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  • 1.
    Browall, Maria
    et al.
    University of Skövde, School of Life Sciences. Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden / Johns Hopkins University, Baltimore, Maryland, USA.
    Kenne Sarenmalm, Elisabeth
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Johns Hopkins University, Baltimore, Maryland, USA.
    Nasic, Salmir
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Wengström, Yvonne
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    Johns Hopkins School of Nursing, Baltimore, Maryland, USA.
    Validity and Reliability of the Swedish Version of the Memorial Symptom Assessment Scale (MSAS): An Instrument for the Evaluation of Symptom Prevalence, Characteristics, and Distress2013In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 46, no 1, 131-141 p.Article in journal (Refereed)
  • 2.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm.
    Kenne Sarenmalm, Elisabeth
    Research and Development Centre, Skaraborg Hospital, Skövde.
    Persson, Lars-Olof
    Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
    Patient-reported stressful events and coping strategies in post-menopausal women with breast cancer2016In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 25, no 2, 324-333 p.Article in journal (Refereed)
  • 3.
    Gaston-Johansson, Fannie
    et al.
    Johns Hopkins University, Department of Acute and Chronic Care, School of Nursing, Baltimore, MD, USA.
    Fall-Dickson, Jane M.
    National Institute of Health, Symptom Management Branch, National Institute of Nursing, Research, Bethesda, MD, USA.
    Nanda, Joy P.
    Johns Hopkins Medical Institutions, Baltimore, MD, USA.
    Kenne Sarenmalm, Elisabeth
    Skaraborg Hospital, Department of Research and Development Centre, Skövde, Sweden.
    Browall, Maria
    University of Skövde, School of Life Sciences.
    Goldstein, Nancy
    Johns Hopkins University, Department of Acute and Chronic Care, School of Nursing, Baltimore, MD, USA.
    Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy2012In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 3, 530-539 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study aims to examine the effectiveness of a self-management multimodal comprehensive coping strategy program (CCSP) on quality of life (QOL) among breast cancer patients 1 year after treatment.

    METHODS: Patients (n = 110) with stage II, III, or IV breast cancer scheduled to receive high dose chemotherapy and autologous hematopoietic stem cell transplantation were randomized to either CCSP treatment or control group. The CCSP intervention was taught 2 week before hospital admission with reinforcement at specified times during treatment and 3 months after discharge. The CCSP components included educational information, cognitive restructuring, coping skills enhancement, and relaxation with guided imagery. Instruments administered at baseline included the following: Quality of Life Index-Cancer Version (QOLI-CV), State-Trait Anxiety Inventory, Beck Depression Inventory, and Coping Strategies Questionnaire. At 1-year follow-up, patients (n = 73) completed and returned the follow-up QOLI-CV.

    RESULTS: Patients were mainly ≥40 years of age, married, Caucasian, and diagnosed with advanced breast cancer. A model measuring effectiveness of CCSP on QOL (total and subscale) at 1-year follow-up showed that the CCSP group (n = 38) had significant improvement in overall QOL (p < 0.01), health and functioning (p < 0.05), and socioeconomic (p < 0.05) and psychological/spiritual well-being (p < 0.01) compared with the control group (n = 35). The CCSP patients frequently used the CCSP to manage psychological (51%) and sleep problems (60%).

    CONCLUSIONS: The CCSP improved QOL for patients at 1-year follow-up. Patients overwhelmingly reported that CCSP was beneficial. The CCSP as an effective coping intervention has potential as a self-management program for breast cancer survivors.

  • 4.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Johns Hopkins University, Baltimore, Maryland, USA / Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Johns Hopkins University, Baltimore, Maryland, USA / Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden / Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA / Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA.
    Symptom Burden Clusters: A Challenge for Targeted Symptom Management. A Longitudinal Study Examining Symptom Burden Clusters in Breast Cancer2014In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 47, no 4, 731-741 p.Article in journal (Refereed)
    Abstract [en]

    Context: Although there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters. Objectives: To explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer. Methods: In this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups. Results: Three clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with "change in the way food tastes" as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden. Conclusion: This study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients. © 2013 U.S. Cancer Pain Relief Committee.

  • 5.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Johns Hopkins School of Nursing, Baltimore, MD, USA.
    Browall, Maria
    University of Skövde, School of Life Sciences. Johns Hopkins School of Nursing, Baltimore, MD, USA / Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Persson, L.-O.
    Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Fall-Dickson, Jane M.
    National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
    Gaston-Johansson, Fanny
    Johns Hopkins School of Nursing, Baltimore, MD, USA.
    Relationship of sense of coherence to stressful events, coping strategies, health status, and quality of life in women with breast cancer2013In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 1, 20-27 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To test the hypothesis that Antonovsky's concept of sense of coherence (SOC) predicts stressful events, coping strategies, health status, and quality of life (QoL) in a cohort of postmenopausal women (n = 131) with newly diagnosed primary or recurrent breast cancer.

    Methods: Regression analyses of longitudinal data at baseline through 6 months following breast cancer diagnosis examined the relationships between SOC (13-item version), daily assessment of coping with stressful events, health status, and QoL (EORTC QLQ-30).

