| 1. |
- Blom, Kerstin, et al.
(författare)
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Sleep during pelvic-abdominal radiotherapy for cancer : a longitudinal study with special attention to sleep in relation to nausea and quality of life
- 2021
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Ingår i: Cancer Nursing. - : Wolters Kluwer. - 0162-220X .- 1538-9804. ; 44:4, s. 333-344
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Poor sleep, nausea, psychological distress, and a lowered quality of life are common during radiotherapy for cancer. There is a lack of studies on the relationship between radiotherapy-induced nausea and sleep. This longitudinal study analyzes data from 196 patients who underwent pelvic-abdominal radiotherapy for cancer.OBJECTIVE: The aim of this study was to investigate sleep parameters weekly before, during, and after radiotherapy in relation to nausea and other patient characteristics, clinical characteristics, psychological distress, and quality of life.METHODS: Patients (n = 196, 84% women; mean age, 63 years; 68% had gynecological tumor, 28% had colorectal tumor, and 4% had other tumors) longitudinally answered questionnaires before, during, and after their radiotherapy over the abdominal and pelvic fields.RESULTS: Poor sleep was experienced by 30% of the participants, and sleep (quality and difficulty falling asleep) improved during and after treatment compared with baseline. Experiencing nausea during treatment was associated with worse sleep quality during radiotherapy. Baseline anxiety was associated with worse sleep quality before, during, and after treatment. Poor sleep was associated with worse quality of life.CONCLUSION: Nausea, more than a number of other variables, is a possible predictor of poor sleep in patients during radiotherapy for cancer.IMPLICATIONS FOR PRACTICE: The results indicate that effectively managing nausea may be important for sleep quality, and possibly quality of life, in patients undergoing radiotherapy for cancer. More research is needed before recommendations for practice can be made.
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| 2. |
- Efverman, Anna
(författare)
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Implementation of acupuncture in routine oncology care: A comparison of physicians’, nurses’, physiotherapists’ and acupuncturists’ practice and beliefs
- 2022
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Ingår i: Integrative Cancer Therapies. - : SAGE. - 1534-7354 .- 1552-695X. ; 21, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background:It is important to investigate beliefs in acupuncture in professionals because professionals’ expectations may affect treatment outcomes.Aim:To document the type, number, and education of professionals practicing acupuncture. Further, to compare beliefs about the effectiveness of acupuncture for common cancer related symptoms in the different types of professionals.Methods:This cross-sectional study employed a questionnaire on practice and beliefs regarding acupuncture effects for symptoms that commonly occur in patients treated within oncology care settings. The respondents (n = 555) consisted of oncology professionals that is, physicians (n = 133), nurses (n = 172), and physiotherapists (n = 117). Additional respondents consisted of acupuncturists (n = 133), working outside approved health care.Results:Of the respondents, acupuncture was practiced by 4% of the physicians, 6% of the nurses, 58% of the physiotherapists, and 90% of the acupuncturists. The professionals believed acupuncture to be effective for pain (of the physicians, nurses, physiotherapists, and acupuncturists, 94%, 98%, 89%, and 99% respectively believed in the effectiveness), chemotherapy-induced nausea (corresponding figures: 74%, 89%, 89%, and 93%), and vasomotor symptoms (corresponding figures: 71%, 81%, 80%, and 97%). The physicians believed acupuncture to be effective in a mean of 5 symptoms, nurses in 6 symptoms, physiotherapists in 6 symptoms, and acupuncturists in 10 symptoms (P < .001).Conclusions:Since the professionals varied substantially regarding practice, education and beliefs in acupuncture, oncology clinics may consider delivering patient preferred acupuncture according to evidence-informed guidelines rather than on varying preferences among the professionals, since professionals’ treatment expectations may modify treatment outcomes.
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| 3. |
- Efverman, Anna, et al.
