The antiemetic effectiveness of 5-HT3 receptor antagonists in combination with dexamethasone in patients receiving short-term infusion chemotherapy has been well demonstrated. Less information is available about the efficacy of the same antiemetic combination in patients treated with regimens of chemotherapy in which the drugs are delivered in continuous infusion of several hours. The purpose of this study was to report the effectiveness of a double administration of antiemetic drugs in patients treated with strong emesis-inducing drugs for several days. In this study, 19 male and 13 female patients with osteosarcoma, ages 9 to 45 years, treated with chemotherapy, received intravenous tropisetron 5 mg plus dexamethasone 8 mg every 12 hours during the first two cycles of the preoperative treatment: cisplatin 120 mg/m2 over 48 hours followed by Adriamycin 75 mg/m2 delivered in 24 hours and continuous infusion of ifosfamide 15 g/m2 over 120 hours. The assessment of the antiemetic efficacy was performed three times every day: from 8:00 am to 4:00 pm, from 4:00 pm to 12:00 am, and from 12:00 am to 8:00 am. The patients were followed from the beginning of the treatment until 2 hours after its end, when they were discharged from hospital. Complete protection from emesis was obtained in 80% of the 256 days of treatment: 81% during the first cycle (cisplatin 120 mg/m2 in 48 hours followed by Adriamycin 75 mg/m2 delivered in 24 hours) and 79% during the second cycle (continuous infusion of ifosfamide 15 g/m2 in 120 hours). In both cycles, complete protection declined from the first to the last day of treatment (from 100% to 62% during the first cycle and from 100% to 63% during the second cycle). These results indicate that when chemotherapy is administered in a protracted infusion, higher doses of antiemetic agents are necessary to achieve acceptable antiemetic activity.
Due to the large group of patients with advanced testicular cancer now being cured, it is important to identify the men who are at risk of deteriorated health. The purposes of this study were: (1) to delineate and compare frequency of self-perceived physical, psychologic, and general symptoms in men treated for testicular cancer with those of a general population sample and (2) to compare self-perceived physical, psychologic, and general symptoms in relation to secondary Raynaud phenomena, sexual dysfunction, infertility, and self-perceived attractiveness in different treatment modalities. The subjects were 277 survivors of testicular cancer (M = 42.2 years) who had completed a self-reported questionnaire (75.5% response rate). A population survey comprising 392 men was used as a comparison group (M = 45 years). The result demonstrated that although survivors of testicular cancer as a group reported significantly less frequency of backache, leg pain, cough, and eye problems than did the general population sample, they described that they significantly more often felt cold. Men reporting secondary Raynaud phenomena, infertility, and/or feeling less attractive had experienced significantly more self-perceived symptoms. Oncologist nurses could play an important role in psychologic counseling for those men.
An integral part of the treatment of most thyroid cancer patients is the administration of 131iodine. These patients should be hospitalized when given 131I. This paper reviews the basics of nuclear and radiation physics as applied to 131I therapy. Discussed in detail are the various facets of radiation safety which nurses need to be aware of when caring for a thyroid cancer patient treated with 131l. Among these facets are patient room assignment, regulation of visitors, patient feeding, handling of wastes, and procedures to follow in case of emergency surgery or death.
In the Netherlands Cancer Institute, the daily workload of nurses has been measured since 1976. Each day the head nurse ranks the patients into one of the seven categories of care requirements. It can be inferred from the data that the percentage of patients who need intensive nursing care has doubled from 30% in 1976 to more than 60% in 1989. The increase in the nursing staff has only partially kept abreast of the increase in the workload. In addition to this simple technique, a more refined "factor evaluation system" has been developed. On the basis of this method, a more detailed check can be made as to what connection there is between the characteristics of the patient, the particular disease and treatment on the one hand, and the nursing workload on the other. Because of this it is possible to assess and to predict the consequences for nursing care when a new therapy is introduced. The correlation between both assessment methods is good: 0.72. A plea is made to use both methods of assessment in conjunction: the simple method for assessing the daily workload, and the refined and thus more laborious method to analyze the factors responsible for changes in the workload. In view of the rapid dissemination of new oncological therapies, it is essential that international consensus be reached with regard to a method for measuring the workload of nurses. In this way the consequences of these new therapies for the workload of nurses might be known more rapidly and proper measures could be taken.
Lung cancer is the leading cause of cancer deaths in the world. Physical activity could help lung cancer patients improve their health.
The purpose of our study was to investigate lung cancer patients' physical activity preferences and relevant contributing factors, so that we could develop individualized intervention strategies to fit their needs.
This study used a descriptive and correlational design. Instruments included a physical activity preference survey form, the Physical Activity Social Support Scale, and Physical Activity Self-efficacy Scale.
