Academic literature on the topic 'Dyspnea, Psychosocial impact'

Purpose Chronic obstructive pulmonary disease (COPD) is associated with multiple psychosocial and behavioral factors. Prior research suggests that mind-body interventions may support the development and maintenance of healthy behaviors and improve health-related quality-of-life in such patients. We sought to qualitatively explore cognitive, psychosocial, and behavioral changes in patients with COPD who participated in two different mind-body interventions compared to an education control. Methods We analyzed semi-structured qualitative exit interviews from a prospective, randomized pilot trial (N = 123) investigating 12-weeks of Tai Chi (TC) vs. mind-body breathing (MBB) vs. education (EDU) control in patients with moderate-severe COPD. TC involved traditional movements, that integrate meditative breathing, while MBB focused mainly on meditative breathing techniques alone. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis of randomly selected transcripts was performed by two independent reviewers using an iterative process to identify emergent themes informed by grounded theory methods until thematic saturation was reached. Results A total of 66 transcripts were reviewed (N = 22 TC, N = 22 MBB, N = 22 EDU). Participants were mean age = 68.1 years, GOLD Stage = 2.3, baseline FEV11 percent predicted mean (SD): 58% (13.4), 42.4% female. We identified six frequently mentioned themes: 1) overall awareness and understanding, 2) self-care knowledge, skills and behaviors, 3) behavior-related neurocognitive concepts, 4) physical function, 5) psychological well-being, and 6) social support/social function. Compared to EDU, more participants in TC and MBB noted improvements in awareness of self and the mind-body connection (e.g., body and breath awareness), knowledge of breathing techniques and integration of self-care skills with daily activities, self-efficacy for symptom management (particularly managing anxiety and dyspnea), acceptance of disease, physical function improvements (e.g., endurance, dyspnea, fatigue), and psychological well-being (particularly relaxation, emotion regulation and decreased reactivity). Compared to MBB, those in TC shared more intention to continue with self-care behaviors, physical activity self-efficacy, and improved flexibility. All three groups, including EDU, noted increased social support and knowledge of disease. Those in EDU, however, had fewer mentions of processes related to behavior change, and less concrete changes in neurocognitive, psychological, and physical function domains. Conclusions Mind-body interventions including meditative breathing may impact behavior-related neurocognitive and emotional factors that improve self-care management and support positive behavioral changes in patients with COPD. Trial registration This trial is registered in Clinical Trials.gov, ID number NCT01551953.

Background Characterizing the prevalence and persistence of symptoms associated with COVID-19 infection following hospitalization and their impact is essential to planning post-acute community-based clinical services. This study seeks to identify persistent COVID-19 symptoms in patients 35 days post-hospitalization and their impact on quality of life, health, physical, mental, and psychosocial function. Methods and findings This prospective cohort study used the PROMIS® Instruments to identify symptoms and quality of life parameters in consecutively enrolled patients between March 22 and April 16, 2020, in New Jersey. The 183 patients (median age 57 years; 61.5% male, 54.1% white) reported persistent symptoms at 35 days, including fatigue (55.0%), dyspnea (45.3%), muscular pain (51%), associated with a lower odds rating general health (41.5%, OR 0.093 [95% CI: 0.026, 0.329], p = 0.0002), quality of life (39.8%; OR 0.116 [95% CI: 0.038, 0.364], p = 0.0002), physical health (38.7%, OR 0.055 [95% CI: 0.016, 0.193], p <0.0001), mental health (43.7%, OR 0.093 [95% CI: 0.021, 0.418], p = 0.0019) and social active role (38.7%, OR 0.095 [95% CI: 0.031, 0.291], p<0.0001), as very good/excellent, particularly adults aged 65 to 75 years (OR 8·666 [95% CI: 2·216, 33·884], p = 0·0019). Conclusions COVID-19 symptoms commonly persist to 35 days, impacting quality of life, health, physical and mental function. Early post-acute evaluation of symptoms and their impact on function is necessary to plan community-based services.

