An Individualized Representational Intervention to Improve Symptom Management (IRIS) in Older Breast Cancer Survivors: Three Pilot Studies (original) (raw)
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Symptom Clusters and Quality of Life in Older Adult Breast Cancer Survivors
Oncology Nursing Forum, 2011
Objective-To identify symptom clusters in older breast cancer survivors and examine whether symptom clusters are related to demographic, health, and quality of life variables. Design-Symptom bother measures were analyzed using factor analysis to identify possible symptom clusters and the resulting clusters were then correlated with quality of life measures. Setting-The randomized clinical trail from which the data used for these analyses were drawn took place over the phone between the participant and a trained research nurse. Sample-Data from 192 older breast cancer survivors (mean age = 70) who had participated in a randomized clinical trial testing a symptom management intervention were used for this study. Methods-This was a secondary data analysis of the baseline measures of demographics, health history, symptom bother, and physical, mental, and existential dimensions of quality of life. Exploratory and confirmatory factor analyses were conducted as well as MIMIC modeling and partial correlation analyses to assess the relationships amongst clusters and demographic, health history, and quality of life measures. Main research variables-The main research variables were self-reported symptom bother, demographics such as age and education level, health history and quality of life. Findings-Seven clinically distinct symptom clusters tapping 36 different symptoms in older breast cancer survivors were found, and these symptom clusters were significantly related to multiple dimensions of quality of life. Conclusions-Older breast cancer survivors experience multiple, concurrent symptoms that appear to cluster. Identifying symptom clusters helps to elucidate possible inter-symptom relationships, which may lead to the design of more effective symptom management interventions for older breast cancer survivors. Implications for Nursing-Older breast cancer survivors should be assessed for a wide variety of symptoms if clinicians hope to identify and understand inter-symptom relationships. Such an assessment would enable more comprehensive symptom management.
Symptoms, Symptom Beliefs, and Quality of Life of Older Breast Cancer Survivors: A Comparative Study
Oncology Nursing Forum, 2006
To compare symptoms, symptom beliefs, and quality of life (QOL) of older breast cancer survivors to those of older women without breast cancer. Design: Descriptive, correlational study. Setting: Urban and rural communities in the Midwest United States. Sample: 18 breast cancer survivors and 24 women without breast cancer, older than age 64 (-X age = 76 years). Methods: In-home interviews using structured instruments. Main Research Variables: Symptom distress (number of and distress from symptoms), symptom beliefs, chronic health problems, and QOL. Findings: No group differences existed in demographic characteristics, symptom number, symptom bother, chronic health conditions, or QOL. Women in both groups most often attributed the cause of their symptoms to aging, chronic illness, or unknown, but rarely to breast cancer. Attributing symptoms to chronic illness or breast cancer was signifi cantly related to more pain, depression, role impairment, and poorer mental health. Not knowing the cause of symptoms was signifi cantly related to poorer social functioning, mental health, and purpose in life; less energy; and higher levels of depression and anxiety. Conclusions: The symptom experience and QOL of older breast cancer survivors are similar to those of older women with other chronic health problems. Beliefs about symptoms infl uence QOL in older women. Implications for Nursing: A broader assessment of symptoms is needed to assist older breast cancer survivors with symptom management. Symptom interventions in older women should address patients' beliefs about symptoms if QOL is to be enhanced.
Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study
Cancer, 2019
BackgroundLittle is known about longitudinal symptom burden, its consequences for well‐being, and whether lifestyle moderates the burden in older survivors.MethodsThe authors report on 36‐month data from survivors aged ≥60 years with newly diagnosed, nonmetastatic breast cancer and noncancer controls recruited from August 2010 through June 2016. Symptom burden was measured as the sum of self‐reported symptoms/diseases as follows: pain (yes or no), fatigue (on the Functional Assessment of Cancer Therapy [FACT]‐Fatigue scale), cognitive (on the FACT‐Cognitive scale), sleep problems (yes or no), depression (on the Center for Epidemiologic Studies Depression scale), anxiety (on the State‐Trait Anxiety Inventory), and cardiac problems and neuropathy (yes or no). Well‐being was measured using the FACT‐General scale, with scores from 0 to 100. Lifestyle included smoking, alcohol use, body mass index, physical activity, and leisure activities. Mixed models assessed relations between treatme...
