual well-being as well as with the physical health, psychological health, and environmental health domains of quality of life. Social support and spiritual well-being were found to correlate positively with all four domains of quality of life. Social support was identified as the main predictor of quality of life. Symptom distress, social support, and spiritual well-being should be incorporated into nursing education to improve medical staff awareness of these issues and promote the timely evaluation of patient needs. Moreover, medical staff should provide appropriate social and spiritual support and multi-disciplinary care as well as make referrals when necessary to related support groups to improve clinical care quality to enhance patient quality of life.

Health-related quality of life in Chinese children and adolescents with cancer.

Cancer diagnosis and related treatment can have multiple impacts on children's health-related quality of life (HRQoL). This study aimed to determine profiles of HRQoL in Chinese children and adolescents with cancer based on patient-reported outcomes. This cross-sectional study recruited 310 pediatric patients with cancer (in treatment and survivorship) aged 8-17 years old and their family caregivers from four hospitals in China. The participants were asked to complete the PROMIS Pediatric-25 Profile 2.0, along with a demographic and clinical characteristics questionnaire, fatigue screening item, and an item assessing the family caregiver's coping style. Latent profile analysis was used to identify profiles. Two profiles were identified: Profile 1, "low symptom and high function" (n = 147, 47.4%); and Profile 2, "high symptom and low function" (n = 163, 52.5%). Children reporting ≥3 on the five-point Symptom Distress Scale fatigue screening item were more likely to be in Profile 2 (OR = 1.961; 95% CI: 1.098-3.501). Participants were less likely to be in Profile 2 if they were in survivorship (OR = 0.494; 95% CI: 0.271-0.903), or their caregiver's coping style was identified as facing positively (OR = 0.439; 95% CI: 0.274-0.703). The identified profiles demonstrate the heterogeneity in HRQoL among pediatric patients with cancer, and the importance of supporting caregivers' coping as a means of supporting the child. Knowledge of these profiles can assist clinicians in better identifying and targeting interventions for children with cancer.

Sleep Quality and Related Factors Among Liver Transplant Recipients in Korea: A Cross-Sectional Study.

Poor sleep quality is common after liver transplantation, which lowers health-related quality of life. However, the detection and management of sleeping difficulties in liver transplant recipients have been limited. This study was designed to assess sleep quality in liver transplant recipients in Korea and associated factors, including symptom experience, depression, and family support, using the theory of unpleasant symptoms as a theoretical framework. This cross-sectional study of 149 liver transplant recipients in a Korean tertiary hospital was conducted in 2019. Data were obtained using several structured self-report questionnaires, including the Pittsburgh Sleep Quality Index, Modified Transplant Symptom Occurrence and Symptom Distress Scale, Center for Epidemiologic Studies Depression Scale-Revised, and Family Support Scale. Multiple linear regression was used to determine the factors associated with sleep quality. The prevalence of sleep disturbance was 55% in the sample. Low sleep quality was associated with being female and with having a higher symptom experience, higher depressive symptoms, and lower family support. In the multiple linear regression analysis, depression and symptom experience was shown to significantly affect sleep quality. The liver transplant recipients in this study reported poor sleep quality. The factors associated with the sleep quality included depression and symptom experience. To enhance sleep quality, interventions designed to reduce depression and symptoms related to liver transplantation should be provided. The results of this study may be used to develop nursing strategies to improve sleep quality in liver transplant recipients.

