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Original Article
- A Structural Model for Chemotherapy Related Cognitive Impairment and Quality of Life in Breast Cancer Patients
- Jung Ran Lee, Pok Ja Oh
- J Korean Acad Nurs 2019;49(4):375-385. Published online January 15, 2019
- DOI: https://doi.org/10.4040/jkan.2019.49.4.375
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Abstract
PDF Abstract Purpose This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model.
Methods The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs.
Results The modified model was a good fit for the data. The model fit indices were χ 2=423.18 (
p <.001), χ 2/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (β=.38,p =.002), depression and anxiety (β=.25,p =.002), and symptom experiences (β=.19,p =.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (β=-.51,p =.001), symptom experiences (β=-.27,p =.001), menopausal symptoms (β=-.22,p =.008), and chemotherapy-related cognitive impairment (β=-.15,p =.024) had direct effects on the quality of life and these variables explained 91.3%.Conclusion These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.
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Citations
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Review Article
- Effectiveness of Non-Pharmacologic Interventions in Chemotherapy Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis
- Pok-Ja Oh, You Lim Kim
- J Korean Acad Nurs 2018;48(2):123-142. Published online January 15, 2018
- DOI: https://doi.org/10.4040/jkan.2018.48.2.123
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Abstract
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Abstract Purpose This study was conducted to evaluate the effectiveness of non-pharmacologic interventions in chemotherapy-induced peripheral neuropathy (CIPN).
Methods PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean databases (Until August 2017) were searched. The main search strategy combined terms for peripheral neuropathy and presence of neoplasms. The risk of bias was assessed using the Cochrane's Risk of Bias tool for randomized studies and the Risk of Bias Assessment tool for non-randomized studies. To estimate the effect size, a meta-analysis of the studies was performed using the Rev Man 5.3 program of the Cochrane Library random-effects models were used in the analyses.
Results Twenty-two studies with a total of 954 participants met the inclusion criteria. Of the 22 studies, 12 were used to estimate the effect size of the non-pharmacologic interventions. The non-pharmacologic interventions used in patients with CIPN were exercise, acupuncture, massage, and foot bath. The acupuncture significantly reduced CIPN symptoms and signs (d=-0.71) and CIPN pain (d=-0.73) (
p <.001). Massage and foot bath were also effective in reducing CIPN symptoms (d=-0.68; 95% CI=-1.05, -0.30;p <.001; I2=19%).Exercis-es were effective in improving muscle strength and endurance(d=-0.55) and quality of life (d=-2.96), but they were not significantly effective in improving CIPN.Conclusion Although these results provide little evidence of the effectiveness of acupuncture, massage, and foot bath in the treatment of CIPN, they suggest that these interventions can reduce CIPN symptoms in patients with cancer. However, the findings of this study should be interpreted with caution as there is a relative lack of data in this field, and additional well-designed studies are needed. PROSPERO registration: CRD42017076278.
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Korean Journal of Adult Nursing.2022; 34(3): 258. CrossRef - Treatment and diagnosis of chemotherapy-induced peripheral neuropathy: An update
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Original Articles
- The Structural Equation Model on Resilience of Breast Cancer Patients Receiving Chemotherapy
- Jeong Ha Yang, Ok Soo Kim
- J Korean Acad Nurs 2016;46(3):327-337. Published online June 30, 2016
- DOI: https://doi.org/10.4040/jkan.2016.46.3.327
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Abstract
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Purpose The purpose of this study was to construct and test a structural equation model on resilience of breast cancer patients receiving chemotherapy.
Methods Participants were 204 patients with breast cancer who received chemotherapy treatment. They participated in a structured interview, which included social support, depression, symptom experience, self-efficacy, hope, resilience, and infection prevention behaviors. Data were analyzed using SPSS/WIN 20.0 and AMOS 18.0.
Results Lower depression (γ=-.33,
p =.020) and symptom experience (γ=-.31,p =.012) and higher self-efficacy (γ=.32,p =.005) and hope (γ=.48,p =.016) were influenced by higher social support. Greater resilience was influenced by lower symptom experience (β=-.18,p =.016), higher self-efficacy (β=.49,p =.023), and higher hope (β=.46,p =.012), and these predictors explained 66.7% of variance in resilience. Greater resilience (β=.54,p =.009) made an impact on greater infection prevention behaviors. Resilience mediated the relations of symptom experience (β=-.10p =.013), self-efficacy (β=.27,p =.006) and hope (β=.25,p =.009) with infection prevention behaviors. These predictors explained 24.9% of variance in infection prevention behaviors.Conclusion The findings of the study suggest that breast cancer patientsw ith greater resilience who are receiving chemotherapy participate in increased infection prevention behaviors. Further research should be conducted to seek intervention strategies that improve breast cancer patients' resilience.
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- Prevalence and Characteristics of Chemotherapy-related Cognitive Impairment in Patients with Breast Cancer
- Jin-Hee Park, Sun Hyoung Bae, Yong-Sik Jung, Young-Mi Jung
- J Korean Acad Nurs 2015;45(1):118-128. Published online February 27, 2015
- DOI: https://doi.org/10.4040/jkan.2015.45.1.118
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Abstract
PDF
Purpose Evidence suggests that some patients with breast cancer experience cognitive difficulties following chemotherapy. This longitudinal study was done to examine the prevalence of cognitive impairment and trajectory of cognitive function over time in women with breast cancer, who received adjuvant chemotherapy.
Methods Participants were 137 patients with breast cancer. They completed neuropsychological tests and the Functional Assessment of Cancer Therapy-Cognitive Function before adjuvant therapy (pretest), toward the end of adjuvant therapy (posttest), and 6 months after the completion of adjuvant therapy (follow-up test). Of the patients, 91 were treated with adjuvant chemotherapy and 46 patients who did not receive chemotherapy made up the comparison group. A reliable-change index and repeated-measure ANOVA were used for statistical analyses.
Results At the posttest point, over 30% of patients showed complex cognitive impairment and reported greater difficulty in subjective cognitive function. At the follow-up test point, 22.0% of patients exhibited complex cognitive impairment and 30.8% of patients complained of subjective cognitive impairment. Repeated-measure ANOVA showed significant decreases after receiving chemotherapy followed by small improvements 6 months after the completion of chemotherapy in cognitive domains of change for attention and concentration, memory, executive function, and subjective cognitive function.
Conclusion These results suggest that chemotherapy in patients with breast cancer may be associated with objective and subjective cognitive impairments. Further studies are needed to explore the potential risk factors and predictor of chemotherapy-related cognitive changes. Also nursing interventions for prevention and intervention of cognitive impairments should be developed and tested.
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- Impact of nonpharmacological interventions on cognitive impairment in women with breast cancer: A systematic review and meta-analysis
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