Dissertations (Open Access)

Date of Award

Spring 5-2017

Degree Name

Doctor of Philosophy in Nursing (PhD)


Geri LoBiondo-Wood, PhD - Chair

Second Advisor

Rebecca Casarez PhD

Third Advisor

Barbara O'Brien MD

Fourth Advisor

Terri Armstrong PhD


Background Patients with leptomeningeal metastasis (LM) have symptoms related to disease within the neuroaxis, cancer sites outside the neuroaxis and treatment toxicities. Furthermore, the meaning ascribed to advanced cancer, such as LM, may impact the perceived severity, frequency and distress of symptoms as well as quality of life (QoL) and depression. Our aim was to explore and describe relationships among meaning of illness (MoI), depression, QoL and symptom burden in LM patients and to explore whether adding spine-related items from the MD Anderson Symptom Inventory-Spine (MDASI-SP) to the MDASI-Brain Tumor (BT) enhanced understanding of symptom burden in this population.

Methods Five items unique to the MDASI-SP were added to the MDASI-BT and the difference between the mean scores of the MDASI-BT before and after addition of the spine-related items was analyzed. Thirty participants with LM were consented and enrolled into one of two groups: Newly-diagnosed (n=15) and on active treatment (n=15). Correlational analysis was done to assess relationships between variables.

Results The sample was primarily white (73%), female (63%) with a median age of 54 years. Breast cancer was the most common primary cancer (50%) with the brain being the most common site of metastasis (23%). There were no associations between MoI and symptom burden (p=.12). Higher scores on the CMS correlated with better QoL (p<.01) and less depressive symptoms (p<.01). There was no significant difference in means between the original and modified MDASI-BT (p=.33).

Conclusion Depressive symptoms and QoL in LM patients is related to the positive or negative constructs of MoI indicating a need for meaning-centered interventions. Patients may rise to the challenge of cancer, endorsing a positive construct of MoI despite poor prognosis and limited life expectancy. Longitudinal studies comparing the relationship of MoI with the MDASI-BT and the modified MDASI-BT may help clarify findings of no relationship between MoI and symptom burden.


leptomeningeal metastasis

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