Introduction. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality throughout the world. At present, the pharmacological therapy is not enough for a patient with COPD in regard to heath status and exercise tolerance. It requires additional therapies aimed to improve the quality of life, delay the lung function decline, increase exercise capacity, and reduce the respiratory symptoms and the number of exacerbations. Pulmonary rehabilitation program (PRP) has been shown to improve respiratory muscle, to optimize functional, psychosocial, behavioral and nutritional status. The aim of the present study was to asses the impact of PRP on COPD patients, focusing on the clinical benefits of PRP, which may further provide to the patients a good support for change. Material and method. Sixty-seven patients with clinically stable COPD were enrolled in this prospective study, consisting in a 6-weeks of PRP. There were recorded demographic data, smoking and medical history, and abnormal findings at the physical examination. All patients completed CAT (COPD Assessment Test) questionnaire and dyspnea on Borg scale, they performed spirometry, and six minutes walking test (6MWT), before and after the completion of the rehabilitation program. Results and Discussions. After the 6-week period of PRP, a large proportion of patients presented higher values of spirometric parameters, although the change was no statistically significant. The impact of COPD on the patient’s health was significantly improved, 58.2% of patients registered < 10 points of CAT questionnaire after PRP (p<0.05). 75% of patients reported a 0-5 points of dyspnea on Borg scale comparing with 29% before the PRP (p=0.0147), and 56% a 0-5 points of fatigue while only 25% of patients had the same score before the rehabilitation programme (p=0,022). Only 8 patients (11.94% vs 31.34%, p<0.05) reported a SaO2 lower than 90% after the PRP. The 6MWD was longer than 250m at the end of the 6-weeks of PRP for 38 patients (56.7% vs 22.38%, p<0.05). Conclusions. The present study showed that a PRP added to pharmacological treatment had a beneficial role of increasing the patient’ health status and exercise tolerance for COPD patients.

e20542 Background: Advanced cancer patients develop severe physical and psychosocial symptom clusters. There is limited data on the impact of an outpatient interdisciplinary team (IDT) consultation lead by palliative care specialists on symptom clusters. Cluster composition and consistence, response rate and predictors of response are unknown. Methods: 914 consecutive patients with advanced cancer presenting in the OSC from Jan 2003 to Oct 2008 with a complete Edmonton symptom assessment scale at the initial and follow-up visit (median 14 days, range 1–4 wks), and CAGE status (alcohol screening) were reviewed. Wilcoxon ranked sign test was used to determine whether symptoms changed over time. Principal components factor analysis with varimax rotation was used to determine clusters of symptoms at baseline and at follow-up. The number of factors calculated was determined based upon the number of eigen values that were greater than one. Results: Median age was 59 yrs, female were 46%. The most common primary cancer was Lung (19%). Baseline and follow-up visit scores (mean, SD) were: fatigue 5.7 (2.1) and 5.2 (2.2, p<0.0001), pain 4.9 (2.6) and 4.1 (2.6 p<0.0001), nausea 1.8 (2.4) and 1.7 (2.3, p=0.1), depression 2.6 (2.5) and 2.2(2.4,p<0.0001), anxiety 2.9 (2.7) and 2.4 (2.4, p<0.0001), drowsiness 3.2 (2.8) and 3.2 (2.6, p=0.7), dyspnea 2.6 (2.7) and 2.4 (2.6), p=0.0027), appetite 4.2(2.7) and 3.9 (2.7, p<0.0001), sleep 4.2 (2.6) and 3.8 (2.6, p<0.0001) and well being 4.3 (2.5) and 3.9 (2.3, p<0.0001). During the follow- up the symptom clusters varied from a 3 factor to a 2 factor model, reflecting the impact of the IDT on symptom burden. CAGE positive and CAGE negative patients had a significantly different symptom cluster model. Conclusions: Cluster composition differs when patients are assessed and managed by an IDT and among patients who screen positive for alcoholism. [Table: see text] No significant financial relationships to disclose.

Introduction. The main task of this study was to study the level of knowledge of the Ukrainian patient about chronic obstructive pulmonary disease (COPD), and the factors that cause and affect this indicator, with the help of a validated instrument. Methods. 41 patients were involved in the study. Socio-demographic data, information on the duration, course of the disease and cooperation with a physical therapist were collected. Anthropometric measurements, spirometry, pulse oximetry, tonometry were performed. Patients were surveyed with Modified Medical Research Council Dyspnea Scale, Hospital Anxiety and Depression Scale, Clinical COPD Questionnaire score, and Bristol COPD Knowledge Questionnaire (BCKQ). Bristol COPD Knowledge Questionnaire was translated, cross-culturally adapted and validated. Regression analysis was performed to determine relationships between the level of knowledge about the disease, socio-demographic data, indicators of respiratory system functional status, and survey data. Results. The average total score for BCKQ was 24.71±9.62 points. Patients gave the least number of correct answers to the question related to medical treatment. The level of knowledge depends on the factors such as age (β=-0.557; 95% CI: -1.041–0.086, p=0.086), duration of the disease (β=-0.114; 95% CI: -0.077–0.055, p=0.048), respiratory ratings, functional limitations, and own psychosocial dysfunction according to the CCQ scale (β =-0.506; 95% CI: -0.007–0.752, p=0.053), and the HADS depression score (β =-0.655; 95% CI: -4.257– -0.085, p=0.043). Conclusion. The level of knowledge of Ukrainian patients about COPD is low. More experience of the disease did not affect the increase in the level of knowledge. Older patients had a lower level of knowledge about their disease. Impact of body mass index, spirometry results, level of severity of shortness of breath, and symptoms of the disease on the level of knowledge was not revealed.