From 81 lung cancer patients' physical activity preferences, our results showed that during the course of their illness, 85.2% of patients wanted to have a physical activity consultation and preferred to obtain advice from their physicians (28.4%) through face-to-face counseling (48.1%). Moreover, patients (70.4%) showed an interest in physical activity programs, and many (69.1%) revealed that they were able to participate. About 88.9% of patients showed a preference for walking, and 54.3% patients preferred moderate physical activity.
This study also revealed that social support and self-efficacy for physical activity effectively predicted moderate physical activity preferences.
Implications for practice:
The adherence to regular physical activity is improved by understanding the lung cancer patients' unique preferences for physical activity.
Advancements in surgical techniques, procurement, and immunosuppressant therapy have made organ transplantation a major treatment modality with increasing survival posttransplantation. However, this longevity has placed individuals with transplanted organs at an increased risk for developing cancer. This article examines the following pertinent issues. First, what is the prevalence of malignancies among transplant recipients? Second, are organ recipients told that they may be at risk for developing cancer? Third, is the medical community trading one lethal disease for another? And finally, are oncology nurses properly trained to handle the maintenance of a transplanted organ while caring for a person with cancer? This article looks at several ethical issues, including the ethical principle of autonomy, which examines the respect for a patient's right to choose or refuse treatment. Within this text, autonomy will be the basis for informed consent and the need for cancer risk disclosure. The ethical principle of beneficence is also examined, in regards to the health-care community trading one illness for another. The final ethical principle of nonmaleficence is considered and the need for future oncology nurses to examine their practice to determine if they are ready to care for these posttransplant cancer patients.
The purpose of this descriptive exploratory study by the Dutch Oncology Nursing Society was to describe the problem areas in the care of patients who are receiving chemotherapy as perceived by patients and professional caregivers as well as to explore differences between the perceptions of patients and professional caregivers. Three independent samples of 120 patients who are being treated with chemotherapy, 42 chemotherapy prescribing medical specialists, and 68 oncology nurses who are involved in the daily bedside care of the patients undergoing chemotherapy participated in the study. Patients and professional caregivers completed a 69- and a 58-item self-administered questionnaire, respectively. Results show that patients were satisfied with the medical and nursing care they received. Furthermore, results suggest that professional caregivers perceive the experience of patients with chemotherapy differently than patients, eg, patients perceive chemotherapy as reassuring that something is being done; whereas caregivers think that patients experience chemotherapy as something to fear or be anxious or uncertain about. It further seems that professional caregivers are more prone to act upon the medical-technical aspects of the treatment than to act on psychosocial sequelae of the treatment.
Despite the increasing risk of breast cancer with age, older women are less likely to engage in breast cancer screening behaviors than are younger women. In order to examine articles written on the topic of breast cancer and cancer, a historical survey was conducted of women's magazines popular between 1929 and 1949. This survey was an attempt to identify the messages of that period and compare them with the beliefs and knowledge prevalent among women who are today 75 to 84 years of age. There were striking similarities found between the messages in the early magazines and in older women's beliefs today. This literature was also compared with the medical literature of the same time to identify the role of the nurse and common themes. This article outlines specific mass-media strategies that nurses can use to design appropriate messages for women of different ages as well as for policy makers and the public at large through popular media such as magazines.
The systematic accumulation of widely scattered research results is essential to developing a scientific basis for clinical practice. The purposes of this study were to describe 10 years of patient-related oncology nursing research in the United States, assess effectiveness of interventions, and test a prototype for research synthesis projects. Using a nursing framework and strategies of integrative research review and meta-analysis, 428 studies were selected for the study. The studies were found to be predominantly descriptive (90%), with convenience samples (79%), and a median sample size of 48. Subjects were predominantly in treatment or rehabilitation (52%), with demographic and stage of disease characteristics largely unreported. Of the 428 studies, 42 met the criteria for meta-analytic treatment. Interventions were found to be significantly effective, with membership in the intervention group improving success rate by 22%. The prototype was judged highly for adherence to standards and usefulness for adaptation to other research syntheses. Because of wide diversity in topics studied, missing information on subjects, and lack of replication, implications for research-based practice are premature at this time. Recommendations for future research include new studies, replications, and new research syntheses with an international scope for nurses studying and providing cancer care.
A manual examination of 3 primary oncology nursing journals was conducted to identify quantitative studies about chaplains and community-based clergy that were published between 1990 and 1999. This systematic review identified 7 studies involving chaplains and/or clergy dealing with a range of issues. Although the rate at which such studies were published in the oncology nursing literature was relatively low (1 in 123 studies), this rate far exceeds the rate found in a similar review of psychology journals (1 in 600 studies). The nature of the 7 studies and the issues they addressed are discussed and the authors make recommendations for future collaborative efforts.