(författare)
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Observing the Implementation of Shared Decision-making in Routine Radiotherapy Cancer Nursing : An Explorative Longitudinal Questionnaire Study
- 2021
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Ingår i: Cancer Nursing. - : Wolters Kluwer. - 0162-220X .- 1538-9804. ; 44:5, s. 369-377
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundHealthcare professionals have driven decision-making in the past. However, shared decision-making has the potential to increase quality of care.ObjectiveTo determine to what degree patients undergoing routine pelvic radiotherapy care perceive decision-making as being shared between patient and healthcare professionals.MethodsThis exploratory longitudinal study covered 193 patients undergoing pelvic radiotherapy, mostly women (n = 161 [84%]) treated for a gynecological (n = 132 [68%]) or colorectal (n = 54 [28%]) cancer. We collected data regarding self-perceived level of shared decision-making at the start of radiotherapy and quality of life (QoL) (91%–95% response rate per week) during the radiotherapy period.ResultsThe patients reported that they shared the decision-making with the healthcare professionals much (n = 137 [71%]), moderately (n = 33 [17%]), a little (n = 12 [6%]), or not at all (n = 11 [6%]). Male patients (P = .048), patients who did not live with their partner (P = .034), patients with higher education (P = .043), and patients with low functional capacity (P = .018) perceived lower levels of shared decision-making. A higher level of shared decision-making was related to higher QoL at baseline and during the first to third weeks of radiotherapy (P ranged from .001 to .044).ConclusionsAlmost 9 of 10 patients reported that they shared the decision-making moderately or much with the healthcare professionals. The study identified subgroups perceiving lower levels of shared decision-making and found that a higher level of shared decision-making was related to better QoL.ImplicationsHealthcare professionals may need to pay extra attention to patients who may perceive that they share decision-making to a low extent.This study was supported by the Swedish Cancer Society, the Vårdal Institute, the Cancer Rehabilitation Foundation, the County Council of Östergötland, and Linköping University, Sweden.
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| 4. |
- Efverman, Anna
(författare)
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Physical, leisure, and daily living activities in patients before, during, and after radiotherapy for cancer : Which patients need support in activities?
- 2024
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Ingår i: Cancer Nursing. - : Wolters Kluwer. - 0162-220X .- 1538-9804. ; 47:3, s. 169-179
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Tidskriftsartikel (refereegranskat)abstract
- Background: Avoiding inactivity and staying active during cancer therapy have great health effects.Objective: The aims of this study were to describe level of daily, leisure, and physical activities before, during, and after radiotherapy and to investigate whether patients who had not restored activity level after radiotherapy differed from patients who had restored activity level regarding different characteristics.Methods: In this descriptive longitudinal study, 196 patients undergoing pelvic-abdominal radiotherapy reported their activity level at baseline, weekly during radiotherapy, and at 1 month after radiotherapy.Results: Patients decreased activity level during radiotherapy (P < .001 for all activities): physical activity (34% of patients decreased level), walking (26%), leisure activities (44%), social activities (15%), housework (34%), shopping (28%), and activities in general (28%). Almost half (47%) had not restored activity level after radiotherapy. Patients with colorectal cancer, older than 65 years, who had less education than university, and high capacity in overall daily activities at baseline were more likely than other patients not to restore activity level after radiotherapy. The patients not restoring their activity level after radiotherapy were more likely than others to experience anxious mood (P = .016), depressed mood (P = .003), and poor quality of life (P = .003) after radiotherapy.Conclusion: Patients’ activity level decreased during radiotherapy, and almost half of patients did not restore activity level after radiotherapy.Implications for Practice: Given that restored activity level after radiotherapy was less common in certain subgroups and that patients who restored activity level experienced better quality of life and less frequent anxious and depressed mood, cancer nursing professionals should consider supporting these subgroups of patients in performing activities. Guidelines recommend avoiding inactivity and staying active during and after cancer therapy, because of the great health effects of activity.1,2 However, little is known about the characteristics of patients who decrease their activity level during radiotherapy for cancer and do not restore activity level after radiotherapy; this is a subgroup of patients who may need more support from cancer nursing professionals.