Introduction: In Greece, it is estimated that annually 600 new cases of cervical cancer are diagnosed, being the third most common form of cancer in women after breast cancer (22.9%) and colon cancer (9.4%).In addition to being life-threatening, such a diagnosis can also represent the psychological impact of gynecological cancers; there are negative emotional consequences of such a diagnosis for both patients and their families affecting the quality of life (QOL) of patients with gynecological cancer.Aim: To examine the quality of life (QOL) of women with recent diagnosis of gynecologic cancer (RDGC) in Greece during their illness and to identify the psychosocial problems and the symptoms faced by women in the early stages of the disease.Material and Method: A prospective study of 63 patients with RDGC before undergoing hysterectomy, who completed the EORTC QLQ-C30 questionnaire.Results: The patients were between 45 and 50 years old (19.6%). Impaired physical functioning of women with RDGC was associated with strenuous activity or a long walk. Emotionally, patients showed a lack of concentration, tension, anxiety, irritation and depression. Age was negatively correlated with depression (p-value = 0.05<0.1). More than half of women had pain and few of them suffered a lot. Pain, shortness of breath (dyspnea) and fatigue caused discomfort and interference with daily living activities. More than half had sleeping disorders. Constipation and lack of appetite were common symptoms of the digestive system. Most women had no social or financial problems and rated their quality of life “very good”.Conclusions: Women with a RDGC, besides the common physical symptoms such as fatigue, pain, anorexia, sleep disorders and loss of appetite, had also emotional disorders. The feeling of depression was present in most patients. It was found that the younger the patient, the more depressed they feel.

Background: Cancer patients can experience both physical and non-physical problems such as psychosocial, spiritual, and emotional problems, which impact the quality of life. Previous studies on quality of life mostly have employed multivariate analyses. To our knowledge, no studies have focused yet on the underlying causal relationship between factors representing the quality of life of cancer patients, which is very important when attempting to improve the quality of life. Objective: The study aims to model the causal relationships between the factors that represent cancer and quality of life.Methods: This study uses the S3C-Latent method to estimate the causal model relationships between the factors. The S3C-Latent method combines Structural Equation Model (SEM), a multi objective optimization method, and the stability selection approach, to estimate a stable and parsimonious causal model.Results: There are nine causal relations that have been found, i.e., from physical to global health with a reliability score of 0.73, to performance status with a reliability score of 1, from emotional to global health with a reliability score of 0.71, to performance status with a reliability score of 0.82, from nausea, loss of appetite, dyspnea, insomnia, loss of appetite and from constipation to performance status with reliability scores of 0.76; 1; 0.61; 0.76; 0.72; 0.70, respectively. Moreover, this study found that 15 associations (strong relation where the causal direction cannot be determined from the data alone) between factors with reliability scores range from 0.65 to 1.Conclusion: The estimated model is consistent with the results shown in previous studies. The model is expected to provide evidence-based recommendation for health care providers in designing strategies to increase cancer patients’ life quality. For future research, we suggest studies to include more variables in the model to capture a broader view to the problem.

IntroductionThe aim of this cohort study was to examine health-related quality of life (HRQoL) and symptomatology in patients with pulmonary hypertension (PH) and explore factors that influence its evolution over time.MethodsA prospective longitudinal multisite cohort study. Participants were recruited from specialist UK PH centres and completed a questionnaire pack at baseline, 6, 12 and 18 months to assess HRQoL (emPHasis-10), dyspnoea, fatigue, sleep, anxiety and depression.Results185 patients entered the study at baseline and 126 (68%) completed month 18. At baseline, patients had significant impairment of HRQoL, anxiety, depression, dyspnoea and severe fatigue. No significant changes, apart from a reduction in the Hospital Anxiety and Depression Scale-Anxiety score (P=0.04), were observed over 18 months. Depression and dyspnoea were predictors of HRQoL (P=0.002 and P=0.03, respectively). Oxygen use was also associated with diminished HRQoL and increased symptom severity.ConclusionPatients with PH experience high levels of symptom severity and the negative impact on HRQoL was unchanged over time. The use of oxygen therapy, in particular, was associated with a significant impact on HRQoL. Further study of factors impacting HRQoL and interventions that target a combination of physiological and psychosocial consequences of living with PH are needed.