Survival rates and side effects have become the dominant constructs of cancer treatment and care, to the detriment of more supportive and patient-focused approaches. The concept of quality of life introduced to address this has failed to temper the language of oncology. Here an argument is made for the place of cancer nursing as a therapeutic enterprise in its own right, which warrants much greater recognition. Clear evidence for the therapeutic effects of cancer nursing intervention from a series of meta-analyses of cancer nursing interventions exists. Cancer nursing as therapy has the potential to operate on four levels and can effect radical change by reconstructing care, cancer services, and wider health care environments so that they are much more patient focused and offer nursing therapy as an integral part of care. These include fundamental knowledge or theory generation for therapeutic practice, therapeutic interventions for individuals or problems, developing and changing health systems or environments, or critique and reconstruction of care from a societal perspective. The features of cancer nursing as therapy can be identified and are described. Cancer nurses are encouraged to take up the challenge offered by the concept of therapeutic cancer nursing so that its potential for nurses, patients, and cancer services can be realised.
This study aimed to assess nurses' involvement in the supportive care of patients with recently diagnosed breast cancer in Dutch hospitals. A questionnaire used to evaluate various aspects of nursing care for breast cancer patients was sent to the surgical nursing teams in all 120 Dutch hospitals that provide surgical treatment for these patients. Nursing care was defined to be optimal if it met the following criteria: (a) Specialized nursing support is provided to all patients during admission and in the outpatient departments both before and after surgery. (b) A protocol is in place outlining standard nursing procedures for breast cancer patients. (c) Formal communication about each breast cancer patient exists between the nurses involved. On the basis of this definition, it was found that optimal nursing care was provided in only 6% of the hospitals. Nursing care fell short mainly in the outpatient setting. This shortcoming also was recognized by most respondents, and many were already planning improvements. Nurses had varying opinions about their responsibility to provide the patient with information about the disease and its treatment, and consensus was lacking. In summary, nursing care for newly diagnosed breast cancer patients in Dutch hospitals needs improvement, especially in the outpatient setting.
Although advanced cancer treatments prolong survivors' lives, a significant proportion experienced poorer health-related quality of life (HRQoL) than general populations. Identifying their needs is essential to develop a health service delivery model to improve patient outcomes.
The objective of this study was to examine the perceived unmet needs and HRQoL of Chinese cancer survivors who completed treatment less than 1 year ago.
Three hundred seventy-six participants completed a self-report survey: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy: General. Descriptive statistics were used to examine the prevalence of unmet needs. Multivariable logistic regressions were conducted to identify participants' characteristics that were associated with unmet needs. Multiple linear regression was used to delineate which domains of unmet needs were significantly associated with HRQoL with adjustment for potential confounding factors.
Healthcare information was the most common unmet needs among the survivors. Age, stage of cancer, and remission were significantly associated with 1 or more unmet need domains. Participants with unmet needs in physical, psychological, and patient care domains, on average, have poorer HRQoL.
Chinese cancer survivors have various unmet needs that might have adverse effects on their HRQoL. Younger age, more advanced stages of cancer, and remission were factors contributing to further unmet needs.
Implications for practice:
The results provided useful information on the special needs of survivors that may affect their HRQoL, enabling clinicians to plan better how to allocate existing limited resources to those who most require them.
The aim of this study was to describe bowel problems, self-care practices, and information needs of patients who have recovered from the acute effects of sphincter-saving surgery for colorectal cancer. A retrospective, descriptive survey was conducted using a structured telephone interview and mailed questionnaires. The sample consisted of 101 patients who had undergone sphincter-saving surgery for colorectal cancer in the last 6 to 24 months. Most participants (71.3%) reported a change in bowel habits after surgery. The 6 most frequently reported gastrointestinal problems were incomplete evacuation (75.2%), excessive flatus (75.2%), urgency (73.3%), straining (61.4%), perianal soreness or itching (49.5%), and bloating (43.6%). Incontinence of feces (varying from smears to complete bowel action) was reported by 37.6% of participants. The most frequently reported information needs were related to diet (50.5%) and managing conditions such as diarrhea (31.7%), bloating/wind/gas (28.7%), pain (21.8%), and incomplete emptying of the bowel (18.8%). Patients who had recovered from the acute effects of sphincter-saving surgery for colorectal cancer reported a wide range of bowel problems and ongoing concerns about managing symptoms. Findings from this study provide valuable information to guide the development of educational resources to prevent or better manage bowel problems after surgery.
The importance of hope in determining the adjustment of patients with cancer to their illness has been recognized. Stressful events such as pain and disease metastasis may have an impact on patients' hope levels. This study had three purposes: 1) to examine the effect of disease status on hope levels among patients with cancer who have pain; (2) to compare the level of hope between patients with cancer who have pain and those do not; and (3) to determine which dimensions of pain are associated with hope. Patients (n = 226) with various cancer diagnoses completed the Herth Hope Index. Disease status was measured by one objective indicator (disease stage) and one subjective indicator (perceived treatment effect). The Perceived Meanings of Cancer Pain Inventory was used to measure the cognitive dimension of pain, whereas pain intensity and relief were used to represent the sensory dimension of pain. The patients' disease stage did not affect their level of hope, but their perception of treatment effect was associated with this factor. No difference in level of hope was found between patients with pain and those without pain. For those with pain, the cognitive dimension of pain (meaning ascribed to pain) was significantly correlated with hope, whereas sensory dimensions (pain intensity and relief) showed no such correlation. The study results support the role of cognition in promoting the psychological well-being of patients with cancer.
