Online Exclusive Article

A Comparison of the Theory of Unpleasant Symptoms and the Conceptual Model of Chemotherapy-Related Changes in Cognitive Function

Jamie S. Myers
cognitive function
ONF 2009, 36(1), E1-E10. DOI: 10.1188/09.ONF.E1-E10

Purpose/Objectives: To explore the use of the Theory of Unpleasant Symptoms (TUS) as a model for describing the symptom experience related to the cognitive impairment associated with standard-dose chemotherapy and compare and contrast that use of the TUS with the Conceptual Model of Chemotherapy-Related Changes in Cognitive Function.

Data Sources: PubMed database.

Data Synthesis: Retrospective and prospective clinical trials have substantiated the incidence of mild to moderate cognitive impairment. Patients have reported a significant effect on quality of life. Associated factors may include age, anemia, fatigue, depression, anxiety, hormone levels, cytokine release, and genetic makeup. Establishing the appropriateness of a working model to describe the relationships would provide additional structure and focus for empirical research.

Conclusions: Both models have utility for describing the relationships of factors associated with chemotherapy-related cognitive impairment.

Implications for Nursing: Blending of the TUS and the Conceptual Model of Chemotherapy-Related Changes in Cognitive Function may provide an enhanced framework for further research about the physiologic and psychological aspects of chemotherapy-related cognitive impairment.

