Screening for fear of cancer recurrence : instrument validation and current status in early stage lung cancer patients

Background Fear of cancer recurrence (FCR) is one of the most distressing concerns for cancer patients. A psychometrically validated brief scale is urgently needed for use in busy clinical oncology settings. This study aimed to (1) develop and validate the 7-item fear of cancer recurrence scale Chinese version (FCR7-C), and (2) explore the severity of FCR in post-operative early-stage lung cancer patients in Taiwan. Methods Early-stage lung cancer patients were recruited from a medical center in Taiwan. The FCR7-C was evaluated for content and construct validity and internal consistency reliability. Construct validity of FCR7-C was determined by the empirically supported correlation and confirmatory factor analysis (CFA). Results A total of 160 subjects were recruited. The FCR7-C was shown to have satisfactory content validity and internal consistency reliability (Cronbach's α = 0.9). The uni-dimensional structure was confirmed by CFA that showed a good fit for the model. The FCR7-C score correlates positively with the degree of most of the physical symptoms, anxiety, and depression, but correlates negatively with patient age, performance status, and quality of life. We found that 81.9% of patients reported at least some FCR, with a mean FCR severity of 15.18 (SD = 7.78). Conclusion FCR7-C is a brief screening tool with good psychometrics. Patients with early-stage lung cancer still revealed mild to moderate level of FCR. Applying the FCR7-C for to screen cancer patients’ distress and further develop personalized psychological interventions would be strongly suggested.Publisher PDFPeer reviewe

Increased pain intensity is associated with greater verbal communication difficulty and increased production of speech and co-speech gestures

Effective pain communication is essential if adequate treatment and support are to be provided. Pain communication is often multimodal, with sufferers utilising speech, nonverbal behaviours (such as facial expressions), and co-speech gestures (bodily movements, primarily of the hands and arms that accompany speech and can convey semantic information) to communicate their experience. Research suggests that the production of nonverbal pain behaviours is positively associated with pain intensity, but it is not known whether this is also the case for speech and co-speech gestures. The present study explored whether increased pain intensity is associated with greater speech and gesture production during face-to-face communication about acute, experimental pain. Participants (N = 26) were exposed to experimentally elicited pressure pain to the fingernail bed at high and low intensities and took part in video-recorded semi-structured interviews. Despite rating more intense pain as more difficult to communicate (t(25) = 2.21, p = .037), participants produced significantly longer verbal pain descriptions and more co-speech gestures in the high intensity pain condition (Words: t(25) = 3.57, p = .001; Gestures: t(25) = 3.66, p = .001). This suggests that spoken and gestural communication about pain is enhanced when pain is more intense. Thus, in addition to conveying detailed semantic information about pain, speech and co-speech gestures may provide a cue to pain intensity, with implications for the treatment and support received by pain sufferers. Future work should consider whether these findings are applicable within the context of clinical interactions about pain

Are Nurses Prepared to Manage Cancer Pain? A National Survey of Nurses’ Knowledge about Pain Control in Taiwan

Nurses play a crucial role in cancer pain control, but little is known about how wellprepared nurses are to manage cancer pain in Taiwan. The purpose of this study was to examine the level of knowledge about pain management among Taiwanese nurses with different background characteristics & to determine the predictor(s) of nurses’ pain management knowledge. Nurse subjects were recruited by a cross-sectional nationwide survey with stratified sampling from nine hospitals distributed in the four major geographic regions of Taiwan. The Nurses’ Knowledge & Attitudes Survey-Taiwanese version (NKAS-T) & a background information form were used to collect the data. Of 1900 surveys distributed, 1797 valid questionnaires (94.5%) were analyzed. The average correct response rate was 50.5%, with rates ranging from 7–86% for each survey question. Results from stepwise regression showed that nurses with higher mean correct answer scores had BS or higher degrees, had received pain education at professional conferences, had more prior hours of pain education, had longer clinical care experiences, & always worked with cancer patients. Nurses who worked in intensive care units, however, had significantly lower mean correct scores. The results strongly suggest an urgent need to strengthen pain education in Taiwan. The results also provide the direction for developing pain education

Fatigue Experiences in Hepatocellular Carcinoma Patients During Six Weeks of Sterotactic Radiotherapy

Purpose. To compare fatigue experiences and related factors during the first 6 weeks of stereotactic radiotherapy (SRT) for liver cancer patients with and without fatigue before SRT. Patients and Methods. Subjects (n = 91) were liver cancer patients receiving SRT at two teaching hospitals in northern Taiwan. Data were collected at seven times: the week before SRT (T0) and the end of each of the first 6 weeks of SRT (T1, T2, T3, T4, T5, and T6). Study variables were fatigue intensity, fatigue interference (with patients’ daily life), functional status, symptom distress, sleep disturbance, depressive status, radiation dose, stage of cancer, and selected laboratory data. Results. Subjects were divided at T0 into two groups by fatigue level: those without (group 1, n = 32) and with (group 2, n = 59) pretreatment fatigue distress. Patients in group 2 had higher levels of fatigue intensity and interference than did patients in group 1. Both groups had similar patterns of fatigue interference, peaking at T5. However, patterns of average fatigue intensity differed slightly. In group 2, fatigue intensity remained constant until T3 and then increased to a peak at T5. In group 1, fatigue intensity increased to a peak between T4 and T5. Generalized estimating equation analysis showed significant differences between groups in fatigue intensity and interference across 6 weeks. Examination of factors related to fatigue after SRT indicated that sleep disturbance significantly predicted both fatigue intensity and interference in group 1, but depressive status, overall symptom distress, and education level predicted fatigue intensity and interference for group 2. Conclusion. Liver cancer patients with or without fatigue before treatment had different fatigue experiences across 6 weeks of radiation therapy. Fatigue experiences of liver cancer patients receiving SRT can be better understood through future studies exploring patients’ long-term fatigue changes and responses to fatigue-management interventions