The purpose of this article is to analyze the concept of symptom clusters and to discuss its application to cancer nursing to promote communication and enhance scientific knowledge. Rodgers' evolutionary method of concept analysis served as the framework for reviewing literature from psychology/psychiatry, general medicine, and nursing. Attributes of symptom clusters were relationships of symptoms and relationships of clusters, concurrence, underlying dimensions, stability, and common etiology. The major antecedent was the presence of 2 or more symptoms. Consequences were poorer physical health status, interference with activities of daily living, emotional distress, and increased financial burden. A symptom cluster is defined as consisting of 2 or more symptoms that are related to each other and that occur together. Symptom clusters are composed of stable groups of symptoms, are relatively independent of other clusters, and may reveal specific underlying dimensions of symptoms. Relationships among symptoms within a cluster should be stronger than relationships among symptoms across different clusters. Symptoms in a cluster may or may not share the same etiology. Symptom should be broadened to include both subjective (self-reported) symptoms and objective (observed) signs. Implications for researchers include the need to use a clear definition, determine the optimal methods of identifying etiology and nature of symptom clusters in various populations, assess the clinical utility of symptom clusters, and test interventions. Implications for practitioners include the need to comprehensively assess symptoms over the entire cancer trajectory, select interventions that target single and multiple symptoms, and evaluate outcomes that include quality of life and economic variables.
The Catalan Network of Smoke-free Hospitals coordinates a smoking cessation program addressed to hospital workers. The program included training in tobacco cessation, a common software, and free access to pharmacological treatments.
This study aimed to evaluate the effectiveness of the Catalan Network of Smoke-free Hospitals smoking cessation program for abstinence among workers of the 33 participating hospitals.
A total of 930 hospital workers (in 33 hospitals) attended the cessation units between July 2005 and December 2007. The program included active follow-up during 6 months after quitting. We calculated 6-month abstinence probabilities by means of Kaplan-Meier curves according to gender, age, years of tobacco consumption, profession, Fagerström Test for Nicotine Dependence (FTND) score, and use of pharmacotherapy.
Overall abstinence probability was 0.504 (95% confidence interval [CI]: 0.431-0.570) at 6 months of follow-up. Abstinence was higher in men (0.526, 95% CI = 0.398-0.651) than in women (0.495, 95% CI = 0.410-0.581). Physicians had higher abstinence (0.659, 95% CI = 0.506-0.811) than nurses (0.463, 95% CI = 0.349-0.576). Workers with high nicotine dependence (FTND > 7) had lower abstinence probability (0.376, 95% CI = 0.256-0.495) than workers, with FTND score equal or below 6 (0.529, 95% CI = 0.458-0.599). We observed the highest abstinence probabilities in workers treated with combined pharmacotherapy (0.761, 95% CI = 0.588-0.933).
Significant predictors of abstinence were smoking 10 to 19 cigarettes/day, having present low or medium FTND score, and using combined treatment (nicotine replacement therapy and bupropion).
The results show the feasibility and success of a smoking cessation program for hospital workers coordinated at the regional level.
For women with stage I or II breast cancer, randomized trials have demonstrated no significant difference in survival rates between women receiving modified radical mastectomy (MRM) and women receiving breast conserving (BC) surgery. Therefore, many women are now in a position of having a choice between these two options. Twenty-two women who met the surgical criteria for having this choice were interviewed 1 to 2 weeks postsurgery to determine factors they had considered when deciding between MRM and BC, how much they wished to participate in decision-making, and the sources of information they used. The sample was purposefully limited to women attending one clinic in order to insure control over variables such as the information to which patients are exposed. When asked why they had chosen a given surgery, two factors, concerns about radiotherapy (p = 0.003) and body integrity (p = 0.04), emerged as significantly different for women choosing BC vs. MRM. Furthermore, women reported that participation in decision-making was important to them and that they had had sufficient participation in the decision-making process. Finally, they rated "people" sources of information as more important than written or visual materials, suggesting that nurses and other care providers are important in supporting women through the decision-making process.
Although exercise has been addressed as a promising therapy for cancer adverse effects, few studies have evaluated the beneficial effects of exercise for colorectal cancer (CRC) patients during chemotherapy.
The purpose of this study was to compare the effects of supervised-exercise intervention with those of usual care on cardiorespiratory fitness, muscle strength, fatigue, emotional distress, sleep quality, and quality of life (QoL) in patients with CRC undergoing chemotherapy.
