Abstract This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with ...osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all P s ≤ 0.05) of variance in measures of pain (partial r2 p r2 = 0.10), psychological disability (p r2 = 0.20), physical disability (p r2 = 0.11), and gait velocity at normal (p r2 = 0.04), fast (p r2 = 0.04), and intermediate speeds (p r2 = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (p r2 = 0.07) and walking at a fast speed (p r2 = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.
Abstract Purpose To evaluate the impact of guided meditation and music interventions on patient anxiety, pain, and fatigue during imaging-guided breast biopsy. Methods After giving informed consent, ...121 women needing percutaneous imaging-guided breast biopsy were randomized into three groups: (1) guided meditation; (2) music; (3) standard-care control group. During biopsy, the meditation and music groups listened to an audio-recorded, guided, loving-kindness meditation and relaxing music, respectively; the standard-care control group received supportive dialogue from the biopsy team. Immediately before and after biopsy, participants completed questionnaires measuring anxiety (State-Trait Anxiety Inventory Scale), biopsy pain (Brief Pain Inventory), and fatigue (modified Functional Assessment of Chronic Illness Therapy-Fatigue). After biopsy, participants completed questionnaires assessing radiologist–patient communication (modified Questionnaire on the Quality of Physician–Patient Interaction), demographics, and medical history. Results The meditation and music groups reported significantly greater anxiety reduction ( P values < .05) and reduced fatigue after biopsy than the standard-care control group; the standard-care control group reported increased fatigue after biopsy. The meditation group additionally showed significantly lower pain during biopsy, compared with the music group ( P = .03). No significant difference in patient-perceived quality of radiologist–patient communication was noted among groups. Conclusions Listening to guided meditation significantly lowered biopsy pain during imaging-guided breast biopsy; meditation and music reduced patient anxiety and fatigue without compromising radiologist–patient communication. These simple, inexpensive interventions could improve women’s experiences during core-needle breast biopsy.
Abstract Context The Patient Care Monitor (PCM) is a review of systems survey delivered by means of an electronic patient-reported outcomes (ePRO) data capture system that uses wireless tablet ...computers. Although the PCM 1.0 is validated, the updated PCM 2.0 has not been validated nor tested in the academic setting. Objectives To validate and test the PCM 2.0 in three cancer populations. Methods Two hundred seventy-five individuals participated in three clinical trials enrolling breast ( n = 65), gastrointestinal ( n = 113), and lung ( n = 97) cancer patients. Internal consistency was evaluated using Cronbach's alpha coefficients calculated for six PCM subscales (general physical symptoms, treatment side effects, distress, despair, impaired performance, and impaired ambulation) and a Quality-of-Life Index. Construct validity was evaluated through Pearson's correlation between PCM subscales and subscales of the Functional Assessment of Cancer Therapy—General (FACT-G), the M.D. Anderson Symptom Inventory (MDASI), and the Functional Assessment of Chronic Illness Therapy—Fatigue (FACIT-F). The participants had the following characteristics: mean age was 58 years (standard deviation: 11), 52% were females, 79% were whites, 17% were blacks, 62% had no college degree, and 78% had metastatic or recurrent disease. Results Raw and normalized scores for PCM 2.0 subscales were internally consistent across study cohorts. PCM 2.0 subscales correlated significantly ( P < 0.05) with the corresponding subscales on FACT-G, MDASI, and FACIT-F, with the exception of FACT-G social well-being, particularly for the lung cancer population. These correlations demonstrated construct validity. PCM 2.0 results followed expected patterns by cancer etiology. Prior reports demonstrate patient satisfaction with PCM 2.0. Conclusion Within three unique academic oncology populations, PCM 2.0 is a valid ePRO instrument for assessing symptoms with seven patient-centered subscale or index domains.
