Symptom Distress Scale Research Articles

Randomized controlled trial of abdominal binders for postoperative pain, distress, and blood loss after cesarean delivery.

To assess the effect of using abdominal binders on pain, distress, and postpartum hemorrhage after cesarean delivery. The present prospective randomized controlled trial enrolled patients undergoing non-emergency cesarean deliveries in Gonbad-e Kavus, Golestan Province, Iran, between January 22 and October 23, 2015. Patients were randomized in a 1:1 ratio by blocks of four or six to a control group or to use an abdominal binder after delivery; all patients received routine care. The primary outcomes were visual analog scale-assessed pain, symptom distress scale (SDS)-assessed distress, and hemoglobin and hematocrit levels. Participants and researchers were masked to treatment assignments until after cesarean delivery, and data analysis was unmasked; intention-to-treat analyses were performed. There were 89 patients enrolled in each group, with no differences in baseline pain scores, SDS scores, and hemoglobin and hematocrit levels between the groups (all P>0.05). Pain and SDS scores were lower in the binder group at all post-baseline time points compared with the control group (all P<0.001). Hemoglobin and hematocrit levels were higher among patients who received binders 36hours after baseline (both P<0.001). There was one patient who experienced hemorrhage in the binders group and one patient requested removal of their binder. Patients who received abdominal binders reported less pain, lower SDS scores, and higher hemoglobin and hematocrit levels following cesarean delivery. IRCT2015042521917N2.

Side Effects of Immunosuppressive Regimens After Renal Transplantation and Multiple-Sample Assessment of Quality of Life

Influences of the side effects and interferences of immunosuppressants on the quality of life (QOL) of renal transplant recipients have been discussed. 72 renal transplant recipients were surveyed utilizing 25-item health status questionnaires, and modified transplant symptom occurrence and symptom distress scales. The results showed that the frequencies and symptom interferences of side effect after receiving immunosuppressants were below medium level. Physical and mental health related QOL was most significantly affected by symptom occurrence and symptom distress, respectively. Besides, postoperative comorbidity, work status, age and household income have also been demonstrated to be able to predict the postoperative QOL. Side effects all occurred to various extents after receiving immunosuppressants to the renal transplant recipients, the occurrence and interference of the symptoms were not apparent, which would affect the postoperative QOL.

The Relationship Between Coping Behaviors and Symptom Distress in Elderly Patients With Cancer Undergoing Initial Chemotherapy

Elderly cancer patients undergoing initial chemotherapy often suffer discomfort from medication-related symptom distress. This discomfort may affect treatment responses and outcomes negatively. This correlational, cross-sectional design study used a purposive sample of 100 patients who were both over 60 years of age and currently undergoing initial chemotherapy. The participants completed a structured questionnaire that was administered at a medical center in southern Taiwan. The questionnaire included a demographics datasheet, Coping Behavior Scale, and Symptom Distress Scale. Data was analyzed using descriptive statistics, Pearson's correlations, Mann-Whitney U, and Kruskal Wallis tests, which were run on SPSS 19.0 software. This correlational, cross-sectional design study used a purposive sample of 100 patients who were both over 60 years of age and currently undergoing initial chemotherapy. The participants completed a structured questionnaire that was administered at a medical center in southern Taiwan. The questionnaire included a demographics datasheet, Coping Behavior Scale, and Symptom Distress Scale. Data was analyzed using descriptive statistics, Pearson's correlations, Mann-Whitney U, and Kruskal Wallis tests, which were run on SPSS 19.0 software. Three-quarters (78%) of participants reported that they suffered from more than four distress symptoms. The top distress symptoms in terms of severity included: fatigue, poor appetite, insomnia, dry mouth, and altered bowel habits. The top distress symptoms in terms of frequency included: fatigue, dry mouth, poor appetite, insomnia, and altered bowel habits. "Problem-focused" coping was the most frequent type of coping behavior (mean = 3.19, SD = 0.24) that was used by participants. Furthermore, more frequent use of "emotions-focused" coping behaviors was associated with a greater risk of experiencing serious distress symptoms (r =.44, p < .001). Number of chronic diseases, cancer stage, and type of cancer treatment had no significant influence of symptom distress. Findings confirmed the relationship between coping behavior and symptom distress in elderly Taiwanese cancer patients undergoing initial chemotherapy. The results suggest that healthcare providers may use interventions that target patient coping behavior in order to alleviate the chemotherapy-induced symptoms of distress in elderly cancer patients.

