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Open Access Publications from the University of California

Scholarly Works (177 results)

  • Article
  • Peer Reviewed
UC San Francisco Previously Published Works (2023)
BACKGROUND: Morning and evening fatigue are distinct and distressing symptoms experienced during chemotherapy that demonstrate a large amount of interindividual variability. OBJECTIVES: The objectives of this study were to identify subgroups of patients with distinct morning and evening fatigue co-occurrence profiles and evaluate for differences among these subgroups in demographic, clinical, and symptom characteristics and quality of life. METHODS: Oncology patients ( n = 1,334) completed the Lee Fatigue Scale to self-report morning and evening fatigue, six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct morning and evening physical fatigue profiles. RESULTS: Four distinct morning and evening fatigue profiles were identified (i.e., Both Low, Low Morning + Moderate Evening, Both Moderate, and Both High). Compared to the Both Low profile, the Both High profile was significantly younger, less likely to be married or partnered, more likely to live alone, had a higher comorbidity burden, and lower functional status. The Both High profile had higher levels of anxiety, depressive symptoms, sleep disturbance, and pain and lower levels of quality of life. DISCUSSION: The variability in the morning and evening severity scores among the four profiles supports the hypothesis that morning and evening fatigue are distinct but related symptoms. Clinically meaningful levels of both morning and evening fatigue were reported by 50.4% of our sample, which suggests that the co-occurrence of these two symptoms is relatively common. Patients in Both Moderate and Both High profiles experienced an extremely high symptom burden that warrants ongoing assessments and aggressive symptom management interventions.
    Cover page: Distinct Profiles of Morning and Evening Fatigue Co-Occurrence in Patients During Chemotherapy.
    • Thesis
    • Peer Reviewed
    UC Riverside Electronic Theses and Dissertations (2019)

    Gas-phase reduced sulfur compounds (dimethylsulfide, dimethyldisulfide) and amines (trimethylamine, diethylamine, butylamine, ammonia) are both present in relatively high concentrations over agricultural land and are both thought to be important to new particle formation and particle growth. Despite this, there is a lack of knowledge on how amines oxidize in the atmosphere, there are discrepancies in results from studies focused on determining the oxidation products of reduced sulfur compounds, and there have been no investigations into how these co-emitted compounds interact to form aerosol. This thesis will begin to fill these information gaps. First, the major difficulties involved in running experiments on reduced sulfurs and amines is discussed. The methodology by which these compounds can be successfully oxidized in a 37.5 cubic meter Teflon environmental chamber is laid out. Next, results are presented from oxidation of reduced sulfur compounds under extreme dry conditions. The importance of nitrogen oxides was also probed. This marks the very first investigation of these compounds under dry conditions. The subsequent study is focused on these same oxidation experiment under humid conditions. These studies provide insight into the importance of water vapor to the mass concentration and composition of secondary aerosol. Results from both of these studies are used to update existing oxidation mechanisms as well as aerosol yields for dimethylsulfide and dimethyldisulfide. To date, this represents the most atmospherically relevant reduced sulfur oxidation study. Next, the physical and chemical properties of secondary aerosol formed through the oxidation of amines under both dry and humid conditions are discussed. Finally, results are discussed from interaction experiments involving the oxidation of an amine in the presence of a reduced sulfur compound. This study is the first of its kind and provides a more realistic look at how these compounds react in the atmosphere to form secondary aerosol. Chemical and physical aerosol properties measured during multiple precursor experiments are compared to results from individual precursor experiments to determine if the two compounds are interacting. Furthermore, when it is determined that an interaction occurred, the nature of this interaction is investigated and a mechanism by which aerosol forms is developed.

      Cover page: Secondary Aerosol Formation from the Oxidation of Amines and Reduced Sulfur Compounds
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2016)
        Cover page: PREDICTORS AND TRAJECTORIES OF SLEEP DISTURBANCE IN ONCOLOGY OUTPATIENTS DURING CHEMOTHERAPY.
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2013)
          Cover page: OCCURRENCE OF COMMON SYMPTOMS CAN BE USED TO CATEGORIZE ONCOLOGY PATIENTS WITH DISTINCT SYMPTOM EXPERIENCES
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2016)

          Context

          Little is known about the phenotypic and molecular characteristics associated with changes over time in fatigue and lack of energy in patients with breast cancer.

          Objectives

          The aim of this study was to identify subgroups (i.e., latent classes) of women with distinct fatigue and energy trajectories; evaluate for differences in phenotypic characteristics between the latent classes for fatigue and energy; and evaluate for associations between polymorphisms in genes for pro- and anti-inflammatory cytokines, their receptors, and their transcriptional regulators and latent class membership.