    Results: The findings support Antonovsky's concept of SOC. Women with strong SOC reported fewer stressful events and more days without stressful events. They used more coping strategies and more frequently used distraction, situation redefinition, direct action, and relaxation, but seldom religion, to cope with stressful events, and reported better health status and QoL. Women with weak SOC experienced more distress and used fewer coping strategies, and they more frequently used coping strategies such as catharsis and seeking social and spiritual support, but seldom acceptance of the situation. They reported worse health status and QoL, regardless of disease stage or treatment. The relationships between SOC and health status and QoL were linear.

    Conclusions: Sense of coherence significantly predicts distress, number and type of coping strategies such as direct action and relaxation, health status, and QoL in women with breast cancer. Our data suggest that the SOC scale may be a useful screening tool to identify individuals particularly vulnerable to distress and unable to cope adequately. Assessing SOC strength may assist health care providers to provide individualized patient interventions.

  • 6.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Andersson, Bengt A.
    Department of Clinical immunology and transfusion medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Karlsson, Per
    Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital,Sweden University of Gothenburg, Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Mindfulness and its efficacy for psychological and biological responses in women with breast cancer2017In: Cancer Medicine, ISSN 2045-7634, E-ISSN 2045-7634, Vol. 6, no 5, 1108-1122 p.Article in journal (Refereed)
    Abstract [en]

    Many breast cancer survivors have to deal with a variety of psychological andphysiological sequelae including impaired immune responses. The primary purposeof this randomized controlled trial was to determine the efficacy of amindfulness-basedstress reduction (MBSR) intervention for mood disorders inwomen with breast cancer. Secondary outcomes were symptom experience, healthstatus, coping capacity, mindfulness, posttraumatic growth, and immune status.This RTC assigned 166 women with breast cancer to one of three groups: MBSR(8 weekly group sessions of MBSR), active controls (self-instructingMBSR) andnon-MBSR.The primary outcome measure was the Hospital Anxiety and DepressionScale. Secondary outcome measures were: Memorial Symptom AssessmentScale, SF-36,Sense of Coherence, Five Facets of Mindfulness Questionnaire,and Posttraumatic Growth Index. Blood samples were analyzed using flow cytometryfor NK-cellactivity (FANKIA) and lymphocyte phenotyping; concentrationsof cytokines were determined in sera using commercial high sensitivityIL-6and IL-8ELISA (enzyme-linkedimmunosorbent assay) kits. Results provideevidence for beneficial effects of MBSR on psychological and biological responses.Women in the MBSR group experienced significant improvements in depressionscores, with a mean pre-MBSRHAD-scoreof 4.3 and post-MBSRscore of 3.3(P = 0.001), and compared to non-MBSR(P = 0.015). Significant improvementson scores for distress, symptom burden, and mental health were also observed.Furthermore, MBSR facilitated coping capacity as well as mindfulness and posttraumaticgrowth. Significant benefits in immune response within the MBSRgroup and between groups were observed. MBSR have potential for alleviatingdepression, symptom experience, and for enhancing coping capacity, mindfulnessand posttraumatic growth, which may improve breast cancer survivorship.MBSR also led to beneficial effect on immune function; the clinical implicationsof this finding merit further research.

  • 7.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Life Sciences.
    Holmberg, Stig B.
    Department of Surgery, SU/Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andersson, Bengt A.
    Microbiology and Immunology, Göteborg University, Göteborg, Sweden.
    Odén, Anders
    Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Mindfulness based stress reduction study design of a longitudinal randomized controlled complementary intervention in women with breast cancer2013In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, Vol. 13, 248Article in journal (Refereed)
    Abstract [en]

    Background: The stress of a breast cancer diagnosis and its treatment can produce a variety of psychosocial sequelae including impaired immune responses. Mindfulness Based Stress Reduction (MBSR) is a structured complementary program that incorporates meditation, yoga and mind-body exercises. Despite promising empirical evidence for the efficacy of MBSR, there is a need for randomized controlled trials (RCT). There is also a need for RCTs investigating the efficacy of psychosocial interventions on mood disorder and immune response in women with breast cancer. Therefore, the overall aim is to determine the efficacy of a Mindfulness Based Stress Reduction (MBSR) intervention on well-being and immune response in women with breast cancer.Methods and design: In this RCT, patients diagnosed with breast cancer, will consecutively be recruited to participate. Participants will be randomized into one of three groups: MBSR Intervention I (weekly group sessions + self-instructing program), MBSR Intervention II (self-instructing program), and Controls (non-MBSR). Data will be collected before start of intervention, and 3, 6, and 12 months and thereafter yearly up to 5 years. This study may contribute to evidence-based knowledge concerning the efficacy of MBSR to support patient empowerment to regain health in breast cancer disease.Discussion: The present study may contribute to evidence-based knowledge concerning the efficacy of mindfulness training to support patient empowerment to regain health in a breast cancer disease. If MBSR is effective for symptom relief and quality of life, the method will have significant clinical relevance that may generate standard of care for patients with breast cancer.Trial registration: ClinicalTrials.gov: NCT01591915. © 2013 Kenne Sarenmalm et al.; licensee BioMed Central Ltd.

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