Congress Abstracts 2006

37

A STUDY ON THE RELATIONSHIP BETWEEN FATIGUE, PAIN, INSOMNIA, AND GENDER IN PERSONS WITH LUNG CANCER. Amy Hoffman, MSN, RN, Barbara A. Given, PhD, RN, FAAN, Alexander von Eye, PhD, Charles W. Given, PhD, and Audrey G. Gift, PhD, RN, FAAN, Michigan State University, East Lansing, MI.

Lung cancer is a disease with serious concurrent symptoms, such as fatigue, pain, and insomnia for both men and women. Investigating symptoms that may cluster together in specific cancer populations is important and is relatively new to nursing. Likewise, the study of gender differences to improve nursing-sensitive patient outcomes such as symptom status has become prominent. Targeting interventions towards symptom clusters and gender differences may identify those with lung cancer who could benefit from tailored symptom management protocol.

For recently diagnosed persons with lung cancer, this study examined the relationship between fatigue, pain, insomnia, and gender, while controlling for age, co-morbidities, and stage of cancer.

The Theory of Unpleasant Symptoms (TOUS) was used to guide this study. The TOUS conceptualizes symptoms as occurring together and identifies categories of antecedents to the symptoms.

Secondary data analysis from baseline observation of a randomized clinical intervention trial was performed on 80 persons with lung cancer using only their pre-chemotherapy information. Multinomial log-linear modeling was performed to identify the most parsimonious model from the saturated model to explain the relationships between fatigue, pain, insomnia, and gender.

Among patients with lung cancer, fatigue (94%) and pain (67%) were the most frequently occurring symptoms with insomnia occurring 50% of the time. A model containing all main effects; 2-way interactions of fatigue and pain, pain and insomnia, and insomnia and gender; and the 3-way interaction of fatigue, pain, and insomnia along with three covariates (i.e., age, co-morbidities, and stage of cancer) was a good fit to the data (Likelihood Ratio Chi-Square 0.875; 2 d.f.; p = 0.646). Parameter estimates indicate a statistically significant effect from the model was the 3-way interaction of pain, fatigue, and insomnia. Gender did not make a difference. Also, the delta difference test shows that age, co-morbidities, and stage of cancer are not significant covariates. By understanding this symptom cluster, oncology nurses can target specific troublesome symptoms to optimize symptom management and achieve the delivery of high quality cancer care.