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| 5. |
- Efverman, Anna
(författare)
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Treatment expectations seem to affect bowel health when using acupuncture during radiotherapy for cancer : Secondary outcomes from a clinical randomized sham-controlled trial
- 2020
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Ingår i: Complementary Therapies in Medicine. - : Elsevier. - 0965-2299 .- 1873-6963. ; 52
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo investigate if frequent stools (“diarrhoea”), infrequent stools (“constipation”), capacity in daily activities and Quality of Life (QoL) differed between patients treated with verum or sham acupuncture, and if patients with more positive treatment expectations differed regarding frequent stools and infrequent stools from patients with less positive treatment expectations.MethodsIn this randomized sham controlled trial, 200 patients received verum traditional penetrating acupuncture or sham acupuncture using a telescopic non-penetrating sham-needle 2–3 times a week during abdominal-pelvic radiotherapy (12 needling sessions during median 5 radiotherapy weeks). The patients registered stool frequency once a week, and registered capacity in daily activities and QoL at the start and end of radiotherapy, and at a one-month follow-up.ResultsIn the verum acupuncture group, 29 of 96 answering patients (30 %) experienced frequent stools and 7 (7 %) experienced infrequent stools at least one week of radiotherapy. In the sham acupuncture group, 21 of 97 (22 %) experienced frequent stools (p = 0.175) and 10 (10 %) experienced infrequent stools (p = 0.613). Patients with low treatment expectancy were more likely than other patients to experience frequent stools (60 % versus 26 %, p = 0.014) but not to experience infrequent stools (25 % versus 12 %, p = 0.334).ConclusionPenetrating acupuncture was not effective for frequent stools or for infrequent stools and did not improve capacity in daily activities or QoL in patients undergoing pelvic-abdominal irradiation for cancer more than non-penetrating acupuncture. Since patients with low acupuncture treatment expectations were more likely to experience frequent stools compared to other patients, non-specific treatment effects warrant further studies.
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| 6. |
- Lagerstedt, Kristina, et al.
(författare)
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A Randomized Sham-Controlled Mixed Methods Pilot Study of the Feasibility of Acupuncture for Chemotherapy-Induced Neuropathy: Lessons Learned From Patient Experiences in Integrative Cancer Care
- 2023
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Ingår i: Integrative Cancer Therapies. - : SAGE. - 1534-7354 .- 1552-695X. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveSince there is a lack of effective pharmacological therapies for chemotherapy-induced neuropathy and many patients ask for integrative cancer therapies such as acupuncture, the objective of this pilot study was to describe patients’ experiences, and to study the feasibility and short-term effects of genuine acupuncture for chemotherapy-induced neuropathic pain and unpleasant sensations compared to sham acupuncture.Methods:The pilot study used mixed methods, collecting quantitative and qualitative data. Patients (n = 12) with chemotherapy-induced neuropathy after colorectal cancer were blindly randomized to genuine acupuncture or telescopic sham acupuncture. Individual interviews were conducted, and were analyzed using qualitative content analysis. The patients registered pain and unpleasant sensations (100 mm Visual Analog Scales) before and after n = 120 sessions, n = 60 genuine and n = 60 sham acupuncture sessions.Results:Five categories of patient experiences were described. The neuropathy negatively affected life. Physical activity was perceived to be important for health, but neuropathy was a barrier. The neuropathy required symptom-managing strategies. Acupuncture was pleasant and valuable, but some patients presented doubts regarding its effect mechanisms. After the genuine acupuncture sessions, pain (mean −2.0 steps relief during each session) and unpleasant sensations (−2.4) in the face was reduced more than after sham acupuncture (+0.1 steps worse pain, P = .018, +0.1 steps worse unpleasant sensations, P = .036). After genuine acupuncture, unpleasant sensations in the hands were reduced less (−0.23) compared to after sham acupuncture (−5.5, P = .002). Pain or unpleasant sensations in the feet did not change.Conclusions:Patients experienced that the neuropathy negatively changed their life and that acupuncture was pleasant and valuable. Patients receiving genuine acupuncture had short-term effects regarding pain and unpleasant sensations in the face compared to patients receiving sham acupuncture, while hands and feet did not improve. The patients were successfully blinded and complied with the acupuncture. We welcome future full-scaled randomized sham-controlled acupuncture studies.
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| 7. |
- Stake-Nilsson, Kerstin, et al.