Initial revision of Symptom Distress Scale for postoperative patients with pituitary tumor

Objective To revise the Symptom Distress Scale for postoperative patients with pituitary tumor and to test its reliability and validity. Methods On the base of previous qualitative interview and literature review, Delphi consultation was performed to identify items of the Symptom Distress Scale for postoperative patients with pituitary tumor. By convenience sampling method, totally 191 patients from four first-class ternary hospitals in Jiangsu province were investigated effectively by this scale. Results A scale of 4 factors and 16 items was identified by expert interviews, item analysis, exploratory factor analysis and the four factors could explain 69.812% of the variance. The Cronbach α coefficient of the scale was 0.920, the content validity index was 0.915, and the interrater reliability was 0.860. Conclusions Symptom Distress Scale for postoperative patients with pituitary tumor has good reliability and validity to assess the symptom distress of pituitary tumor patients after operation. Key words: Pituitary tumor; Postoperation; Symptom distress; Reliability; Validity

Differences in the symptom distress between young adult and adult patients with advanced cancer admitted to acute palliative care unit.

99 Background: Understanding about young adults with advanced cancer in palliative care was still insufficient. The purpose of this study was to identify the differences in symptom distress between young (20-39 years) and older (≥ 40 years) adults with advanced cancer who were admitted to acute palliative care unit. Methods: We retrospectively analyzed 502 consecutive patients admitted to acute palliative care unit between April 2015 and March 2016 in two tertiary cancer centers. Descriptive statistics, analysis of Edmonton Symptom Assessment Scale (ESAS), and Symptom Distress Scale (SDS) were performed. Results: Among 502 patients, 33 (7%) were aged 20-39 years, and 469 (93%) were aged ≥ 40 years. The most common malignancies among the young adult patients were stomach and colorectal cancers. SDS was similar between young adult (38.7 ± 15.1) and old adult (41.5 ± 13.7) patients. However, pain, nausea, poor feeling of well-being sense, sleep disturbance, and financial distress were numerically higher in young adult group than older adult group. Especially, sleep disturbance (5.72 vs. 4.56, p = 0.030) and financial distress (4.44 vs. 2.87, p = 0.008) showed statistically significant difference. Conclusions: Young adult advanced cancer patients appear to show different symptom profiles. Further research is needed to identify determinants and to provide timely integration of palliative care services for this unique patient cohort.

Abstract PR331

Background & Objectives: Total Knee Arthroplasty (TKA) is a common surgical procedure for patients with end stage joint disease [1]. Poorly controlled pain in the post-operative setting is associated with higher levels of opioid use and opioid related adverse effects, immobility, morbidity, longer hospital admissions, and decreased overall patient satisfaction [2]. There is no current gold standard for pain reduction in the post-operative time period. One narcotic alternative, intravenous acetaminophen, was first commercialized in Europe in 2002 and has subsequently been approved by the FDA. Preliminary studies have found it safe and efficacious for decreasing post-operative pain, including TKA. We plan to perform a three arm study comparing the clinical advantages of a periarticular liposomal bupivacaine injection versus a standardized knee injection cocktail previously described versus this same knee injection cocktail with the addition of intravenous acetaminophen on decreasing opioid related side effects without sacrificing expected levels of analgesia. The main study endpoints will be a Visual Analogue Score (VAS) Pain score and Opioid Related Symptoms Distress Scale (OR-SDS). Additional endpoints will include Total Morphine Equivalents (TME) administered, Actual Length of Stay, Active Knee Range of Motion, and Discharge location. Materials & Methods: This will be a randomized, prospective, single-center clinical trial to evaluate the efficacy of three treatment methods on reducing pain in patients undergoing a TKA. The study will involve 141 patients divided evenly into three treatment arms. All patients in this study will be treated with the standardized spinal anesthesia, the standardized adductor canal block, 10 mg of dexamethasone intravenously, and four postoperative doses of IV ketorolac (15 mg every eight hours for forty-eight hours). The Standardized Spinal Anesthesia After it is washed with epinephrine, between 1.4 ml to 2 ml of hyperbaric bupivacaine will be drawn into the syringe (with dosage dependent on the height of patient and duration of surgery). The Standardized Adductor Canal Block Periarticular Liposomal Bupivacaine Injection Treatment Group Standardized Knee Cocktail Treatment Group IV Acetaminophen Plus Standardized Knee Cocktail Treatment Group Results: The results of the 141 currently enrolled patients will be reported after statistical analysis. Conclusion: The result of the 141 currently enrolled patients will be reported after statistical analysis with conclusions to follow.

