Rosalie Valdres - Academia.edu (original) (raw)

Papers by Rosalie Valdres

Nursing Clinics of North America, Dec 1, 2001

Journal of Clinical Oncology, May 20, 2010

e19598 Background: Apathy, or lack of motivation, has been little studied in cancer patients. Bec... more e19598 Background: Apathy, or lack of motivation, has been little studied in cancer patients. Because interventions for Cancer-Related Fatigue (CRF) often include behavioral change and involve commitment to treatment, patient apathy may be detrimental to outcome success. We conducted an observational study in our CRF Clinic and report on 110 patients evaluated for apathy. Our objectives were to investigate associations between apathy and fatigue-related symptoms and determine if clinically apathetic patients differed from the non-apathetic in symptom burden. Methods: New CRF patients were evaluated for apathy using the Apathy Evaluation Scale, Clinician Version (AES-C) as primary outcome measure. The AES-C provides a continuous apathy score (range 18-72); scores can also be used to categorize patients as apathetic or non-apathetic (AES-C ≥ 38 reflects clinically significant apathy). To explore apathy and fatigue symptom associations, AES-C scores were correlated (Spearman's rho) with five symptoms commonl...

Journal of Clinical Oncology, May 20, 2010

e19540 Background: Interventions for CRF require patient commitment, particularly if incorporatin... more e19540 Background: Interventions for CRF require patient commitment, particularly if incorporating lifestyle change. Apathy, or lack of motivation, may diminish prospects for a successful outcome, yet few studies have addressed apathy in cancer patients. We conducted an observational study in our CRF Clinic and report on 79 patients evaluated for apathy. Our objective was to determine the apathy information source (clinician vs. patient) most associated with fatigue-related symptoms. Methods: New CRF patients were evaluated for apathy using the Apathy Evaluation Scale (AES); its scores (range 18-72) can be used to classify patients as apathetic or not (≥38 = clinically significant apathy). Two AES versions were employed: Clinician (AES-C) and Patient (AES-S). Scores and reliability were compared, then scores correlated (Spearman's rho) with five symptoms commonly experienced by CRF patients (fatigue, pain, depression, anxiety, sleep disturbance). Apathetic patient symptoms were compared (Mann-Whitney U) t...

Journal of Clinical Oncology, Jul 15, 2004

8115 Background: Fatigue is the most common symptom of cancer patients and has been described in ... more 8115 Background: Fatigue is the most common symptom of cancer patients and has been described in various populations. Our objectives are to describe solid tumor patients (STP) and clinical factors associated with severe fatigue (defined as worst fatigue in past 24 hours ≥7/10) in an acute care setting and to determine whether certain clinical factors available during the emergency center (EC) visit identify patients with severe fatigue. METHODS A retrospective cohort of 653 STP admitted to the EC from 5/1/01 to 8/15/01 was studied. Data abstracted from the medical record included demographic, clinical and cancer treatment factors. Descriptive statistics, chi-square and "student" t-tests were utilized. In developing a preliminary predictive model, stepwise logistic regression was employed. RESULTS The mean age was 56 years (range, 19-92); 333 (51%) were female. The most frequent malignancies were breast cancer 119 (18%) and lung cancer 98 (15%). The majority, 345 (53%) had controlled disease. Of the cohort, 277 (58%) had Zubrod performance scores ≥ 2. Half (326) were not currently receiving cancer treatment. Fifty-seven percent (372) had severe fatigue and over half (51%) had both severe fatigue and severe pain. (Table 1) Conclusions: A majority of STP seeking acute care has severe fatigue. This preliminary model identifies clinical factors in STP with severe fatigue in our EC. Model validation is necessary. If validated, some patients may benefit from earlier identification and referral for fatigue management strategies. This may improve their overall quality of life and potentially influence a lower care level with less cost. [Figure: see text] [Table: see text].

Nursing Clinics of North America

Supportive Care in Cancer, 2009

Journal of Clinical Oncology, Jun 1, 2005

8252 Background: Fever is a very common symptom in cancer patients and the leading cause of emerg... more 8252 Background: Fever is a very common symptom in cancer patients and the leading cause of emergency center (EC) visits at M.D. Anderson Cancer Center. Cancer-related fatigue is also common among ...