Abstract Context Holding back, or withholding discussion of disease-related thoughts and emotions, is associated with negative outcomes including lower quality of life, diminished well-being, and ...relational distress. For patients undergoing hematopoietic stem cell transplantation (HSCT), the degree to which one holds back from discussing illness-related concerns may be an important determinant of social well-being and health; however, this has not been systematically assessed in this population. Objectives The purpose of the present study was to assess the moderating effects of holding back discussion of disease-related concerns on the relationship between health-related symptoms and social well-being in adult patients undergoing HSCT. Methods Seventy autologous ( n = 55) and allogeneic ( n = 15) HSCT patients completed measures of holding back, social well-being, and health symptoms (i.e., pain, fatigue, sleep problems, cognitive problems) both before and after transplantation (i.e., three months after transplantation and six months after transplantation). Results In patients with average to high levels of holding back, health symptoms were significantly related to lower levels of social well-being; however, for patients with low levels of holding back, the relationship between health symptoms and social well-being was not significant. Conclusion The results of the present study suggest that the level of holding back may be important in understanding how health-related symptoms relate to social well-being in patients undergoing HSCT. These findings underscore the importance of addressing how patients undergoing HSCT communicate about their disease with others as this may be related to their adjustment to illness and treatment.
Abstract Purpose The aim of this study was to evaluate patient anxiety and its association with perceived radiologist-patient communication in the setting of imaging-guided breast biopsy. Methods ...After informed consent was obtained, 138 women recommended for imaging-guided breast procedures completed questionnaires immediately before and after biopsies, measuring state anxiety using the State-Trait Anxiety Inventory (range, 20-80). Before biopsies, women also completed questionnaires regarding their perceived communication with the radiologists recommending the procedures (modified Questionnaire on the Quality of Physician-Patient Interaction), demographic characteristics, and medical history; immediately after the biopsies, they completed a measure of perceived communication with the radiologists performing the biopsies. Experience levels (eg, attending radiologist, fellow) of the radiologists recommending and performing the biopsies were recorded. Data were analyzed using paired and independent t tests, one-way analysis of variance, Pearson’s correlations, and multiple linear regression analyses. Results Average prebiopsy anxiety was 44.5 ± 12.4 (range, 20-77) on a scale ranging from 20 to 80 points. Perceived communication with radiologists recommending biopsies averaged 52.4 ± 11.5 (range, 18-65). Better communication with radiologists recommending biopsies was significantly associated with lower levels of prebiopsy anxiety ( r = −0.22, P = .01). After the biopsies, women’s anxiety significantly decreased (paired t = −7.32, P < .001). Better communication with radiologists performing biopsies (mean, 57.8 ± 8.4; range, 32-65) was associated with lower postbiopsy anxiety after accounting for patients’ baseline anxiety levels (β = −0.17, P = .04). White women reported higher prebiopsy and postbiopsy anxiety; nonwhite women reported poorer communication with recommending radiologists. Conclusions Patients’ perceptions of better communication with radiologists were associated with lower levels of anxiety before and after biopsies. These results have implications for radiologist training and adherence to mammographic screening.
The purpose of this study was to evaluate pain experienced during imaging-guided core-needle breast biopsies and to identify factors that predict increased pain perception during procedures.
In this ...institutional review board-approved, HIPAA-compliant protocol, 136 women undergoing stereotactically or ultrasound-guided breast biopsy or cyst aspiration were recruited and provided written informed consent. Participants filled out questionnaires assessing anticipated biopsy pain, ongoing breast pain, pain experienced during biopsy, catastrophic thoughts about pain during biopsy, anxiety, perceived communication with the radiologist, chronic life stress, and demographic and medical information. Procedure type, experience level of the radiologist performing the biopsy, number of biopsies, breast density, histology, and tumor size were recorded for each patient. Data were analyzed using Spearman's ρ correlations and a probit regression model.