Abstract P6-08-05: Racial and Economic Disparities in Social Support and Symptom Distress among Women Diagnosed with Early-Stage Breast Cancer

Abstract Introduction: Social support (SS) is predictive of symptom distress among patients with breast cancer (BC) during the treatment and post-treatment phases. There is evidence of racial and economic disparities in SS seen among patients with cancer. Little is known about how race and income influence SS among patients with BC. Objectives: 1) To describe SS in women with early-stage BC prior to or at their first chemotherapy treatment (i.e., baseline); 2) To examine how SS varies by race, income level, ability to meet basic financial needs at baseline; and 3) To examine the association between SS and symptom distress at baseline. Methods: This secondary analysis employed a descriptive, correlational, comparative design with data from the baseline time point of SEMOARS: The Symptom Experience, Management and Outcomes According to Race and Social Determinants of Health (R01-MD012245), a multi-site, repeated, multi-method study comparing the symptom experience and management in Black and White women with early-stage BC. Inclusion criteria were female, Black or White race, age at least 18 years and prescribed chemotherapy for BC stages 1–3. Measures included self-reported race; income level measured by annual income (low: < $29,999; medium: $30,000 to $69,999, high: ≥ $70,000) and affordability of basic needs (single item: yes or no). The Interpersonal Support Evaluation List includes four subscales (possible range 0-30), assessing the perceived availability of support (emotional, tangible, self-esteem, and belonging). The Symptom Distress Scale measures the current experiences of 11 symptoms and their severity (possible range: item:1-5; total score:13-65). Descriptive, comparative, correlational, and regression analyses were used. Results: Participants (N=248; mean age 52.9±12.3 years) were 58.9% White and 41.1%, Black, 54% married/partnered, 57.3% employed, 70.8% had some college education, and 98% insured. Half of the sample (50.5%) reported high income, 30.3% reported medium income, and 19.2% low income. One-fifth (18.5%) reported an inability to afford basic needs. Income and race are moderately correlated, with Black patients more likely to have low income (39.5% vs. 7.6) and less likely to have high income (22.4% vs. 66.7%) (Cramer’s V=.472; p<.001). On average, patients reported moderately high levels of SS (emotional=26±5; tangible=25±6; self-esteem=23±4; belonging=25±5). Compared to White patients, Black patients reported lower levels of SS: emotional (24.4 vs. 27.0; p<.001), tangible (24.3 vs. 25.8; p=.02), and belonging (24.3 vs. 25.6; p=.02). Using one-way analysis of variance with multiple comparisons there were significant differences in SS by income level, where patients with low income had lower SS levels (all subscales) when compared with patients of high income (all p<.001) and lower tangible SS when compared with medium income (p=.005). Patients with a medium income had lower emotional and tangible SS when compared with those having high income (p=.003; .022; respectively). Inability to afford basic needs was associated with lower SS (all subscales; p<.01). For all SS subscales lower SS was associated with worse symptom distress (r= -.213;p=.004 to r=-.265; p<.001). Adjusting for race and income (high vs. low and medium; low vs. medium and high), lower scores for each SS subscale, except belonging, were predictive of higher symptom distress scores (all p<.05). Discussion: For this cohort, Black race, low income, and inability to afford basic needs were associated with lower levels of baseline SS. Regardless of race and income, poor baseline emotional, tangible, and self-esteem SS were significantly correlated with increased symptom distress. Future Directions: SS is a predictive marker of symptom distress as patients begin BC chemotherapy. Interventions to increase SS in Black and/or low-income women with BC at the patient, clinic, and community level are needed. Coefficients of associations for individual social support subscales with symptoms distress adjusting for race and income level [UnTable-Footnote]–Notes: n=175; SS: social support; race was categorized as (0= Black; 1= White); †income level was categorized as (0=medium and high; 1=low: reference) Citation Format: Hiba Abujaradeh, Susan Mazanec, Susan M. Sereika, Adam M. Brufsky, Catherine M. Bender, Mary C. Connolly, Margaret Q. Rosenzweig. Racial and Economic Disparities in Social Support and Symptom Distress among Women Diagnosed with Early-Stage Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-05.