Multidimensional Pain Inventory-Screening Chinese Version (Mpi-Sc): Psychometric Testing in Terminal Cancer Patients in Taiwan

Cancer pain is identified as a multidimensional experience, but relatively few brief instruments are available for assessing the complex pain-related experiences of terminal cancer patients in Taiwan. The purposes of this study were to (1) translate and examine the feasibility and psychometric characteristics of the eight-item Multidimensional Pain Inventory-Screening Chinese (MPI-sC) when used with patients having terminal cancer and (2) apply the MPI-sC to examine multidimensional pain- related experiences of terminal cancer patients in Taiwan. The MPI- sC was tested in 106 terminal cancer inpatients at a hospice setting in Taipei. The results showed that the MPI-sC has satisfactory face and content validity, feasibility, acceptable internal consistency reliability ( overall Cronbach's alpha of 0.75), and overall support of theoretical assumptions. However, instead of the four-factor structure of the original instrument, we found a three- factor structure (with pain intensity and pain interference merged into one factor) that explained 76.73% of the variance. Close to half the patients (48.1%) had considerable levels of pain interference, and a majority (72 .6%) reported not having control in life based on the cut- point of MPI-sC categorization. Our results support the brief MPI-sC as a feasible and valid tool for assessing and representing multidimensional pain experiences in terminal cancer patients . The MPI-sC could help clinicians and researchers assess the complex multidimensional pain experiences of terminal cancer patients, including Chinese- speaking cancer populations

Fatigue Experiences in Hepatocellular Carcinoma Patients during Six Weeks of Stereotactic Radiotherapy

Purpose. To compare fatigue experiences and related factors during the first 6 weeks of stereotactic radiotherapy (SRT) for liver cancer patients with and without fatigue before SRT. Patients and Methods. Subjects (n = 91) were liver cancer patients receiving SRT at two teaching hospitals in northern Taiwan. Data were collected at seven times: the week before SRT ( T0) and the end of each of the first 6 weeks of SRT (T1, T2, T3, T4, T5, and T6). Study variables were fatigue intensity, fatigue interference ( with patients' daily life), functional status, symptom distress, sleep disturbance, depressive status, radiation dose, stage of cancer, and selected laboratory data. Results. Subjects were divided at T0 into two groups by fatigue level: those without (group 1, n = 32) and with (group 2 , n = 59) pretreatment fatigue distress. Patients in group 2 had higher levels of fatigue intensity and interference than did patients in group 1. Both groups had similar patterns of fatigue interference, peaking at T5. However, patterns of average fatigue intensity differed slightly. In group 2, fatigue intensity remained constant until T3 and then increased to a peak at T5. In group 1, fatigue intensity increased to a peak between T4 and T5. Generalized estimating equation analysis showed significant differences between groups in fatigue intensity and interference across 6 weeks. Examination of factors related to fatigue after SRT indicated that sleep disturbance significantly predicted both fatigue intensity and interference in group 1, but depressive status, overall symptom distress, and education level predicted fatigue intensity and interference for group 2. Conclusion. Liver cancer patients with or without fatigue before treatment had different fatigue experiences across 6 weeks of radiation therapy. Fatigue experiences of liver cancer patients receiving SRT can be better understood through future studies exploring patients' long-term fatigue changes and responses to fatigue-management interventions

Are Nurses Prepared to Manage Cancer Pain? A National Survey of Nurses' Knowledge About Pain Control in Taiwan

Nurses play a crucial role in cancer pain control, but little is known about how well-prepared nurses are to manage cancer pain in Taiwan. The purpose of this study was to examine the level of knowledge about pain management among Taiwanese nurses with different background characteristics and to determine the predictor(s) of nurses' pain management knowledge. Nurse subjects were recruited by a cross- sectional nationwide survey with stratified sampling from nine hospitals distributed in the four major geographic regions of Taiwan. The Nurses' Knowledge and Attitudes Survey-Taiwanese version (NKAS-T) and a background information from were used to collect the data. Of 1900 surveys distributed, 1797 valid questionnaires (94.5 %) were analyzed. The average correct response rate was 50.5 %, with rates ranging from 7-86 % for each survey question. Results from stepwise regression showed that nurses with higher mean correct answer scores had BS or higher degrees, had received pain education at professional coup,conferences , had more prior hours of pain education, had longer clinical care experiences, and always worked with cancer patients. Nurses who worked in intensive care units, however , had significantly lower mean correct scores. The results strongly suggest an urgent need to strengthen pain education in Taiwan. The results also provide the direction,for developing pain education