No abstract

The purposes of this study were: 1) to compare performance status, mood states, and level of hope between patients with cancer pain and patients without cancer pain; and 2) to determine the relationships of pain intensity and pain interference with daily life to performance status, mood states, and level of hope. A total of 233 Taiwanese cancer patients with pain and 251 without pain participated. The self report instruments consisted of the Chinese version of the Profile of Mood States (POMS) short form, the Chinese version of the Herth Hope Index, the Brief Pain Inventory-Chinese version (BPI-C), the Chinese version of the Karnorfsy Performance Scale (KPS), and a demographic questionnaire. The major findings of this study were that cancer patients with pain reported significantly lower levels of performance status and higher levels of total mood disturbance than did cancer patients who did not experience pain after controlling for sex, disease stage, and recruitment site. In addition, patients with cancer pain experienced significantly more anger, fatigue, depression, confusion, and lethargy than did patients without pain after controlling for sex, disease stage, and recruitment site. Among patients with pain, pain intensity was significantly correlated with performance status and mood state, but not with level of hope. Pain interference with daily life was significantly correlated both with performance status, mood state, and level of hope. Pain intensity and pain interference were significantly correlated with each mood state as well as with total mood disturbance. This study has demonstrated the effect of cancer pain on patients' physical, psychological, and spiritual life and has supported the multidimensional notion of the cancer pain experience in Taiwanese patients.

To determine the incidence of infections with hepatitis B virus (HBV) among Chinese preschool children, 1,510 children (mean age, 29 months) were tested for HBV markers; 15.9% were infected with HBV (7.8% positive for hepatitis B surface antigen [HBsAg] and 8.1% positive for antibody to HBsAg) and 84.1% were susceptible when the children were enrolled in the study. The average length of follow-up was 2.1 years among 1,110 children. Among the 924 susceptible children who were followed up, 10.6% had seroconversions for HBV markers, none of which was associated with clinical illness; the annual incidence of HBV infections was 5.0%. Among the 98 children who experienced HBV infections during the study, 23% became HBsAg carriers, and HBsAg persistence was age-related, with most carriers being among the youngest children infected. In contrast, among the children with HBV markers at the time of enrollment, 118 (49.2%) were HBsAg-positive and 86% were still positive on follow-up. The incidence of HBV infections was significantly associated with the frequency of previous injections.

BackgroundLymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD) could prevent or manage limb edema in women after breast-cancer surgery.MethodsWe performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro), SCOPUS, and Cochrane Central Register of Controlled Trials electronic databases were searched for articles on MLD published before December 2012, with no language restrictions. The primary outcome for prevention was the incidence of postoperative lymphedema. The outcome for management of lymphedema was a reduction in edema volume.ResultsIn total, 10 RCTs with 566 patients were identified. Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI) of 0.14 to 2.82. Seven studies assessed the reduction in arm volume, and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI, −9.34 to 159.58).ConclusionsThe current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema.

The number one cause of cancer death in Taiwan is lung cancer. Of the few studies describing the experience of patients living with lung cancer, most use bivariate analyses to test associations between individual symptoms. Few have systematically investigated multiple symptoms. This prospective study was undertaken to explore the phenomenon of symptom distress, to investigate the presence of symptom clusters, and to examine the relationship of symptom clusters to symptom interference with daily life in Taiwanese lung cancer patients. A sample of 108 lung cancer patients was recruited using the Taiwanese version of the M. D. Anderson Symptom Inventory. Data were analyzed by hierarchical cluster analysis, factor analysis, Pearson correlation, t-test, and regression analysis. The top five most-severe symptoms were fatigue, sleep disturbance, lack of appetite, shortness of breath, and general distress. Factor analysis generated a two-factor solution (general and gastrointestinal symptoms) for symptom severity items. Consistent with the result from factor analysis, cluster analysis also indicated the same two cluster groups (general and gastrointestinal symptoms). Both clusters were significantly correlated with symptom interference items; however, the general symptom cluster presented higher correlation coefficients than did the gastrointestinal symptom cluster. These results provide an important basis for developing novel strategies to manage multiple symptoms in lung cancer patients and thereby improve their well-being.

The purpose of this research was to investigate the effectiveness of a patient and family pain education program on reducing cancer patients' and their families' barriers to (i.e., concerns or misconceptions about) cancer pain management, on increasing patients' adherence to a prescribed analgesic regimen, and on decreasing pain intensity and pain interference with daily life. An experimental and longitudinal design was used. The experimental group consisted of 31 pairs of cancer outpatients and their family carers, while the control group consisted of 30 patient-family pairs (N=122). Patients and their family carers in the experimental group simultaneously received a pain management education program. Both groups had pretest data collection and after-test follow-ups on the second and fourth weeks at the outpatient clinics. Comparisons between those two groups were made using the Generalized Estimating Equations (GEE) method. Results revealed that at both the second and fourth weeks, patients and family carers in the experimental group showed a significantly greater reduction in barrier scores than did patients and family carers in the control group. At the second and fourth weeks, patients in the experimental group reported significantly better adherence to a scheduled analgesic regimen than did patients in the control group. In the fourth week, patients in the experimental group reported significantly lower levels of worst pain intensity and pain interference than did patients in the control group. This research provides evidence of the effectiveness of a patient and family pain education program.

The impact of cancer pain on the quality of life of lung cancer patients is obvious, but the relationship of cancer pain to uncertainty and level of hope in cancer patients is not clear and has been the subject of only a few studies. The purpose of this study is to look at the relationship of pain to uncertainty and hope in Taiwanese lung cancer patients. A crosssectional and descriptive correlational design was used in this study. A convenience sample of lung cancer patients was recruited from chest medicine and oncology inpatient units at three teaching hospitals in the Taipei area of Taiwan. The research instruments included the Brief Pain Inventory-Chinese version (BPI-C), Mishel's Uncertainty Illness Scale (MUIS), and the Herth Hope Index (HHI). Data were analyzed using descriptive statistics, Pearson's correlation, and multiple regression. A total of 164 subjects were recruited, including 79 patients with cancer pain and 85 patients without cancer pain. The major findings were: 1) there were significant differences in level of uncertainty and level of hope between patients with cancer pain and those without. Patients with cancer pain reported higher levels of uncertainty and lower levels of hope than did patients without cancer pain; 2) pain severity was not significantly related to level of uncertainty; however, pain interference with daily life was positively correlated to level of uncertainty; 3) both pain severity and pain interference were negatively correlated with level of hope; and 4) after controlling for pain severity and pain interference, uncertainty was a significant predictor of level of hope. Important implications for future studies are discussed.

The purpose of this pilot study was to explore the effectiveness of a pain education program to overcome patient-related barriers in managing cancer pain for Taiwanese home care patients with cancer. The pain education program was developed based on previous studies of Taiwanese patient-related barriers to cancer pain management. The Barriers Questionnaire-Taiwan form, the Brief Pain Inventory, the Medication Adherence Questionnaire, and a demographic questionnaire were used for data collection. The sample consisted of 18 patients in the experimental group and 19 patients in the control group. Descriptive statistics, tests, and paired tests were used to analyze the data. Results of this study revealed that patients who received the pain educational program had significantly greater reduction in Barriers Questionnaire-Taiwan form scores and more improvement in medication adherence compared with patients who did not participate in the program. When compared to pretest scores, patients scores after receiving the pain education intervention showed significant improvement on the Barriers Questionnaire-Taiwan form, medication adherence, pain intensity, and pain interference. The results of this study support the effectiveness of the pain education program on overcoming the barriers to cancer pain management for Taiwanese home care patients with cancer.