Symptom Management Recommendations Research Articles

Psychobiological Responses to Preferred and Prescribed Intensity Exercise in Major Depressive Disorder.

This study aimed to compare psychological and biological responses to preferred and prescribed steady-state exercise intensities to a patient-selected preferred intensity. Female adults (N = 24, age = 38.6 ± 14.0 yr) diagnosed with MDD completed four 30-min sessions of cycling exercise at three prescribed intensities (RPE of 11, 13, and 15) and one session with a self-selected intensity (preferred). Order was randomized and counterbalanced. Depressed mood (DM) was evaluated before, 10 min, and 30 min postexercise using the Profile of Mood States. Serum brain-derived neurotrophic factor (BDNF) was measured before and within 10 min postexercise. Changes in BDNF and DM for the preferred session were compared with the following prescribed sessions: 1) performed at the most similar intensity (matched on RPE; closest) and 2) with the greatest improvement in DM (greatest). Compared with the preferred session, improvement in DM was significantly larger after the greatest session (30 min postexercise: -11.8 ± 7.4 vs -3.4 ± 4.8), and the BDNF response was significantly greater after the closest session (5.4 ± 6.9 vs -1.4 ± 9.8 ng·mL). Permitting patients to select their own exercise intensity did not maximize improvements in mood. Further, preferred intensity exercise was also associated with a smaller BDNF response. Overall, the results suggest that exercise undertaken to improve mood should be prescribed on an individual basis in MDD and not necessarily based on the patient's preferred intensity. Clinicians, psychologists, and other practitioners should consider providing clear exercise intensity recommendations for symptom management in depression rather than allowing patients to self-select their intensity.

Recommendations for symptom management in women with vulvar neoplasms after surgical treatment: An evidence-based guideline.

To develop an evidence-based guideline for nurses and other health care professionals involved in pre- and postsurgical care of women with vulvar cancer (VC) or vulvar intraepithelial neoplasia (VIN). This evidence-based guideline was developed according to six domains of the methodological framework AGREE II. Literature research with focus on cancer care, symptom management and self-management/counselling was conducted from April to August 2013 in the databases CINAHL, Cochrane Library, PsycINFO, PubMed as well as in 14 international guideline databases. Interdisciplinary experts (n=14) were involved in the development of the guideline from December 2013 to January 2014. This guideline is currently tested in the WOMAN-PRO II RCT (Clinical Trial No: NCT01986725). For the definition of recommendations, five guidelines, one meta-analysis, two systematic reviews and two randomized controlled trials were included. In total, 24 recommendations were formulated to answer 22 clinical questions based on patients' perspective and experts' opinion. Evidence ranged from 3.5 to 5 (3.5=weak evidence and/or clinical relevance, 5=best evidence and/or clinical relevance). The recommendations were subsumed under different themes regarding physical, psychological and psychosocial aspects. The clinical practice guideline developed in this study firstly provides recommendations for symptom management issues focusing on self-management interventions for women with VC or VIN. As an interdisciplinary guideline it should be used in addition to the existing medical guideline in the German speaking context.

Abstract P1-10-16: Improving provider adherence to breast cancer care quality metrics: Use of a novel care planning tool