The Effects of Supportive Caring on Symptoms Distress, Nursing Needs, and Depression in Patients With Brain Tumor After Surgery: A Preliminary Study

Brain tumors are mainly treated with surgery. However, patients still experience many symptoms and nursing needs due to disease and treatment-related factors that, if not improved in a timely manner, may result in depression. The purpose of this study was to examine the effectiveness of supportive caring on symptom distress, nursing needs, and depressive symptoms in patients with brain tumor after surgery. This study adopted a two-group, pre- and post-test experimental design. The enrolled participants were randomized into two groups. Those in the experimental group received a phone-based supportive caring intervention twice at 1 and 3 months after surgery. Those in the control group received usual discharge care. The measurement outcomes included a supportive care needs survey, symptom distress scales, and the center for epidemiological studies of depression. Baseline data was collected prior to hospital discharge (T0), with follow-up data collected at one month (T1), three months (T2), and six months (T3) after surgery. The results of the generalized estimating equation analysis showed that nursing needs in the experimental group at T1 (β = -23.61, p < .001), T2 (β = -22.51, p < .001), and T3 (β = -22.26, p < .001) were significant lower than in the control group. Also, symptom distress in the experimental group at T1 (β = -7.03, p = .019) and T2 (β = -8.39, p = .003) was significantly lower than in the control group. However, depressive symptoms in the experimental group were lower than in the control group only at T2 (β = -8.55, p = .005). The results of this study confirm that supportive care helps improve nursing needs, symptoms distress, and depressive symptoms in patients with brain tumor after surgery. Medical team members should pay attention to these issues following surgery.

Abstract B106: Racial differences in baseline financial distress, basic needs, social support, and symptom distress among women receiving early-stage breast cancer chemotherapy

Abstract Little is known about how baseline financial health for patients with breast cancer (BC) influences racial disparity in outcomes. Thus, this study sought to: 1) describe financial hardship in women prior to chemotherapy for early-stage breast cancer (baseline) and how that varies by race; 2) examine associations between baseline financial health, perceived stress, symptom distress and social support Methods: This analysis employed a descriptive correlational comparative design using data from the baseline time point of SEMOARS: The Symptom Experience, Management and Outcomes According to Race and Social Determinants of Health a multi-site, repeated measures, mixed-methods study comparing the symptom experience of Black and White women with BC. Inclusion criteria were female, Black or White race, 18 years of age or older, prescribed chemotherapy for a diagnosis of stages 1–3 BC. Measures included demographic characteristics, self-reported race, and basic needs assessment of food, housing, utilities, and health. Economic Hardship, the 17-item Psychological Sense of Economic Hardship includes 4 subscales reflecting recent economic strain. The Interpersonal Support Evaluation List (ISEL) assesses the perceived availability of social support, and the Symptom Distress Scale (SDS) evaluates the current symptom experiences of 11 symptoms. Descriptive, comparative and correlational statistics were used. Results: A total of 248 women were included in this cross-sectional analysis. Participants had a mean age of 52.99±12.31 years; were 58.9% White and 41.1% Black, 54% partnered, 57.3% employed, and 70.8% had some college education. Almost all participants (98%) had some form of insurance. Almost one fifth (18.5%) of patients reported inadequate household income to meet their basic needs and 41.5% reported somewhat or extreme difficulty in paying for their basic needs. Compared to White patients, Black patients reported significantly higher (worse) levels of economic hardship (1.17±2.95 vs. -0.70±2.36; p&amp;lt;.001) and reported inadequate income to meet basic needs (30.5% vs. 10.5%; p&amp;lt;.001), and somewhat or extreme difficulty in paying for their basic needs (50.5% vs. 27.6%; 9.5% vs. 3.9%, ps&amp;lt;.001 respectively). Economic hardship had significant weak to moderate correlations with symptom distress (r=0.389, p&amp;lt;.001) and social support subscales (r= -0.333 to -0.445, all p&amp;lt;.001), in the expected directions. Black race was associated with worse economic hardship, its subscales, and inadequate current household income (rs= -0.208 to -0.334; all ps &amp;lt;.001). Using multiple linear regression, 34% of the variance in economic hardship was explained for this cohort (F(6, 169)=19.81, p&amp;lt;0.001). Of the predictor variables, Black race was significantly associated with economic hardship (Beta= -0.239, p&amp;lt;0.001, 95% CI: -2.10 to -0.58). Discussion: Black patients begin BC chemotherapy with greater financial distress, less social support, and higher physical symptoms than White patients. This holds implications for racial differences in the ability to tolerate chemotherapy Citation Format: Margaret Q. Rosenzweig, Catherine Bender, Susan Sereika, Mary Connolly, Hiba Abujaradeh, Susan Mazanec. Racial differences in baseline financial distress, basic needs, social support, and symptom distress among women receiving early-stage breast cancer chemotherapy [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B106.