A Feasibility Pilot Trial of Individualized Homeopathic Treatment of Fatigue in Children Receiving Chemotherapy.

Fatigue is a major problem in children with cancer. The objective was to examine the feasibility of performing a clinical trial of homeopathic treatment for fatigue in children receiving chemotherapy. This was a single-institution, open-label, pilot study. Children 2 to 18 years old, diagnosed with cancer, and receiving chemotherapy were eligible. Participants were given individualized homeopathic treatment for a maximum of 14 days. In-home or clinic assessments were conducted up to 3 times weekly. Feasibility was defined as the ability to recruit and administer homeopathy to 10 participants within 1 year. Fatigue was measured using the Symptom Distress Scale daily and the PedsQL Multidimensional Fatigue Module weekly. Between April 2012 and April 2014, 155 potential participants were identified. There were 45 eligible and contacted patients; 36 declined participation, 30 because they were not interested; 9 agreed to participate, but 1 participant withdrew prior to treatment initiation. Median length of homeopathic treatment was 10.5 (range = 6 to 14) days. All parents found homeopathic treatment to be easy or very easy to follow. Trials of individualized homeopathy for fatigue reduction in pediatric cancer are not feasible in this context; lack of interest was a primary reason. Alternative approaches to evaluating homeopathy efficacy are needed.

The Exploration of Health-Related Quality of Life.

The purpose of this study was to explore quality of life (QoL) and the factors influencing QoL in gynecological cancer patients. One hundred sixty-seven patients with gynecologic cancers were recruited from a district hospital in Southern Taiwan. The instruments used included the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 Version 3.0 in Chinese (EORTC QLQ-C30), the Symptom Distress Scale, and demographic characteristics and disease-related variables. The results showed that the mean score for the QLQ-C30 was 61.13 ( SD = 22.71). In the stepwise regression model, two factors predicted overall global QoL: symptom distress (33.8%) and current occupation (2.2%). These predictors accounted for 36.0% of the total variance. These results showed that symptom distress was a predictor of QoL. This study provides a reference for use when designing improved educational care programs that reduce patient symptom distress and enhance gynecologic cancer patients' QoL.

MHealth self-care interventions: managing symptoms following breast cancer treatment.

Many women suffer from daily distressing symptoms related to lymphedema following breast cancer treatment. Lymphedema, an abnormal accumulation of lymph fluid in the ipsilateral body area or upper limb, remains an ongoing major health problem affecting more than 40% of 3.1 million breast cancer survivors in the United States. Patient-centered care related to lymphedema symptom management is often inadequately addressed in clinical research and practice. mHealth plays a significant role in improving self-care, patient-clinician communication, and access to health information. The-Optimal-Lymph-Flow health IT system (TOLF) is a patient-centered, web-and-mobile-based educational and behavioral mHealth interventions focusing on safe, innovative, and pragmatic electronic assessment and self-care strategies for lymphedema symptom management. The purpose of this paper is to describe the development and test of TOLF system. The development of TOLF was guided by the Model of Self-Care for Lymphedema Symptom Management and designed based on principles fostering accessibility, convenience, and efficiency of mHealth system to enhance training and motivating assessment of and self-care for lymphedema symptoms. Test of TOLF was accomplished by conducting a psychometric study to evaluate reliability, validity, and efficiency of the electronic version of Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI), a usability testing and a pilot feasibility testing of mHealth self-care interventions. Findings from the psychometric study with 355 breast cancer survivors demonstrated high internal consistency of the electronic version of the instrument: a Cronbach's alpha coefficient of 0.959 for the total scale, 0.919 for symptom occurrence, and 0.946 for symptom distress. Discriminant validity of the instrument was supported by a significant difference in symptom occurrence (z=-6.938, P<0.000), symptom distress (z=-5.894, P<0.000), and total scale (z=-6.547, P<0.000) between breast cancer survivors with lymphedema and those without it. Findings of usability testing showed that breast cancer survivors were very satisfied with the mHealth self-care interventions: 90% rated the system having no usability problems; 10% noted minor cosmetic problems: spelling errors or text font size. The majority of participants 96.6% strongly agreed that the system was easy to use and effective in helping to learn about lymphedema, symptoms and self-care strategies. Feasibility testing demonstrated that a 12-week one group intervention using TOLF had significantly positive effects on less pain (P=0.031), less soreness (P=0.021), less aching (P=0.024), less tenderness (P=0.039), fewer numbers of lymphedema symptoms (P=0.003), and improved symptom distress (P=0.000) at 12 weeks after intervention. Themes from the qualitative data included empowerment, high quality information, loving avatar simulation videos, easy accessibility, and user-friendliness. TOLF system using the electronic version of the instrument is able to assess patients' lymphedema symptoms with high reliability and validity. TOLF system is also able to deliver self-care interventions to enhance self-care strategies for lymphedema symptom management.

