Purpose/Objectives: To examine symptom severity's relationship to symptom interference, education, age, marital status, and type of chemotherapy treatment in Israeli women with stage I or II breast cancer.
Design: Cross-sectional, descriptive, correlational design.
Setting: Hadassah University Hospital's oncology daytime care unit in Israel.
Sample: 51 women with stage I or II breast cancer who were receiving an adjuvant chemotherapy protocol that included doxorubicin.
Methods: Women receiving adjuvant chemotherapy were given the M.D. Anderson Symptom Inventory (MDASI), a modified version of the Breast Cancer Prevention Trial Hot Flashes Subscale (BCPT-HFS), and a demographic and treatment questionnaire to assess their symptoms toward the end of their chemotherapy treatment.
Main Research Variables: Symptom severity, symptom interference, education, age, marital status, and type of chemotherapy treatment.
Findings: The most frequent and severe symptoms were fatigue, sleep disturbance, and drowsiness. The MDASI symptom severity total scores were positively correlated with total scores of interference with activities of daily life, with most individual symptoms being significantly related to the total interference scores. The strongest relationships were found with fatigue, distress, and sadness. Education was inversely related to the MDASI general symptom severity total scores; age was inversely related to the BCPT-HFS total scores. Patients who received treatment with doxorubicin plus cyclophosphamide or doxorubicin, cyclophosphamide, plus fluorouracil had greater symptom severity than those who received doxorubicin plus cyclophosphamide followed by paclitaxel and had their symptoms evaluated after receiving paclitaxel.
Conclusions: Increased symptom severity disrupts daily function and life in women with breast cancer.
Implications for Nursing: Evidence-based symptom profiles for different chemotherapy protocols are needed.
Armstrong, T. S. (2003). Symptoms experience: A concept analysis. Oncology Nursing Forum, 30, 601-606. dx.doi.org/10.1188/03.ONF.601-606
Boehmke, M. M. (2004). Measurement of symptom distress in women with early-stage breast cancer. Cancer Nursing, 27, 144-152. dx.doi.org/10.1097/00002820-200403000-00008
Boehmke, M. M., & Dickerson, S. S. (2005). Symptom, symptom experiences, and symptom distress encountered by women with breast cancer undergoing current treatment modalities. Cancer Nursing, 28, 382-389. dx.doi.org/10.1097/00002820-200509000-00008
Bottomley, A., Biganzoli, L., Cufer, T., Coleman, R. E., Coens, C., Efficace, F., … Piccart, M. (2004). Randomized, controlled trial investigating short-term health-related quality of life with doxorubicin and paclitaxel versus doxorubicin and cyclophosphamide as first-line chemotherapy in patients with metastatic breast cancer. Journal of Clinical Oncology, 22, 2576-2586. dx.doi.org/10.1200/JCO.2004.02.037
Byar, K. L., Berger, A. M., Bakken, S. L., & Cetak, M. A. (2006). Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life [Online exclusive]. Oncology Nursing Forum, 33, E18 E26. dx.doi.org/10.1188/06.ONF.E18-E26
Cleeland, C. S. (2007). Symptom burden: Multiple symptoms and their impact as patient-reported outcomes. Journal of the National Cancer Institute. Monographs, 37, 16-21. dx.doi.org/10.1093/jncimonographs/lgm005
Cleeland, C. S., Mendoza, T. R., Wang, X. S., Chou, C., Harle, M. T., Morrissey, M., & Engstrom, M. C. (2000). Assessing symptom distress in cancer patients. Cancer, 89, 1634-1646.