Abstract Background: With rapid advances in research clinicians often struggle to remain current on evolving care guidelines as well as current National Quality Standards (NQS) relevant to breast cancer management. Adherence to NQS now drives much reimbursement for cancer center services but clinical workflow processes and IT solutions are often not in place to effectively document adherence. The On Q Care Planning SystemTM (CPS), an evidence-based patient assessment and care planning software, has been designed to close gaps in quality cancer care and facilitate data collection to help centers both better understand and document their adherence rates to quality care standards. Methods: This multi-site study will enroll approximately 150 non-metastatic breast cancer patients, presenting for no greater than their second medical oncology visit, across five cancer centers. Patients must be planned for but not yet receiving chemotherapy treatment. A between subject design using 150 matched historical controls will be used to assess the impact of the 2-part intervention, at both the patient and provider level, on select quality metrics. At two consecutive clinical visits, patients will engage with the On Q CPS to assess family and medical history and current symptoms and receive two separate care plans. Care plans include (when applicable) recommendations for symptom management and appropriate referrals (i.e. genetic counseling for those at increased hereditary risk, and/or reproductive endocrinology for those interested in preserving fertility). To augment the effectiveness of the On Q CPS, providers will also participate in certified continuing medical education activities designed to educate about evidence-based assessment, decision-making, and management strategies for breast cancer patients. The primary aim is to evaluate provider adherence to select quality metrics among recently diagnosed breast cancer patients following the intervention, and compare to adherence rates for historical controls from the pre-intervention period. Metrics of primary interest include distress screening and management, complete family history assessment, genetic counseling referral, discussion of infertility risk, and discussion of fertility preservation options and/or referral to a specialist. These metrics have been chosen as the primary endpoints given that they have been historically documented as being resistant to change. Outcomes will be assessed by chart abstraction using a score card method of select quality metrics for both enrolled patients and matched historical controls. Analysis/Results: Patient enrollment begins in June 2015 and thus data will be presented at time of symposium. Patient characteristics and primary outcomes will be analyzed using a multi-step approach to first describe and then compare, at the individual patient level, provider adherence to the select quality metrics evaluated in this study. Descriptive statistics will also be estimated within a mixed model approach for the rate with which each single metric was achieved across patients. Conclusions: The On Q CPS, a care planning software tool, has the potential to both improve provider adherence to NQS and allow institutions an easy and accessible way to document that adherence. Citation Format: Hathaway A, Halilova K, Gaguski ME, Thomas K, Dudley WN, Stricker CT, Hammelef KJ, Panzer SL, Rocque GB. Improving provider adherence to breast cancer care quality metrics: Use of a novel care planning tool. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-16.

Feasibility of Implementing Innovative Supportive Care Plans for Symptom Management in Multiple Myeloma

Introduction: Treatment of Multiple Myeloma (MM) is undergoing transformation. With the rapid emergence of new agents and regimens has also come new toxicities that limit their tolerability and impact patient adherence. Innovative strategies are needed to proactively screen for, assess, and manage disease- and treatment-related symptoms, and engage patients (pts) and families in their identification and self-management. To be sustainable, processes must efficiently integrated within clinical workflows. Growing attention is thus being placed on the potential of novel health information technology (IT) solutions to transform cancer care delivery. Yet, most IT solutions to date have focused little attention to supportive care and facilitating self-management of symptoms. The Carevive (formally On Q) Care Planning System™ (CPS) was developed to address this gap, by providing efficient and clinically integrated IT solutions that facilitate evidence-based supportive care, while concurrently promoting supported self-management. The primary objective of this study is to assess the feasibility of the Carevive CPS electronic symptom screening and care management system in pts receiving active treatment for MM.Methods: Ninety pts with MM and their healthcare providers (physicians and nurse practitioners) are planned for enrollment to this in-progress multi-center pilot intervention study (30 pts each at 3 sites). All participants must be 18 years or older with a pathologically confirmed diagnosis of MM and currently receiving treatment for at least 4 weeks prior to enrollment. At baseline and a 4-8 week follow-up, each patient completes an electronic patient-reported outcome (ePRO) questionnaire in the Carevive CPS about their symptoms. These, plus clinical data, are processed by the Carevive CPS proprietary rules engine to generate personalized, guideline-driven care plans with peer-reviewed and evidence-based recommendations for symptom management. Providers review, finalize, and deliver these care plans containing individually tailored education, resources, and referrals at the 2 clinical visits. Care plans can be delivered to the pts electronically (via secure email or thumb drive) or paper. Feasibility of delivery of the Carevive CPS intervention was assessed by: a) patient enrollment and attrition, b) completion rates of key intervention components (e.g., completion of the questionnaire by pts, percent of pts who receive a care plan), and c) process variables (e.g. format of care plan delivery, time spent discussing the care plan). A tracking log was used to capture percentage of pts enrolled and rates of completion of ePRO questionnaires. Process variables were captured using a study designed worksheet, completed by research staff following each intervention visit. Achievement of feasibility of the intervention was defined as a questionnaire and care plan completion rate of 75% or higher.Data Analysis: To date 20 pts have enrolled at 2 participating sites, with a third site planned to open for enrollment in August 2015. Nine providers are participating to date. Updated data on both pts and providers will be presented at time of the symposium. Of the 25 pts approached to participate, 20 participated for a consent rate of 80%. 20/20 (100%) of pts completed the questionnaire in full. The average time the patient spent independently completing the questionnaire was 7.36 minutes and 100% of these pts received care plans. Healthcare providers spent an average of 5.55 minutes discussing the care plan with the patient. Care plan delivery has been predominately electronic, with 70% having been delivered via secure email or thumb drive and 30% being delivered via paper format.Conclusions: The Carevive CPS is a novel electronic platform designed to deliver evidence-based and personalized supportive care plans to pts at the point of care. Preliminary data, which will be updated at time of presentation, are supportive of its feasibility in MM. The 75% threshold for feasibility has been met for enrollment, ePRO questionnaire completion, and care plan delivery. Time spent in questionnaire completion and care plan review was low compared to other studies. These feasibility data provide initial evidence to support the Carevive CPS intervention. Future studies are planned to evaluate the impact on patient outcomes including symptom burden and adherence to therapy. DisclosuresFaiman:Amgen/Onyx: Consultancy; Takeda/Millennium: Consultancy; Celgene: Consultancy, Speakers Bureau. Nadia:Carevive, Inc.: Employment. Panzer:Carevive, Inc.: Employment.