          Methods

          Patients were enrolled before and followed for six months after breast cancer surgery. Latent class analyses were done to identify subgroups of patients with distinct fatigue and energy trajectories. Candidate gene analyses were done to identify cytokine genes associated with these two symptoms.

          Results

          For both fatigue and lack of energy, two distinct latent classes were identified. Phenotypic characteristics associated with the higher fatigue class were younger age, higher education, lower Karnofsky Performance Status score, higher comorbidity, higher number of lymph nodes removed, and receipt of chemotherapy (CTX). Polymorphisms in interleukin (IL) 1β and IL10 were associated with membership in the higher fatigue class. Phenotypic characteristics associated with the lower energy class included: a lower Karnofsky Performance Status score and a higher comorbidity score. A polymorphism in IL1R1 was associated with membership in the lower energy class.

          Conclusion

          Within each latent class, the severity of fatigue and decrements in energy were relatively stable over the first six months after breast cancer surgery. Distinct phenotypic characteristics and genetic polymorphisms were associated with membership in the higher fatigue and lower energy classes.
            Cover page: Polymorphisms in Cytokine Genes Are Associated With Higher Levels of Fatigue and Lower Levels of Energy in Women After Breast Cancer Surgery.
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2016)

            Purpose

            Not all oncology patients and their family caregivers (FCs) experience the same quality of life (QOL). The purposes of this study were to identify latent classes of oncology patients (n = 168) and their FCs (n = 85) with distinct physical, psychological, social, and spiritual well-being trajectories from prior to through 4 months after the completion of radiation therapy and to evaluate for demographic, clinical, and genetic characteristics that distinguished between these latent classes.

            Methods

            Using growth mixture modeling, two latent classes were found for three (i.e., physical, psychological, and social well-being) of the four QOL domains evaluated.

            Results

            Across these three domains, the largest percentage of participants reported relatively high well-being scores across the 6 months of the study. Across these three QOL domains, patients and FCs who were younger, female, belonged to an ethnic minority group, had children at home, had multiple comorbid conditions, or had a lower functional status, were more likely to be classified in the lower QOL class. The social well-being domain was the only domain that had a polymorphism in nuclear factor kappa beta 2 (NFKB2) associated with latent class membership. Carrying one or two doses of the rare allele for rs7897947 was associated with a 54 % decrease in the odds of belonging to the lower social well-being class [OR (95 % CI) = .46 (.21, .99), p = .049].

            Conclusions

            These findings suggest that a number of phenotypic and molecular characteristics contribute to differences in QOL in oncology patients and their FCs.
              Cover page: Phenotypic and molecular characteristics associated with various domains of quality of life in oncology patients and their family caregivers
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2015)

              Purpose/objectives

              To evaluate gender differences in quality of life (QOL), demographic, clinical, and symptom characteristics.


              Design

              Prospective, observational.


              Setting

              Two radiation oncology departments in northern California.


              Sample

              185 patients before initiation of radiation therapy (RT).


              Methods

              At their RT simulation visit, patients completed a demographic questionnaire, a measure of QOL, and symptom-specific scales. Backward elimination regression analyses were conducted to determine the significant predictors of QOL
.

              Main research variables

              QOL, gender, and 20 potential predictors
.

              Findings

              In women, depressive symptoms, functional status, age, and having children at home explained 64% of the variance in QOL. In men, depressive symptoms, state anxiety, number of comorbidities, being a member of a racial or ethnic minority, and age explained 70% of the variance in QOL
.

              Conclusions

              Predictors of QOL differed by gender. Depressive symptom score was the greatest contributor to QOL in both genders.
.

              Implications for nursing

              Nurses need to assess for QOL and depression at the initiation of RT. Knowledge of the different predictors of QOL may be useful in the design of gender-specific interventions to improve QOL.
                Cover page: Gender Differences in Predictors of Quality of Life at the Initiation of Radiation Therapy.
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2012)

                Objective

                Determine levels of agreement among intensive care unit patients and their family members, nurses, and physicians (proxies) regarding patients' symptoms and compare levels of mean intensity (i.e., the magnitude of a symptom sensation) and distress (i.e., the degree of emotionality that a symptom engenders) of symptoms among patients and proxy reporters.

                Design

                Prospective study of proxy reporters of symptoms in seriously ill patients.

                Settings

                Two intensive care units in a tertiary medical center in the Western United States.

                Patients

                Two hundred and forty-five intensive care unit patients, 243 family members, 103 nurses, and 92 physicians.

                Interventions

                None.