(författare)
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A Study of Self-Care Practice in Routine Radiotherapy Care: Identifying Differences Between Practitioners and Non-Practitioners in Sociodemographic, Clinical, Functional, and Quality-of-Life-Related Characteristics
- 2022
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Ingår i: Integrative Cancer Therapies. - : Sage Publications. - 1534-7354 .- 1552-695X. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The objective of this study was to describe self-care practice during radiotherapy for cancer and to identify potential differences between practitioners and non-practitioners of self-care regarding sociodemographic, clinical, functional, and quality-of-life-related characteristics.Methods: In this descriptive study, 439 patients (87% response rate) undergoing radiotherapy responded to a study questionnaire regarding self-care, sociodemographic, clinical (eg, experienced symptoms), functional, and quality-of-life-related characteristics.Results: Of the 439 patients, 189 (43%) practiced at least one self-care strategy, while 250 (57%) did not. In total, the patients described 332 self-care practices, resulting in 14 different categories of self-care strategies. The 5 most common indicators of practicing self-care were fatigue, general wellbeing, psychological symptoms, nausea, vomiting and improving physical condition. The 5 most common self-care strategies were physical activity, increased recovery, healthy eating, distraction, and skincare. Patients who were married, were older than 69, patients with less education than university education, patients undergoing a combination of internal and external radiotherapy, patients experiencing fewer than 8 symptoms, and better quality of life, practiced self-care to a lower extent than did other patients. Functional capacity did not differ between self-care practitioners and non-practitioners.Conclusion and Implications for Practice: Of the patients undergoing radiotherapy, slightly less than half practiced self-care during an ordinary week of radiotherapy. Because older and less-educated patients were less likely to practice self-care, cancer care practitioners should consider paying particular attention to helping such patients with their self-care practice.
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| 8. |
- Tödt, Kristina, et al.
(författare)
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Fatigue During Cancer-Related Radiotherapy and Associations with Activities, Work Ability and Quality of Life : Paying Attention to Subgroups more Likely to Experience Fatigue
- 2022
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Ingår i: Integrative Cancer Therapies. - : SAGE Publications. - 1534-7354 .- 1552-695X. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Having knowledge of which patients are more likely to experience fatigue during radiotherapy and the relationship between fatigue and health-related quality of life (HRQL) is important to improve identification and care of patients experiencing burdensome fatigue. Objective: To identify subgroups of patients, varying in situational, physiological, and psychological factors, who are more likely to experience fatigue an ordinary week of radiotherapy, and to compare patients experiencing and not experiencing fatigue regarding perceived HRQL and functional performance, that is, daily and physical activity and work ability. Methods: Cross-sectional study of 457 patients (52% women) undergoing radiotherapy (38% breast, 32% prostate cancer), using self-reported questionnaire data on fatigue, HRQL and functional performance analyzed using multivariable regression models. Results: Of the 448 patients who answered the fatigue question, 321 (72%) experienced fatigue. Patients reporting any comorbidity or depressed mood were more likely to experience fatigue, relative risk (RR) 1.56 ([95% confidence interval (CI)] 1.13-2.16) and RR 2.57 (CI 1.73-3.83), respectively. Patients with fatigue reported worse HRQL and performed less physical activity, including daily (P =.003), vigorous (P =.003) and moderate (P =.002) activity. Patients with and without fatigue reported 60% versus 40% sickness absence. Conclusion: Patients with depressed mood or comorbidity were more likely to experience fatigue an ordinary week of radiotherapy than other patients were. Patients experiencing fatigue perceived worse HRQL and performed less daily and physical activity compared to patients not experiencing fatigue. Cancer care practitioners may consider paying extra attention to these subgroups of patients.