Review of Themes and Recommendations Encountered in Palliative Care Consults with Pediatric Dialysis Patients (S751)

Objectives Understand the complexities of providing recommendations for the pediatric dialysis population. Recognize common symptoms in the pediatric dialysis population. Original Research Background. End stage renal disease (ESRD) requiring dialysis is frequently lifelimiting in children. Mortality rates are approximately 30 times that of the general population, although they are decreasing as available therapies improve. Pediatric palliative care services have been used occasionally in this population; however, there is scant literature available on whether patients with consultations by a designated pediatric palliative care service have common themes to their recommendations or interventions. Research Objectives. The goal of this research was to better characterize palliative care team involvement with this specific population. Methods. The retrospective study reviewed pediatric palliative care consultations for children with ESRD undergoing dialysis from 1/2006-12/2012. Quantitative data regarding patient was collected and impressions from the initial consultation were compiled. Consults were de-identified and re-analyzed for additional underlying themes using consensus coding. Results. Chart review included thirty-seven patients aged 5 weeks through 18 years; seven patients were excluded after initial review. Eligible patients were on chronic hemodialysis, peritoneal dialysis, or acute hemodialysis. Of the standard palliative care metrics identified by the consultation team, the most common was ‘‘complex or time-intensive communication and/or interdisciplinary psychosocial support’’ (65% of consults), followed by ‘‘information/education regarding palliative care and hospice philosophies’’ (59%) and ‘‘clarification of goals and assistance with difficult decision-making’’ and ‘‘resources/transitions,’’ both 41% of consults. More than 50% of patients requiring improved communication with healthcare providers. Specific symptom management recommendations were also detailed, identifying pain (32%), poor sleep (24%), fatigue (27%), and poor appetite (27%). Conclusions. This study demonstrates a retrospective review of one institution’s experience with pediatric end-stage-renal disease patients. Themes addressed during consultation are highlighted to assist palliative care providers and nephrologists in assessing and developing tools for intervention in this patient population. Implications for Research, Policy, or Practice. This study demonstrates important themes for practitioners who deal with this population to address.