Objective: To investigate and document the effects of breathlessness on the everyday lives of patients with cancer and COPD and their carers. This subject has been little researched, although dyspnoea is recognized as a disabling, distressing symptom. The number of breathless people is increasing as patients with all types of cardio-respiratory disease live longer.Methods: Patients with severe COPD and cancer and their carers were interviewed at home using a semistructured format to record their perceptions of the impact of breathlessness, the help they had received from medical and caring services, and their ideas on how these could be improved.Results: 10 patients with COPD (6 male) and 10 with cancer (6 male) and their spouses were interviewed. All patients found breathlessness frightening, disabling, and restricting. Patients developed a stoical, philosophical approach in order to live with dyspnoea and the difficulties it imposed: this was also an important way of reducing the emotional impact of breathlessness. Patients' spouses suffered significantly, experiencing severe anxiety and helplessness as they witnessed their partners' suffering and felt powerless to reduce it. The restrictions imposed by breathlessness affected their lives profoundly. Support of all kinds, practical, medical, and psychosocial was highly valued but was provided inconsistently and sporadically. Where help was given it came most frequently from general practitioners (GPs, family physicians) and specialist respiratory nurses.Significance of results: This study is the first to document the psychosocial needs of carers, which are not adequately recognized or addressed at present. Patients and carers may feel most isolated and need support outside the working hours of most services and future provision needs to reflect this. Patients with cancer experience a more rapid onset of breathlessness. More clinicians need to be educated in the management of chronic breathlessness so known helpful strategies are more widely employed.

Abstract Introduction Although most of the studies about health related quality of life (HRQoL) focuses on acute leukemia survivors, few studies compared the HRQoL in acute leukemia survivors with that of the general population. The objective of the present study was to evaluate the HRQoL of acute leukemia survivors in a case-control study using The Sixth Korean National Health and Nutrition Examination Survey (KNHANES VI). Method We enrolled 149 acute leukemia survivors from three Korean tertiary care centers from 1983 through 2014. Survivors completed a set of questionnaires which included the EuroQOL five dimensions questionnaire (EQ-5D), the EORTC Quality of Life Core Questionnaire (QLQ-C30), Brief Fatigue Inventory (BFI), Hospital Anxiety and Depression Scale for Korean (HADS-K), Brief Encounter Psychosocial Instrument (BEPSI), Abbreviated Dyadic Adjustment Score (ADAS), and Family APGAR. We identified 447 control subjects matched for age, sex, education status, marital status, and presence of any comorbidity from KNHANES VI database. The scores for EQ-5D and health behaviors regarding rate of smoking, drinking, health medical examination, cancer screening, and vaccination were compared with the general population. Other survey results including EORTC QLQ-C30 were analyzed among the leukemia survivors, to evaluate the impact on QoL of postremission treatment strategy (SCT or chemotherapy). We compared the adjusted QoL mean across groups by analysis of covariance. Result Median age of the study participants was 44 years (range, 16 - 78), and there were 75 men (50%) and 74 women (50%). Majority of the patients had acute myeloid leukemia (n = 121); others had acute lymphoblastic leukemia (n = 24) and acute biphenotypic leukemia (n = 4). Among the survivors, 93 received chemotherapy and 56 received SCT as postremission treatment. Median duration of time between treatment completion and the study survey was 59 months. Examination of each of the five dimensions of the EQ-5D showed that the acute leukemia survivor group was having more difficulties or problems compared with the general population. More than twice as many respondents with leukemia survivors reported having problems with usual activities (14.6% vs. 4.6%, p < 0.001), and anxiety or depression (23.6% vs. 9.1%, p < 0.001). Furthermore, a significant proportion of patients reported pain compared with their matched population (34.7% vs. 20.3%, p= 0.002). Among the survivors, SCT group had clinically significantly worse problems with role functioning, fatigue, and insomnia than chemotherapy group, measured by the QLQ-C30. SCT group also had statistically significantly worse problems with global health status/QoL, physical and emotional functioning, pain, dyspnea, and appetite loss. Depression was higher in the SCT patients compared with the chemotherapy patients (mean HADS-depression score 4.99 vs. 6.56, p= 0.024). There was no difference in the HADS-anxiety score, BFI, BEPSI, dyadic adjustment and family function between the subgroups. In terms of health behaviors, acute leukemia survivor group had lower rate of smoking (5.6% vs. 25.3%, p < 0.001) and drinking in recent 1 year (41.7% vs. 76.7%, p < 0.001), and higher rate of influenza vaccination (63.6% vs. 35.4%, p < 0.001). Only 17% of the leukemia survivors reported that they had been recommended to receive screening for other cancers from health care providers, and 27% and 40% reported that they thought they had lower risk and similar risk of other cancer than general population. However, this lack of a recommendation for second cancer screening and the misperception of second cancer risk did not have negative impact on cancer screening behaviors (cancer screening in recent 2 years, 45.9% for survivor group vs. 52.3% general population, p = 0.175; health examination, 61.0% vs. 63.2% for, p= 0.632). Conclusion These results indicate that, compared to the general population, survivors of acute leukemia have a significantly worse long-term impact on QoL. Moreover, patients who received SCT for postremission treatment had poorer QoL than those treated with chemotherapy. Health behaviors were comparable between the survivors and the general population. These results can increase the awareness of healthcare providers to the need for counseling and interventions among acute leukemia survivors and help them improve their impaired QOL. Disclosures Yun: Janssen: Research Funding.