                Measurements and main results

                On the basis of the magnitude of intraclass correlation coefficients, where coefficients from .35 to .78 are considered to be appropriately robust, correlation coefficients between patients' and family members' ratings met this criterion (≥.35) for intensity in six of ten symptoms. No intensity ratings between patients and nurses had intraclass correlation coefficients >.32. Three symptoms had intensity correlation coefficients of ≥.36 between patients' and physicians' ratings. Correlation coefficients between patients and family members were >.40 for five symptom-distress ratings. No symptoms had distress correlation coefficients of ≥.28 between patients' and nurses' ratings. Two symptoms had symptom-distress correlation coefficients between patients' and physicians' ratings at >.39. Family members, nurses, and physicians reported higher symptom-intensity scores than patients did for 80%, 60%, and 60% of the symptoms, respectively. Family members, nurses, and physicians reported higher symptom-distress scores than patients did for 90%, 70%, and 80% of the symptoms, respectively.

                Conclusions

                Patient-family intraclass correlation coefficients were sufficiently close for us to consider using family members to help assess intensive care unit patients' symptoms. Relatively low intraclass correlation coefficients between intensive care unit clinicians' and patients' symptom ratings indicate that some proxy raters overestimate whereas others underestimate patients' symptoms. Proxy overestimation of patients' symptom scores warrants further study because this may influence decisions about treating patients' symptoms.
                  Cover page: Challenge of assessing symptoms in seriously ill intensive care unit patients: can proxy reporters help?
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2021)

                  Background

                  Few qualitative studies of cancer patients' everyday experiences with pain exist within the large body of cancer pain research. Longitudinal qualitative studies are particularly sparse, and no studies have qualitatively described patients' pain experience over time during participation in a self-management intervention.

                  Objective

                  To longitudinally describe patients' pain experiences during a 10-week pain self-management intervention.

                  Methods

                  This qualitative study was embedded in a randomized controlled trial of a psychoeducational pain management intervention. The data consisted of transcribed audio recordings of each intervention session. An emergent, interpretive approach was used in this longitudinal qualitative analysis.

                  Results

                  Forty-two adult patients were included. The analysis revealed the strikingly dynamic nature of individual patient's pain experiences. Multiple facets of pain contributed to its dynamic nature, including pain in changing locations, co-occurring sources of pain, and varying patterns of pain intensity over time. For individual patients, the cumulative effect of these multiple facets resulted in a phenomenon we termed "complex pain dynamics."

                  Conclusion

                  The results contribute to knowledge about the dynamic nature of cancer patients' pain experiences over a relatively short period. They suggest the need for a new paradigm for management of pain in cancer patients and raise questions about the interpretation of randomized controlled trial results in the absence of qualitative data.

                  Implications for practice

                  Frequent assessments and reassessments of pain are needed in cancer patients with the ongoing development of highly individualized self-management strategies. A large repertoire of interventions is needed to effectively manage pain in cancer patients over time.
                    Cover page: The Experience of Complex Pain Dynamics in Oncology Outpatients: A Longitudinal Qualitative Analysis.
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2019)

                    Background

                    Patients who receive autologous hematopoietic cell transplantation (HCT) for the treatment of hematologic malignancies are at risk of serious adverse outcomes including infections and death. Hyperglycemia following the HCT is associated with increased risk of these adverse outcomes. However, limited information is available on demographic and clinical characteristics that contribute to changes in blood glucose levels following HCT.

                    Objective

                    The objective of this study was to determine the trajectories of fasting blood glucose (FBG) levels as well as the demographic and clinical characteristics that predicted interindividual differences in these FBG trajectories.

                    Methods

                    A sample of adult patients with hematologic malignancies who were scheduled to receive autologous HCT (n = 53) was enrolled in the study. Patients with preexisting diabetes were excluded. Demographic and clinical characteristics were abstracted from electronic medical records. Morning fasting laboratory tests (ie, FBG and absolute neutrophil counts) were obtained. Data were analyzed using hierarchical linear modeling from the day of HCT (day 0) through 14 days post-HCT.

                    Results

                    Among 8 characteristics evaluated, pre-HCT FBG was associated with variability in both the initial levels and the trajectories of FBG. Body mass index was only associated with initial levels of FBG.

                    Conclusions

                    The large amount of interindividual variability in the trajectories of FBG levels following autologous HCT suggests that glucose control in these patients warrants ongoing assessments and preemptive tailoring.

                    Implications for practice

                    Fasting blood glucose monitoring is warranted. Additional research with larger samples is warranted to identify additional modifiable and nonmodifiable characteristics associated with interindividual variability in FBG levels.
                      Cover page: Trajectories of Fasting Blood Glucose in Autologous Hematopoietic Cell Transplantation
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