Seven-year follow-up for energy/vitality outcomes in early stage Hodgkin's disease patients treated with subtotal lymphoid irradiation versus chemotherapy plus radiation: SWOG S9133 and its QOL companion study, S9208.

We describe 7years of follow-up for the energy/vitality outcome in early-stage Hodgkin's disease patients treated on a randomized clinical trial that compared subtotal lymphoid irradiation (STLI) with combined modality treatment (CMT) (SWOG 9133). Survivorship research questions involved the extent to which symptoms/side effects endured over a follow-up period of 7years for this early-stage patient group. Two hundred thirty-nine patients participated in the quality of life (QOL) companion study (SWOG 9208) and completed the SF-36 vitality scale, SF-36 health perception item, Cancer Rehabilitation Evaluation System-Short Form (CARES-SF), and symptom distress scale. This paper reports vitality outcome results obtained from randomization, 6months, and annually for 7years. To assess changes in vitality over time, we used linear mixed models with patient as a random effect. Patients receiving CMT had lower observed vitality at 6months than did the STLI patients (p < .0001). However, beginning at year 1, vitality results did not differ significantly by treatment over the 5-year (p = .13) and 7-year (p = .16) follow-up periods. Vitality only slightly improved over baseline in either group after treatment. The results were similar after accounting for patterns of recurrence and missing data. This study demonstrated that patients with early-stage Hodgkin's disease experience a short-term (at 6months) decrease in vitality with treatment, which is more severe with CMT, but that after the first year, vitality scores were similar between the two treatment groups. Enduring fatigue results for patients receiving these therapies were not observed. Implications for cancer survivors These data provide comprehensive 7-year follow-up vitality information, an important symptom for early-stage lymphoma survivors.

A Systematic Review of the Symptom Distress Scale in Advanced Cancer Studies.

The 13-item Symptom Distress Scale (SDS) is a widely used symptom measurement tool, yet a systematic review summarizing the symptom knowledge generated from its use in patients with advanced cancer is nonexistent. This was a systematic review of the research literature in which investigators utilized the SDS as the measure of symptoms in patients with advanced cancer. We searched PubMed, CINAHL, EMBASE, and Web of Science for primary research studies published between 1978 and 2013 that utilized the SDS as the measurement tool in patients with advanced cancer. Nine hundred eighteen documents were found. Applying inclusion/exclusion criteria, 21 articles and 2 dissertations were included. The majority of investigators utilized descriptive, cross-sectional research designs conducted with convenience samples. Inconsistent reporting of SDS total scores, individual item scores, age ranges and means, gender distributions, cancer types, cancer stages, and psychometric properties made comparisons difficult. Available mean SDS scores ranged from 17.6 to 38.8. Reports of internal consistency ranged from 0.67 to 0.88. Weighted means indicated fatigue to be the most prevalent and distressing symptom. Appetite ranked higher than pain intensity and pain frequency. The SDS captures the patient's symptom experience in a manner that informs the researcher or clinician about the severity of the respondents' reported symptom distress. The SDS is widely used in a variety of cancer diagnoses. The SDS is a tool clinicians can use to assess 11 symptoms experienced by patients with advanced cancer.

