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Börjesson, S., Nordin, K., Fjällskog, M.-L., Rissanen, R., Peterson, M. & Arving, C. (2018). Colored body images reveal the perceived intensity anddistribution of pain in women with breast cancer treated with adjuvant taxanes:: a prospective multi-method study of pain experience. Scandinavian Journal of Pain, 581-591
Open this publication in new window or tab >>Colored body images reveal the perceived intensity anddistribution of pain in women with breast cancer treated with adjuvant taxanes:: a prospective multi-method study of pain experience
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2018 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, p. 581-591Article, review/survey (Refereed) Published
Abstract [en]

Background and aims:

Breast cancer is the most prevalent adult cancer worldwide. A broader use of screening for early detection and adjuvant systemic therapy with chemotherapy has resulted in improved survival rates. Taxane-containing chemotherapy is one of the cornerstones of the treatment. However, taxane-containing chemotherapy may result in acute chemotherapy-induced nociceptive and neuropathic pain. Since this pain may be an additional burden for the patient both during and after taxane chemotherapy, it is important to rapidly discover and treat it. There is yet no gold standard for assessing taxane-induced pain. In the clinic, applying multiple methods for collecting information on pain may better describe the patients’ pain experiences. The aim was to document the pain during and after taxane through the contribution of different methods for collecting information on taxane-induced pain. Fifty-three women scheduled for adjuvant sequential chemotherapy at doses of ≥75 mg/m2 of docetaxel and epirubicin were enrolled in the study.

Methods:

Prospective pain assessments were done on a visual analog scale (VAS) before and during each cycle of treatment for about 5 months, and using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire’s (EORTC-QLQ-C30) two pain questions at baseline, 3 months, and 12 months. Participants scoring pain on the VAS >30 and undergoing an interview also colored their pain on a body image during treatment and at 12 months.

Results:

Surprisingly widespread, intense pain was detected using a multi-method approach. The colored body image showed pain being perceived on 51% of the body surface area during treatment, and on 18% 12 months after inclusion. In general, the pain started and peaked in intensity after the first cycle of taxane. After Cycle 3, most women reported an increase in pain on the VAS. Some women continued to report some pain even during the epirubicin cycles. The VAS scores dropped after the last chemotherapy cycle, but not to the baseline level. At baseline, 3 months and 12 months after inclusion, the women who estimated VAS >30 reported higher levels of pain on the pain questions of the EORTC-QLQ-C30.

Conclusions:

This study contributes information on how different pain assessment tools offer different information in the assessment of pain. The colored body image brings another dimension to pain diagnostics, providing additional information on the involved body areas and the pain intensities as experienced by the women. A multi-method approach to assessing pain offers many advantages. The timing of the assessment is important to properly assess pain.

Implications:

Pain relief needs to be included in the chemotherapy treatment, with individual assessment and treatment of pain, in the same way as is done in chemotherapy-triggered nausea. There is a time window whereby the risk of pain development is at its highest within 24–48 h after receiving taxane chemotherapy. Proper attention to pain evaluation and treatment should be in focus during this time window.

Place, publisher, year, edition, pages
Berlin/Boston: , 2018
National Category
Cancer and Oncology
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-356212 (URN)10.1515/sjpain-2018-0050 (DOI)000451213600006 ()29949517 (PubMedID)
Funder
Swedish Cancer Society, 100001
Available from: 2018-07-23 Created: 2018-07-23 Last updated: 2019-01-18Bibliographically approved
Hellerstedt Börjesson, S. (2018). Taxane-induced pain: Experiences of women with breast cancer and nurses providing their care. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Taxane-induced pain: Experiences of women with breast cancer and nurses providing their care
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Breast cancer patients receiving taxane chemotherapy run a substantial risk of develop taxane-induced pain, but little is known about women’s experiences of such pain. The aim of this thesis was to explore women’s acute and longstanding experiences of taxane-induced pain, to evaluate the pain intensity and distribution using different assessment methods, and to study nurses´ perceptions of taxane-induced pain in people with breast cancer.

The women experienced pain during chemotherapy with 37– 48% incidence of acute taxane-induced pain. The subjective burden of taxane-induced pain described by the women covered narratives from manageable pain to very difficult and disabling pain with a major impact on their lifeworld (Study I).

Longstanding pain in the lifeworld of women with previous breast cancer, was explored through a retrospective reflection after 12 months. The descriptions of pain revealed a time perspective; as pain perceived at that specific time, currently ongoing pain, and pain expectations for the future. This resulted in the women sensing themselves of being somewhere between health and illness gazing into an uncertain future (Study II).

