Inflammation And Cancer-Related Fatigue In Breast Cancer Survivors

Purpose: Cancer-related fatigue negatively impacts quality of life and possible recurrence and overall mortality in breast cancer survivors. This study aimed to investigate the associations between inflammation and cancer-related fatigue in breast cancer survivors using methods of systematic review and quantitative assessment of the Hormones and Physical Exercise (HOPE) Study in a high-risk population. Methods: A PubMed search was conducted to identify peer-reviewed studies that assessed the associations among inflammatory markers, CRP, IL-6, and TNF-α, and cancer-related fatigue in breast cancer survivors. The HOPE Study was a randomized control trial in 121 postmenopausal Stage I-IIIC breast cancer survivors, who were taking Aromatase Inhibitors (AIs) and experiencing arthralgia. This study investigated the associations of baseline (N = 69) pro-inflammatory markers CRP, IL-6, and TNF-α and self-reported fatigue. Results: Fifteen studies with more than 1,900 participants were included in the systematic review. The literature inconclusively supports a positive association between CRP and cancer-related fatigue. TNF-α and IL-6 were not associated with cancer-related fatigue. In the HOPE Study, CRP, IL-6, and TNF-α, fatigue, and sleep duration were not significantly associated. There was the suggestion of a positive trending association between CRP and cancer-related fatigue among women with higher stage of disease. BMI status and joint pain intensity were significant risk factors of cancer-related fatigue. Conclusion: A growing body of literature inconclusively supports the link between downstream inflammatory activity and cancer-related fatigue. There may be subgroups of women, e.g. those with higher stage of disease, for whom this may be particularly important. A further understanding of cancer-related fatigue mechanisms and the development of effective interventions are necessary to improve the quality and duration of life in the increasing population of cancer survivors

Effect of Telephone Counseling on Physical Activity among Older Adult Cancer Survivors

The elderly population, especially those with cancer coupled with low health literacy, is at high risk for poor health outcomes. Telephone counseling has been shown to be effective in improving health behaviors among other populations, but it has not been studied for older adult cancer survivors. The purpose of this mixed methods study was to examine the effectiveness of telephone counseling on physical activity among older adult cancer survivors (n=50). The relationship between health literacy level and perceived changes in physical activity was assessed. Based on existing literature and Orem\u27s Theory of Self-care, the following hypotheses were tested: H1: Telephone counseling intervention will improve physical activity of elderly cancer survivors. H2: Among older adult cancer survivors, there will be an inverse relationship between health literacy level and improved physical activity. A one-way paired t-test was used to test pre- and post-intervention activity levels. The relationship between level of health literacy and improved physical activity was evaluated using Spearman\u27s rho. Elderly cancer survivors\u27 perceptions of the challenges, barriers, and beneficial elements of being physically active were assessed using content analysis. One-way paired t-test revealed no significant improvement in older cancer survivors\u27 physical activity level after telephone counseling. Spearman\u27s rho also revealed no significant improvement in the physical activity levels of older cancer survivors with limited health literacy. Although the quantitative data analysis did not reach significance, the open-ended questions revealed that the telephone counseling was beneficial. It provided education and information about physical activity in cancer recovery, provided motivation and promoted accountability, self-encouragement and sustainability

Reliability and Validity of the Outcome Questionnaire in a Heterogeneous Cancer Population

The Institute of Medicine (IOM) and National Cancer Comprehensive Network (NCCN) now require integration of psychosocial care into the treatment of cancer patients to identify, monitor, and treat psychosocial distress. Despite the widespread use of Patient Reported Outcomes (PRO) for these purposes, no gold standard PRO for assessing distress exists for psycho-oncology research and clinical practice. This study examined the reliability, validity, and preliminary treatment effects of the Outcome Questionnaire, a PRO never before been used or validated with heterogeneous cancer patients. Adult cancer survivors were recruited nationwide to participate in an online support group (N=187) and randomly assigned to a treatment or wait-list condition in a longitudinal randomized controlled trial. The OQ Total Score demonstrated excellent reliability (ïƒ¡ï€ = 0.92). However, the subscales varied in the quality of their reliability ratings. Convergent validity was demonstrated, but divergent validity was not adequately shown. Three new significant factors were identified through exploratory factor analysis. For preliminary treatment effects in the online support group study, it was shown that those with a worse perceived health status F (1, 90) = 7.48, p = 0.008 and those who engaged more with the online support group improved over time F (1, 59) = 6.00, p = 0.018. These findings suggest mixed support for the implementation of the OQ as a PRO in a chronic disease sample. Generally, if the OQ is to be used as is within a cancer population, the Total Score may be interpreted as both reliable and valid and able to demonstrate treatment effects in a cancer population, but the subscale scores should not be interpreted

