Browsing by Subject "cancer symptom management"

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    Development of a Patient Centered Outcome Questionnaire for Advanced Lung Cancer Patients
    (2020-05) Krueger, Ellen F.; Mosher, Catherine; Hirsh, Adam; McGrew, John
    Symptom research with advanced lung cancer patients has primarily focused on symptom severity, frequency, and distress; yet, little is known about advanced lung cancer patients’ priorities and success criteria for symptom improvement. To address these gaps in the literature, this study examined these outcomes using a modified Patient Centered Outcomes Questionnaire (PCOQ), which has largely been used with adults with chronic pain. Advanced lung cancer patients (N = 102) were recruited from the Indiana University Simon Cancer Center to participate in a one-time self-report survey, including demographic and medical questionnaires, symptom treatment history, standardized measures of symptom severity and quality of life, and the modified PCOQ focused on eight common symptoms in advanced lung cancer. Cancer information was collected from medical records. My primary aim was to evaluate the construct validity of the PCOQ. As hypothesized, symptom severity ratings on the PCOQ were positively correlated with standardized assessments of the same symptoms as well as functional status. Greater severity of most symptoms on the PCOQ was also correlated with worse quality of life, and greater severity of four symptoms was correlated with having more medical comorbidities. Positive, moderate correlations were found between the severity and importance of seeing improvement in cough, fatigue, sleep problems, and pain on the PCOQ. Patients considered low levels of symptom severity to be acceptable following symptom treatment; no differences were found across the eight symptoms. Latent profile analysis identified four patient subgroups based on the importance of seeing improvement in each of the symptoms: (1) those who rated all symptoms as low in importance (n = 12); (2) those who rated bronchial symptoms and sleep problems as low in importance and all other symptoms as moderately important (n = 29); (3) those who rated nausea and emotional distress as low in importance and all other symptoms as moderately important (n = 23); and (4) those who rated all symptoms as highly important (n = 33). These subgroups were unrelated to demographic and clinical factors, except for functional status. Findings suggest that symptom severity and importance are related yet distinct aspects of the advanced lung cancer symptom experience. Furthermore, patients have heterogeneous priorities for symptom management, which has implications for tailoring treatment.
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    A prospective examination of change in executive function and physical activity in older breast cancer survivors
    (2020-08) Tometich, Danielle Bowman; Mosher, Catherine E.; Cyders, Melissa A.; McDonald, Brenna C.; Saykin, Andrew J.
    Only one third of older breast cancer survivors (BCS) meet national physical activity (PA) guidelines. Theories of self-regulation and research with older adults suggest that executive function (EF) plays an important role in PA, yet the impact of lower EF on older survivors’ PA is unknown. My project addressed this gap using secondary data from the Thinking and Living with Cancer (TLC) cohort study, which examined cognitive function among older BCS pre-treatment, followed every 12 months, and contemporaneously assessed matched controls. My first aim was to test two hypotheses regarding EF change and PA and determine if these relationships differ between BCS and controls. My hypotheses were: 1) EF decline from baseline to 12 months will predict lower PA at 24 months, and 2) lower PA at 12 months will predict EF decline from 12 to 24 months. My second aim was to explore whether the effects of EF change on PA in BCS differed based on risk factors for accelerated cognitive decline (i.e., older age, more advanced cancer stage, comorbidity, and APOE ε4 genotype). The TLC study measured EF with neuropsychological tests and PA with the International Physical Activity Questionnaire-Short Form. For aims 1 and 2, I used multiple regression with multiple imputation. Primary results showed no significant effect of EF change from baseline to 12 months on PA at 24 months (β=-0.01, p=0.88) and no significant group (BCS vs. controls) by EF interaction (β=-0.05, p=0.33). Separate models in BCS and controls showed similar findings. In the entire sample, PA at 12 months significantly predicted EF change from 12 to 24 months (β=0.17, p=0.01), but there was no significant group by PA interaction (β=-0.06, p=0.54). Separate analyses by group found a significant effect of PA for controls (β=0.07, p=0.02), but not for BCS (β=0.05, p=0.27). Regarding the second aim, there were no significant interactions between EF change and the proposed risk factors on PA. Findings were largely inconsistent with theory and prior research. Continued research in this area will inform future exercise interventions to improve physical and cognitive health for the growing population of older cancer survivors.