Ivanova, M. O., Ionova, T. I., Kalyadina, S. A., Uspenskaya, O. S., Kishtovich, A. V., Guo, H., … Wang, X. S. (2005). Cancer-related symptom assessment in Russia: Validation and utility of the Russian M. D. Anderson Symptom Inventory. Journal of Pain and Symptom Management, 30, 443-453. dx.doi.org/10.1016/j.jpainsymman.2005.04.015
Jim, H. S., Andrykowski, M. A., Munster, P. N., & Jacobsen, P. B. (2007). Physical symptoms/side effects during breast cancer treatment predict posttreatment distress. Annals of Behavioral Medicine, 34, 200-208. dx.doi.org/10.1007/BF02872674
Kirkova, J., Davis, M. P., Walsh, D., Tiernan, E., O'Leary, N., LeGrand, S. B., … Russell, K. M. (2006). Cancer symptom assessment instruments: A systematic review. Journal of Clinical Oncology, 24, 1459-1473. dx.doi.org/10.1200/JCO.2005.02.8332
Lee, B., Dantzer, R., Langley, K. E., Bannett, G. J., Dougherty, P. M., Dunn, A. J., … Cleeland, C. S. (2004). A cytokine-based neuroimmunologic mechanism of cancer-related symptoms. Neuroimmunomodulation, 11, 279-292. dx.doi.org/10.1159/000079408
Manning-Walsh, J. K. (2005). Psychospiritual well-being and symptom distress in women with breast cancer [Online exclusive]. Oncology Nursing Forum, 32, E56 E62. dx.doi.org/10.1188/05.ONF.E56-E62
Mannor, B., & Zohar, C. (2006). Sexual functioning and information needs in women with premature menopause following breast cancer treatment [In Hebrew]. Harefuah, 145, 90-94.
Mystakidou, K., Cleeland, C. S., Tsilika, E., Katsouda, E., Primikiri, A., Parpa, E., … Mendoza, T. (2004). Greek MD Anderson Symptom Inventory: Validation and utility in cancer patients. Oncology, 67, 203-210. dx.doi.org/10.1159/000081318
Okuyama, T., Wang, X. S., Akechi, T., Mendoza, T. R., Hosaka, T., Cleeland, C. S., & Uchitomi, Y. (2003). Japanese version of the MD Anderson Symptom Inventory: A validation study. Journal of Pain and Symptom Management, 26, 1093-1104.
Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice (8th ed.). Philadelphia, PA: Lippincott Williams and Wilkins.
Schultz, P. N., Klein, M. J., Beck, M. L., Stava, C. & Sellin, R. V. (2005). Breast cancer: Relationship between menopausal symptoms, physiologic health effects of cancer treatment and physical constraints on quality of life in long-term survivors. Journal of Clinical Nursing, 14, 204-211. dx.doi.org/10.1111/j.1365-2702.2004.01030.x
Stanton, A. L., Bernaards, C. A., & Ganz, P. A. (2005). The BCPT symptom scales: A measure of physical symptoms for women diagnosed with or at risk for breast cancer. Journal of the National Cancer Institute, 97, 448-456. dx.doi.org/10.1093/jnci/dji069
Wang, X. S., Fairclough, D. L., Liao, Z., Komaki, R., Chang, J. Y., Mobley, G. M., & Cleeland, C. S. (2006). Longitudinal study of the relationship between chemoradiation therapy for non-small-cell lung cancer and patient symptoms. Journal of Clinical Oncology, 24, 4485-4491. dx.doi.org/10.1200/JCO.2006.07.1126
Wang, X. S., Laudico, A. V., Guo, H., Mendoza, T. R., Matsuda, M. L., Yosuico, V. D., … Cleeland, C. S. (2006). Filipino version of the M. D. Anderson Symptom Inventory: Validation and multisymptom measurement in cancer patients. Journal of Pain and Symptom Management, 31, 542-552. dx.doi.org/10.1016/j.jpainsymman.2005.11.011
Wang, X. S., Wang, Y., Guo, H., Mendoza, T. R., Hao, X. S., & Cleeland, C. S. (2004). Chinese version of the M. D. Anderson Symptom Inventory: Validation and application of symptom measurement in cancer patients. Cancer, 101, 1890-1901. dx.doi.org/10.1002/cncr.20448
Yun, Y. H., Mendoza, T. R., Kang, I. O., You, C. H., Roh, J. W., Lee, C. G., … Wang, X. S. (2006). Validation study of the Korean version of the M. D. Anderson Symptom Inventory. Journal of Pain and Symptom Management, 31, 345-352. dx.doi.org/10.1016/j.jpainsymman.2005.07.013