A comparison of self-reported and device measured sedentary behaviour in adults: a systematic review and meta-analysis

© 2020 The Authors. Published by BMC. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1186/s12966-020-00938-3BACKGROUND:Sedentary behaviour (SB) is a risk factor for chronic disease and premature mortality. While many individual studies have examined the reliability and validity of various self-report measures for assessing SB, it is not clear, in general, how self-reported SB (e.g., questionnaires, logs, ecological momentary assessments (EMAs)) compares to device measures (e.g., accelerometers, inclinometers). OBJECTIVE:The primary objective of this systematic review was to compare self-report versus device measures of SB in adults. METHODS:Six bibliographic databases were searched to identify all studies which included a comparable self-report and device measure of SB in adults. Risk of bias within and across studies was assessed. Results were synthesized using meta-analyses. RESULTS:The review included 185 unique studies. A total of 123 studies comprising 173 comparisons and data from 55,199 participants were used to examine general criterion validity. The average mean difference was -105.19 minutes/day (95% CI: -127.21, -83.17); self-report underestimated sedentary time by ~1.74 hours/day compared to device measures. Self-reported time spent sedentary at work was ~40 minutes higher than when assessed by devices. Single item measures performed more poorly than multi-item questionnaires, EMAs and logs/diaries. On average, when compared to inclinometers, multi-item questionnaires, EMAs and logs/diaries were not significantly different, but had substantial amount of variability (up to 6 hours/day within individual studies) with approximately half over-reporting and half under-reporting. A total of 54 studies provided an assessment of reliability of a self-report measure, on average the reliability was good (ICC = 0.66). CONCLUSIONS:Evidence from this review suggests that single-item self-report measures generally underestimate sedentary time when compared to device measures. For accuracy, multi-item questionnaires, EMAs and logs/diaries with a shorter recall period should be encouraged above single item questions and longer recall periods if sedentary time is a primary outcome of study. Users should also be aware of the high degree of variability between and within tools. Studies should exert caution when comparing associations between different self-report and device measures with health outcomes. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42019118755.Dr. Stephanie Prince was funded by a Canadian Institutes of Health Research (CIHR) – Public Health Agency of Canada Health System Impact Fellowship. Dr. Jennifer Reed is funded, in part, by a CIHR New Investigator Salary Award. Dr. Jennifer Reed was awarded a Planning and Dissemination Grant (#150435) from the CIHR to support Open Access publication charges.Published versio

A Mixed Methods Exploration Of Stigma, Discrimination, And Sleep Among Those On Medication For Opioid Use Disorder