The Nursing Clinics of North America, 2001

Fatigue is a commonly reported and observed symptom among patients at the University of Texas M.D... more Fatigue is a commonly reported and observed symptom among patients at the University of Texas M.D. Anderson Cancer Center. Caring for patients with this debilitating symptom is a major challenge. The nurse practitioner in the Fatigue Clinic has a special role in the management of these patients.

Supportive Care Cancer

Patients with symptomatic, advanced cancer continue to be referred late or not at all for hospice... more Patients with symptomatic, advanced cancer continue to be referred late or not at all for hospice or palliative care. We conducted a retrospective cohort study to determine whether evidence of cancer progression is an independent predictor of short-term mortality in acutely symptomatic cancer patients. We reviewed the records of 396 patients who visited the emergency center at a comprehensive cancer center in January 2000. Records were reviewed for clinical characteristics, including symptoms, type and extent of cancer, and whether the patient's cancer was stable or progressing (uncontrolled) at the time of the emergency center visit. Cox regression analysis was used to assess survival at 90 and 180 days, after controlling for patient characteristics. Patients who died within 14, 90, or 180 days were more likely to have disease progression than those who did not. Dyspnea on emergency center presentation and disease progression were independent predictors of death within 90 or 18...

Nursing Clinics of North America

Fatigue is a commonly reported and observed symptom among patients at the University of Texas M.D... more Fatigue is a commonly reported and observed symptom among patients at the University of Texas M.D. Anderson Cancer Center. Caring for patients with this debilitating symptom is a major challenge. The nurse practitioner in the Fatigue Clinic has a special role in the management of these patients.

Cancer patients visiting the emergency center (EC) are seldom assessed or treated for severe fati... more Cancer patients visiting the emergency center (EC) are seldom assessed or treated for severe fatigue, a common symptom in sick patients due to acute medical conditions arising from cancer and cancer treatment. We provide a profile of cancer-related fatigue within the EC setting. Using a single-item screening tool derived from the Brief Fatigue Inventory, 928 patients (636 with solid tumors, 292 with hematological malignancies) triaged in the EC of a tertiary cancer center rated their fatigue at its worst in the last 24 hours. Patient demographic and clinical factors were retrospectively reviewed from medical records. The chief complaints of patients seeking emergency care included fever, pain, gastrointestinal symptoms, dyspnea, fatigue, and bleeding. More than half (54%) reported severe fatigue (seven or higher on a 0e10 scale) upon EC admission. Moderate to severe pain was highly associated with fatigue severity. Patients with severe fatigue were more likely to be unstable and unable to go home after EC care. In multivariate logistic regression analysis for severe fatigue, the significant risk factors for patients with solid tumors included dizziness (odds ratio [OR] ¼ 3.59), severe pain (OR ¼ 1.98), poor performance status (OR ¼ 1.81), and being female (OR ¼ 1.56). Dyspnea was significantly associated with severe fatigue in patients with hematological malignancies (OR ¼ 4.74). Although fatigue was not the major reason for an ER visit, single-item fatigue-severity screening demonstrated highly prevalent severe fatigue in sicker EC cancer patients and in those patients who also suffered from other symptoms.

Supportive Care in Cancer, 2003

We treated low-risk febrile neutropenic cancer patients utilizing two standard outpatient antibio... more We treated low-risk febrile neutropenic cancer patients utilizing two standard outpatient antibiotic pathways: oral ampicillin/clavulanate (500 mg) and ciprofloxacin (500 mg) or intravenous ceftazidime (2 g) and clindamycin (600 mg) every 8 h. The objectives were to determine the success of outpatient treatment of low-risk febrile neutropenia, to identify factors predicting outpatient failure, and to determine mortality related to the febrile episode. Eligibility criteria included solid tumor diagnosis, stable vital signs, temperature > or =38.0 degrees C, absolute neutrophil count (ANC) of <1000/ml, patient compliance, no significant organ dysfunction, ability to tolerate oral medication and fluids for oral pathway, residence within 30 miles of the institution, 24-h caregiver, and telephone and transportation access. There were 257 febrile episodes in 191 patients meeting the criteria. Patients were treated during March 1998 through February 2000. Median age was 48 (range, 17-77) years, and 60% (n = 153) had an entry ANC of <100/ml; 205 (80%) febrile episodes successfully responded to outpatient treatment, and 52 (20%) were hospitalized. Logistic regression analysis showed the following were related to hospitalization: mucositis >grade 2 (p < 0.002); Zubrod performance status > or =2 (p = 0.029); ANC <100/ml (p = 0.039), and age…

Clinical Journal of Oncology Nursing, 2007

M.D. Anderson Cancer Center in Houston. At the time this article was written, Ho was a nurse prac... more M.D. Anderson Cancer Center in Houston. At the time this article was written, Ho was a nurse practitioner at the University of Texas M.D. Anderson Cancer Center. Mention of specific products and opinions related to those products do not indicate or imply endorsement by the Clinical Journal of Oncology Nursing or the Oncology Nursing Society.