Patients with stage II or III CRC admitted for adjuvant chemotherapy were allocated to either a supervised-exercise group that received a combined aerobic and resistance exercise program or a "usual care" control group for 12 weeks. The outcomes, QoL, muscle strength, cardiorespiratory fitness, emotional distress, physical activity, fatigue, and sleep quality, were assessed at baseline and after intervention.
Significant interactions between intervention and time were observed for the role functioning and pain subscales of QoL and physical activity level. The time main effects were significant for the secondary outcomes: hand-grip strength, cardiorespiratory fitness, physical activity level, and physical functioning, role functioning, social functioning, fatigue, and pain subscales of QoL.
Compared with usual care, the supervised exercise demonstrated larger effects than usual care on physical activity level and role functioning and pain subscales of QoL.
Implications for practice:
Supervised-exercise program is suggested to be incorporated as part of supportive care to promote the cardiorespiratory fitness, muscle strength, physical activity level, and QoL of patients with CRC undergoing chemotherapy.
The Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales are commonly used to assess health-related quality of life of healthy children and pediatric patients. Validation of the Generic Core Scales among Chinese pediatric cancer patients has not been reported in the literature. The scales can serve to measure different quality-of-life domains that are not captured by the PedsQL Cancer Module.
Psychometric properties of the Chinese version of the PedsQL 4.0 among pediatric cancer patients and their caretakers were examined.
The Generic Core Scales were administered to 335 pairs of pediatric cancer patients (aged 8-18 years) and their caretakers in Hong Kong.
A 5-factor structure (physical, emotional, social, school-related cognitive function, and missed school) was identified in the patient and proxy versions of the scales using confirmatory factor analysis. Both versions of the total scale reported Cronbach α's of .90 or greater, with almost all subscales reporting α's of .70 or greater. Test-retest reliability at 2 weeks was acceptable (intraclass correlations ≥0.60) for a majority of subscales. Agreement between patients' and caretakers' ratings was medium.
The scales demonstrated acceptable psychometric properties and construct validity.
Implications for practice:
This study validated the Chinese version of the Generic Core Scales among pediatric cancer patients and their caretakers, which supports the future use of the scales in clinical settings. The Generic Core Scales can also be supplementary to the PedsQL Cancer Module for measuring multiple domains of quality of life in cancer population.
AIDS (acquired immune deficiency syndrome), discovered in 1981, is defined by the Centers for Disease Control (CDC) as "a disease, at least moderately predictive of a defect in cell-mediated immunity occurring in a person with no known cause for diminished resistance to that disease." AIDS has been found in the following groups: homosexual/bisexual 71 %, I.V. drug abusers 17%, Haitians 5%, hemophiliac A individuals 1%, and others 6 %. The etiology of the defect in cell-mediated immunity remains unknown. Symptoms of AIDS include lymph-adenopathy, malaise, weight loss, fever, and night sweats. Common associated diseases include Pneunocystis carinii pneumonia (PCP) (51%), Kaposi's sarcoma (30%), and other opportunistic infections (12%). While the actual care is individualized there are two goals in the plan: 1) prevent AIDS transmission, and 2) minimize opportunistic infections. The first is accomplished through the use of good isolation technique and the second by minimizing the exposure of AIDS patients to infected persons. Nurses publicizing their findings will help ef-fectiate the discovery of AIDS prevention and treatment.
Because the concept of cancer survivorship (CS) has become widely popularized, it is tempting to assume that all individuals treated for cancer will personally identify with the public term. This is the first investigation about the meaning of the taken-for-granted concept from the perspective of a group of older survivors.
How women 70 years or older who recently completed treatment for primary, early-stage breast cancer relate to concepts such as "cancer survivor" and "cancer survivorship."
Data were collected and analyzed using constructivist grounded theory.
The majority of the 18 women, 70 to 94 years of age, did not self-identify as cancer survivors or identify with the phases of CS. Some had never heard of CS. Instead of perceiving CS as a discrete concept, the women used comparisons and self-judgments to contemplate how much they deserved the title, how they compared with real cancer survivors, and how they can be certain that they are cancer-free.
Although the benefits of identifying as a cancer survivor may be self-evident to health care providers and researchers, the women did not simply accept the generic concept as part of their well-established personal identities. Cancer survivorship was an ambiguous concept that predated the women's cancer experience.
The generic title of cancer survivor is here to stay because it is useful to advocates, consumers, providers, and researchers alike. However, "survivors" will be best served by providers and researchers who are aware that the concept is not organic but is learned from outside sources.