Analgesic effectiveness and tolerability of oral oxycodone/naloxone and pregabalin in patients with lung cancer and neuropathic pain: an observational analysis.

IntroductionCancer-related pain has a severe negative impact on quality of life. Combination analgesic therapy with oxycodone and pregabalin is effective for treating neuropathic cancer pain. We investigated the efficacy and tolerability of a dose-escalation combination therapy with prolonged-release oxycodone/naloxone (OXN-PR) and pregabalin in patients with non-small-cell lung cancer and severe neuropathic pain.MethodsThis was a 4-week, open-label, observational study. Patients were treated with OXN-PR and pregabalin. Average pain intensity ([API] measured on a 0–10 numerical rating scale) and neuropathic pain (Douleur Neuropathique 4) were assessed at study entry and at follow-up visits. The primary endpoint was response to treatment, defined as a reduction of API at T28 ≥30% from baseline. Secondary endpoints included other efficacy measures, as well as patient satisfaction and quality of life (Brief Pain Inventory Short Form), Hospital Anxiety and Depression Scale, and Symptom Distress Scale; bowel function was also assessed.ResultsA total of 56 patients were enrolled. API at baseline was 8.0±0.9, and decreased after 4 weeks by 48% (4.2±1.9; P<0.0001 vs baseline); 46 (82.1%) patients responded to treatment. Significant improvements were also reported in number/severity of breakthrough cancer pain episodes (P=0.001), Brief Pain Inventory Short Form (P=0.0002), Symptom Distress Scale (P<0.0001), Hospital Anxiety and Depression Scale depression (P=0.0006) and anxiety (P<0.0001) subscales, and bowel function (P=0.0003). At study end, 37 (66.0%) patients were satisfied/very satisfied with the new analgesic treatment. Combination therapy had a good safety profile.ConclusionOXN-PR and pregabalin were safe and highly effective in a real-world setting of severe neuropathic cancer pain, with a high rate of satisfaction, without interference on bowel function.

Prediction of treatment outcome in daily generalized mental health care practice: first steps towards personalized treatment by clinical decision support

Rationale, aims and objectives: Results from prediction studies are often of limited value because potential predictors are measured with instruments that are not routinely used, the results are presented in terms that are difficult to translate to individual patients and the relations between predictors and outcome are complex. These problems were faced by deriving decision trees for classification using information routinely accessed in generalized mental healthcare for intake purposes and treatment monitoring.Method: Positive treatment outcome was defined as symptom improvement, measured with the symptom distress scale of the Outcome Questionnaire (OQ-45.2). The analysis process consisted of 3 phases, derivation of a possible decision tree, selection of the best 10 trees and assessment of classification performance after integration of these 10 trees. This analysis was performed 3 times, for all patients without any missing data, for the full set of patients and for the patients in which intermediate outcome data were available.Results: The prediction performance of the 3 integrated classifiers varied from poor (AUC 0.68) in the complete sample including patients with missing variables, to good (AUC 0.83) including early response as predictor. Complex interactions between variables were found.Conclusion: The present study shows the need for registration of clinical and sociodemographic variables and outcome monitoring in a systematic way to prevent missing variables and automated decision support systems to use complex interactions between variables for outcome prediction.

Effect of tolerance versus chronic immunosuppression protocols on the quality of life of kidney transplant recipients.

