Higher symptom burden is associated with lower function in women taking adjuvant endocrine therapy for breast cancer.
Date
2019-03
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To explore the impact of symptoms on physical function in women on adjuvant endocrine therapy for breast cancer.Methods
Eligible women were postmenopausal, had hormone receptor positive, stage I-IIIA breast cancer, completed surgery, chemotherapy, radiation, and on adjuvant endocrine therapy. At a routine follow-up visit, women (N = 107) completed standardized symptom measures: Brief Fatigue Inventory, Brief Pain Inventory, Menopause Specific Quality of Life Questionnaire, Functional Assessment of Cancer Therapy Neurotoxicity scales. Two performance measures assessed function: grip strength (Jamar dynamometer; n = 71) and timed get-up-and-go (TUG; n = 103). Analyses were performed with an overall symptom composite score. Correlations and multiple linear regression analyses were performed to test adverse effects on physical function.Results
The mean age was 64 years (range 45-84), 81% white, 84% on an aromatase inhibitor, and on endocrine therapy for mean 35 months (range 1-130 months). Dominant hand grip strength was inversely correlated with symptom composite scores (r = -0.29, p = .02). Slower TUG was positively correlated with higher Charlson comorbidity level (r = 0.36, p < .001) and higher symptom composite scores (r = 0.24, p = .01). In multivariate analyses, weaker dominant and non-dominant hand grip strength were significantly associated with greater symptom composite scores (β = -0.27, t = 2.43, p = .02 and β = -0.36, t = 3.15, p = .003, respectively) and slower TUG was associated with higher symptom composite scores (β = 0.18, t = 1.97, p = .05).Conclusions
Higher symptom burden is associated with worse physical function, as measured by hand grip strength and TUG. Further study to determine the impact of endocrine therapy and its side effects on function is warranted.Type
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Sitlinger, Andrea, Rebecca A Shelby, Alyssa N Van Denburg, Heidi White, Sarah N Edmond, Paul K Marcom, Hayden B Bosworth, Francis J Keefe, et al. (2019). Higher symptom burden is associated with lower function in women taking adjuvant endocrine therapy for breast cancer. Journal of geriatric oncology, 10(2). pp. 317–321. 10.1016/j.jgo.2018.11.008 Retrieved from https://hdl.handle.net/10161/33916.
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Scholars@Duke
Andrea Sitlinger
Rebecca A Shelby
Rebecca Shelby, Ph.D. is an Associate Professor with Tenure in the Department of Psychiatry and Behavioral Sciences at Duke University and the Director of Education and Training for the Duke Cancer Patient Support Program. Dr. Shelby is a member of the Duke Pain Prevention and Treatment Research Program and the Duke Cancer Control and Population Sciences Program. Dr. Shelby completed her graduate training in clinical psychology at the Ohio State University and her clinical internship and postdoctoral fellowship at Duke University Medical Center. Her research focuses on developing and evaluating behavioral interventions for cancer patients, management of cancer pain and treatment side effects, and improving adherence to recommended care. Dr. Shelby serves on the Duke clinical psychology internship faculty and supervises clinical psychology fellows, interns, and clinical psychology graduate practicum students completing clinical rotations as part of the Duke Cancer Patient Support Program.
Heidi Kay White
Dr. White's clinical expertise involves the care of older adults, especially care transitions, long-term care, and post-acute care. She services as the Vice-Chief of Clinical Affairs in the Geriatrics Division At Duke University. She has worked with peer faculty to develop clinical programs including Peri-operative Optimization of Senior Health (POSH) and Health Optimization Program for Elders (HOPE) which is a transitional care program from the hospital to skilled nursing facilities. She serves as geriatrics medical director for Duke Population Health Management Office. She is a member of the Executive steering committee for the Duke University Health System Geriatrics Operational Plan. She is the medical director of Croasdaile Village Retirement Community. Her educational activities include bedside teaching in the hospital, clinic and nursing home with geriatrics fellows, residents, medical students and other professional students such as nurse practitioner, and physician assistant. She co-directs the Advanced Course in Long-Term Care for an interprofessional group of learners. She is a past President of AMDA The Society for Post-Acute and Long-Term Care Medicine. She has worked to develop competencies for practitioners in this environment and developed online educational modules. Dr. White’s research focuses on the general medical care of older adults with cognitive impairment. She has studied the nutritional decline and weight loss that often accompanies Alzheimer’s disease. In collaboration with Edward Levin, PhD, Associate Professor in the Department of Psychiatry, she has explored the cognitive effects of nicotine transdermal patches in older adults with varying degrees of cognitive impairment. Other work includes studying the effects of personalized music in older adults with dementia and implementing personalized music programs for pain and delirium relief in hospital and dementia care in nursing homes and assisted living facilities. Current work focuses on clinical program development and sustainability.
keywords: cognitive impairment, Alzheimer's disease, weight loss, nutrition, nicotine
Francis Joseph Keefe
I am Director of the Duke Pain Prevention and Treatment Research Program, an active NIH funded clinical research program focused on developing new and more effective ways of assessing and treating patients having acute and persistent pain. I have been active in nationally and internationally in shaping the pain research agenda. For the past 10 years I served as Editor in Chief of PAIN the premier journal in pain research. I also have served as the Chair of a number of NIH Study Sections. Finally, I was a member of the Institute of Medicine committee that published a report in 2011 (Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research) that has played a key role in shaping national policies in pain research and pain care.
Over my career, I have played a key role in the development of clinical pain services and pain research programs at Duke Medical Center. For over 20 years, I directed the Duke Pain Management Program and was a leader in the development of Duke Medical Center's multidisciplinary pain programs (both out-patient and in-patient.) I collaborate actively with investigators in other countries (e.g. United Kingdom, South Africa, China, and Australia).
Over the course of my career, I have collaborated closely with investigators both in and outside my lab. Together we have developed and refined a number of treatment protocols for persistent pain conditions (e.g. pain in patients with advanced cancer; sickle cell disease, and persistent joint pain due to osteo- and rheumatoid arthritis) including partner and caregiver-assisted pain coping skills training interventions. We have conducted a number of NIH- and foundation- funded randomized clinical trials testing the efficacy of these and other behavioral interventions (e.g. aerobic exercise protocols, yoga based interventions, mindfulness-based interventions, forgiveness-based interventions, loving kindness meditation, and emotional disclosure).
I currently serve as a Co-Investigator on a number of NIH grants, a number of which are funded by the HEAL Initiative. Many of these grants are testing novel strategies for delivering training in pain coping skills (e.g. video over internet, web-based training, virtual reality interventions, and apps for mobile devices). Along these lines, I collaborated with Dr. Chris Rini to develop an internet-based program for training in pain coping skills called painTRAINER (available at mypaintrainer.org). This program is free to any individuals or health professionals who wish to use it. I have a keen interest in exploring the efficacy of these and other strategies (e.g. training physical therapists, social workers, and nurses) promise to increase access to behavioral pain management interventions making them more widely available to the large population of patients and caregivers who might benefit from them.I have published over 490 papers on topics ranging from pain coping strategies used during mammography to behavioral approaches to managing acute pain and pain at end of life. I have a longstanding interest in mentoring students and early career professionals interested in developing, testing, and disseminating novel protocols for managing pain, stress, and medical symptoms.
Gretchen Genevieve Kimmick
Breast cancer; treatment of breast cancer; management of menopausal symptoms in breast cancer survivors; survivorship issues after breast cancer; supportive care in managment of cancer patients; breast cancer and treatment of cancer in older persons; diagnosis and management of cancer in underserved populations.
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