Translation, cross-cultural adaptation, and psychometric evaluation of the Persian version of the Symptom Distress Scale (SDS) in heart failure patients.

Patients with heart failure experience severe and chronic physical and psychological manifestations while the disease progresses. Assessing the degree of distress caused by manifestations of the disease in patients is the first step in designing and evaluating intervention programs to improve patients' symptoms. The aim of this study was to investigate the psychometric properties of the Persian version of the Symptom Distress Scale in HF patients. This study was conducted via methodological research design from March to November 2019. The translation process and cross-cultural adaptation were performed using a process recommended by the World Health Organization. The face and content validity and internal consistency were used to evaluate the validity and reliability of the instrument. The scale was evaluated by exploratory and confirmatory factor analysis in 300 patients with heart failure, and the obtained data were analyzed using SPSS-22 and AMOS-22 software. The content validity of the scale was approved based on the results of the study. One-factor scale with 13 items was used in the confirmatory factor analysis, and the results showed that the instrument had high goodness-of-fit indices. Spearman correlation test for convergent validity showed a correlation between the score obtained by the Scale of Symptoms of Disease and the scores of The European Heart Failure Self-care Behavior scale (9 items) (P < 0.0001). The Persian version of the Symptom Distress Scale can be used as a valid instrument for people with heart failure due to its desirable psychometric properties.

High-dose dexamethasone in low pain responders undergoing total knee arthroplasty: a randomised double-blind trial

BackgroundPostoperative pain after total knee arthroplasty (TKA) is a continuing problem despite optimised multimodal analgesia. Previous studies have shown preoperative glucocorticoids to reduce postoperative pain, but knowledge about specific doses and effects in specific patient groups is lacking. MethodsA two-centre, double-blind, two-arm study comparing preoperative dexamethasone (1 mg kg−1vs 0.3 mg kg−1 i.v.) on postoperative pain in 160 planned TKA subjects with low preoperative pain catastrophising and no opioid use. Subjects received multimodal analgesia with paracetamol, cyclooxygenase-2 inhibitors, local anaesthetic infiltration analgesia, and rescue opioids. The primary outcome was percentage of subjects experiencing moderate to severe pain (visual analogue scale >30 mm) upon ambulation at 24 h. Secondary outcomes included pain scores, postoperative inflammation (C-reactive protein), opioid and antiemetics use, and ‘Quality of Recovery-15’ and ‘Opioid-Related Symptom Distress Scale’, length of stay, readmissions, and complications up to Day 90. ResultsA total of 157 subjects (80 vs 77) were included. No difference was found between groups in the incidence of subjects experiencing visual analogue scale >30 on ambulation 24 h after surgery (56% vs 53%, relative risk =1.07, confidence interval: 0.8–1.4, P=0.65). No differences in other pain outcomes or use of rescue opioids and antiemetics, in Quality of Recovery-15 and Opioid-Related Symptom Distress Scale, length of stay, readmissions, or complications. C-reactive protein values were comparable at 24 h (13 [6–25] mg L−1vs 16 [9–38] mg L−1, P = 0.07), but lower at 48 h (26 [9–52] mg L−1vs 50 [30–72] mg L−1, P<0.01) in the high-dose group. ConclusionUse of 1 mg kg−1vs 0.3 mg kg−1 i.v. dexamethasone in low pain responders after TKA did not improve early postoperative pain or other outcomes in contrast to benefits in a high pain responder population. Clinical trial registrationNCT03758170 (first registration 29-11-2018).

