Taxane-induced pain : Experiences of women with breast cancer and nurses providing their care

Breast cancer patients receiving taxane chemotherapy run a substantial risk of develop taxane-induced pain, but little is known about women’s experiences of such pain. The aim of this thesis was to explore women’s acute and longstanding experiences of taxane-induced pain, to evaluate the pain intensity and distribution using different assessment methods, and to study nurses´ perceptions of taxane-induced pain in people with breast cancer. The women experienced pain during chemotherapy with 37– 48% incidence of acute taxane-induced pain. The subjective burden of taxane-induced pain described by the women covered narratives from manageable pain to very difficult and disabling pain with a major impact on their lifeworld (Study I). Longstanding pain in the lifeworld of women with previous breast cancer, was explored through a retrospective reflection after 12 months. The descriptions of pain revealed a time perspective; as pain perceived at that specific time, currently ongoing pain, and pain expectations for the future. This resulted in the women sensing themselves of being somewhere between health and illness gazing into an uncertain future (Study II). A quantitative longitudinal assessment of taxane-induced pain using; the body image, the VAS, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) showed the women’s estimated pain; its intensity, distribution and occurrence - as it appeared during the actual taxane treatment and up to a year afterward. The baseline measurement on the VAS revealed low initial pain, VAS <10, which changed at treatment Cycle 1. The body image revealed intense and widespread pain, and pain after 12 months, as did the EORTC QLQ -C30 (Study III). The nurses’ estimations of taxane-induced pain varied to large extent in both prevalence and intensity. Large parts of the body were expected to be involved in the pain. Nurses lacked local and/or national guidelines reflecting a low level of generalized use of prophylaxis against taxane pain (Study IV). In conclusion, taxane-induced pain is a common debilitating symptom during taxane chemotherapy for women with breast cancer. Pain impacts women´s life during as well as long time after the completion of taxane treatment. Taxane pain can be accurately or successfully estimated using various pain assessment tools. Furthermore, guidelines for dealing with taxane-induced pain are needed

Taxane-induced pain : Experiences of women with breast cancer and nurses providing their care

Breast cancer patients receiving taxane chemotherapy run a substantial risk of develop taxane-induced pain, but little is known about women’s experiences of such pain. The aim of this thesis was to explore women’s acute and longstanding experiences of taxane-induced pain, to evaluate the pain intensity and distribution using different assessment methods, and to study nurses´ perceptions of taxane-induced pain in people with breast cancer. The women experienced pain during chemotherapy with 37– 48% incidence of acute taxane-induced pain. The subjective burden of taxane-induced pain described by the women covered narratives from manageable pain to very difficult and disabling pain with a major impact on their lifeworld (Study I). Longstanding pain in the lifeworld of women with previous breast cancer, was explored through a retrospective reflection after 12 months. The descriptions of pain revealed a time perspective; as pain perceived at that specific time, currently ongoing pain, and pain expectations for the future. This resulted in the women sensing themselves of being somewhere between health and illness gazing into an uncertain future (Study II). A quantitative longitudinal assessment of taxane-induced pain using; the body image, the VAS, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) showed the women’s estimated pain; its intensity, distribution and occurrence - as it appeared during the actual taxane treatment and up to a year afterward. The baseline measurement on the VAS revealed low initial pain, VAS <10, which changed at treatment Cycle 1. The body image revealed intense and widespread pain, and pain after 12 months, as did the EORTC QLQ -C30 (Study III). The nurses’ estimations of taxane-induced pain varied to large extent in both prevalence and intensity. Large parts of the body were expected to be involved in the pain. Nurses lacked local and/or national guidelines reflecting a low level of generalized use of prophylaxis against taxane pain (Study IV). In conclusion, taxane-induced pain is a common debilitating symptom during taxane chemotherapy for women with breast cancer. Pain impacts women´s life during as well as long time after the completion of taxane treatment. Taxane pain can be accurately or successfully estimated using various pain assessment tools. Furthermore, guidelines for dealing with taxane-induced pain are needed

Smärta vid adjuvant cytostatikabehandling : Uppfattningar och inverkan på dagligt liv hoskvinnor diagnostiserade med bröstcancer

