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      Experiencing neutropenia: Quality of life interviews with adult cancer patients

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          Abstract

          Background

          Neutropenia is a common toxicity in chemotherapy but detailed information about how neutropenia is associated with changes in patients' quality of life is not readily available. This prospective study interviewed patients with grade 4 neutropenia to provide qualitative information on patients' experience of developing and coping with grade 4 neutropenia during a cycle of chemotherapy.

          Methods

          A sample of 34 patients who developed grade 4 neutropenia during the first cycle of chemotherapy completed a total of 100 structured clinical interviews. Interviews were transcribed, and 2 raters inductively developed 5 broad categories comprising 80 specific complaint domains nominated by patients. Thirty-five patient-nominated problems were mentioned in 5% or more of the interviews.

          Results

          Fatigue was the most common physical symptom. Interference in daily routine, negative self-evaluation, negative emotion, and social isolation were other common complaints associated with neutropenia.

          Conclusion

          Neutropenia is associated with a number of negative experiences among cancer patients undergoing chemotherapy, and these negative experiences have an adverse effect on the patient's quality of life. Oncology nurses can play a key role in helping patients manage adverse effects to maintain their quality of life.

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          Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer.

          I Tabbara, Mike J. Crawford, Matthew D. Johnson … (1991)
          Neutropenia and infection are major dose-limiting side effects of chemotherapy. Previous studies have suggested that recombinant methionyl granulocyte colony-stimulating factor (G-CSF) can reduce chemotherapy-related neutropenia in patients with cancer. We conducted a randomized clinical trial to test this hypothesis and the clinical implications. Patients with small-cell lung cancer were enrolled in a multicenter, randomized, double-blind, placebo-controlled trial of recombinant methionyl G-CSF to study the incidence of infection as manifested by fever with neutropenia (absolute neutrophil count, less than 1.0 x 10(9) per liter, with a temperature greater than or equal to 38.2 degrees C) resulting from up to six cycles of chemotherapy with cyclophosphamide, doxorubicin, and etoposide. The patients were randomly assigned to receive either placebo or G-CSF, with treatment beginning on day 4 and continuing through day 17 of a 21-day cycle. The safety of the study treatment could be evaluated in 207 of the 211 patients assigned to either drug, and its efficacy in 199. At least one episode of fever with neutropenia occurred in 77 percent of the placebo group, as compared with 40 percent of the G-CSF group (P less than 0.001). Over all cycles of chemotherapy, the median duration of grade IV neutropenia (absolute neutrophil count, less than 0.5 x 10(9) per liter) was six days with placebo as compared with one day with G-CSF. During cycles of blinded treatment, the number of days of treatment with intravenous antibiotics, the number of days of hospitalization, and the incidence of confirmed infections were reduced by approximately 50 percent when G-CSF was given, as compared with placebo. Mild-to-moderate medullary bone pain occurred in 20 percent of the patients receiving G-CSF. The use of G-CSF as an adjunct to chemotherapy in patients with small-cell cancer of the lung was well tolerated and led to reductions in the incidence of fever with neutropenia and culture-confirmed infections; in the incidence, duration, and severity of grade IV neutropenia; and in the total number of days of treatment with intravenous antibiotics and days of hospitalization.
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            The role of qualitative research in psychological journals.

            Sean Kidd (2002)
            The acceptance of qualitative research in 15 journals published and distributed by the American Psychological Association (APA) was investigated. This investigation included a PsycINFO search using the keyword qualitative, an analysis of 15 APA journals for frequency of qualitative publication, a content analysis of the journal descriptions, and the results of qualitative interviews with 10 of the chief editors of those journals. The results indicate that there exists a substantial amount of interest in the potential contribution of qualitative methods in major psychological journals, although this interest is not ubiquitous, well defined, or communicated. These findings highlight the need for APA to state its position regarding the applicability of qualitative methods in the study of psychology.
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              Clarification and integration of similar quality of life concepts.

              B Haas (1998)
              To identify major problems that obscure understanding of quality of life; to differentiate quality of life from other closely related concepts, and to offer a definition of quality of life. Quality of life is a term frequently used, but seldom defined, in nursing research. Multiple interpretations and measures make evaluating research difficult. The need to clarify concepts, develop nursing theory, and enhance communication is significant. Concept clarification is also essential for research instrument development and evaluation. ORGANIZING CONSTRUCT AND SCOPE: Concept analysis as proposed by Walker and Avant. Preconceived theories were avoided to keep the analysis as unbiased as possible. The analyst considered many descriptions of quality of life, but eventually included only those in the scientific literature. CINAHL, Medline, Psych-Info, ERIC, Social Science Abstracts, and reference lists from published articles in nursing, medicine, psychology, and sociology were used. Twenty-seven theory-based articles and book chapters published since 1989 and a convenience sample of 88 research articles published in 1997 were used. This sample was selected from 16,480 articles published 1993 to 1998. Concept clarification comparisons to identify the major attributes of several closely related concepts, including well-being, satisfaction with life, and functional status. Major attributes were validated by a panel of cohorts who met weekly for five consecutive weeks for the purpose of analyzing various concepts. Quality of life is comprised of subjective indicators such as well-being and satisfaction with life and objective indicators, such as functional status. Continued dialog and research is necessary to distinguish between the concepts of health and quality of life. A model showing the relationships among quality of life, well-being, functional status, and satisfaction with life is provided and a definition of quality of life is offered. Researchers and authors should include the definition of quality of life used in their work. Instruments should reflect the theoretic definition used. Care should be taken to clarify if functional status, well-being, satisfaction with life are the concepts under consideration as reflecting a part of overall quality of life.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Nurs
                Title: BMC Nursing
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6955
                Publication date Collection: 2005
                Publication date (Electronic): 8 July 2005
                Volume: 4
                Page: 4
                Affiliations
                [1 ]West Clinic, 100 Humphreys Blvd Suite 100, Memphis, TN 38104 USA
                [2 ]Supportive Oncology Services and Accelerated Community Oncology Research Network, 1790 Kirby Parkway, Suite 101, Memphis, TN 38138 USA
                Article
                Publisher ID: 1472-6955-4-4
                DOI: 10.1186/1472-6955-4-4
                PMC ID: 1180832
                PubMed ID: 16004611
                SO-VID: 0aca1e32-2246-4115-9cde-97ab089206cb
                Copyright © Copyright © 2005 Fortner et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 4 February 2005
                Date accepted : 8 July 2005
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Nursing
                Data availability:
                ScienceOpen disciplines: Nursing

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