Bony metastasis is the most common cause of cancer pain. Strontium-89 (Sr-89), or Metastron, therapy has been shown to be effective for the palliation of pain due to skeletal metastases. By reducing opioid analgesics intake and restoring mobility, Sr-89 improves the patient's quality of life. Sr-89 is given conveniently as an outpatient procedure, and when necessary it can be repeated at 3-month intervals. Sr-89 is useful as an adjunct to local external beam radiation (EBR) because Sr-89 will target all skeletal metastases, including those not included in the EBR field. Because Sr-89 is a beta-emitting radionuclide with a long physical half-life (50.5 days), precautions should be taken by the caretaker(s) against Sr-89 contamination from the patient's blood or excretions, particularly if the patient is incontinent.
Little is known of the experiences of oncology patients who abandon biomedicine to use alternate therapies. This ethnography provides insights into the experiences of eight estranged informants. Six main themes emerging from the analysis are (a) expressed stress: emotions such as anger and fear, (b) taking control, (c) belief in a cure, (d) social group association, (e) cost considerations, and (f) mystical insights into health care. Conducted over 3 years, the study includes a network sample and longitudinal case study with one key witness. Individual interviews and one focus group were included. Insights are provided for health professionals who may encounter biomedical abandonment.
To explore and evaluate the safety and efficacy of early oral intake following major abdominal gynecological oncology surgery. During an 11-month period, 60 gynecological oncology patients undergoing major intra-abdominal surgery were enrolled in a randomized controlled clinical trial of semiliquid diet (experimental group) compared with clear feeds (control group) 6 hours after operation. Patients were evaluated for nausea, vomiting, bowel sound, passage of flatus, body weight difference before and after operation, urine acetone, fasting blood sugar, and prealbumin level, and need for nasogastric tube decompression. There were significantly higher incidences of nausea, shorter time of regular diet resumption, and higher level of prealbumin on postoperative day 7 in patients from the experimental group than those from the control group (P < .05). No significant differences were found in vomiting, the time to development of bowel sound and passage of flatus, body weight difference before and after operation, urine acetone and fasting blood sugar on postoperative day 1, and prealbumin level on postoperative day 2 between the 2 groups. Early oral intake with semiliquid diet 6 hours after major intra-abdominal gynecological oncology surgery is safe and well tolerated.
A descriptive study explored the ramifications of home deaths on widows of home hospice patients, as compared with widows following the deaths of their husbands within hospital settings. The hypothesis stated that differences existed in coping abilities between these groups. Data were collected from the F-COPES inventory, the Jalowiec Coping Scale, and a demographic data sheet in the homes of 32 widows whose husbands had died at home, as well as 36 widows whose spouses had died within a hospital, approximately 1 year after the death. Interviews were conducted with five widows from each group. Descriptive analyses, chi-square tests, t test techniques, and multiple regression analyses were used to identify differences in coping behaviors between the groups, as well as strengths and weaknesses of the instruments. The results of this study (p > 0.05) demonstrated that widows following death at home of their husbands utilized different coping mechanisms during the bereavement period than widows who did not participate in a hospice program. Thus, the hypothesis was supported. A theoretical framework for this project was developed on the basis of recent sociological endeavors in the study of coping and social support. Findings indicated areas for further hospice program development, recognition of some problems of widows, and recommendations for use of home hospices. Ideas for further research were generated.
Orem's Self-Care Deficit Theory of Nursing includes symptoms experienced by patients as a component of health state that influence self-care agency (S-CA). Nursing care plans reflect this relationship, but there are no supporting data. The purpose of this descriptive study (part of a larger study, US PHS Grant No. 5 R01 NUO 1154-02), was to examine the relationship between self-reported symptoms and S-CA perceived by patients receiving antineoplastic chemotherapy (CT). Telephone interviews were conducted with 20 patients averaging six cycles of CT. The interview schedule developed by the authors utilized open-ended questions regarding self-care (S-C) and symptomatology. Major themes were then identified and verified through subsequent interviews. Tiredness and weakness were identified as the symptoms that most interfered with S-C activities. Thus, informants limited their expenditure of energy by (a) planning/scheduling activities and work, (b) decreasing nonessential activities, and (c) increasing dependence on others for home management. Findings suggest a relationship between S-CA and health state. Further quantitative and qualitative research is needed for validation. Findings are applicable in nursing practice to assist new patients in coping with S-C deficits resulting from CT.
Education of cancer patients is complicated by a number of factors including timing, understanding of medical terms, and anxiety-induced inattention. The concern about patient education has led to the common practice of providing brochures about cancer, responses to cancer, treatment, and management of side effects. This material is often written at reading levels that do not match the reading ability of the patient. Research has indicated that the stated educational level is not equivalent to reading level. Realistic testing of a patient's reading ability thus becomes important in choosing the correct educational materials. This article reviews seven common available tests and discusses in detail the use of the Rapid Estimation of Adult Literacy in Medicine (REALM).