Featured adjuvant chemotherapy treatment in women with breast cancer can lead to pain. The aim of this study was to explore, the variety of perceptions and impact of adjuvantchemotherapy-induced pain in daily life, of some women newly diagnosed with breast cancer.Inclusion criteria were participating in an ongoing stress management projectand chemotherapy of (anthracycline/taxan) in doses of 75mg² or more. Exclusioncriteria were inability to understand and communicate in Swedish and mentalillness. After ethical approval of the sub study in September 2010, women wereconsecutively included through oral and written request. Phenomenologicalapproach was used in the eight interviews and data analysis. The resultconsisted of five categories of description, the obvious pain, themanageable pain, the lonely pain, the unimaginable pain andultimately the crippling pain. The existence was open when the pain feltdescribable and manageable, while it was concluded when the pain seemedinexplicable and life drastically changed. The study showed a significantpainful impact of chemotherapy. The woman had difficulties to refer to theinformation given by the medical services, when the pain went beyond previousexperiences. There was a tendency that the woman waited before she contactedthe medical services, this waiting made room for difficult thoughts andfeelings. A question for further research is how the staff can capture andbetter help the women who experience severe pain.Dagens adjuvanta cytostatikabehandlingav kvinnor med bröstcancer kan leda till smärta. Denna studies syfte var att undersöka olikauppfattningar om inverkan av smärta, utlöst av adjuvant cytostatikabehandling,på dagligt liv hos några kvinnor som nyligen diagnostiserats med bröstcancer.Inklusionskriterier var deltagande i ett pågående stresshanteringsprojekt ochcytostatikabehandling i doser om 75mg² eller mer av antracyklin och/ellertaxan. Exklusionskriterier var oförmåga att förstå och kommunicera på svenska ochpsykisk sjukdom. Efter etiskt godkännande av delstudien i september 2010 inkluderades kvinnorna konsekutivt genommuntlig och skriftlig förfrågan. Fenomenologisk ansats användes i de åttaintervjuerna och i resultatbearbetningen. Resultatet kom att utgöras av fembeskrivningskategorier: den förklarliga smärtan, den övervinneliga smärtan, denensamma smärtan, den ofattbara smärtan och sist den förlamande smärtan.Tillvaron var öppen då smärtankändes förklarbar och därmed hanterbar, medan den slöts när smärtan kändesoförklarlig och kvinnornas liv förändrades drastiskt. Studien visar på en betydande smärtinverkan vid cytostatikabehandling. Kvinnornafick svårt att referera till den av sjukvården givna informationen, när smärtangick utanför tidigare beskrivning och smärtupplevelser. Det fanns en tendensatt kvinnan avvaktade innan hon kontaktade sjukvården och i denna väntanuppstod svåra tankar och känslor. En fråga för vidare forskning är hurpersonalen kan fånga upp och bättre hjälpa de kvinnor som får svåra smärtor

Taxane-induced pain : Experiences of women with breast cancer and nurses providing their care

Breast cancer patients receiving taxane chemotherapy run a substantial risk of develop taxane-induced pain, but little is known about women’s experiences of such pain. The aim of this thesis was to explore women’s acute and longstanding experiences of taxane-induced pain, to evaluate the pain intensity and distribution using different assessment methods, and to study nurses´ perceptions of taxane-induced pain in people with breast cancer. The women experienced pain during chemotherapy with 37– 48% incidence of acute taxane-induced pain. The subjective burden of taxane-induced pain described by the women covered narratives from manageable pain to very difficult and disabling pain with a major impact on their lifeworld (Study I). Longstanding pain in the lifeworld of women with previous breast cancer, was explored through a retrospective reflection after 12 months. The descriptions of pain revealed a time perspective; as pain perceived at that specific time, currently ongoing pain, and pain expectations for the future. This resulted in the women sensing themselves of being somewhere between health and illness gazing into an uncertain future (Study II). A quantitative longitudinal assessment of taxane-induced pain using; the body image, the VAS, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) showed the women’s estimated pain; its intensity, distribution and occurrence - as it appeared during the actual taxane treatment and up to a year afterward. The baseline measurement on the VAS revealed low initial pain, VAS <10, which changed at treatment Cycle 1. The body image revealed intense and widespread pain, and pain after 12 months, as did the EORTC QLQ -C30 (Study III). The nurses’ estimations of taxane-induced pain varied to large extent in both prevalence and intensity. Large parts of the body were expected to be involved in the pain. Nurses lacked local and/or national guidelines reflecting a low level of generalized use of prophylaxis against taxane pain (Study IV). In conclusion, taxane-induced pain is a common debilitating symptom during taxane chemotherapy for women with breast cancer. Pain impacts women´s life during as well as long time after the completion of taxane treatment. Taxane pain can be accurately or successfully estimated using various pain assessment tools. Furthermore, guidelines for dealing with taxane-induced pain are needed

Women Treated for Breast Cancer, Experiences of Chemotherapy-Induced Pain: : Memories, Any Present Pain and Future reflections

BACKGROUND: Breast cancer survivors make up a growing population facing treatment that poses long-standing adverse effects including chemotherapy-related body function changes and/or pain. There is limited knowledge of patients' lived experiences of chemotherapy-induced pain (CHIP). OBJECTIVE: The aim of this study was to explore CHIP and any long-standing pain experiences in the lifeworld of breast cancer survivors. METHODS: Fifteen women participated in a follow-up interview a year after having experienced CHIP. They were interviewed from a lifeworld perspective; the interviews were analyzed through guided phenomenology reflection. RESULTS: A past perspective: CHIP is often described in metaphors, leads to changes in a patient's lifeworld, and impacts lived time. The women become entirely dependent on others but at the same time feel isolated and alone. Existential pain was experienced as increased vulnerability. Present perspective: Pain engages same parts of the body, but at a lower intensity than during CHIP. The pain creates time awareness. Expected normality in relationships/daily life has not yet been achieved, and a painful existence emerges in-between health and illness. Future perspective: There are expectations of pain continuing, and there is insecurity regarding whom to turn to in such cases. A painful awareness emerges about one's own and others' fragile existence. CONCLUSIONS: Experiencing CHIP can impact the lifeworld of women with a history of breast cancer. After CHIP, there are continued experiences of pain that trigger insecurity about whether one is healthy. IMPLICATIONS FOR PRACTICE: Cancer survivors would likely benefit from communication and information about and evaluation of CHIP