Online Exclusive Article
Symptoms Before, During, and 14 Months After the Beginning of Treatment as Perceived by Patients With Lymphoma
Purpose/Objectives: To explore occurrence of symptoms and relationships between them as perceived by patients with lymphoma before, during, and 14 months after the beginning of treatment.
Research Approach: Qualitative and longitudinal.
Setting: A major oncology center in the United Kingdom.
Participants: 10 adult patients with lymphoma (3 women and 7 men) were recruited at treatment initiation.
Methodologic Approach: Semistructured audiotaped interviews were conducted with participants in median 15 days, 4 months, and 14 months after diagnosis. Analysis of the verbatim transcripts was inspired by interpretive description, which is a grounded approach articulating patterns emerging in relation to clinical phenomena.
Main Research Variables: Symptoms.
Findings: Symptoms commonly reported by patients in this sample were lack of energy, lymphadenopathy, weight loss, itching, pain, sadness, night sweats, sleeping difficulties, and hair loss. Co-occurring prediagnosis symptoms seem to have led patients to seek medical attention; co-occurring symptoms during treatment seem to have a cumulatively distressing effect. Several of the symptoms were described as interrelated, with one symptom leading to one or more other symptoms.
Conclusions: The data confirm a complex symptomatology in patients with lymphoma. In addition, the findings support that co-occurring symptoms may have a synergistic effect on patients' health outcomes and add new knowledge about relationships between symptoms from patients' perspectives.
Interpretation: Illustrating symptoms and interrelationships between symptoms using diagrams may be useful to support communication as well as in identifying targets for symptom management.
Jump to a section
References
Armstrong, T. S. (2003). Symptoms experience: A concept analysis. Oncology Nursing Forum, 30, 601-606. doi: 10.1188/03.ONF.601-606
Bruner, D. W., Barsevick, A., Tian, C., Randall, M., Mannel, R., Cohn, D. E., … Spirtos, N. M. (2007). Randomized trial results of quality of life comparing whole abdominal irradiation and combination chemotherapy in advanced endometrial carcinoma: A gynecologic oncology group study. Quality of Life Research, 16, 89-100. doi: 10.1007/s11136-006-9003-5
Cleeland, C. S., Mendoza, T. R., Wang, X. S., Chou, C., Harle, M. T., Morrissey, M., Engstrom, M. C. (2000). Assessing symptom distress in cancer patients: The M. D. Anderson Symptom Inventory. Cancer, 89, 1634-1646. doi: 10.1002/1097-0142(20001001)89:7<1634::AID-CNCR29>3.0.CO;2-V
Devlen, J., Maguire, P., Phillips, P., & Crowther, D. (1987). Psychological problems associated with diagnosis and treatment of lymphomas. II: Prospective study. BMJ (Clinical Research Ed.), 295, 955-957. doi: 10.1136/bmj.295.6604.955
Diehl, V., & Fuchs, M. (2007). Early, intermediate, and advanced Hodgkin lymphoma: Modern treatment strategies. Annals of Oncology, 18(Suppl. 9), ix71-ix79. doi: 10.1093/annonc/mdm297
Dodd, M. J., Miaskowski, C., & Paul, S. M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28, 465-470.
Donovan, K. A., & Jacobsen, P. B. (2007). Fatigue, depression, and insomnia: Evidence for a symptom cluster in cancer. Seminars in Oncology Nursing, 23, 127-135. doi: 10.1016/j.soncn.2007.01.004
Doorduijn, J., Buijt, I., Holt, B., Steijaert, M., Uyl-de Groot, C., & Sonneveld, P. (2005). Self-reported quality of life in elderly patients with aggressive non-Hodgkin lymphoma treated with CHOP chemotherapy. European Journal of Haematology, 75, 116-123.