Journal of Pain and Symptom Management, 2010

Cancer-related fatigue (CRF) is a significant issue for cancer patients and frequently precipitat... more Cancer-related fatigue (CRF) is a significant issue for cancer patients and frequently precipitates increased stress and anxiety for patients and caregivers alike. CRF may present well after the initial phase of cancer diagnosis and treatment, regardless of whether the cancer is in remission, widely metastatic, or somewhere in between. Determining whether the etiology of fatigue is potentially reversible and whether it is an effect of treatment or another unrelated cause is often perplexing. Because of the significant impact of CRF on patients at our institution, we organized a CRF clinic and began evaluating patients for fatigue in 1998. Our goal has been to initiate a more focused and, at the same time, more comprehensive effort in educating, evaluating, and treating CRF. The purpose of this report was to present a retrospective review of patients treated in our CRF clinic between 1998 and 2005, to examine the outcomes of our patients, and to briefly describe some of the challenges encountered in treating these patients. This information may help reassess and improve approaches in addressing CRF and subsequently improve fatigue in these patients.

Journal of the National Comprehensive Cancer Network : JNCCN, 2003

Cancer-related fatigue (CRF) is the most prevalent symptom of cancer, occurring in 60% to 90% of ... more Cancer-related fatigue (CRF) is the most prevalent symptom of cancer, occurring in 60% to 90% of patients and surpassing pain in frequency. CRF may increase patients' anxieties and hamper their quality of life. We developed a CRF clinic in 1998 because we believed there needed to be a more focused effort on the education, evaluation, and treatment of CRF for our patients. Since then, we have gained clinical insights into the planning, development, and evolution of this endeavor. Our objective is to share our experiences and provide preliminary analysis of the first 123 patients evaluated in this clinic.

Nursing Clinics of North America, Dec 1, 2001

Journal of Clinical Oncology, May 20, 2010

e19598 Background: Apathy, or lack of motivation, has been little studied in cancer patients. Bec... more e19598 Background: Apathy, or lack of motivation, has been little studied in cancer patients. Because interventions for Cancer-Related Fatigue (CRF) often include behavioral change and involve commitment to treatment, patient apathy may be detrimental to outcome success. We conducted an observational study in our CRF Clinic and report on 110 patients evaluated for apathy. Our objectives were to investigate associations between apathy and fatigue-related symptoms and determine if clinically apathetic patients differed from the non-apathetic in symptom burden. Methods: New CRF patients were evaluated for apathy using the Apathy Evaluation Scale, Clinician Version (AES-C) as primary outcome measure. The AES-C provides a continuous apathy score (range 18-72); scores can also be used to categorize patients as apathetic or non-apathetic (AES-C ≥ 38 reflects clinically significant apathy). To explore apathy and fatigue symptom associations, AES-C scores were correlated (Spearman's rho) with five symptoms commonl...

Journal of Clinical Oncology, May 20, 2010

e19540 Background: Interventions for CRF require patient commitment, particularly if incorporatin... more e19540 Background: Interventions for CRF require patient commitment, particularly if incorporating lifestyle change. Apathy, or lack of motivation, may diminish prospects for a successful outcome, yet few studies have addressed apathy in cancer patients. We conducted an observational study in our CRF Clinic and report on 79 patients evaluated for apathy. Our objective was to determine the apathy information source (clinician vs. patient) most associated with fatigue-related symptoms. Methods: New CRF patients were evaluated for apathy using the Apathy Evaluation Scale (AES); its scores (range 18-72) can be used to classify patients as apathetic or not (≥38 = clinically significant apathy). Two AES versions were employed: Clinician (AES-C) and Patient (AES-S). Scores and reliability were compared, then scores correlated (Spearman's rho) with five symptoms commonly experienced by CRF patients (fatigue, pain, depression, anxiety, sleep disturbance). Apathetic patient symptoms were compared (Mann-Whitney U) t...