A Systematic Review of Informal Caregiver Responses to Pain in Patients with Advanced Illness (S752)

Objectives Understand the complexities of providing recommendations for the pediatric dialysis population. Recognize common symptoms in the pediatric dialysis population. Original Research Background. End stage renal disease (ESRD) requiring dialysis is frequently lifelimiting in children. Mortality rates are approximately 30 times that of the general population, although they are decreasing as available therapies improve. Pediatric palliative care services have been used occasionally in this population; however, there is scant literature available on whether patients with consultations by a designated pediatric palliative care service have common themes to their recommendations or interventions. Research Objectives. The goal of this research was to better characterize palliative care team involvement with this specific population. Methods. The retrospective study reviewed pediatric palliative care consultations for children with ESRD undergoing dialysis from 1/2006-12/2012. Quantitative data regarding patient was collected and impressions from the initial consultation were compiled. Consults were de-identified and re-analyzed for additional underlying themes using consensus coding. Results. Chart review included thirty-seven patients aged 5 weeks through 18 years; seven patients were excluded after initial review. Eligible patients were on chronic hemodialysis, peritoneal dialysis, or acute hemodialysis. Of the standard palliative care metrics identified by the consultation team, the most common was ‘‘complex or time-intensive communication and/or interdisciplinary psychosocial support’’ (65% of consults), followed by ‘‘information/education regarding palliative care and hospice philosophies’’ (59%) and ‘‘clarification of goals and assistance with difficult decision-making’’ and ‘‘resources/transitions,’’ both 41% of consults. More than 50% of patients requiring improved communication with healthcare providers. Specific symptom management recommendations were also detailed, identifying pain (32%), poor sleep (24%), fatigue (27%), and poor appetite (27%). Conclusions. This study demonstrates a retrospective review of one institution’s experience with pediatric end-stage-renal disease patients. Themes addressed during consultation are highlighted to assist palliative care providers and nephrologists in assessing and developing tools for intervention in this patient population. Implications for Research, Policy, or Practice. This study demonstrates important themes for practitioners who deal with this population to address.

Feasibility of Using Algorithm-Based Clinical Decision Support for Symptom Assessment and Management in Lung Cancer

ContextDistressing symptoms interfere with the quality of life in patients with lung cancer. Algorithm-based clinical decision support (CDS) to improve evidence-based management of isolated symptoms seems promising, but no reports yet address multiple symptoms. ObjectivesThis study examined the feasibility of CDS for a Symptom Assessment and Management Intervention targeting common symptoms in patients with lung cancer (SAMI-L) in ambulatory oncology. The study objectives were to evaluate completion and delivery rates of the SAMI-L report and clinician adherence to the algorithm-based recommendations. MethodsPatients completed a web-based symptom assessment and SAMI-L created tailored recommendations for symptom management. Completion of assessments and delivery of reports were recorded. Medical record review assessed clinician adherence to recommendations. Feasibility was defined as 75% or higher report completion and delivery rates and 80% or higher clinician adherence to recommendations. Descriptive statistics and generalized estimating equations were used for data analyses. ResultsSymptom assessment completion was 84% (95% CI=81–87%). Delivery of completed reports was 90% (95% CI=86–93%). Depression (36%), pain (30%), and fatigue (18%) occurred most frequently, followed by anxiety (11%) and dyspnea (6%). On average, overall recommendation adherence was 57% (95% CI=52–62%) and was not dependent on the number of recommendations (P=0.45). Adherence was higher for anxiety (66%; 95% CI=55–77%), depression (64%; 95% CI=56–71%), pain (62%; 95% CI=52–72%), and dyspnea (51%; 95% CI=38–64%) than for fatigue (38%; 95% CI=28–47%). ConclusionThe CDS systems, such as SAMI-L, have the potential to fill a gap in promoting evidence-based care.