A quantitative longitudinal assessment of taxane-induced pain using; the body image, the VAS, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) showed the women’s estimated pain; its intensity, distribution and occurrence - as it appeared during the actual taxane treatment and up to a year afterward. The baseline measurement on the VAS revealed low initial pain, VAS <10, which changed at treatment Cycle 1. The body image revealed intense and widespread pain, and pain after 12 months, as did the EORTC QLQ -C30 (Study III).

The nurses’ estimations of taxane-induced pain varied to large extent in both prevalence and intensity. Large parts of the body were expected to be involved in the pain. Nurses lacked local and/or national guidelines reflecting a low level of generalized use of prophylaxis against taxane pain (Study IV).

In conclusion, taxane-induced pain is a common debilitating symptom during taxane chemotherapy for women with breast cancer. Pain impacts women´s life during as well as long time after the completion of taxane treatment. Taxane pain can be accurately or successfully estimated using various pain assessment tools. Furthermore, guidelines for dealing with taxane-induced pain are needed.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 74
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1501
Keywords
taxane-induced pain, lifeworld research, pain assessment, caring
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-362513 (URN)978-91-513-0462-5 (ISBN)
Public defence
2018-11-23, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-10-30 Created: 2018-10-05 Last updated: 2018-11-23
Hellerstedt-Börjesson, S., Nordin, K., Fjällskog, M.-L., Holmström, I. K. & Arving, C. (2016). Women Treated for Breast Cancer, Experiences of Chemotherapy-Induced Pain:: Memories, Any Present Pain and Future reflections. Cancer Nursing, 39(6), 464-472
Open this publication in new window or tab >>Women Treated for Breast Cancer, Experiences of Chemotherapy-Induced Pain:: Memories, Any Present Pain and Future reflections
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2016 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 39, no 6, p. 464-472Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Breast cancer survivors make up a growing population facing treatment that poses long-standing adverse effects including chemotherapy-related body function changes and/or pain. There is limited knowledge of patients' lived experiences of chemotherapy-induced pain (CHIP).

OBJECTIVE: The aim of this study was to explore CHIP and any long-standing pain experiences in the lifeworld of breast cancer survivors.

METHODS: Fifteen women participated in a follow-up interview a year after having experienced CHIP. They were interviewed from a lifeworld perspective; the interviews were analyzed through guided phenomenology reflection.

RESULTS: A past perspective: CHIP is often described in metaphors, leads to changes in a patient's lifeworld, and impacts lived time. The women become entirely dependent on others but at the same time feel isolated and alone. Existential pain was experienced as increased vulnerability. Present perspective: Pain engages same parts of the body, but at a lower intensity than during CHIP. The pain creates time awareness. Expected normality in relationships/daily life has not yet been achieved, and a painful existence emerges in-between health and illness. Future perspective: There are expectations of pain continuing, and there is insecurity regarding whom to turn to in such cases. A painful awareness emerges about one's own and others' fragile existence.

CONCLUSIONS: Experiencing CHIP can impact the lifeworld of women with a history of breast cancer. After CHIP, there are continued experiences of pain that trigger insecurity about whether one is healthy.

IMPLICATIONS FOR PRACTICE: Cancer survivors would likely benefit from communication and information about and evaluation of CHIP.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-268691 (URN)10.1097/NCC.0000000000000322 (DOI)000387114100012 ()26632880 (PubMedID)
Funder
Swedish Cancer Society, 10 0001
Available from: 2015-12-09 Created: 2015-12-09 Last updated: 2018-10-05Bibliographically approved
Hellerstedt-Börjesson, S., Nordin, K., Fjällskog, M.-L., Holmström, I. K. & Arving, C. (2015). Women With Breast Cancer: Experience of Chemotherapy-Induced Pain: Triangulation of Methods. Cancer Nursing, 38(1), 31-39
Open this publication in new window or tab >>Women With Breast Cancer: Experience of Chemotherapy-Induced Pain: Triangulation of Methods
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2015 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 38, no 1, p. 31-39Article in journal (Refereed) Published
Abstract [en]

BACKGROUND

Chemotherapy treatment for cancer diseases can cause body pain during adjuvant therapy.

OBJECTIVE

The aim was to describe the perceived impact of adjuvant chemotherapy-induced pain (CHIP) on the daily lives of women with newly diagnosed breast cancer, using triangulation.

METHOD

Fifty-seven women scheduled for chemotherapy in doses of 75 mg/m2 or greater of epirubicin and/or docetaxel participated. Twenty-two of these women registered pain with values of 4 or more on the visual analog scale on day 10 following chemotherapy. Of these 22, 16 participated in an interview and colored a printed body image. A qualitative thematic stepwise analysis of the interviews was performed.