This article is a case study of a 32-year-old African-American woman diagnosed with an abnormal Pap smear, who did not follow through with the recommended colposcopy procedure. This case study highlights the role of illness explanatory models in nonadherence to follow-up treatment for an abnormal Pap smear. Illness explanatory models are an individual's personal interpretation of the illness. Research indicates that patients' illness explanatory models may not agree with biomedical explanations, but may sometimes have an adverse impact on health and illness behavior. This case study draws attention to the impact of illness explanatory models of cancer resulting from experience with cancer in the family, personal belief systems, and spiritual faith on the patient's decision not to follow through with recommended treatment for an abnormal Pap smear. Addressing illness explanatory models is of clinical importance in determining methods that will motivate women to follow through with treatment protocols when diagnosed with an abnormal Pap smear. Further in-depth study of the role these explanatory models of cancer play in nonadherence to treatment protocols is needed.
Breast cancer remains the most common cancer in women, and screening mammography is the best method for early detection. Approximately 10% to 15% of women undergoing screening mammography have abnormal or incomplete findings that require further diagnostic studies. The time to follow up is reported to be between 9 weeks and more than 19 weeks. Evidence indicates that a delay of more than 3 months in women with symptomatic breast cancer is associated with increased rates of breast cancer recurrence and death. The reasons for the delay are varied, and study findings suggest that minority and low-income women experience more delays than other groups do. The results from 22 studies are summarized. The identified barriers to completion of screening mammography were grouped as patient, provider, and system categories. Most of the studies were descriptive, retrospective studies that describe and measure the barriers in varied ways. Patient barriers were the most extensively described barrier, with little attention given to specific provider and system barriers. Women of nonwhite race with lack of insurance emerged as a subgroup that experienced more delay after abnormal or incomplete results. Provider and system barriers are also not well documented, and further exploration of these barriers is also recommended.
The purpose of this study was to evaluate whether the adherence concerns related to follow-up were different between groups of women after abnormal screening results of mammography (Mam) and Papanicolaou (Pap) test. Taiwanese women with abnormal Mam screening results (n = 42) and abnormal Pap test results (n = 109) provided data via a self-administered survey. Data were collected in 2005. After providing informed consent, women completed the AFAR, an 18 item questionnaire that measured the Adherence concerns of Follow-up after Abnormal screening Results. The results showed that (1) for both Mam and Pap test groups, the most important adherence concern for clinical follow-up after abnormal screening results is disease related, followed by others' response and resource accessibility; and (2) in these 2 clinical follow-up groups, women in the Mam group were more likely to be concerned with all of the 18 adherence factors than those in the Pap test group (OR, 2.46-9.86). The most important adherence concern on clinical follow-up after abnormal screening results for Mam and Pap test women is disease related. Mammography women considered significantly more adherence concerns than Pap test women. These differences imply that improving follow-up after Mam or Pap screen may require different interventions.
Survivors of pediatric brain tumors are often affected by late effects, such as motility disturbance of limb(s), seizure, ocular/visual impairment, endocrine abnormality, and higher brain dysfunction, resulting from the disease and its treatment. Appropriate provision of supportive care will require understanding the effects of these experiences on survivors' health-related quality of life (HRQOL).
The aim of this study was to identify the relationships between late effects and specific aspects of the HRQOL of pediatric brain tumor survivors.
We distributed questionnaires for measuring HRQOL to 138 survivors and their parents at 8 hospitals and 1 clinic in Japan and simultaneously surveyed late effects using information provided by the survivors' attending physicians. We compared the HRQOL of survivors with and survivors without specific late effects.
A total of 106 survivors and their parents returned the questionnaires to the researchers. The HRQOL of survivors 18 years or older was negatively affected by all 5 late effects, indicating that their higher impairment was associated with diminished HRQOL. The HRQOL of survivors aged 12 to 17 years was negatively affected by 2 late effects (ocular/visual impairment and motility disturbance of the limbs). A part of the HRQOL subdomain (motor and cognitive functioning) of survivors aged 12 to 17 years was positively related to ocular/visual impairment.
Five late effects influenced the HRQOL of pediatric brain tumor survivors.
Nurses and other health professionals should provide specific care designed to support aspects of HRQOL affected by late effects. For example, survivors with ocular/visual impairment may be expected to require additional emotional support, and those with seizures or endocrine abnormalities may be expected to require additional support for sleep disorders.
Hepatocellular carcinoma patients often experience sleep disturbance after undergoing transcatheter arterial chemoembolization (TACE).
The objectives of this study were to (1) examine and compare symptom distress, depression, and sleep quality in hepatocellular carcinoma patients undergoing TACE with sleep disturbance versus without sleep disturbance and (2) examine the determinants of sleep disturbance in these patients.
Hepatocellular carcinoma patients undergoing TACE were recruited. The patients were evaluated 1 week (T1) and 1 month (T2) after receiving TACE in terms of performance status, symptom distress, depression (T1), and sleep disturbance (T2). Logistic regression was used to determine the predictive factors of sleep disturbance.