Development and implementation of a telehealth-enhanced intervention for pain and symptom management

Managing chronic pain effectively is often challenging for health care providers and patients. Telehealth technologies can bridge geographic distance and improve patients' quality of care in communities where access to pain specialists has previously been unavailable. This paper describes the development and evaluation of a telehealth intervention (TelePain) designed to address the need for pain specialist consultation regarding pain and symptom management issues in non-academic medical centers. We describe the theoretical foundation and development of a multifaceted intervention using a cluster randomized clinical trial design. Health care providers and their patients with chronic pain are enrolled in the study. Patient participants receive the intervention (report of symptoms and receipt of a pain graph) weekly for 8weeks and are contacted at 12weeks for completion of post-intervention follow-up measures. Their providers attend TelePain sessions which involve a didactic presentation on an evidence-based topic related to pain management followed by patient case presentations and discussion by community clinicians. Symptom management recommendations for each patient case are made by a panel of pain specialists representing internal medicine, addiction medicine, rehabilitation medicine, anesthesiology, psychiatry, and nursing. The outcomes assessed in this randomized trial focus on pain intensity, pain's interference on function and sleep, and anxiety, depression, and cost-effectiveness. Some of the challenges and lessons that we have learned early in implementing the TelePain intervention are also reported.

Massage therapy for essential tremor: Quieting the mind

Essential tremor (ET) is a neurological disorder causing rhythmical shaking of part of the body. The condition is known to have an inheritable tendency and can present in more than one family member, known as familial tremor. Treatment of the disorder is commonly by way of prescription medication. ET is progressive and in its mildest form can be sensed and/or observed when performing simple motor skills or activities of daily living (ADL). To examine the influence of massage therapy on the severity of ET using an activity-based rating scale pre- and post-treatment. The study period included five consecutive weekly sessions. The subject, a 63-year-old female, indicated her hands and head as the primary areas affected by ET. The treatment aim was to reduce sympathetic nervous system firing; therefore, the massage techniques implemented were relaxation-based. Methods included Swedish massage, hydrotherapy, myofascial release, diaphragmatic breathing, remedial exercise education and affirmative symptom management recommendations. Drawings of an Archimedes spiral for comparison pre- and post-treatment provided an objective, visual representation of tremor intensity affecting fine motor control. Goniometric measurements were taken to mark changes in cervical range of motion. Tremor intensity decreased after each session; demonstrated by improved fine motor skills. The client also reported an increased functionality in cervical range, which was documented during the first and last visits. The results suggest that tremors, symptomatic to ET, can be eased through initiatives that encourage a parasympathetic response. Massage therapy has shown to be a valuable method of treatment for ET. Tremor severity can present in an irregular pattern due to subjective individual triggers; therefore, further controlled research is required to lessen the variability between subjects and to validate these findings.

Creating Computable Algorithms for Symptom Management in an Outpatient Thoracic Oncology Setting

ContextAdequate symptom management is essential to ensure quality cancer care, but symptom management is not always evidence based. Adapting and automating national guidelines for use at the point of care may enhance use by clinicians. ObjectivesThis article reports on a process of adapting research evidence for use in a clinical decision support system that provided individualized symptom management recommendations to clinicians at the point of care. MethodsUsing a modified ADAPTE process, panels of local experts adapted national guidelines and integrated research evidence to create computable algorithms with explicit recommendations for management of the most common symptoms (pain, fatigue, dyspnea, depression, and anxiety) associated with lung cancer. ResultsSmall multidisciplinary groups and a consensus panel, using a nominal group technique, modified and subsequently approved computable algorithms for fatigue, dyspnea, moderate pain, severe pain, depression, and anxiety. The approved algorithms represented the consensus of multidisciplinary clinicians on pharmacological and behavioral interventions tailored to the patient's age, comorbidities, laboratory values, current medications, and patient-reported symptom severity. Algorithms also were reconciled with one another to enable simultaneous management of several symptoms. ConclusionA modified ADAPTE process and nominal group technique enabled the development and approval of locally adapted computable algorithms for individualized symptom management in patients with lung cancer. The process was more complex and required more time and resources than initially anticipated, but it resulted in computable algorithms that represented the consensus of many experts.