Social Determinants of Health and Symptom Burden During Cancer Treatment.

Cancer survivors (defined as individuals from diagnosis to the end of life) in treatment experience multiple physical and psychological symptoms (e.g., fatigue, pain, depression, anxiety, disturbed sleep) that influence their well-being and treatment outcomes. Underrepresented cancer survivors may disproportionately experience greater symptom burden (number of symptoms, symptom severity, depression, anxiety). The aim of this study was to examine the relationships of social determinants of health, including age, ethnicity, education, income and whether income meets the survivor's needs, neighborhood (rural vs. urban), access to healthcare (e.g., insurance), and social isolation, with symptom burden in cancer survivors. This secondary analysis included baseline data from 400 cancer survivors of solid tumor cancers undergoing chemotherapy or targeted therapy who participated in a larger randomized trial of symptom management interventions. Symptom burden was measured by the Center for Epidemiological Studies-Depression scale for depression and Patient-Reported Outcomes Measurement Information System scores for anxiety and social isolation, summed severity index of 16 symptoms from the General Symptom Distress Scale, and the total number of symptoms. Self-reported comorbid conditions were measured using the Bayliss tool. General linear models were used to relate symptom measures (one at a time) to age, number of comorbid conditions, level of education, marital status, income meeting needs, and size of metropolitan neighborhood. Additional covariates included site of cancer, its treatment, and whether the cancer was metastatic. Non-Hispanic White survivors ( n = 191) were older and had more comorbid conditions, a higher proportion of metastatic cancers, and higher levels of education and income compared with Hispanic survivors ( n = 168) and non-Hispanic survivors of other races ( n = 41). Compared with the other two groups, Hispanic survivors had the lowest rate of health insurance availability, and non-Hispanic survivors of other races had the lowest social isolation. Age, number of comorbid conditions, and social isolation were significantly associated with number of symptoms, symptom severity, and depression. Age and social isolation were associated with anxiety. In addition, the symptom severity of non-Hispanic White survivors was lower than that of Hispanic survivors and non-Hispanic survivors of other races. These findings highlight the health disparities in symptom burden experienced among cancer survivors when considering their social determinants of health. Assessing these may help clinicians address health disparities in cancer care.

Dietary Factors, Time of the Week, Physical Fitness and Saliva Cortisol: Their Modulatory Effect on Mental Distress and Mood.

Background: The purpose of the study was to assess the effect of diet quality and physical fitness on saliva cortisol, mood, and mental distress. These relationships were compared between a peak weekday (Wednesday) and a weekend day (Saturday) when mood may fluctuate. Methods: Forty-eight healthy college students participated in the study. Participants completed the Mood and Anxiety Symptom (MASQ) and Kessler Psychological Distress Scale 10 questionnaires on Wednesday and Saturday and recorded their diet for three days. Saliva was collected before and after a workout for cortisol extraction. Results: SA had significantly higher saliva cortisol levels post-workout but lower MASQ scores on Saturday (p < 0.05). There was a very significant association between MASQ scores on Wednesday (p = 0.005), which became less significant on Saturday. In addition, lower BMI values and high-fat consumption were associated with higher cortisol levels after exercise (p < 0.05). Conclusions: There is a strong link between dietary factors, cortisol levels, mood, and time of the week. In addition, our results suggest that saliva cortisol levels may not be directly linked to negative affect but are influenced by diet quality when mental distress exists. In addition, physical fitness may play a role in improving mood during weekends.

Nurse-led cancer palliative care compared to oncologist-led cancer palliative care: A retrospective analysis of Chinese patients suffering from cancer and receiving chemotherapy.