No pain (0 out of 10) was reported by 39.7% of women, mild pain (1-3 out of 10) by 48.5%, and moderate to severe pain (≥4 out of 10) by 11.8% (n = 16). Significant (P < .05) predictors of greater biopsy pain in the probit regression model included younger age, greater prebiopsy breast pain, higher anticipated biopsy pain, and undergoing a stereotactic procedure. Anticipated biopsy pain correlated most strongly with biopsy pain (β = .27, P = .004).
Most patients report minimal pain during imaging-guided biopsy procedures. Women experiencing greater pain levels tended to report higher anticipated pain before the procedure. Communication with patients before biopsy regarding minimal average pain reported during biopsy and encouragement to make use of coping strategies may reduce patient anxiety and anticipated pain.
This randomized, double-blind controlled study evaluated the effectiveness of sodium bicarbonate-buffered lidocaine on reducing pain during imaging-guided breast biopsies.
This prospective, ...HIPAA-compliant study randomly assigned 85 women undergoing ultrasound- or stereotactic-guided core-needle breast biopsies to receive intradermally and intraparenchymally either 1% lidocaine buffered with sodium bicarbonate (9:1 ratio) (bicarbonate study group) or 1% lidocaine alone (control group). Pain was evaluated using a 0-to-10 Likert pain scale during both intradermal and intraparenchymal anesthesia injections and during tissue sampling. Prebiopsy breast pain, anxiety, medical history, demographics, biopsy type, radiologist level of training, breast density, and lesion histology were recorded. Data were analyzed using analysis of variance and analysis of covariance.
Unadjusted mean pain scores were 1.47 and 2.07 (study and control groups, respectively; P = .15) during intradermal injections, and 1.84 and 2.98 (study and control groups, respectively; P = .03) during intraparenchymal injections. Tissue sampling mean pain scores were .81 and 1.71 (study and control groups, respectively; P = .07). Moderator analyses found (1) among patients with preprocedural pain, those in the bicarbonate group experienced less intradermal injection pain (0.85 ± 1.23) than patients in the control group (2.50 ± 2.09); (2) among patients with fatty or scattered fibroglandular tissue, those in the bicarbonate group (1.35 ± 1.95) experienced less intraparenchymal injection pain than the control group (3.52 ± 3.13); and (3) during ultrasound-guided biopsies, patients in the bicarbonate group experienced less tissue-sampling pain (0.23 ± 0.63) than the control group (1.79 ± 3.05).
Overall, buffering lidocaine with sodium bicarbonate significantly reduced pain during intraparenchymal injections, and additional pain reduction was found in certain patient subgroups during intradermal injections, intraparenchymal injections, and tissue sampling.
The aim of this study was to evaluate patient anxiety and its association with perceived radiologist-patient communication in the setting of imaging-guided breast biopsy.
After informed consent was ...obtained, 138 women recommended for imaging-guided breast procedures completed questionnaires immediately before and after biopsies, measuring state anxiety using the State-Trait Anxiety Inventory (range, 20-80). Before biopsies, women also completed questionnaires regarding their perceived communication with the radiologists recommending the procedures (modified Questionnaire on the Quality of Physician-Patient Interaction), demographic characteristics, and medical history; immediately after the biopsies, they completed a measure of perceived communication with the radiologists performing the biopsies. Experience levels (eg, attending radiologist, fellow) of the radiologists recommending and performing the biopsies were recorded. Data were analyzed using paired and independent t tests, one-way analysis of variance, Pearson's correlations, and multiple linear regression analyses.
Average prebiopsy anxiety was 44.5 ± 12.4 (range, 20-77) on a scale ranging from 20 to 80 points. Perceived communication with radiologists recommending biopsies averaged 52.4 ± 11.5 (range, 18-65). Better communication with radiologists recommending biopsies was significantly associated with lower levels of prebiopsy anxiety (r = -0.22, P = .01). After the biopsies, women's anxiety significantly decreased (paired t = -7.32, P < .001). Better communication with radiologists performing biopsies (mean, 57.8 ± 8.4; range, 32-65) was associated with lower postbiopsy anxiety after accounting for patients' baseline anxiety levels (β = -0.17, P = .04). White women reported higher prebiopsy and postbiopsy anxiety; nonwhite women reported poorer communication with recommending radiologists.