Introdução: A importância de manter os pacientes DPOC ativos é inquestionável e para que se interfira neste comportamento é essencial compreender os fatores que estão associados ao nível de atividade física na vida diária (AFVD) nesta população. A percepção da própria doença é um fator psicossocial que tem sido estudado em inúmeras doenças crônicas e que apresenta associação com diversos desfechos clínicos relevantes tais como a qualidade de vida e adesão à terapêutica. Porém, sua relação com o nível de AFVD em pacientes com DPOC clinicamente estáveis é pouco conhecido. Objetivo: Identificar possíveis grupos (clusters) de acordo com a percepção da doença e identificar se há diferença no nível de AFVD e nos demais fatores clínicos, demográficos e psicossociais entre estes grupos. Métodos: Estudo transversal no qual foram recrutados 150 pacientes com DPOC e avaliados em relação à percepção da própria doença, auto-eficácia, suporte social, qualidade de vida, controle clínico da doença e nível de AFVD (Actigraph GT3x). Foi realizada uma análise de cluster de acordo com a percepção da doença para identificar grupos de pacientes com perfis semelhantes e investigada as características e diferenças entre os clusters. Resultados: A análise de cluster identificou dois grupos: O cluster 1 apresentou uma percepção mais negativa da doença (PND; n=95) e cluster 2 uma percepção mais positiva da doença (PPD; n=55). O cluster PND apresentou pior escolaridade, dispneia, auto-eficácia, qualidade de vida e controle clínico (p < 0,001 para todas as variáveis) em comparação ao cluster PPD. Não foi observada diferença em relação ao nível de AFVD entre os clusters. Conclusão: Pacientes com uma percepção negativa de sua doença também apresentaram pior dispnéia, autoeficácia, qualidade de vida, controle clinico e nível educacional apesar de não haver diferença na função pulmonar entre os clusters. Estes achados sugerem a relevância de investigar e identificar a percepção da doença para estabelecer melhores estratégias terapêuticas nesta população
Rationale: Illness perception (IP) concerns how patients evaluate living with a disease and this perceptions may influence quality of life health and patients\' adherence behaviors. However, how IP is related with daily life physical activity (DLPA) in COPD patients remains poorly known. Objective: To identify possible clusters according to COPD patients IPs and explore associations between IPs with DLPA and psycho-demographic factors. Methods: This cross-sectional study included 150 COPD outpatients in medical treatment from an University hospital. Illness perception, social support, clinical control, health-related quality of life, self-efficacy and DPLA (GT3X, accelerometer) were evaluated. Cluster analysis of IPs was used to establish groups of patients holding distinct beliefs. Differences between clusters were tested using a T-test or a Mann-Whitney-U-test. Results: Cluster analysis revealed two distinct groups. In the cluster NIP (negative illness perception; n=95) patients presented a worst IP than cluster PIP (positive illness perceptions; n=55). The NIP presented the worst education, dyspnea, self-efficacy, quality of life and clinical control (p < 0.0001 for all variables) compared to the cluster PIP. There was no difference in the level of DLPA. Conclusions: Patients with a negative perception of their disease also presented worse dyspnea, self-efficacy, quality of life, clinical control and educational level, although there was no difference in lung function among the clusters. These findings suggest the relevance of investigating and identifying the perception of the disease to establish better therapeutic strategies in this population