Cancer palliative care is recommended by guidelines for patients with early stage of cancer. Unlike the Western countries, in mainland China, cancer patients receive specialist-led cancer palliative care. Nurse-led cancer palliative care (NUC) is not well established yet. To compare the clinical outcome measures, quality of life and symptom distress in patients suffering from cancer who received NUC with the same results in patient who received consulting oncologist-led cancer palliative care (ONC). The study was a chart review of a database of patients suffering from cancer. Data regarding clinical outcome measures, quality of life and symptom distress of patients suffering from cancer who were receiving chemotherapy and NUC (NUC cohort, n = 185) or ONC (ONC cohort, n = 170) were collected and analyzed. One oncologist or 1 nurse was involved in treating 1 patient during the patient's hospital visit. Each visit took 30 min. The Chinese version of the Symptom Distress Scale was used for the evaluation of the degree of symptom distress. The simplified Chinese version of the European Organization for Research and Treatment Quality of Life Questionnaire (the EORTC QLQ-C30) v. 3.0 was used for evaluation of the quality of life. Female patients preferred NUC (p < 0.0001). The pain intensity (4.13 ±1.71 compared to 3.35 ±1.01, p < 0.0001), dyspnea (3.89 ±1.48 compared to 2.82 ±0.97, p < 0.0001), constipation (3.56 ±1.78 compared to 3.06 ±1.89, p = 0.0107), and degree of symptom distress (38.09 ±7.26 compared to 35.05 ±7.92, p = 0.0002) were reported higher among patients from the ONC cohort than among those from the NUC cohort. Patients from the NUC cohort reported a better quality of life than those from the ONC cohort (70.41 ±13.62 compared to 45.63 ±7.94, p < 0.0001). The NUC results in better clinical outcome measures and higher quality of life than ONC for patients receiving chemotherapy.

Adherence to Analgesics Among Outpatients Seriously Ill With Cancer.

Adherence to prescribed analgesics for patients seriously ill with cancer pain is essential for comfort. The objective of this study was to determine the analgesic adherence in seriously ill patients with cancer and its association with clinical and demographic characteristics. This is a cross-sectional study. At home, 202 patients with cancer (mean age, 59.9 ± 14.2 years; 58% female, 48% Black, and 42% White) admitted to hospice/palliative care completed measures on a pen tablet: PAIN Report It, Symptom Distress Scale, mood state item, Pittsburgh Sleep Quality Index item, and Pain Management Index. The mean current pain intensity was 4.4 ± 2.9, and the mean worst pain in the past 24 hours was 7.2 ± 2.7. More than one-half of participants were not satisfied with their pain level (54%) and reported their pain was more intense than they wanted to tolerate for 18 hours or longer in the last 24 hours (51%). Only 12% were not prescribed analgesics appropriate for the intensity of their pain. Adherence rates were variable: nonsteroidal anti-inflammatory drugs (0.63 ± 0.50), adjuvants (0.93 ± 0.50), World Health Organization step 2 opioids (0.63 ± 0.49), and step 3 opioids (0.80 ± 0.40). With setting/clinical/demographic variables in the model, dose intervals of less than 8 hours were associated with less adherence ( P < .001). Little progress has been made toward improving analgesic adherence even in settings providing analgesics without cost. Research focused on targeting analgesic dose intervals and barriers not related to cost is needed. Dose intervals of 8 hours or longer were significantly associated with higher adherence rates; therefore, use of longer-acting analgesics is one strategy to improve pain control at the end of life.

Body image and sexuality concerns in women with breast cancer-related lymphedema: a cross-sectional study.