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| 9. |
- Tödt, Kristina, 1966-
(författare)
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Fatigue in long-term illness : Influencing factors and functional performance in chronic obstructive pulmonary disease and in cancer
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Syfte: Avhandlingen studerade sambandet mellan fatigue (trötthet) och valda inverkande faktorer, funktionsförmåga (fysisk och daglig aktivitet och arbetsförmåga) samt med hälsorelaterad livskvalitet (HRQL) vid kroniskt obstruktiv lungsjukdom (KOL) och vid cancer. Metod: Patienter med KOL (n=121, delarbete I-II) och patienter med cancer under pågående strålbehandling (n=457, delarbete III) studerades i tvärsnittsstudier. Canceröverlevare följdes longitudinellt upp sju år efter strålbehandling (n=215, jämfört med 172 matchade icke-cancerreferenter, delarbete IV). Data samlades in genom frågeformulär och kliniska bedömningar. Beskrivande och inferentiell statistik användes.Resultat: Fatigue förekom hos 74% av patienterna med KOL, 72% hos patienterna under cancerbehandling, 58% hos långtids-canceröverlevarna samt 41% av referenterna. Svårare sjukdom och sämre ansträngningsförmåga vid KOL, och samsjuklighet och nedstämdhet vid cancer under strålbehandling var associerat med större sannolikheten för fatigue. Fatigue under tidigare strålbehandling, och nuvarande nedstämdhet, smärta och antal symptom var associerat med fatigue vid uppföljningen. Svår fatigue hade samband med låg fysisk aktivitet vid KOL och fatigue vid strålbehandling med mindre fysisk och daglig aktivitet och sämre HRQL. Under strålbehandling rapporterade patienter med fatigue 60% sjukfrånvaro gentemot 40% utan. Fatigue hade minskat vid uppföljning men var värre än hos referenterna. Fysisk och daglig aktivitet hade förbättrats och var inte sämre än referenternas. Självskattad arbetsförmåga och arbetsprocent var dock lägre. Fatigue och tilltron till sin arbetsförmåga var associerat med självskattad arbetsförmåga hos canceröverlevare som arbetade. Konklusion: Att uppmärksamma fatigue kan underlätta för hälso och sjukvårdspersonal att identifiera och ge stöd till patienter med nedsatt funktionsförmåga samt till canceröverlevare med risk för långvarig fatigue och påverkad arbetsförmåga.
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| 10. |
- Tödt, Kristina, 1966-, et al.
(författare)
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What does self-care practice look like among patients undergoing radiotherapy in routine radiotherapy care?
- 2023
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Ingår i: Palliative & Supportive Care. - : Springer. - 1478-9515 .- 1478-9523. ; 31:S1, s. S162-
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionSupporting cancer survivors in practicing evidence-based self-care has a central place in the rehabilitation plan to reduce side-efects of cancer treatment. However, knowledge is needed on the implementation of self-care practice among patients in routine radiotherapy care. Are there diferences in characteristics between self-care practitioners and non-practicing patients?MethodsA study questionnaire including self-care and symptoms was delivered to 507 eligible patients undergoing radiotherapy at radiotherapy clinics in Sweden. The questions about self-care practice were responded by n=439 (51% women, 49% men) with breast (38%), prostate (33%), or other cancer (29%) types.ResultsOf the responding patients, 43% (n=189) practiced some form of self-care. The 332 self-reported descriptions of self-care were categorized into 14 self-care strategies of which six were practiced by more than 10 patients: physical activity (n=113), increased recovery (n=69), healthy eating (n=66), distraction (n=24), skincare (n=20), and self-medication (n=12). The most common indicators for self-care practice were fatigue (experienced by 72 %), general wellbeing (poor general wellbeing experienced by10%), psychological symptoms (worrying experienced by 44% and feeling sad by 42%), nausea (experienced by 34%), vomiting (experienced by 12%), and improving physical condition. Of the patients reporting experience of the above symptoms, 42%, 46%, 48%, 41%, 53%, and 47% practiced selfcare. Older age, relative risk (RR) 2.62, 95% confdence interval (CI) 1.6-4.28 and lower education i.e., elementary and secondary school, RR 1.75,CI 1.00-3.03 and RR 1.46, CI 1.16-1.85 were independently related with increased likelihood of being non-practitioners.ConclusionsRoughly 40% of patients undergoing radiotherapy in a routine care setting practiced self-care. The most common indicator was fatigue, and the most common self-care strategy was physical activity. Half of symptomatic patients are non-practitioners who might beneft from evidenced based self-care. Among them, older and those with lower education might need more support in selfcare than others.
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