Patients' perceptions of better communication with radiologists were associated with lower levels of anxiety before and after biopsies. These results have implications for radiologist training and adherence to mammographic screening.
Abstract Context Dyspnea is a poorly understood subjective sensation. Existing dyspnea measures fail to adequately address its multidimensionality. A Japanese group developed and validated the Cancer ...Dyspnea Scale (CDS) for assessing dyspnea in patients with advanced lung cancer. Objectives We evaluated the validity and reliability of the English version of the CDS (CDS-E) that has 12 items and takes, on average, 140 seconds for individuals to complete. Methods Eligible patients had advanced lung cancer, consented, and were fluent in English. Participants completed a 100 mm visual analogue scale (VAS), the modified Borg scale, the CDS-E, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy—Lung quality-of-life scale. Demographic, radiographic, and treatment information were obtained from patients' medical records. Results One hundred twelve participants were enrolled at three sites in the U.S., Australia, and the U.K. Mean age was 64.5 years (SD 11.5); 90% were Caucasian, 68% had Eastern Cooperative Oncology Group performance status 0–1, and 50% had non-small cell carcinoma. All completed the CDS-E independently, without difficulty. The CDS-E had reasonable internal consistency overall (Cronbach's α = 0.71) and for each of the three factors (effort, anxiety, discomfort Cronbach's α = 0.80–0.84). CDS-E scores were significantly correlated with the 100 mm VAS ( r = 0.82; P < 0.001) and the modified Borg ( r = 0.87; P < 0.001). After factor analysis, the CDS-E was revised by removing three items (r-CDS-E). Conclusion The CDS-E and r-CDS-E are reliable and valid measures of the sensation and the psychological components of dyspnea, with the shorter version having similar psychometric properties.
Pediatric cancer survivors who have been exposed to anthracycline (ANT) chemotherapy are an ever increasing population at risk for premature cardiac disease. Studies have shown that ANT is associated ...with impaired left ventricular (LV) myocardial deformation, but this has not been shown to be associated with traditional echocardiographic measures of LV systolic dysfunction. The aim of this study was to test the hypothesis that changes in LV longitudinal peak systolic strain (LPSS) would correlate with parameters of LV systolic dysfunction.
This study included 19 prospectively enrolled pediatric patients receiving ANT (mean dose, 296 ± 103 mg/m(2)) and 19 controls matched for age, gender, and body surface area. For ANT patients, echocardiography was performed at baseline, mid, and final treatment points (0, 4, and 8 months). Standard echocardiographic parameters and two-dimensional speckle tracking-derived longitudinal strain parameters were obtained and compared with baseline measurements in controls. Associations between changes in LV global LPSS and standard echocardiographic indices were explored.
Within the ANT group, the change in LV global LPSS showed a significant decrease compared with baseline at 4 months (8.7 ± 0.2%, P = .033) and 8 months (9.2 ± 0.3%, P = .015), while the percentage change in ejection fraction (EF) showed a statistically significant decrease at 8 months (4.3 ± 0.1%, P = .044). LV global LPSS was decreased in the ANT group compared with controls at 4 months (18.1 ± 2.5% vs 20.5 ± 1.5%, P = .011) and 8 months (18.1 ± 2.8%, P = .032). Segmental changes in mid and apical LV LPSS average were significantly correlated with change in EF (mid: r = -0.49, β = -0.645, P = 0.039; apical: r = -0.48, β = -0.4126, P = .046).
In adolescents who receive ANT therapy, changes in two-dimensional LV global LPSS precede decreases in EF, and segmental changes in mid and apical LV LPSS suggest an increased likelihood that depressed LV EF will be observed later in follow-up. Two-dimensional speckle tracking-derived LV LPSS is potentially useful in the serial clinical monitoring of ANT cardiotoxicity.
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