(1) To determine, in women with breast cancer-related lymphedema (BCRL), the frequency, intensity and distress of body image and sexuality concerns. (2) To examine relationships between body image and sexuality concerns, and lymphedema, personal and cancer treatment factors. Women with BCRL (n = 64) completed the Lymphedema Symptom Intensity and Distress Scale - Arm (LSIDS-A), which focuses on the intensity and distress of a range of lymphedema symptoms. They also underwent a lymphedema assessment. Responses to eight questions from the LSIDS-A regarding sexuality, body image and intimate relationships were considered. Frequency of responses was tabulated. Multiple linear regressions were used to determine if specific factors were related to higher intensity and distress scores associated with body image and sexuality issues. Body image and sexuality concerns were common (48%, 23% respectively). Participants reported a range (0-10) of intensity and distress related to body image and sexuality symptoms. Univariate linear regression revealed greater intensity of sexuality concerns was associated with younger age, whilst distress related to sexuality concerns was associated with higher inter-arm bioimpedance ratio and shorter duration of lymphedema. Body image concerns were not related to any considered factors. Body image and sexuality concerns are common, intense and distressing for patients with breast cancer lymphedema. Assessment of both the intensity and distressed caused by these symptoms is necessary to understand the impact of lymphedema.

Naloxegol and Postoperative Urinary Retention: A Randomized Trial.

Background: Naloxegol antagonizes peripheral opioid-related side effects without preventing opioid-related analgesia. However, the effect of naloxegol on opioid-induced bladder dysfunction remains unknown. Hypothesis: patients given naloxegol have lower residual bladder urine volume than those given placebo. Methods: 136 patients scheduled for elective hip and knee surgery were randomized to oral naloxegol or placebo given the morning of surgery, and on the first two postoperative mornings. Residual urine volume was measured ultrasonographically within 30 min after voiding once in the morning and once in the afternoon for two postoperative days. Opioid-related Symptom Distress Scale (ORSDS), the need for indwelling urinary catheterization, and quality of recovery (QoR) score were secondary outcomes. Results: 67 were randomized to naloxegol and 64 to placebo. We did not identify a significant effect on urine residual volume, with an estimated ratio of geometric means of 0.9 (0.3, 2.6), p = 0.84. There were no significant differences in ORSDS or QoR. There were 19 (29%) patients assigned to naloxegol who needed indwelling urination catheterization versus 7 (11%) patients in the placebo group, p = 0.012. Conclusions: Our results do not support use of naloxegol for postoperative urinary retention after hip and knee surgery.

High-dose steroids in high pain responders undergoing total knee arthroplasty: a randomised double-blind trial

BackgroundTotal knee arthroplasty (TKA) is associated with moderate-to-severe postoperative pain despite multimodal opioid-sparing analgesia. Pain catastrophising or preoperative opioid therapy is associated with increased postoperative pain. Preoperative glucocorticoid improves pain after TKA, but dose-finding studies and benefit in high pain responders are lacking. MethodsA randomised double-blind controlled trial with preoperative high-dose intravenous dexamethasone 1 mg kg−1 or intermediate-dose dexamethasone 0.3 mg kg−1 in 88 patients undergoing TKA with preoperative pain catastrophising score >20 or regular opioid use was designed. The primary outcome was the proportion of patients experiencing moderate-to-severe pain (VAS >30) during a 5 m walk 24 h postoperatively. Secondary outcomes included pain at rest during nights and at passive leg raise, C-reactive protein, opioid use, quality of sleep, Quality of Recovery-15 and Opioid-Related Symptom Distress Scale, readmission, and complications. ResultsModerate-to-severe pain when walking 24 h postoperatively was reduced (high dose vs intermediate dose, 49% vs 79%; P<0.01), along with pain at leg raise at 24 and 48 h (14% vs 29%, P=0.02 and 12% vs 31%, P=0.03, respectively). C-reactive protein was reduced in the high-dose group at both 24 and 48 h (both P<0.01). Quality of Recovery-15 was also improved (P<0.01). ConclusionsWhen compared with preoperative dexamethasone 0.3 mg kg−1 i.v., dexamethasone 1 mg kg−1 reduced moderate-to-severe pain 24 h after TKA and improved recovery in high pain responders without apparent side-effects. Clinical trial registrationNCT03763734.