Insomnia occurs in as many as 75% of people with Opioid Use Disorder (OUD). The prevalence of insomnia is attributable to concurrent factors such as mental health disorders, chronic pain, and medication use; however the contribution of social factors is not well understood. Persistent social factors and concerns within this population include stigma and discrimination. People who use prescribed medication for OUD (MOUD) report stigma and discrimination related to OUD, MOUD, and possibly other characteristics (e.g., race, gender, socioeconomic status, and incarceration history). However, the relationship between OUD-related stigma and discrimination with insomnia and between intersectional experiences, perceptions of stigma, and discrimination among patients on MOUD are not well understood. This dissertation research is nested within the NIH HEAL funded mechanistic study (CLOUDS STUDY: Collaboration Linking Opioid Use Disorder and Sleep) whose primary goal is understanding the contributions of sleep deficiency to relapse and retention in MOUD. The purpose of this dissertation is to examine the association between OUD-related stigma, and intersectional discrimination with insomnia among individuals on MOUD. Using a convergent mixed methods design, we addressed the following aims: Aim 1: Examine the associations between OUD-related stigma and intersectional discrimination with insomnia among individuals on MOUD [quantitative]. Hypothesis: OUD-related stigma and intersectional discrimination are positively correlated with insomnia severity among individuals on MOUD. Aim 2: Describe (1) how individuals perceive issues of stigma, discrimination, and sleep; (2) the intersectional phenomena of stigma and discrimination; (3) how experiences and perceptions associate with sleep [qualitative]. Aim 3: Gain a comprehensive understanding of the relationship between stigma and discrimination with insomnia among individuals on MOUD through integration of quantitative and qualitative data from Aims 1 and 2 [mixed methods].Informed by the Health Stigma and Discrimination Framework, manuscript #1 was a systematic review of original research describing associations between dimensions of stigma and sleep deficiency. There was consistent evidence that stigma, whether internalized, perceived, or anticipated, is associated with self-reported characteristics of sleep deficiency. This review highlighted important gaps in the literature which included, but were not limited to, the lack of exploration of this association among highly stigmatized populations, including those on MOUD. In manuscript #2, I report qualitative findings from 25 diverse participants on MOUD who described how they experienced intersectional stigma and discrimination and identified supports and resources that could be used to better understand and cope with the cumulative experiences of multiple forms of disadvantage. Five themes with supporting subthemes highlighted several identities that intersected with OUD. The intersection of multiple marginalized identities, which often led to discriminatory experiences, internalization of negative feelings, anticipated stigma, and shifts in self-perception. Participants also commented on recommendations for care to address the cumulative intersecting experiences of OUD. In manuscript #3, I explored (1) the relationships among OUD-related stigma, intersectional discrimination and insomnia among participants on MOUD, (2) how individuals perceived stigma, discrimination, and sleep. and (3) how individuals believed their experiences with discrimination and stigma were linked to sleep. The integration of quantitative and qualitative data led to a more comprehensive understanding of the relationship between stigma, discrimination, and sleep and the intersectional phenomena of stigma and discrimination experienced by this population. Analysis revealed moderate correlations between intersectional discrimination, physical symptoms and psychological distress with insomnia severity. Participants’ descriptions of their sleep illustrated how they connected discriminatory and stigmatizing experiences to sleep. Overall, the findings of this dissertation underscore that OUD-related stigma is a complex and nuanced concept. Study findings add to the growing body of literature linking intersectional discrimination, physical symptoms, and psychological distress with insomnia in people on MOUD. These findings may help to inform future intervention development aimed at advancing anti-discrimination efforts to improve sleep outcomes among those with OUD

Contributions to the psychological evaluation of UK exercise referral: the ER-QLS a measure of exercise-related life-quality

The benefits of physical activity for health are sufficient enough to be incorporated into UK public health policy and the exercise referral scheme is a popular method of engaging sedentary individuals into a more active lifestyle. However, the evidence base as to the extent to which such schemes impact upon holistic health outcomes is limited. This deficit is particularly apparent for psychological measures, despite these being reported as the most likely outcomes of a referral into exercise. The primary reason for this problem is the lack of tools available to exercise professionals with which to capture this valuable data. This thesis proposes that, in addition to the more commonplace monitoring of physiological outcomes and physical activity level, that psychological responses to, and outcomes of, a referral into exercise should be monitored as part of routine practice. The complete thesis provides an exercise referral sensitive quality of life measure, the Exercise Referral Quality of Life Scale (ER-QLS), which is intended for use in practice and/or for the purposes of research. Five stages of research were undertaken to produce the final measure. Two were qualitative and three were quantitative

Posttraumatic stress disorder and other consequences of a PICU admission

Currently, there is a paucity of literature regarding children\u27s experiences in a pediatric intensive care unit (PICU) relative to caregivers\u27 experiences. Children admitted to a PICU and their caregivers are at risk for various psychopathology. Disorders commonly identified in seriously ill children include depression, anxiety, acute stress disorder, and posttraumatic stress disorder. Caregivers of seriously ill children are at increased risk of depression, generalized anxiety disorder, acute stress disorder, and posttraumatic stress disorder. Researchers often fail to examine all relevant psychopathology and contributing factors and stressors, such as family environment, in seriously ill children and their caregivers. This study assessed 54 children admitted to a local PICU and their caregivers for relevant psychopathology. The mediating factors between the development of acute stress disorder and posttraumatic stress disorder were examined. The first hypotheses was parental psychopathology, specifically symptoms of anxiety, depression, and ASD, would mediate the relationship between (1) youth ASD symptoms during PICU admission and (2) the development of PTSD symptoms 4-7 weeks after discharge from the PICU. The second hypotheses was a child\u27s psychological functioning prior to admission, specifically symptoms of anxiety and depression, would mediate the relationship between (1) youth ASD symptoms during PICU admission and (2) the development of PTSD symptoms 4-7 weeks after discharge from the PICU. The third hypothesis was that parental psychopathology, specifically symptoms of anxiety and depression, will mediate the relationship between (1) parental ASD symptoms during their child\u27s PICU admission and (2) the development of PTSD symptoms 4-7 weeks after their child is discharged from the PICU. The fourth hypothesis was that family environment impacted symptoms of psychopathology in both the youth and the caregiver. Specifically, control and conflict were hypothesized to be positively correlated with symptoms of depression and anxiety. With respect to cohesion and expressiveness a negative relationship was hypothesized. A relationship between independence and the symptoms of depression and anxiety was also hypothesized. Analyses did not confirm hypotheses one or three. For hypothesis three, results supported a full mediation by youth anxiety as measured, however, a subsequent Sobel test for the model was not significant. ASD symptoms were a predictor for PTSD, replicating findings of previous research. Study findings also implicate subjective experience and anxiety in the development of ASD and PTSD. A discussion of study results indicate children admitted to a PICU and their parents are at increased risk for psychopathology and assessment should occur as well as intervention consideration