Comments on the ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation

Adequate symptom management is essential to ensure quality cancer care, but symptom management is not always evidence based. Adapting and automating national guidelines for use at the point of care may enhance use by clinicians.This article reports on a process of adapting research evidence for use in a clinical decision support system that provided individualized symptom management recommendations to clinicians at the point of care.Using a modified ADAPTE process, panels of local experts adapted national guidelines and integrated research evidence to create computable algorithms with explicit recommendations for management of the most common symptoms (pain, fatigue, dyspnea, depression, and anxiety) associated with lung cancer.Small multidisciplinary groups and a consensus panel, using a nominal group technique, modified and subsequently approved computable algorithms for fatigue, dyspnea, moderate pain, severe pain, depression, and anxiety. The approved algorithms represented the consensus of multidisciplinary clinicians on pharmacological and behavioral interventions tailored to the patient's age, comorbidities, laboratory values, current medications, and patient-reported symptom severity. Algorithms also were reconciled with one another to enable simultaneous management of several symptoms.A modified ADAPTE process and nominal group technique enabled the development and approval of locally adapted computable algorithms for individualized symptom management in patients with lung cancer. The process was more complex and required more time and resources than initially anticipated, but it resulted in computable algorithms that represented the consensus of many experts.

Supportive Care Assessment: Patient Preferences for Disclosure of Palliative Care Information

Objectives 1. Describe the interactions with hematologic malignancy (HM) clinicians enabling the integration of a palliative medicine consult service into the HM unit serving patients with acute leukemias, multiple myeloma, lymphomas, MDS, and post bone marrow transplant patients. 2. Identify outcomes including clinician satisfaction and improvement in patient symptom control, goals of care discussions, and hospice referral created by the collaboration with palliative medicine. I. Background. There is little published data on the utility of palliative care (PC) consultation in HM inpatients. II. Research Objectives. We hypothesized that integrating PC consultants in the HM team would improve symptom control, frequency of goals of care (GOC) discussions, and hospice referrals. III. Methods. We assessed the HM team’s understanding of PC, gave PC lectures, held IDT meetings and daily PC rounds. Satisfaction surveys were administered 18 months into the PC program. Patients reported symptom intensity daily. GOC discussions and hospice enrollment were documented. IV. Results. August 2006eApril 2009, 282 PC consults were performed on HM patients for pain control (70%), GOC (46%), or other refractory symptoms. 14/18 (78%) HM physicians and 18/ 35 (51%) HM nurses completed satisfaction surveys. Mean ratings for ease of referral, communication, useful symptom management recommendations, and help with end-of-life (EOL) discussions were 4.8e5 (out of 5) for physicians and 4.3e4.4 for nurses. Helpfulness in addressing physical symptoms, delirium, psychosocial issues, EOL decision-making, family distress, and home care planning was 4.4e5 among physicians, and 4e4.5 among nurses. HM physicians and nurses agreed PC was extremely important to the care of their patients (mean 4.9 and 4.8). Eighty percent ofpatients reported pain acceptable or very acceptable within 48 hours of consultation. Non-pain symptoms of constipation, N/V, and dyspnea were well controlled within 48e72 hours; depression, delirium, and anxiety were not. PC consultants documented the first inpatient GOC conversations in 129 patients, ~70% of whom subsequently had a DNR entered. Fifty-three of 119 patients who died (44.5 %) were referred to hospice programs. V. Conclusion. HM patients receive intense therapy that bears witness to frequent patient/family suffering that a PC team can ameliorate. EOL decision-making and hospice referral are markedly enhanced. VI. Implications for Research, Policy, or Practice. PC plays a vital role on an HM unit.