RESULTS

Chemotherapy-induced pain had a profound impact on daily life. Ten women reported the worst possible pain, with visual analog scale scores of 8 to 10. Three different categories crystallized: perception (A) of manageable pain, which allowed the women to maintain their daily lives; perception (B) of pain beyond imagination, whereby the impact of pain had become more complex; and perception (C) of crippling pain, challenging the women's confidence in survival.

CONCLUSIONS

The findings highlight the inability to capture CHIP with 1 method only; it is thus necessary to use complimentary methods to capture pain. We found that pain had a considerable impact on daily life, with surprisingly high scores of perceived pain, findings that to date have been poorly investigated qualitatively.

IMPLICATIONS FOR PRACTICE

Nurses need to (1) better identify, understand and treat CHIP, using instruments and protocols; and (2) provide improved communication about pain and pain management.

National Category
Other Medical Sciences Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-224617 (URN)10.1097/NCC.0000000000000124 (DOI)000346161400010 ()24457228 (PubMedID)
Available from: 2014-05-15 Created: 2014-05-14 Last updated: 2018-10-05Bibliographically approved
Backman, M., Wengstrom, Y., Johansson, B., Sköldengen, I., Hellersted Börjesson, S., Tärnbro, S. & Berglund, Å. (2014). A randomized pilot study with daily walking during adjuvant chemotherapy for patients with breast and colorectal cancer. Acta Oncologica, 53(4), 510-520
Open this publication in new window or tab >>A randomized pilot study with daily walking during adjuvant chemotherapy for patients with breast and colorectal cancer
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2014 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 53, no 4, p. 510-520Article in journal (Refereed) Published
Abstract [en]

Background. Physical activity during chemotherapy has been shown in several studies to reduce fatigue, improve symptoms and impact positively on health-related quality of life (HRQoL). Challenges associated with intervention studies on physical activity during cancer treatment relate to consistent adherence. The primary objective was to study feasibility and adherence of physical activity intervention among patients with cancer during adjuvant chemotherapy treatment. The secondary objective was to investigate the effects of physical activity on health aspects, including HRQoL, symptoms and surrogate markers for cardiovascular disease. Material and methods. This randomized controlled trial included patients with breast cancer (BRCA) and colorectal cancer (CRC) during adjuvant chemotherapy. The intervention continued for 10 weeks and included daily walks of 10 000 steps and a weekly supervised group walk. Adherence was assessed by a pedometer and the number of participants who reported step counts every week and percentage of participants who achieved the target steps every week. Results. Adherence average reached 91% during the intervention period; in total 74% completed the exercise intervention. The majority of the participants achieved an average of 83% of the target of 10 000 steps per day for 10 weeks. There was a significant increase in daily physical activity (p = 0.016) in the intervention group. Significant differences were also found for some breast cancer-specific symptoms [swelling, mobility and pain (p = 0.045)]. The study showed a relatively small weight gain an average of 0.9 kg in the intervention group and 1.3 kg in the control group. Conclusion. Physical activity in the form of walking is feasible during adjuvant chemotherapy treatment despite increasing symptoms. The physical activity increased in the intervention group during the study time and had a positive impact on breast symptoms and the weight gain was lower in comparison to previous studies.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-223859 (URN)10.3109/0284186X.2013.873820 (DOI)000333350400010 ()
Available from: 2014-05-09 Created: 2014-04-28 Last updated: 2017-12-05Bibliographically approved
Jangland, E., Becker, D., Börjeson, S., Doherty, C., Gimm, O., Griffith, P., . . . Yngman-Uhlin, P. (2014). The development of a Swedish Nurse Practitioner Program: a request from clinicians and a process supported by US experience. Journal of Nursing Education and Practice, 4(2), 38-48
Open this publication in new window or tab >>The development of a Swedish Nurse Practitioner Program: a request from clinicians and a process supported by US experience
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2014 (English)In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 4, no 2, p. 38-48Article in journal (Refereed) Published
Abstract [en]