Kidney transplant patients on tolerance protocols avoid the morbidity associated with the use of conventional chronic immunosuppressive regimens. However, the impact of tolerance versus conventional regimens on the quality of life (QOL) of kidney transplant patients is unknown. Five patients who achieved long-term immunosuppression-free renal allograft survival after combined kidney and bone marrow transplantation (tolerant group) were compared with thirty-two comparable kidney transplant recipients on conventional immunosuppression (conventional group). QOL was compared with 16 conventional recipients using the Kidney Disease Quality of Life Short Form 36 (KDQOL SF-36) and the Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-59R). Patients in the tolerant group required significantly less treatment after transplant for hypertension and no medications for diabetes (P < 0.01). There was no incidence of diabetes, dyslipidemia, or malignancies in the tolerant group, while these were observed in 12.5%, 40.6%, and 11.8% of the conventional group, respectively. Tolerant patients experienced better overall health (P < 0.01) and scored higher on kidney transplant-targeted scales and healthy survey scales than patients in the conventional group according to the KDQOL SF-36 (P < 0.05). Tolerant patients were less likely to experience depression, dyspnea, excessive appetite/thirst, flatulence, hearing loss, itching, joint pain, lack of energy, muscle cramps, and lack of libido than conventional patients according to the MTSOSD-59R (P < 0.05). Kidney transplant recipients who achieved tolerance experience significantly fewer incidences of complications, improved QOL, and fewer comorbid symptoms compared with patients on conventional immunosuppression. These results support the expanded use of tolerance protocols in kidney transplantation.

Exploration of the Care Needs of Post-Chemotherapy Lung Cancer Patients and Related Factors

Chemotherapy (CT) is the first priority treatment for advanced stage lung cancer. However, symptom distress, impaired ability to conduct daily activities, and post-CT care needs are potential side effects of CT. To explore the factors related to the care needs of post-chemotherapy lung cancer patients. A cross-sectional study was used. One hundred and twenty-one adult patients who had been diagnosed with advanced-stage lung cancer and who had undergone CT using the Platinum and Docetaxel doublet regimen were recruited from a medical center in southern Taiwan. The instruments used included a nursing care needs survey, symptoms distress scale, daily activity interference scale, and patient characteristics datasheet. Participants self-prioritized their emergency management, health consultation, and emotional support activities based on their perceived care needs. The top three post-CT symptoms in terms of severity were: fatigue, appetite change, and sleep disorder. Primary disruptions in daily activities during the post-CT period related to: holding social activities, work, and stair climbing. Significant and positive correlations were found among daily activity interference (r = .30, p < .01), symptoms distress (r = .23, p < .01), and care needs. The regression model indicated daily activity interference as a predictor of care needs, accounting for 10.7% of the total variance. These results highlight the relationships among care needs, symptom distress, and daily activity interference in post-chemotherapy lung-cancer patients. The present study provides a reference for nursing care to reduce the symptom distress, to enhance the performance of daily activities, and to meet the care needs of lung-cancer patients.

The Relationship Between Coping Strategies and Type D Personality in Non Late Stage Hepatocellular Carcinoma Survivors

BackgroundOwing to the high recurrence rate of hepatocellular carcinoma, coping with the disease in the survival period can be challenging. The aims of this study were to explore the association between coping strategies and personality and to identify factors associated with coping strategies. MethodsA cross-sectional correlated design was used and patients were recruited by convenience sampling from wards and outpatient departments at a medical center in Taipei. A set of structured questionnaires was used to collect data including patients’ demographic and disease information, Symptom Distress Scale, Type D Scale-14 and the brief COPE scale. Data were analyzed by descriptive statistics and generalized estimating equations. ResultsEmotion-focused strategies were the most frequently used strategies. Among the 163 participants, 31 patients had type D personality (19%) and tended not to use emotion-focused strategies. Factors associated with patients using emotion-focused strategies included female gender, non-type D personality, younger age, higher level of education, Christian/Catholic, longer duration as HBV carrier, and lower level of symptom distress. Factors associated with patients using problem-focused strategies included younger age, higher level of education, longer duration as HBV carrier, and lower level of symptom distress. Younger age was also associated with patients using malfunction strategies. ConclusionsThis study showed that different factors were associated with the three types of coping strategies. We recommend that patients be screened for type D personality, so that those with higher levels of distress when managing their symptoms can be helped to have a positive coping process. Health care providers should also proactively take care of younger patients with mal-adaptation.

Symptom clusters in patients with cancer in the hospice/palliative care setting.

