Symptom prevalence, characteristics and distress in a cancer population The Knowledge Base for Evidence‐based Nursing: A Role for Mixed Methods Research? Psychological and symptom distress in terminal cancer patients with met and unmet needs. Confronting the unexpected: temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors. Symptom clusters and their effect on the functional status of patients with cancer. Symptom experience in patients with primary brain tumours: a longitudinal exploratory study. Symptoms experienced by cancer patients during the first year from diagnosis: patient and informal caregiver ratings and agreement.
Despite the importance of symptom control in the cancer population , few studies have systematic ally assessed the prevalence and characteristics of symptoms or the interactions between various symptom characteristics and other factors related to quality of life ( QOL ) . As part of a validation study of a new symptom assessment instrument , in patients and out- patients with prostate , colon , breast or ovarian cancer were evaluated using the  Memorial Symptom Assessment Scale and other measures of psychological condition , performance status , symptom distress and overall quality of life .  The mean age of the 243 avaluable patients was 55.5 years ( range 23–86 years ) ; over 60 % were women and almost two-thirds had metastatic disease . The Karnofsky Performance Status ( KPS ) score was≤80 in 49.8 % and 123 were in patients at the time of assessment . Across tumour types , 40–80 % experienced lack of energy , pain , feeling drowsy , dry mouth , insomnia , or symptoms indicative of psychological distress . Although symptom characteristics were variable , the proportion of patients who described a symptom as relatively intense or frequent always exceeded the proportion who reported it as highly distressing . The mean ( ±SD , range ) number of symptoms per patient was 11.5±6.0 ( 0–25 ) ; in patients had more symptoms than out patients ( 13.5±5.4 vs. 9.7±6.0 , p<0.002 ) and those with KPS≤80 had more symptoms than those with KPS>80 ( 14.8±5.5 vs. 9.2±4.9 , p<0.0001 ) . The number of symptoms was highly associated with heightened psychological distress and poorer quality of life ( for example , r=0.67 for the relationship with the Functional Living Index-Cancer , a QOL measure ) . These data clarify the prevalence and characteristics of cancer-related symptoms and suggest that the number of symptoms per patient may be a useful quality of life indicator Evidence  -based nursing  is central to the knowledge base for nursing practice . Critics of evidence -based nursing dislike the central role that r and omized controlled trials ( RCTs ) take in providing evidence for nursing , cl aim ing that the context and experience of nursing care are removed from evaluation . Many nursing decisions involve questions regarding the effectiveness of interventions , best evaluated by RCTs . This article explores the epistemological and practical feasibility of combining  qualitative research with RCTs ( mixed methods research ) in evaluations of nursing practice . Through theoretical and practical examples , it proposes that mixed methods research has the potential to enhance the evidence base for nursing This study identified the needs of terminal cancer patients , investigated the factors associated with unmet needs , and assessed psychological and symptom distress associated with unsolved needs . Ninety-four patients were r and omly selected from 324 patients admitted for palliative care in 13 Italian centers .  Two self-administered question naires ( the Symptom Distress Scale and the Psychological Distress Inventory )  were administered to all the patients . Patients needs were identified using a semi-structured interview , aim ed at exploring five areas : physiological needs , safety needs , love and belonging needs , self-esteem needs , self-fulfillment needs . A content analysis of the answers defined 11 needs , and identified patients with unmet needs . The most frequent unmet needs were symptom control ( 62.8 % ) , occupational functioning ( 62.1 % ) , and emotional support ( 51.7 % ) . The less frequently reported needs were those related to personal care ( 14.6 % ) , financial support ( 14.1 % ) , and emotional closeness ( 13.8 % ) . Low functional state was significantly associated with a high proportion of patients with unmet needs of personal care , information , communication , occupational functioning , and emotional closeness . Patients with unmet needs showed significantly higher psychological and symptom distress for most needs . This study provides some suggestions about the concerns that should be carefully considered during the late stage of cancer PURPOSE / OBJECTIVES To describe women 's unexpected and distressing symptom experiences after breast cancer treatment . RESEARCH APPROACH Qualitative and descriptive . SETTING Depending upon their preference , participants were interviewed in their homes or in a private office space in a nearby library . PARTICIPANTS Purposive sample of 13 women 1 - 18 years after breast cancer treatment . METHOD OLOGIC APPROACH Secondary analysis of phenomenologic data ( constant comparative method ) . MAIN RESEARCH VARIABLES Breast cancer symptom distress , ongoing symptoms , and unexpected experiences . FINDINGS Women described experiences of unexpected and distressing symptoms in the years following breast cancer treatment . Symptoms included pain , loss of energy , impaired limb movement , cognitive disturbance , changed sexual experience , and lymphedema . Four central themes were derived : living with lingering symptoms , confronting unexpected situations , losing precancer being , and feeling like a has-been . Distress intensified when women expected symptoms to disappear but symptoms persisted instead . Increased distress also was associated with sudden and unexpected situations or when symptoms elicited feelings of loss about precancer being and feelings of being a has