Anxiety profiles are associated with stress, resilience and symptom severity in outpatients receiving chemotherapy

Oppegaard, Kate; Harris, Carolyn S.; Shin, Joosun; Paul, Steven M.; Cooper, Bruce A.; Levine, Jon D.; Conley, Yvette P.; Hammer, Marilyn J.; Cartwright, Frances; Wright, Fay; Dunn, Laura B.; Kober, Kord M.; Miaskowski, Christine

doi:10.1007/s00520-021-06372-w

Cited by 19 publications

(22 citation statements)

References 38 publications

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“…29 Previous studies found that younger age, more extended disease, more extended surgery, receipt of chemotherapy, poor body image, presence of lymphedema, pain and impaired mobility were risk factors for emotional distress in breast cancer patients. [29][30][31][32][33][34] In addition, worst pain severity profiles were associated with significant stress and multiple co-occurring symptoms. 35 Our study focused on the emotional distress associated with co-occurring symptoms defined as the negative emotions or feelings evoked by an individual's experience of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Co-occurring Fatigue and Lymphatic Pain Incrementally Aggravate Their Negative Effects on Activities of Daily Living, Emotional Distress, and Overall Health of Breast Cancer Patients

McTernan

Qiu

et al. 2022

Integr Cancer Ther

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Background: Fatigue and lymphatic pain are the most common and debilitating long-term adverse effects of breast cancer treatment. Fatigue and pain independently have negative effects on quality of life, physical functions, and cancer recurrence-free survival. The interactions between fatigue and pain may aggravate their negative effects. Objectives: Examine the effects of co-occurring fatigue and lymphatic pain on activities of daily living (ADLs), emotional distress, and overall health of breast cancer patients. Methods: A cross-sectional and observational design was used to enroll 354 breast cancer patients. Valid and reliable instruments were used to assess fatigue, lymphatic pain, ADLs, emotional distress, and overall health. Descriptive statistics and multivariable regression models were used for data analysis. Results: After controlling for demographic and clinical factors, patients with co-occurring fatigue and lymphatic pain had higher odds of having impaired ADLs (OR = 24.43, CI = [5.44-109.67], P < .001) and emotional distress (OR = 26.52, CI = [9.64-72.90], P < .001) compared to patients with only fatigue and only lymphatic pain. Patients with co-occurring fatigue and lymphatic pain had 179% increase in impaired ADL scores ( B = 8.06, CI = [5.54-10.59]) and 211% increase in emotional distress scores ( B = 9.17, CI = [5.52-12.83]) compared to those without co-occurring fatigue and lymphatic pain. Patients with co-occurring fatigue and lymphatic pain had a 34% decrease ( B = −26.29, CI = [−31.90 to −20.69]) and patients with only fatigue had a 33% decrease in overall health scores ( B = −25.74, 95% CI = [−34.14 to −17.33]), indicating poor overall health. Conclusions: Fatigue and lymphatic pain affected 66.4% of breast cancer patients. Findings from this study suggest that co-occurring fatigue and lymphatic pain have negative effects on breast cancer patients’ ADLs, emotional distress, and overall health. The synergistic interactions between fatigue and lymphatic pain incrementally aggravated their negative effects on ADLs and emotional distress. Findings of the study highlight the need to evaluate the underlying mechanisms for co-occurring fatigue and lymphatic pain and develop interventions that target both fatigue and lymphatic pain to improve breast cancer patients’ the quality of life.

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Section: Discussionmentioning

confidence: 99%

Co-occurring Fatigue and Lymphatic Pain Incrementally Aggravate Their Negative Effects on Activities of Daily Living, Emotional Distress, and Overall Health of Breast Cancer Patients

McTernan

Qiu

et al. 2022

Integr Cancer Ther

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“…85 Repeated environmental stressors, especially when unpredictable, induce persistent hyperalgesic states, including hyperalgesic priming, a preclinical model of the transition from acute to chronic pain. 4,26,31,35,41,45,79 We and others have demonstrated, in preclinical 26,79 and clinical 54,55,57,74 studies, the impact of stress and role of the neuroendocrine stress axes in CIPN pain. We have shown that rats exposed to unpredictable sound stress, using an experimental protocol that produces a chronic increase in plasma epinephrine and corticosterone, 40,41 develop hyperalgesic priming, 23,40 a neuroplastic change in nociceptors that markedly prolongs hyperalgesia produced by inflammatory mediators, prototypically prostaglandin E 2 (PGE 2 ), 38 by a PKCɛ-dependent mechanism.…”

Section: Introductionmentioning

confidence: 97%

Neuroendocrine mechanisms in oxaliplatin-induced hyperalgesic priming

Staurengo‐Ferrari

Araldi

Green

et al. 2022

Pain

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“…Unrelieved anxiety has negative effects on treatment outcomes, 13 overall survival, 5,10 functional status, 10 and QOL. 11 Although a number of longitudinal studies have evaluated for changes in anxiety in patients undergoing chemotherapy, 5,6,[14][15][16] only 3 studies 5,14,15 used a person-centered analytic approach to identify groups of patients with distinct anxiety profiles.…”

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confidence: 99%

“…Most recently, we used latent profile analysis (LPA) to evaluate for distinct anxiety profiles in a sample of oncology outpatients over 2 cycles of chemotherapy 15 . State anxiety was evaluated using the Spielberger State Anxiety Inventory (STAI-S).…”

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confidence: 99%

“…Although a person-centered analytic approach was used to identify distinct anxiety profiles, the first 2 studies included only women with breast cancer. In addition, various instruments were used to measure anxiety (ie, Hospital Anxiety and Depression Scale, 14 STAI-S, 15 dichotomous measure 5 ). Finally, whereas all of the studies reported on risk factors for anxiety, only 1 study 15 noted that higher levels of common symptoms (eg, fatigue) were associated with a worst anxiety profile.…”

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confidence: 99%

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Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life

et al. 2022

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Background Anxiety and sleep disturbance are frequent symptoms during chemotherapy. Objectives Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups. Methods Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles. Results Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life. Conclusions More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms. Implications for Practice Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.

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Anxiety profiles are associated with stress, resilience and symptom severity in outpatients receiving chemotherapy

Cited by 19 publications

References 38 publications

Co-occurring Fatigue and Lymphatic Pain Incrementally Aggravate Their Negative Effects on Activities of Daily Living, Emotional Distress, and Overall Health of Breast Cancer Patients

Co-occurring Fatigue and Lymphatic Pain Incrementally Aggravate Their Negative Effects on Activities of Daily Living, Emotional Distress, and Overall Health of Breast Cancer Patients

Neuroendocrine mechanisms in oxaliplatin-induced hyperalgesic priming

Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life

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