Older Breast Cancer Survivors' Symptom Beliefs
Oncology Nursing Forum, 2009
Purpose-The purpose of this investigation was to use Leventhal's Common Sense Model (CSM) to describe older breast cancer survivors' symptom representations, symptom management strategies, and perceived barriers to symptom management. Design-A secondary analysis was conducted using data from three pilot studies testing a theory-based intervention to improve symptom management in older breast cancer survivors. Setting-Advanced practice nurses conducted open-ended interviews among older breast survivors either in the women's home or via telephone. Sample-The women were recruited from the community, an oncology clinic, and a state tumor registry. The women (n = 61, mean age = 69.5) were an average of 4.7 years post-breast cancer diagnosis and reported an average of 17 symptoms. Methods-Content analysis was conducted of field notes taken during baseline interviews. Two coders independently coded responses. Inter-rater reliability was 82.3%. Main Research Variables-Symptom representations, symptom management strategies, and perceived barriers to symptom management. Findings-Women described their symptoms as chronic, with multiple causes (but rarely due to aging), with numerous negative consequences, and not curable or controllable. Women described an average of six symptom management strategies, most typically self-care. The most frequent barrier to symptom management was problems communicating with health care providers. Conclusions-The CSM is a useful framework for understanding the symptom beliefs of older breast cancer survivors.
Survivorship issues in older breast cancer survivors
Breast Cancer Research and Treatment, 2018
Purpose Almost half of breast cancer survivors are aged ≥ 65 years and the proportion is likely to increase due to the aging of the population. The objectives of this article were to review studies of health outcomes among older breast cancer survivors ≥ 65 years to identify gaps in the published literature and offer suggestions for future research. Methods The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from January 1, 1970 through October 1, 2018 were identified using the following MeSH search terms and Boolean algebra commands. Results This review has revealed that older breast cancer survivors cope with health issues related to cancer treatment and the aging process, including comorbidities, osteoporosis, symptoms, physical functioning, cognitive functioning, nutrition, and physical activity. Conclusions Additional research is needed to examine therapeutic interventions to address the health conditions older breast cancer survivors are coping with. Particular focus of further research should be on the nutritional status and physical activity levels of older breast cancer survivors. Individualized nutrition plans and tailored physical activity programs for older survivors are needed that meet people where they are and that form habits.
Quality of Life in Older Women With Early-Stage Breast Cancer in the First Year of Survivorship
Oncology Nursing Forum, 2008
➤ Few research studies have focused on quality of life (QOl) in older women after treatment for early-stage breast cancer. ➤ supportive interventions may slow the decline of QOl in older breast cancer survivors after treatment. ➤ nurses should recognize that older women may experience declines in QOl after treatment despite interventions and education designed to improve QOl. B reast cancer is the most common cancer among women in the united states (American cancer society [Acs], 2008), and more than 2.3 million women are breast cancer survivors (Acs, 2007). The mean age of all women diagnosed with breast cancer is 61 years, and women aged 75-79 years have the highest incidence of the disease (Acs, 2007). As the baby boomer generation ages with increased life expectancy, the number of older women (aged 65 and older) diagnosed with breast cancer also is expected to increase (u.s. census Bureau, 2005). Older women with breast cancer receive standard treatments such as mastectomy, lumpectomy, radiation, chemotherapy, and hormone therapy (chagpar et al.
Journal of Clinical Oncology, 2003
Purpose: There are few data on sequelae of breast cancer treatments in older women. We evaluated posttreatment quality of life and satisfaction in a national population. Patients and Methods: Telephone surveys were conducted with a random cross-sectional sample of 1,812 Medicare beneficiaries 67 years of age and older who were 3, 4, and 5 years posttreatment for stage I and II breast cancer. Regression models were used to estimate the adjusted risk of decrements in physical and mental health functioning by treatment. In a subset of women (n = 732), additional data were used to examine arm problems, impact of cancer, and satisfaction, controlling for baseline health, perceptions of ageism and racism, demographic and clinical factors, region, and surgery year. Results: Use of axillary dissection was the only surgical treatment that affected outcomes, increasing the risk of arm problems four-fold (95% confidence interval, 1.56 to 10.51), controlling for other factors. Having arm proble...
Cancer Nursing, 2009
Negative attitudes about aging of both older adults and health care providers can be barriers to self care in old age. The aims of this study were 1) to examine the extent to which older breast cancer survivors experience barriers to symptom management, and 2) to explore whether barriers influence quality of life. Three possible barriers to symptom management were examined: negative beliefs about managing symptoms, perceived negative attitudes of health care providers, and difficulties in communicating about symptoms. This study was a secondary analysis of pooled baseline data from 61 older (age > 64) women who participated in two pilot studies that tested a symptom management intervention for older breast cancer survivors. The most frequent barrier reported was difficulties in communicating about symptoms with health care providers. Each of the barriers affected psychosocial, but not physical, quality of life. Barriers to symptom management may lead to poorer self care of symptoms that can result in lower levels of psychosocial quality of life. Health care providers need to encourage older cancer survivors to report symptoms and worries related to their cancer diagnosis and should be cautious in expressing attitudes that could reinforce older adults' negative perceptions about aging.