been . Findings suggest that symptom distress has temporal , situational , and attributive dimensions . CONCLUSIONS Breast cancer survivors ' perceptions of ongoing and unexpected symptoms have important influences on quality of life . Underst and ing temporal , situational , and attributive dimensions of symptom distress empowers nurses and healthcare professionals to help breast cancer survivors prepare for subsequent ongoing or unexpected experiences in the years after breast cancer treatment . INTERPRETATION Follow-up care for breast cancer survivors should foster dialogue about ways that symptoms might emerge and that unexpected situations might occur . Prospect i ve studies are needed to examine symptom distress in terms of temporal , situational , and attributive dimensions and explore the relationship between symptom distress and psychological distress after breast cancer treatment PURPOSE / OBJECTIVES To determine the effect of the symptom cluster of pain , fatigue , and sleep insufficiency on functional status during three cycles of chemotherapy . DESIGN Prospect i ve , longitudinal . SETTING 23 outpatient offices and clinics . SAMPLE 93 patients with cancer . The typical participant was female ( 72 % ) , married/partnered ( 65 % ) , white ( 87 % ) , and middle-aged ( 55.4 years ) , with an average of 14.8 years of education . METHODS The  Quality of Life-Cancer ( QOL-CA ) version instrument and the Karnofsky Performance Scale ( KPS )  were completed by 93 out patients receiving chemotherapy at baseline  ( Time 1 ) and at the end of the third cycle ( Time 2 ) . Three items  ( pain , tires easily , sleeps enough to meet needs )  from the QOL-CA question naire were used to measure the symptom cluster . MAIN RESEARCH VARIABLES Symptom cluster , outcome , functional status , chemotherapy . FINDINGS A hierarchical multiple regression model explained 48.4 % of the variance in functional status . The KPS at Time 1 explained 30.8 % of the variance in KPS at Time 2 ( p < 0.001 ) . After KPS at Time 1 was partialled out from KPS at Time 2 , the four independent variables entered in the next step were considered predictors of the change in functional status between Time 1 and Time 2 . Age explained 11.8 % of the change ( p = 0.001 ) , pain explained 10.7 % of the change ( p = 0.002 ) , and fatigue explained 7.3 % of the change ( p = 0.011 ) . Sleep insufficiency statistically was not significant , only explaining 1 % of the change ( p = 0.344 ) . CONCLUSION This study provides beginning insights into the effect of a symptom cluster on patients ' functional status . IMPLICATION S FOR NURSING PRACTICE Healthcare professionals need to be aware of the presence of symptom clusters and their possible synergistic adverse effect on patients ' future morbidity PURPOSE This study was undertaken to further underst and the symptom experience and the impact of symptoms in daily life in people treated for brain tumours . METHODS A qualitative prospect i ve longitudinal design was used with 9 people who were interviewed over 4 time points ( soon after diagnosis , 3 months , 6 months and 12-months post-diagnosis ) , providing 21 interviews in total . RESULTS Key issues for these participants were ongoing fatigue , memory loss and inability to drive . Fatalistic views about the outcomes of their disease were the norm . Participants made adjustments to their lives to accommo date their functional limitations . These included making home alterations , introducing regular exercise to their lives and using complementary therapies . Their expectations did not always match with the reality of the situation , which made several participants angry and dissatisfied with health care professionals . CONCLUSIONS Issues of quality of life are paramount in this group of poor prognosis patients , therefore , health professionals should provide preparatory information to patients on what to expect from the illness and its treatments . Health professionals should also assist patients to manage debilitating symptoms such as fatigue and cognitive impairment OBJECTIVE The aim of this study was to explore the symptom experience of patients with cancer , identify changes in symptoms over time , and explore the congruence of symptom reports between patients and their informal caregivers . METHOD This was a prospect i ve longitudinal evaluation of symptoms over 1 year from start of treatments ( T1 ) using the Memorial Symptom Assessment Scale .  Assessment s and follow up took place at 3 months ( T2 ) , 6 months ( T3 ) and 12 months ( T4 ) . A heterogeneous sample of 100 patients with cancer participated , providing 325 assessment s over time . Furthermore , 82 caregivers also participated , providing 238 dyadic patient-caregiver assessment s over the same time . RESULTS The most commonly occurring , and by far most distressing , symptom was " lack of energy . " Common symptoms reported were lack of concentration , difficulties sleeping , shortness of breath , cough , pain , dry mouth , and feeling drowsy . Symptom occurrence and distress improved over time , particularly from T2 to T3 ( p < 0.05 ) , but the " chronicity " of some generic symptoms was notable . Caregivers tended to overestimate occurrence and distress compared to patients , particularly in symptoms of psychological nature ; κ statistics had a highest coefficient of 0.45 , suggesting moderate agreement between patients and caregivers at best . SIGNIFICANCE OF RESULTS More attention needs to be paid to the commonly reported symptoms by patients , as they have the potential of impacting on quality of life ( QOL ) . As patient-caregiver reports had moderate agreement , effort should be directed to improving this agreement , as caregivers are often communicating patient symptoms to clinicians
Purpose This review paper aim ed to draw together the findings of qualitative research into the symptom experience of adult cancer patients in order to develop a better underst and ing of symptom experiences following cancer treatment .