Effects of a Supervised Exercise Intervention on Recovery From Treatment Regimens in Breast Cancer Survivors

To investigate the effects of supervised exercise training on cardiopulmonary function and fatigue in cancer survivors undergoing various clinical treatments. Pretest and post-test quasiexperimental. Outpatient oncology rehabilitation center. 96 breast cancer survivors undergoing various clinical treatments. Subjects were divided into four groups based on the specific type of clinical treatment: surgery alone (n = 22); surgery and chemotherapy (n = 30); surgery and radiation (n = 17); and surgery, chemotherapy, and radiation (n = 27). Following a comprehensive screening and medical examination, cardiovascular endurance, pulmonary function, and fatigue were assessed, leading to the development of an individualized exercise prescription and a six-month exercise intervention. Repeated-measures analysis of variance and covariance were used to compare the effectiveness of the intervention and differences among treatment groups. Systolic and diastolic blood pressure, resting heart rate, forced vital capacity, forced expiratory volume, predicted oxygen consumption, time on treadmill, and fatigue. Cardiopulmonary function (predicted maximal oxygen consumption and time on treadmill) significantly increased in all groups after exercise training. In addition, resting heart rate and forced vital capacity significantly improved in those receiving surgery, chemotherapy, and radiation. Psychologically, the exercise intervention resulted in significant reductions in behavioral, affective, sensory, cognitive and mood, and total fatigue scale scores in all three groups who received treatment with surgery. The breast cancer survivors in the surgery-alone group showed significant reductions in behavioral, affective, and total fatigue scale scores but not in sensory and cognitive and mood fatigue scale scores. The results suggest that moderate intensity, individualized, prescriptive exercise maintains or improves cardiopulmonary function with concomitant reductions in fatigue regardless of treatment type. Moreover, cancer survivors receiving combination chemotherapy and radiotherapy following surgery appear to benefit to a greater extent as a result of an individualized exercise intervention. Clinicians need to be aware of adjuvant therapies such as moderate exercise that attenuate negative side effects of cancer treatments. Symptom management recommendations should be given to cancer survivors concerning the effectiveness of exercise throughout the cancer continuum and the importance of participating in a cancer rehabilitation exercise program.

Patient–provider communication and perceived control for women experiencing multiple symptoms associated with ovarian cancer

Objectives. Optimal cancer symptom management requires effective patient–health care provider (HCP) communication. The goals of this study were to 1) describe symptom experiences of women with ovarian cancer, 2) evaluate frequency of patient–HCP communication about symptoms, and 3) evaluate whether communication is associated with patients' confidence in managing symptoms. Methods. This was a cross-sectional mailed survey study. The Symptom Experience Survey, containing valid, reliable measures of symptom severity and controllability; symptom communication; and symptom-related coping strategies, was mailed to members of the National Ovarian Cancer Coalition. Descriptive statistics, t tests, correlations, and ANCOVA were used to address study objectives. Results. This analysis focuses on the 279 respondents who had active disease. The majority of women had recurrent disease (96%) and were on chemotherapy (57%). Women reported a mean of 12 concurrent symptoms. Fatigue, bowel disturbances, and peripheral neuropathies were the most severe and most noticed symptoms. Only 61% of women had discussed their most noticed symptom with an HCP in the past month, and only 50% of women reported that they had received symptom management recommendations. Women reported low levels of perceived control over symptoms ( M = 1.97 on a 0–4 scale). There was a significant interaction effect for symptom discussions and management recommendations on perceived control. Women who had never received recommendations had low perceived control whether or not they had discussed their symptom with an HCP in the past month. For women who had received recommendations, those who had discussed their symptom with an HCP in the past month had higher perceived control compared to those who had not discussed their symptom. Conclusions. Women with ovarian cancer experience multiple symptoms, but many do not discuss symptoms with their HCPs and fewer report receiving symptom management recommendations. Women would benefit from more active symptom assessment and discussion of management strategies by HCPs.