Journal of Clinical Oncology, Jul 15, 2004

8115 Background: Fatigue is the most common symptom of cancer patients and has been described in ... more 8115 Background: Fatigue is the most common symptom of cancer patients and has been described in various populations. Our objectives are to describe solid tumor patients (STP) and clinical factors associated with severe fatigue (defined as worst fatigue in past 24 hours ≥7/10) in an acute care setting and to determine whether certain clinical factors available during the emergency center (EC) visit identify patients with severe fatigue. METHODS A retrospective cohort of 653 STP admitted to the EC from 5/1/01 to 8/15/01 was studied. Data abstracted from the medical record included demographic, clinical and cancer treatment factors. Descriptive statistics, chi-square and "student" t-tests were utilized. In developing a preliminary predictive model, stepwise logistic regression was employed. RESULTS The mean age was 56 years (range, 19-92); 333 (51%) were female. The most frequent malignancies were breast cancer 119 (18%) and lung cancer 98 (15%). The majority, 345 (53%) had controlled disease. Of the cohort, 277 (58%) had Zubrod performance scores ≥ 2. Half (326) were not currently receiving cancer treatment. Fifty-seven percent (372) had severe fatigue and over half (51%) had both severe fatigue and severe pain. (Table 1) Conclusions: A majority of STP seeking acute care has severe fatigue. This preliminary model identifies clinical factors in STP with severe fatigue in our EC. Model validation is necessary. If validated, some patients may benefit from earlier identification and referral for fatigue management strategies. This may improve their overall quality of life and potentially influence a lower care level with less cost. [Figure: see text] [Table: see text].

Nursing Clinics of North America

Supportive Care in Cancer, 2009

Journal of Clinical Oncology, Jun 1, 2005

8252 Background: Fever is a very common symptom in cancer patients and the leading cause of emerg... more 8252 Background: Fever is a very common symptom in cancer patients and the leading cause of emergency center (EC) visits at M.D. Anderson Cancer Center. Cancer-related fatigue is also common among ...

The Nursing Clinics of North America, 2001

Fatigue is a commonly reported and observed symptom among patients at the University of Texas M.D... more Fatigue is a commonly reported and observed symptom among patients at the University of Texas M.D. Anderson Cancer Center. Caring for patients with this debilitating symptom is a major challenge. The nurse practitioner in the Fatigue Clinic has a special role in the management of these patients.

Supportive Care Cancer

Patients with symptomatic, advanced cancer continue to be referred late or not at all for hospice... more Patients with symptomatic, advanced cancer continue to be referred late or not at all for hospice or palliative care. We conducted a retrospective cohort study to determine whether evidence of cancer progression is an independent predictor of short-term mortality in acutely symptomatic cancer patients. We reviewed the records of 396 patients who visited the emergency center at a comprehensive cancer center in January 2000. Records were reviewed for clinical characteristics, including symptoms, type and extent of cancer, and whether the patient's cancer was stable or progressing (uncontrolled) at the time of the emergency center visit. Cox regression analysis was used to assess survival at 90 and 180 days, after controlling for patient characteristics. Patients who died within 14, 90, or 180 days were more likely to have disease progression than those who did not. Dyspnea on emergency center presentation and disease progression were independent predictors of death within 90 or 18...

Nursing Clinics of North America

Fatigue is a commonly reported and observed symptom among patients at the University of Texas M.D... more Fatigue is a commonly reported and observed symptom among patients at the University of Texas M.D. Anderson Cancer Center. Caring for patients with this debilitating symptom is a major challenge. The nurse practitioner in the Fatigue Clinic has a special role in the management of these patients.

Cancer patients visiting the emergency center (EC) are seldom assessed or treated for severe fati... more Cancer patients visiting the emergency center (EC) are seldom assessed or treated for severe fatigue, a common symptom in sick patients due to acute medical conditions arising from cancer and cancer treatment. We provide a profile of cancer-related fatigue within the EC setting. Using a single-item screening tool derived from the Brief Fatigue Inventory, 928 patients (636 with solid tumors, 292 with hematological malignancies) triaged in the EC of a tertiary cancer center rated their fatigue at its worst in the last 24 hours. Patient demographic and clinical factors were retrospectively reviewed from medical records. The chief complaints of patients seeking emergency care included fever, pain, gastrointestinal symptoms, dyspnea, fatigue, and bleeding. More than half (54%) reported severe fatigue (seven or higher on a 0e10 scale) upon EC admission. Moderate to severe pain was highly associated with fatigue severity. Patients with severe fatigue were more likely to be unstable and unable to go home after EC care. In multivariate logistic regression analysis for severe fatigue, the significant risk factors for patients with solid tumors included dizziness (odds ratio [OR] ¼ 3.59), severe pain (OR ¼ 1.98), poor performance status (OR ¼ 1.81), and being female (OR ¼ 1.56). Dyspnea was significantly associated with severe fatigue in patients with hematological malignancies (OR ¼ 4.74). Although fatigue was not the major reason for an ER visit, single-item fatigue-severity screening demonstrated highly prevalent severe fatigue in sicker EC cancer patients and in those patients who also suffered from other symptoms.

