Presenter: Lin Lin, PhD, RN Department of Family Health UTHealth School of Nursing
24
“UNCERTAINTY, MOOD STATES, AND SYMPTOMS IN PATIENTS WITH PRIMARY BRAIN TUMORS” Presenter: Lin Lin, PhD, RN Department of Family Health UTHealth School of Nursing
Presenter: Lin Lin, PhD, RN Department of Family Health UTHealth School of Nursing
Presenter: Lin Lin, PhD, RN Department of Family Health
UTHealth School of Nursing
Slide 2
Elizabeth W. Quinn Oncology Research Award The University of
Texas Health Science Center at Houston, School of Nursing Use of
the Modified Mishel Uncertainty in Illness Scale (MUIS) in Patients
with Primary Brain Tumors (PI: Lin Lin) (2009-2010) Dean's Research
Award The University of Texas Health Science Center at Houston,
School of Nursing Develop an Uncertainty Management Intervention
for Patients with Primary Brain Tumors (PI: Lin Lin)
(2011-2012)
Slide 3
Uncertainty is defined as the inability to determine the
meaning of illness-related events. Uncertainty is a cognitive state
created when the individual cannot adequately structure or
categorize an illness event because of insufficient cues.
Uncertainty exists in illness situations that are ambiguous,
complex, unpredictable, and when information is unavailable or
inconsistent. (Mishel, 1988; Mishel & Clayton, 2008)
Slide 4
Mishel (1988)
Slide 5
Tumors that begin in brain tissue are known as primary tumors
of the brain. The most common primary brain tumors are gliomas. A
grade IV astrocytoma is usually called a glioblastoma multiforme
(GBM). Overall, the chance that a person will develop a malignant
tumor of the brain or spinal cord in his or her lifetime is less
than 1% (about 1 in 150 for a man and 1 in 185 for a woman). (ACS,
2012)
Slide 6
Type of Tumor 5-Year Relative Survival Rate Age 20-4445-5455-64
Low-grade (diffuse) astrocytoma 59%40%NA* Anaplastic astrocytoma
49%29%8% Glioblastoma 16%6%3% Oligodendroglioma 85%77%65%
Anaplastic oligodendroglioma 66%53%33% Ependymoma/anaplastic
ependymoma 91%85%84%
Slide 7
The treatment options for brain and spinal cord tumors depend
on several factors, including the type and location of the tumor
and how far it has grown or spread. Surgery is often the first
treatment when it can be done. Some tumors (e.g., glioblastomas)
are not curable by surgery. After maximal safe surgical resection,
chemotherapy wafers may be placed in or near any remaining tumor at
this time. Radiation therapy is then given, usually along with or
followed by chemotherapy if the person's health allows.
Temozolomide is the chemotherapy drug most commonly used to treat
these tumors. It is often given along with radiation therapy, as it
appears to make it more effective. It is then continued after the
radiation is completed. (ACS, 2012)
Slide 8
Cancer recurrence Progressed/controlled Response to treatment:
pseudoprogression or pseudoresponse Effects of the tumor and its
treatment http://www.cancer.org/Cancer/BrainCNSTumorsinAdults
/DetailedGuide/brain-and-spinal-cord-tumors-in-
adults-after-follow-up
Slide 9
(N=186) Gender Employment Status Male99 (53%) Employed
(part-time, full-time, homemaker)94 (52%) Female87 (47%) Employed
(sick leave, disability)24 (13%) Ethnic Background Retired18 (10%)
Asian or Pacific Islander 11 (6%) Unemployed due to diagnosis of
tumor31 (17%) Black10 (6%) Unemployed prior to diagnosis of tumor,
student13 (7%) White 149 (86%) Level of Education Other 3 (2%) Some
high school or high school34 (18%) Hispanic Some college46 (25%)
Yes172 (93%) College graduate53 (29%) No13 (8%) Post
graduate/advanced degree53 (29%) Marital Status Divorced,
Separated, Widowed19 (10%) Married139 (75%) Single28 (15%)
Slide 10
Recurrence(N=186) Yes74 (40%) No112 (60%) Patient Groups Newly
Diagnosed32 (17%) On treatment with MRI64 (34%) On treatment
without MRI21 (11%) Follow-up without active treatment69 (37%)
Tumor Grade Grade I3 (2%) Grade II38 (21%) Grade III59 (32%) Grade
IV (69 GBM)84 (46%) Location Left103 (55%) Right 78 (42%) Midline5
(3%) KPS 8036 (20%) 90150 (81%)