High nursing turnover and a shortage of nurses in acute hospital settings in Sweden challenge health care systems to deliver and ensure safe care. Advanced nursing roles implemented in other countries have offered nurses new career opportunities and had positive effects on patient safety, effectiveness of care, and patient satisfaction. The advanced nursing position of Nurse Practitioner has existed for many years in the United States, while similar extended nursing roles and changes in the scope of nursing practice are being developed in many other countries. In line with this international trend, the role of Nurse Practitioner in surgical care has been proposed for Sweden, and a master’s programme for Acute Nurse Practitioners has been in development for many years. To optimize and facilitate the introduction of this new nursing role and its supporting programme, we elicited the experiences and support of the group who developed a Nurse Practitioner programme for a university in the US. This paper describes this collaboration and sharing of experiences during the process of developing a Swedish Nurse Practitioner programme. We also discuss the challenges of implement- ting any new nursing role in any national health care system. We would like to share our collaborative experiences and thoughts for the future and to open further national and international dialogue about how best to expand the scope of practice for nurses in acute hospital care, and thereby to improve patient care in Sweden and elsewhere.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-210636 (URN)10.5430/jnep.v4n2p38 (DOI)
Available from: 2013-11-12 Created: 2013-11-12 Last updated: 2017-12-06Bibliographically approved
Hellerstedt-Börjesson, S., Arving, C., Nordin, K., Fjällskog, M.-L. & Holmström-Knutsson, I. (2014). Women with breast cancer: Experiences and impact of chemotherapy-induced pain on daily life. Paper presented at 9th European Breast Cancer Conference (EBCC), MAR 19-21, 2014, Glasgow, SCOTLAND. European Journal of Cancer, 50(S2), S108-S108
Open this publication in new window or tab >>Women with breast cancer: Experiences and impact of chemotherapy-induced pain on daily life
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2014 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, no S2, p. S108-S108Article in journal, Meeting abstract (Other academic) Published
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-228240 (URN)000335106700230 ()
Conference
9th European Breast Cancer Conference (EBCC), MAR 19-21, 2014, Glasgow, SCOTLAND
Available from: 2014-07-10 Created: 2014-07-08 Last updated: 2017-12-05Bibliographically approved
Nordin, K., Rissanen, R., Ahlgren, J., Burell, G., Fjällskog, M.-L., Borjesson, S. & Arving, C. (2012). How can health care help female breast cancer patients reduce their stress symptoms?: A randomized intervention study with stepped-care. BMC Cancer, 12, 167
Open this publication in new window or tab >>How can health care help female breast cancer patients reduce their stress symptoms?: A randomized intervention study with stepped-care
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2012 (English)In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 12, p. 167-Article in journal (Refereed) Published
Abstract [en]

Background: A life threatening illness such as breast cancer can lead to a secondary diagnosis of PTSD (post traumatic stress disorder) with intrusive thoughts and avoidance as major symptoms. In a former study by the research group, 80% of the patients with breast cancer reported a high level of stress symptoms close to the diagnosis, such as intrusive thoughts and avoidance behavior. These symptoms remained high throughout the study. The present paper presents the design of a randomized study evaluating the effectiveness and cost-effectiveness of a stress management intervention using a stepped-care design.

Method: Female patients over the age of 18, with a recent diagnosis of breast cancer and scheduled for adjuvant treatment in the form of chemotherapy, radiation therapy and/or hormonal therapy are eligible and will consecutively be included in the study. The study is a prospective longitudinal intervention study with a stepped-care approach, where patients will be randomised to one of two interventions in the final stage of treatment. The first step is a low intensity stress-management intervention that is given to all patients. Patients who do not respond to this level are thereafter given more intensive treatment at later steps in the program and will be randomized to more intensive stress-management intervention in a group setting or individually. The primary out-come is subjective distress (intrusion and avoidance) assessed by the Impact of Event Scale (IES). According to the power-analyses, 300 patients are planned to be included in the study and will be followed for one year. Other outcomes are anxiety, depression, quality of life, fatigue, stress in daily living and utilization of hospital services. This will be assessed with well-known psychometric tested questionnaires. Also, the cost-effectiveness of the intervention given in group or individually will be evaluated.

Discussion: This randomized clinical trial will provide additional empirical evidence regarding the effectiveness of a stress-management program given in group or individually during adjuvant therapy in terms of decreased stress, minimizing fatigue, and maintaining or enhancing patients' quality of life and psychological well-being.

Keywords
Breast cancer, Randomized multicenter interventions study with stepped-care approach, Stress management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-181950 (URN)10.1186/1471-2407-12-167 (DOI)000307557300001 ()
Available from: 2012-10-02 Created: 2012-10-02 Last updated: 2017-12-07Bibliographically approved
Borjesson, S., Nordin, K., Fjällskog, M.-L., Peterson, M. & Arving, C. Nurses’ experiences of taxane-induced pain in people treated for breast cancer.
Open this publication in new window or tab >>Nurses’ experiences of taxane-induced pain in people treated for breast cancer
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(English)In: Article in journal (Other academic) Submitted
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-362508 (URN)
Available from: 2018-10-05 Created: 2018-10-05 Last updated: 2018-10-10
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4769-5327

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