Supportive Care in Cancer, 2003

We treated low-risk febrile neutropenic cancer patients utilizing two standard outpatient antibio... more We treated low-risk febrile neutropenic cancer patients utilizing two standard outpatient antibiotic pathways: oral ampicillin/clavulanate (500 mg) and ciprofloxacin (500 mg) or intravenous ceftazidime (2 g) and clindamycin (600 mg) every 8 h. The objectives were to determine the success of outpatient treatment of low-risk febrile neutropenia, to identify factors predicting outpatient failure, and to determine mortality related to the febrile episode. Eligibility criteria included solid tumor diagnosis, stable vital signs, temperature > or =38.0 degrees C, absolute neutrophil count (ANC) of <1000/ml, patient compliance, no significant organ dysfunction, ability to tolerate oral medication and fluids for oral pathway, residence within 30 miles of the institution, 24-h caregiver, and telephone and transportation access. There were 257 febrile episodes in 191 patients meeting the criteria. Patients were treated during March 1998 through February 2000. Median age was 48 (range, 17-77) years, and 60% (n = 153) had an entry ANC of <100/ml; 205 (80%) febrile episodes successfully responded to outpatient treatment, and 52 (20%) were hospitalized. Logistic regression analysis showed the following were related to hospitalization: mucositis >grade 2 (p < 0.002); Zubrod performance status > or =2 (p = 0.029); ANC <100/ml (p = 0.039), and age…

Clinical Journal of Oncology Nursing, 2007

M.D. Anderson Cancer Center in Houston. At the time this article was written, Ho was a nurse prac... more M.D. Anderson Cancer Center in Houston. At the time this article was written, Ho was a nurse practitioner at the University of Texas M.D. Anderson Cancer Center. Mention of specific products and opinions related to those products do not indicate or imply endorsement by the Clinical Journal of Oncology Nursing or the Oncology Nursing Society.

Journal of Pain and Symptom Management, 2010

Cancer-related fatigue (CRF) is a significant issue for cancer patients and frequently precipitat... more Cancer-related fatigue (CRF) is a significant issue for cancer patients and frequently precipitates increased stress and anxiety for patients and caregivers alike. CRF may present well after the initial phase of cancer diagnosis and treatment, regardless of whether the cancer is in remission, widely metastatic, or somewhere in between. Determining whether the etiology of fatigue is potentially reversible and whether it is an effect of treatment or another unrelated cause is often perplexing. Because of the significant impact of CRF on patients at our institution, we organized a CRF clinic and began evaluating patients for fatigue in 1998. Our goal has been to initiate a more focused and, at the same time, more comprehensive effort in educating, evaluating, and treating CRF. The purpose of this report was to present a retrospective review of patients treated in our CRF clinic between 1998 and 2005, to examine the outcomes of our patients, and to briefly describe some of the challenges encountered in treating these patients. This information may help reassess and improve approaches in addressing CRF and subsequently improve fatigue in these patients.

Journal of the National Comprehensive Cancer Network : JNCCN, 2003

Cancer-related fatigue (CRF) is the most prevalent symptom of cancer, occurring in 60% to 90% of ... more Cancer-related fatigue (CRF) is the most prevalent symptom of cancer, occurring in 60% to 90% of patients and surpassing pain in frequency. CRF may increase patients' anxieties and hamper their quality of life. We developed a CRF clinic in 1998 because we believed there needed to be a more focused effort on the education, evaluation, and treatment of CRF for our patients. Since then, we have gained clinical insights into the planning, development, and evolution of this endeavor. Our objective is to share our experiences and provide preliminary analysis of the first 123 patients evaluated in this clinic.