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    References

    Ahles, T. A. & Saykin, A. (2001). Cognitive effects of standard-dose chemotherapy in patients with cancer. Cancer Investigation, 19(8), 812-820.
    Ahles, T. A., & Saykin, A. J. (2002). Breast cancer chemotherapy-related cognitive dysfunction. Clinical Breast Cancer, 3(Suppl. 3), S84-S90.
    Ahles, T. A., & Saykin, A. J. (2007). Candidate mechanisms for chemotherapy-induced cognitive changes. Nature Reviews. Cancer, 7(3), 192-201.
    Ahles, T. A., Saykin, A. J., Furstenberg, C. T., Cole, B., Mott, L. A., Skalla, K., et al. (2002). Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. Journal of Clinical Oncology, 20(2), 485-493.
    Barnes, D. E., Cauley, J. A., Lui, L. Y., Fink, H. A., McCulloch, C., Stone, K. L., et al. (2007). Women who maintain optimal cognitive function into old age. Journal of the American Geriatrics Society, 55(2), 259-264.
    Barsevick, A. M. (2007). The elusive concept of the symptom cluster. Oncology Nursing Forum, 34(5), 971-980.
    Brady, C. B., Spiro, A., III, & Gaziano, J. M. (2005). Effects of age and hypertension status on cognition: The Veterans Affairs Normative Aging Study. Neuropsychology, 19(6), 770-777.
    Brown, K. A., Esper, P., Kelleher, L. O., O'Neill, J. E. B., Polovich, M., & White, J. M. (Eds.). (2001). Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.
    Chen, M. L., & Tseng, H. H. (2005). Identification and verification of symptom clusters in cancer patients. Journal of Supportive Oncology, 3(6, Suppl. 4), 28-29.
    Chen, Y., Jungsuwadee, P., Vore, M., Butterfield, D. A., & St. Clair, D. K. (2007). Collateral damage in cancer chemotherapy: Oxidative stress in nontargeted tissues. Molecular Interventions, 7(3), 147-156.
    Dantzer, R., & Kelly, K. W. (2007). Twenty years of research on cytokine-induced sickness behavior. Brain, Behavior, and Immunity, 21(2), 153-160.
    Dodd, M., Janson, S., Facione, N., Faucett, J., Froelicher, E. S., Humphreys, J., et al. (2001). Advancing the science of symptom management. Journal of Advanced Nursing, 33(5), 668-676.
    Dodd, M. J., Miaskowski, C., & Paul, S. M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28(3), 465-470.
    Gift, A. G., Jablonski, A., Stommel, M., & Given, C. W. (2004). Symptom clusters in elderly patients with lung cancer. Oncology Nursing Forum, 31(2), 202-212.
    Grady, D., Yaffe, K., Kristof, M., Lin, F., Richards, C., & Barrett-Connor, E. (2002). Effect of postmenopausal hormone therapy on cognitive function: The Heart and Estrogen/Progestin Replacement Study. American Journal of Medicine, 113(7), 543-548.
    Hart, R. P., Wade, J. B., & Martelli, M. F. (2003). Cognitive impairment in patients with chronic pain: The significance of stress. Current Pain and Headache Reports, 7(2), 116-126.
    Hess, L. M., & Insel, K. C. (2007). Chemotherapy-related change in cognitive function: A conceptual model. Oncology Nursing Forum, 34(5), 981-994.
    Hillman, C. H., Motl, R. W., Pontifex, M. B., Posthuma, D., Stubbe, J. H., Boomsma, D. I., et al. (2006). Physical activity and cognitive function in a cross-section of younger and older community-dwelling individuals. Health Psychology, 25(6), 678-687.
    Jansen, C., Miaskowski, C., Dodd, M., Dowling, G., & Kramer, J. (2005). Potential mechanisms for chemotherapy-induced impairments in cognitive function. Oncology Nursing Forum, 32(6), 1151-1163.
    Kim, H. J., McGuire, D. B., Tulman, L., & Barsevick, A. M. (2005). Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nursing, 28(4), 270-282.
    Klemp, J. R., Stanton, A. L., Kimler, B. F., & Fabian, C. J. (2006). Evaluating the effects of chemotherapy on cognitive function and quality of life in pre-menopausal women with breast cancer [Abstract 5075]. Retrieved December 12, 2006, from http://www.abstracts2view.com/sabcs06/view.php?nu=SABCS06L_587
    Lenz, E. R., Pugh, L. C., Milligan, R. A., Gift, A., & Suppe, F. (1997). The middle-range Theory of Unpleasant Symptoms: An update. Advances in Nursing Science, 19(3), 14-27.
    Lenz, E. R., Suppe, F., Gift, A. G., Pugh, L. C., & Milligan, R. A. (1995). Collaborative development of middle-range nursing theories: Toward a Theory of Unpleasant Symptoms. Advances in Nursing Science, 17(3), 1-13.
    Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment (4th ed.). New York: Oxford University Press.
    Mancuso, A., Migliorino, M., De Santis, S., Saponiero, A., & De Marinis, F. (2006). Correlation between anemia and functional/cognitive capacity in elderly lung cancer patients treated with chemotherapy. Annals of Oncology, 17(1), 146-150.
    Massa, E., Madeddu, C., Lusso, M. R., Gramignano, G., & Mantovani, G. (2006). Evaluation of the effectiveness of treatment with erythro-poietin on anemia, cognitive functioning and functions studied by comprehensive geriatric assessment in elderly cancer patients with anemia related to cancer chemotherapy. Critical Reviews in Oncology/Hematology, 57(2), 175-182.
    McCracken, L. M., & Iverson, G. L. (2001). Predicting complaints of impaired cognitive functioning in patients with chronic pain. Journal of Pain and Symptom Management, 21(5), 392-396.
    Meyers, C. A. (2000). Neurocognitive dysfunction in cancer patients. Oncology, 14(1), 75-79.
    Miaskowski, C., Cooper, B. A., Paul, S. M., Dodd, M., Lee, K., Aouizerat, B. E., et al. (2006). Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: A cluster analysis [Online exclusive]. Oncology Nursing Forum, 33(5), E79-E89. Retrieved March 9, 2008, from http://www.ons.org/publications/journals/onf/Volume33/Issue5/pdf/330588… http://www.ons.org/publications/journals/onf/Volume33/Issue5/pdf/3305887.pdf
    Miller, A. H. (2003). Cytokines and sickness behavior: Implications for cancer care and control. Brain, Behavior, and Immunity, 17(Suppl. 1), 132-134.
    O'Shaughnessy, J. (2003). Chemotherapy-related cognitive dysfunction in breast cancer. Seminars in Oncology Nursing, 19(4, Suppl. 2), 17-24.
    Paice, J. A. (2004). Assessment of symptom clusters in people with cancer. Journal of the National Cancer Institute. Monographs, 32, 98-102.
    Parnet, P., Kelley, K. W., Bluthe, R. M., & Dantzer, R. (2002). Expression and regulation of interleukin-1 receptors in the brain. Role in cytokines-induced sickness behavior. Journal of Neuroimmunology, 125(1-2), 5-14.
    Peterson, S. J., & Bredow, T. S. (2004). Middle range theories. Philadelphia: Lippincott Williams and Wilkins.
    Peyron, R., Laurent, B., & Garcia-Larrea, L. (2000). Functional imaging of brain responses to pain: A review and meta-analysis. Clinical Neurophysiology, 30(5), 263-288.
    Pollmacher, T., Haack, M., Schuld, A., Reichenberg, A., & Yirmiya, R. (2002). Low levels of circulating inflammatory cytokines—Do they affect human brain functions? Brain, Behavior, and Immunity, 16(5), 525-532.
    Raz, N., & Rodrigue, K. M. (2006). Differential aging of the brain: Patterns, cognitive correlates and modifiers. Neuroscience and Biobehavioral Reviews, 30(6), 730-748.
    Schretlen, D. J., Inscore, A. B., Jinnah, H. A., Rao, V., Gordon, B., & Pearlson, G. D. (2007). Serum uric acid and cognitive function in community-dwelling older adults. Neuropsychology, 21(1), 136-140.
    Shumaker, S. A., Legault, C., Kuller, L., Rapp, S. R., Thal, L., Lane, D. S., et al. (2004). Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative Memory Study. JAMA, 291(24), 2947-2958.
    Singh-Manoux, A., Britton, A. R., & Marmot, M. (2003). Vascular disease and cognitive function: Evidence from the Whitehall II Study. Journal of the American Geriatrics Society, 51(10), 1445-1450.
    Tannock, I. F., Ahles, T. A., Ganz, P. A., & van Dam, F. S. (2004). Cognitive impairment associated with chemotherapy for cancer: Report of a workshop. Journal of Clinical Oncology, 22(11), 2233-2239.
    Wefel, J. S., Lenzi, R., Theriault, R. L., Davis, R. N., & Meyers, C. A. (2004). The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: Results of a prospective, randomized, longitudinal trial. Cancer, 100(11), 2292-2299.
    Wilkins, C. H., Sheline, Y. I., Roe, C. M., Birge, S. J., & Morris, J. C. (2006). Vitamin D deficiency is associated with low mood and worse cognitive performance in older adults. American Journal of Geriatric Psychiatry, 14(12), 1032-1040.
    Wilson, C. J., Finch, C. E., & Cohen, H. J. (2002). Cytokines and cognition—The case for a head-to-toe inflammatory paradigm. Journal of the American Geriatrics Society, 50(12), 2041-2056.
    Yaffe, K., Barnes, D., Lindquist, K., Cauley, J., Simonsick, E. M., Penninx, B., et al. (2007). Endogenous sex hormone levels and risk of cognitive decline in an older biracial cohort. Neurobiology of Aging, 28(2), 171-178.