Influence of caregiving and personality on the stress level of caregivers of cancer patients: Role of social support as a mediating variable

Informal caregivers have always been a source of providing care to the individuals with chronic illness such as cancer. Increasing rate of pediatric cancer has shifted the patients from hospitals to the home settings. This shift involves the caregivers of pediatric cancer to face ongoing social and emotional challenges that may result in enduring illness and caregiving-related stress. Using Stress Process Theory as the foundation for the theoretical framework, the purpose of this research was to measure the level of variables and to examine the correlation and effects of aspects of caregiving, dimensions of personality and social support on the stress of caregivers of cancer patients in Pakistan. It also aimed to measure mediating effect of social support and the strongest predictor of caregiver’s stress. A total of 286 family caregivers were chosen as respondents from eight cancer treatment hospitals. Stratified and simple random sampling technique was utilized for this process. Descriptive and inferential statistics were performed in order to find the relationship between independent variables (caregiving and personality), mediating variable (social support) and dependent variable (caregiver’s stress). Findings showed that there were no significant direct relation between aspects of caregiving as well as extraversion, neuroticism and openness personality traits with stress. Whereas, conscientiousness and agreeableness personality traits were significantly related to stress of caregivers. Results also revealed that social support acts as a potential mediator between aspects of caregiving and stress as well as extraversion, openness, agreeableness personality traits and stress. Findings also found that agreeableness was the strongest predictor of stress of caregivers. This study presented new information to researchers and practitioners to identify strongest predictors of stress in caregivers along the stress continuum process. It illustrates the distinctive impact of personality and social support on caregiver’s stress. Therefore, helps in developing and implementing effective interventions to fulfill caregiver’s needs must be enhanced in order to reduce their stress level and improve their quality of life

Weight stigma and motivation to exercise : exploring associations and constructs from the basic needs theory.

Social influences, such as weight stigma, perpetuate rates of overweight and obesity, as well as contribute to poor physical and psychological health. It has been postulated that weight stigma negatively affects motivation to exercise, though the literature is mixed and underlying mechanisms of action are not well conceived. The present study aimed to: (1) explore the relationship between frequency of experienced weight stigma and exercise motivation and behavior (2) assess how frequency of experienced weight stigma might differ based on participant characteristics such as body weight and (3) consider unique associations between frequency of personal experiences with weight-based stigma, exercise motivation, and psychological need satisfaction (autonomy, competence, and relatedness) as outlined by the Basic Needs Theory. Exploration and clarification of these relationships will inform future longitudinal studies that can test the proposed conceptual model which suggests that psychological need satisfaction may mediate the relationship between experienced weight stigma and motivation to exercise. Participants were 144 women recruited through online platforms, such as Facebook, as well as a local farmer’s market. The present study utilized a cross-sectional study design and online self-report measures. Participant weight was obtained through self-report, as well as objective methods, as possible. Frequency of experienced weight stigma was not associated with intention to exercise; however, it was positively associated with motivation to avoid exercise and controlled (extrinsic) exercise motivation style and negatively associated with exercise behavior. Individuals with worse health status and those of higher body weight endorsed more frequent experiences with weight stigma situations. Those who endorsed more frequent experiences with weight stigma also endorsed less satisfaction of psychological needs, with the exception of exercise relatedness. Multivariate findings suggested that perceived exercise competence may be most influential with regard to intention to exercise. Results offer partial support for the proposed conceptual model and highlight the need for further exploration of the weight stigma-exercise motivation relationship, with specific focus on mechanisms of action. This research has numerous clinical and research implications. Findings from the present study can inform intervention to increase exercise motivation and behavior, promote adaptive coping and buffer from the negative effects of weight stigma