We determined commonly experienced symptoms reported by adult patients with cancer admitted to urban, ethnically diverse hospice settings and identified symptom clusters. We used hierarchical cluster analysis of 150 patients (41% male, 20-92years [M=59, SD=13.3], 51% African American, 37% Caucasian, 12% other). Using pen-tablet computers, participants completed the Symptom Distress Scale (SDS), a sleep quality item, and listed analgesics consumed in the previous 24h. Four symptom clusters were identified: cluster 1 (Pain-Fatigue) consisted of pain frequency, fatigue, and pain intensity; cluster 2 (Ingestion-Elimination) consisted of appetite and bowel problems; cluster 3 (General Well-Being) consisted of insomnia, appearance, and outlook; and cluster 4 (Respiratory-Nausea-Concentration) consisting of breathing, cough, nausea frequency, nausea intensity, and concentration. There were no significant differences between Caucasians and African Americans on total SDS scores, analgesic consumption, sleep quality, or most cluster scores. This is the first symptom cluster analysis in a US sample with a sizeable proportion of minority hospice/palliative care patients with cancer. Further research to determine the stability of identified symptom clusters over time and discovery of the biological interactions of symptoms within the cluster may lead to symptom management therapies designed for the alleviation of all clustered symptoms.

Abstract C25: The effect of longitudinal symptom distress and overall cancer distress on the ability of African American women to receive prescribed breast cancer chemotherapy without delay

Abstract Background: Racial breast cancer survival disparity is attributed, in part, to disparity in breast cancer treatment. Cancer related distress and symptom incidence and associated distress is historically higher than comparative white women during breast cancer chemotherapy and may influence the ability of African American women to receive full dose and timely chemotherapy. Therefore symptom incidence, distress and overall cancer related distress may be under recognized as a potential etiology of racial survival disparity. Objective: To describe the incidence and severity of symptoms and overall cancer-related distress in African American women and the association of symptom and cancer-related distress to adherence (receiving full dose prescribed without delay) to prescribed chemotherapy over three time points (baseline, midpoint and completion). Methods: A descriptive, correlational analysis was conducted of longitudinal data from a recently completed randomized controlled trial of a psycho-educational intervention entitled the Adherence, Communication, Treatment and Support (ACTS) to encourage adherence to chemotherapy for African American women with breast cancer. In the ACTS Trial we assessed symptom incidence and severity and overall cancer-related distress as potential moderators of women's willingness and/or ability to receive timely and full dose chemotherapy. We measured change of symptom incidence and severity and cancer-related distress at three time points: pre-chemotherapy (Time 1); midpoint of chemotherapy (Time 2) and completion of chemotherapy (Time 3). The Cancer Distress Thermometer (DT) was used to measure cancer-related distress; the total number of symptoms (TOTNS) and the McCorkle Symptom Distress Scale (SDS) total score were to measure symptom incidence and severity, respectively. Adherence data in terms of the number of days delayed related to the patient, clinician, and overall were extracted from medical records. Random coefficient modeling was used for analysis to accommodate the variability in the timing of treatment cycles at the key time points. Results: Subjects (n=142) were diagnosed with any stage invasive breast cancer and were undergoing chemotherapy. Results were based on 131 patients with evaluable data over at least two time points. DT, SDS, and TOTNS significantly changed over time suggesting that SDS and TOTNS increases linearly over time (SDS: b1=0.03324, p&amp;lt;.001; TOTNS: b1=0.02686, p&amp;lt;.001), whereas DT showed a slight decrease (b1=-0.00414, p=.044). Overall cancer-related distress was not significantly associated with clinical delays but was positively related to patient delays (b1=0.2445, p=.034) and total delays (b1=0.5445, p=.018). Overall total number of symptoms and symptom distress was positively related to clinical delays (b1=0.1438, p=.037) and total delays (b1=0.1669, p=.044). Conclusions: Worsening in number of symptoms, overall cancer-related distress and symptom distress over the course of chemotherapy was demonstrated among African American women receiving breast cancer chemotherapy. Worsening symptom and cancer-related distress was associated with lack of ability to receive full dose chemotherapy at the prescribed time. Implications for Practice: The influence of total number of symptoms, symptom distress and overall cancer-related distress on chemotherapy treatment delays is evident among this cohort of African American women receiving chemotherapy. Clinically this emphasizes the importance of close monitoring of cancer-related distress and symptom incidence and severity among African American women in order to allow timely breast cancer chemotherapy. Citation Format: Melissa K. Yee, Susan Sereika, Margaret Quinn Rosenzweig. The effect of longitudinal symptom distress and overall cancer distress on the ability of African American women to receive prescribed breast cancer chemotherapy without delay. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C25.