Elphee, E. E. (2008). Understanding the concept of uncertainty in patients with indolent lymphoma. Oncology Nursing Forum, 35, 449-454. doi: 10.1188/08.ONF.449-454
Evans, L. S., & Hancock, B. W. (2003). Non-Hodgkin lymphoma. Lancet, 362, 139-146. doi: 10.1016/S0140-6736(03)13868-8
Feldman-Stewart, D., Brundage, M. D., Tishelman, C., & the SCRN Team. (2005). A conceptual framework for patient-professional communication: An application to the cancer context. Psycho-Oncology, 14, 801-809. doi: 10.1002/pon.950
Ganz, P. A., Moinpour, C. M., Pauler, D. K., Kornblith, A. B., Gaynor, E. R., Balcerzak, S. P., … Fisher, R. I. (2003). Health status and quality of life in patients with early-stage Hodgkin disease treated on Southwest Oncology Group Study 9133. Journal of Clinical Oncology, 21, 3512-3519. doi: 10.1200/JCO.2003.01.044
Henoch, I., Ploner, A., & Tishelman, C. (2009). Symptom clusters in inoperable patients with lung cancer. A methodological exploration. Oncology Nursing Forum, 36, E282-E292. doi: 10.1188/09.ONF.E282-E292
Holland, J. C., Andersen, B., Breitbart, W. S., Dabrowski, M., Dudley, M. M., Fleishman, S., … Zevon, M. A. (2007). Distress management. Journal of the National Comprehensive Cancer Network, 5, 66-98. Retrieved from http://docserver.ingentaconnect.com/deliver/connect/csp/15401405/v5n1/s… http://docserver.ingentaconnect.com/deliver/connect/csp/15401405/v5n1/s9.pdf?expires=1264437785&id=54599578&titleid=6600&accname=Guest+User&checksum=243E4ADE3DCD2742B7271BF49C76A1A3
Hollen, P. J., Gralla, R. J., Kris, M. G., & Potanovich, L. M. (1993). Quality-of-life assessment in individuals with lung cancer: Testing the Lung Cancer Symptom Scale (LCSS). European Journal of Cancer, 29A(Suppl. 1), S51-S58. doi: 10.1016/S0959-8049(05)80262-X
Jerkeman, M., Kaasa, S., Hjermstad, M., Kvaloy, S., & Cavallin-Stahl, E. (2001). Health-related quality of life and its potential prognostic implications in patients with aggressive lymphoma: A Nordic Lymphoma Group Trial. Medical Oncology, 18, 85-94.
Kim, H. J., McGuire, D. B., Tulman, L., & Barsevick, A. M. (2005). Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nursing, 28, 270-282.
Kirkova, J., Davis, M. P., Walsh, D., Tiernan, E., O'Leary, N., LeGrand, S. B., … Russell, K. M. (2006). Cancer symptom assessment instruments: A systematic review. Journal of Clinical Oncology, 24, 1459-1473. doi: 10.1200/JCO.2005.02.8332
Kirkova, J., & Walsh, D. (2007). Cancer symptom clusters—A dynamic construct. Supportive Care in Cancer, 15, 1011-1013. doi: 10.1007/s00520-007-0259-2
Lacasse, C., & Beck, S. L. (2007). Clinical assessment of symptom clusters. Seminars in Oncology Nursing, 23, 106-112. doi: 10.1016/j.soncn.2007.01.007
Massie, M. J. (2004). Prevalence of depression in patients with cancer. Journal of the National Cancer Institute. Monographs, 32, 57-71. doi: 10.1093/jncimonographs/lgh014
Merli, F., Bertini, M., Luminari, S., Mozzana, R., Berte, R., Trottini, M., … Federico, M. (2004). Quality-of-life assessment in elderly patients with aggressive non-Hodgkin lymphoma treated with anthracycline-containing regimens. Report of a prospective study by the Intergruppo Italiano Linfomi. Haematologica, 89, 973-978. Retrieved from http://www.haematologica.org/cgi/reprint/89/8/973 http://www.haematologica.org/cgi/reprint/89/8/973
Montgomery, C., Pocock, M., Titley, K., & Lloyd, K. (2003). Predicting psychological distress in patients with leukemia and lymphoma. Journal of Psychosomatic Research, 54, 289-292.
Portenoy, R. K., Thaler, H. T., Kornblith, A. B., Lepore, J. M., Friedlander-Klar, H., Kiyasu, E., … Scher, H. (1994). The Memorial Symptom Assessment Scale: An instrument for the evaluation of symptom prevalence, characteristics, and distress. European Journal of Cancer, 30A, 1326-1336. doi: 10.1016/0959-8049(94)90182-1
Rhodes, V. A., & Watson, P. M. (1987). Symptom distress—The concept: Past and present. Seminars in Oncology Nursing, 3, 242-247. doi: 10.1016/S0749-2081(87)80014-1
Rotegard, A. K., Slaughter, L., & Ruland, C. M. (2006). Mapping nurses' natural language to oncology patients' symptom expressions. Studies in Health Technology and Informatics, 122, 987-988.
Sandelowski, M. (1994). The use of quotes in qualitative research. Research in Nursing and Health, 17, 479-482. doi: 10.1002/nur.4770170611
Thorne, S., Kirkham, S. R., & MacDonald-Emes, J. (1997). Interpretive description: A noncategorical qualitative alternative for developing nursing knowledge. Research in Nursing and Health, 20, 169-177. doi: 10.1002/(SICI)1098-240X(199704)20:2<169::AID-NUR9>3.0.CO;2-I
Thorne, S., Thorne, S., Kirkham, S. R., & O'Flynn-Magee, K. (2004). The analytic challenge in interpretive description. International Journal of Qualitative Methods, 3, 1-21.
Tishelman, C., Lövgren, M., Broberger, E., & Sprangers, M. A. G. (2009). Are the most distressing concerns of men and women with inoperable lung cancer adequately assessed? A mixed-methods study. Retrieved from http://diss.kib.ki.se/2009/978-91-7409-357-5
Wooldridge, J. E., Anderson, C. M., & Perry, M. C. (2001). Corticosteroids in advanced cancer. Oncology (Williston Park), 15, 225-234.