Background: Chemotherapy-induced nausea and vomiting (CINV) has been acknowledged as the most distressing symptom caused by chemotherapy. Symptom control by antiemetics in the delayed phase, and especially nausea control has been unsatisfactory and the side effects from the antiemetics have impelled researchers to investigate additional non-pharmacologic interventions for CINV control. The influence of CINV on patients' functional status has been reported, however, the relationship between CINV and their functional status during chemotherapy is understudied.

Purpose: This dissertation is aimed at adding to the knowledge base related to the experiences with and influences of CINV and to the additional interventions for CINV control such as P6 acupressure and aerobic exercise. The specific purpose includes 1) evaluating the effects of acupressure through literature review when acupressure was combined with antiemetics for the control of CINV. 2) exploring the experience of chemotherapy-induced nausea (CIN) in relation to the frequency of P6 digital acupressure in a group of breast cancer patients who had received moderate to highly emetogenic chemotherapy plus applied P6 digital acupressure as an additional intervention for CIN. 3) evaluating the relationship between nausea and a moderate level of aerobic exercise during and after adjuvant cancer treatment for women with breast cancer. 4) determining the relationship of CINV to the functional status of women undergoing chemotherapy for breast cancer treatment.

Methods: A literature review evaluated the effect of P6 acupressure for CINV control. Three data-based studies were conducted using three existing data sets from larger studies. The first study examined the relationship of CIN to the frequency of P6 digital acupressure. The second study evaluated the relationship of nausea and a moderate level of aerobic exercise. The third study explored the relationship between CINV and functional status during chemotherapy.

Findings: CINV, especially in the delayed phase, and nausea is an important clinical issue that may influence functional status of patients. The use of P6 acupressure and performing a moderate level of aerobic exercise are suggested interventions for CINV control. However, further study is clearly needed.

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Background: Recent studies suggest that standard dose chemotherapy (CTX) may cross the blood-brain barrier. However, the evidence for CTX-induced cognitive impairments in breast cancer patients is inconsistent.

Purposes: 1) to describe the literature about CTX-induced cognitive impairments in women with breast cancer; 2) to review the domains of cognitive function and their corresponding neuroanatomic structures as well as present current evidence for neurotoxicity associated with specific CTX agents and potential mechanisms for CTX-induced cognitive impairments; 3) to estimate the effect sizes for the effect of CTX on each domain of cognitive function; 4) to determine the sensitivity of neuropsychological tests which have been used to evaluate CTX-induced impairment in various domains of cognitive function in breast cancer patients; and 5) to assess changes in cognitive function over time in breast cancer patients receiving CTX, and evaluate potential relationships between cognitive function and anxiety, depression, fatigue, hemoglobin levels, menopausal status, and perceived cognitive function.

Methods: We performed meta-analyses to measure effect sizes to determine CTX effect on various domains of cognitive function and to determine neurological test sensitivity. In the longitudinal study, we recruited a multicultural sample of thirty women with breast cancer for neuropsychological testing prior to the initiation and a week after completion of treatment with doxorubicin and cyclophosphamide CTX. Paired t-tests were used to evaluate changes in cognitive scores over time and linear mixed modeling was used to determine whether significant changes remained after controlling for anxiety, depression, fatigue, hemoglobin level, menopausal status, and perceived cognitive function.

Findings: Only two domains of cognitive function (i.e., language, visual memory) had small albeit significant negative effect sizes in the meta-analysis of CTX-induced cognitive impairments in breast cancer patients. We evaluated thirty tests used to measure cognitive changes in breast cancer patients who received CTX, but found only six tests to be sensitive in detecting changes in four of eight domains of cognitive function (i.e., language, motor function, visuospatial skill, and verbal memory). In the longitudinal study significant decreases in cognitive function were found after CTX in visuospatial skill (p < .001) and total cognitive (p = .001) scores over time.

Abstract Symptom clusters are stable groups of interrelated symptoms that occur simultaneously. Research on symptom clusters may yield findings that can be used to improve symptom assessment and management. The purposes of this dissertation research were: to evaluate for differences in symptom clusters in a homogeneous sample of oncology patients who underwent radiation therapy (RT) using both the occurrence rates and severity ratings from the Memorial Symptom Assessment Scale (MSAS), as well as to evaluate for differences in symptom factor severity scores between patients with breast and prostate cancer at the end of RT, and to determine the number and types of symptom clusters at three time points (i.e., at the middle of, at the end of, and 1 month after the completion of RT).

A sample of 160 patients who underwent RT was evaluated in this study. Patients completed a clinical questionnaire that obtained information on demographic and clinical characteristics, as well as the MSAS that measured the multidimensional experience of symptoms. Exploratory factor analyses of symptoms were done for selected time points. While the specific symptoms within each symptom cluster were not identical, three very similar symptom factors (i.e., "mood-cognitive" symptom cluster, "sickness-behavior" symptom cluster, "treatment-related" symptom cluster) were identified regardless of whether occurrence rates or severity ratings were used to create the symptom clusters at the end of RT. However, the factor solution derived using the severity ratings fit the data better. Significant differences in all three symptom severity scores were found between patients with breast and prostate cancer. For all three symptom factors, the patients with breast cancer had higher symptom severity factor scores than the patients with prostate cancer.

Although the number and specific symptoms within each cluster were not identical, three distinct symptom clusters were found across the three time points: "mood-cognitive" symptom cluster, "sickness-behavior" symptom cluster, and "treatment-related" or "pain" symptom cluster. However, differences over time were noted in the "treatment-related" or "pain" symptom clusters. Specifically, at the middle of RT, problem with urination and diarrhea clustered together, while problem with urination and skin problems associated with treatment clustered together at the end of RT. Furthermore, a new symptom cluster (i.e., pain) emerged at 1 month after completion of RT. Future research needs to confirm these findings as well as consider an evaluation of homogeneous samples of patients in terms of both cancer diagnoses and treatments.

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