Long-Term Effectiveness of Combined Treatment with Traditional Chinese Medicine and Western Medicine on the Prognosis of Patients with Lung Cancer.

The study aim was to compare the long-term effect of Western medicine and combined treatment with Traditional Chinese Medicine (TCM) and Western medicine on the prognosis (survival rate, symptom distress, physical function, and quality of life) of patients with lung cancer. Longitudinal study. Two medical centers, one each in Northern and Southern Taiwan. Patients newly diagnosed with lung cancer and treated with Western medicine (n = 54) or TCM plus Western medicine (n = 30). Symptom distress, physical function, and quality of life were measured by using the Symptom Distress Scale, Eastern Cooperative Oncology Group-Performance Status Rating, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30 and EORTC QLQ-LC13), respectively. Data on these measures were collected at baseline (before treatment) and 1, 3, 6, and 12 months after starting treatment. Survival was estimated by Kaplan-Meier curves. Group differences in outcomes were analyzed by generalized estimating equations. Treatment groups did not differ significantly at baseline for demographic information; disease severity; symptom distress; or EORTC QLQ-C30 and QLQ-LC13 scores, except for pain and dyspnea. After adjustment for these baseline effects, the combined-treatment group had better physical function and role function than the Western medicine group at 6 months (p < 0.05). The combined treatment group had better cumulative survival, but this difference did not reach significance. To more precisely estimate the long-term effectiveness of combined treatment on the prognosis of patients with lung cancer, future studies should standardize the number of TCM visits; increase the number of participants by continuous recruitment; and ask patients to complete daily logs with single-item measures of outcomes, such as symptom distress, quality of life, and physical function. Similar studies are suggested in patients with different cancers to develop a collaborative model using Western medicine and TCM.

Decompressive percutaneous endoscopic gastrostomy in advanced cancer patients with small-bowel obstruction is feasible and effective: a large prospective study.

The purpose of this study was to evaluate patient-centered outcomes of decompressive percutaneous endoscopic gastrostomy (dPEG) in patients with malignant bowel obstruction due to advanced gynecological and gastroenteric malignancies. This is a prospective analysis of 158 consecutive patients with small-bowel obstruction from advanced gynecological and gastroenteric cancer who underwent PEG or percutaneous endoscopic jejunostomy (PEJ) positioning for decompressive purposes from 2002 to 2012. All of them had previous abdominal surgery and were unfit for any other surgical procedures. Symptom relief, procedural complications, and post dPEG palliation were assessed. Global Quality of Life (QoL) was evaluated in the last 2years (25 consecutive patients) before and 7days after dPEG placement using the Symptom Distress Scale (SDS). dPEG was successfully performed in 142 out of 158 patients (89.8%). Failure of tube placement occurred in 16 patients (10.1%). In 8/142 (5.6%) patients, dPEG was guided by abdominal ultrasound. In 3/142 patients, dPEG was CT-guided. In 14 (9.8%) patients, who had previously undergone total or subtotal gastrectomy, decompressive percutaneous endoscopic jejunostomy (dPEJ) was performed. In 1/14 patients, dPEJ was CT-guided. Out of 142 patients, 110 (77.4%) experienced relief from nausea and vomiting 2days after PEG. Out of 142 patients, 116 (81.6%) were discharged. The median postoperative hospital stay was 9days (range 3-60). Peristomal infection (14%) and intermittent obstruction (8.4%) were the most frequent complications associated with PEG. Median survival time was 57days (range 4-472) after PEG placement. Twenty-five patients had QoL properly evaluated with SDS score before and 7days after dPEG. Sixteen patients (64%) out of 25 exhibited an improvement of QoL (p < 0.05), 7 (28%) patients exhibited a non-significant worsening of QoL (p = 0.18), and in 2 (8%) patients, it remained unmodified. dPEG is feasible, effective, relieves nausea and vomiting in patients with unremitting small-bowel obstruction from advanced gynecological and gastroenteric cancer, and improves QoL.