Patients with sleep disturbance reported significantly higher overall symptom distress and depression and lower sleep quality than patients without sleep disturbance. The 5 leading causes of symptom distress in both groups were fatigue, pain, poor appetite, chest tightness, and fever. Older age, greater symptom distress, and higher levels of depression were significantly associated with sleep disturbance.
The results of this study show significant associations among symptom distress, depression at baseline, and sleep problems 1 month after undergoing TACE. Clinicians should be aware of the possibility of lasting sleep disturbance in hepatocellular carcinoma patients undergoing TACE.
In clinical care, symptom management, psychological consultation, and relaxation training may promote sleep quality.
Neutropenia is a common and dangerous toxicity of cancer therapy that profoundly affects patients' lives. Neutropenia is typically defined by the numerical value of the absolute neutrophil count. However, considering neutropenia exclusively as the numerical value of the absolute neutrophil count limits its conceptualizations to physiologically related aspects, minimizes its complexities, and neglects dimensions of human response and the patient experience. This article offers a dimensional analysis of neutropenia derived from 42 research and clinical articles. Schatzman's dimensional analysis methods were applied to the literature to identify aspects of this phenomenon lying beyond its numerical boundaries. Dimensions of neutropenia that emerged were sorted into categories of perspective, context, conditions, processes, and consequences. The presence of the same dimension in more than 1 category and the circuitous relationships among categories begin to explicate the complexity and gravity of neutropenia. Articulation of these dimensions is necessary to assemble the beginnings of a theoretical understanding of neutropenia, which is crucial for the development and application of knowledge to research and practice. Limitations evident in the literature illuminate the urgent need for research into the psychosocial as well as physiologic dimensions of neutropenia.
Abstracts are often used to screen a journal article. Little is known about the reporting quality for abstracts of randomized controlled trials (RCTs) in cancer nursing.
This study evaluated the quality of abstracts reporting published RCTs in cancer nursing and examined factors contributing to better reporting quality.
This is a literature review study. Searches were conducted in PubMed and Cumulative Index to Nursing and Allied Health Literature for English-language RCTs involving cancer nursing. Quality of abstract reporting was assessed and scored based on the Consolidated Standards of Reporting Trial statement for Abstracts (CONSORT for Abstracts). Descriptive statistics, univariate, and multivariate analyses were used to identify predictors of better quality of abstracts.
A total of 227 eligible articles published between 1984 and 2010 from 68 journals were identified. On average 46% of the items in the CONSORT for Abstracts were reported. More than 80% of the studies addressed only 6 of the 17 items from the CONSORT for Abstracts. Items concerning randomization, blinding, and intent-to-treat analysis were reported by fewer than 30% of the studies. Publication year, word count, impact factor, number of institutes, corresponding author's country, and funding accounted for 31.6% to 33.2% of the variance of the quality of abstracts based on a multiple regression model.
The reporting quality score of cancer nursing RCT abstracts was suboptimal.
Strategies to improve abstract reporting quality are needed. To ensure that essential RCT information can be reported in the abstract, journal editors may need to reassess word count limits.
Patient-reported outcomes related to symptoms, function, and quality of life during and following cancer treatment can guide care for pediatric cancer patients. To advance the science of patient-reported outcomes, the National Institutes of Health funded the Patient-Reported Outcomes Measurement Information System (PROMIS).
The objective of this study was to assess feasibility and acceptability of the PROMIS pediatric measures, as defined by enrollment and attrition rates as well as missingness by measure, item, participant, and assessment time point.
Eight- to18-year-olds participated in 2 studies: PROMIS I, a cross-sectional study of children in active cancer treatment or survivorship, and PROMIS II, a longitudinal study with 3 assessment time points for children receiving curative treatment.
PROMIS I (n = 200) and PROMIS II (n = 94) had enrollment rates of 92.5% and 89.7%, respectively. For PROMIS I, measure missingness was acceptable (8% missed any measures) and was not related to other study variables. For PROMIS II, measure missingness was minimal (0.8%), and item-level missingness was relatively low. In general, items that were skipped asked about experiences that participants had not encountered in the past 7 days.
In both studies, the PROMIS instruments demonstrated good feasibility and acceptability among pediatric cancer patients. Overall, we had high enrollment, low attrition, and acceptable rates of measure and item missingness.
Our results demonstrate that PROMIS measures are acceptable to 8- to 18-year-olds in different points of cancer care and feasible for use in pediatric cancer inpatient and outpatient settings.
Existential/spiritual needs of advanced cancer patients are not always met in healthcare. Potential barriers for health professionals exploring existential concerns include lack of time, training, tools, and confidence. Yet patients with life-threatening illnesses require holistic care, and interest in their existential/spiritual needs is growing. Preparation and life completion interventions have shown positive results in the existential/spiritual care of hospice-eligible patients in the United States. Nurses are in the ideal position to deliver such interventions, but have not been previously evaluated in this context.
The objective of this study was to explore the acceptability and feasibility of a nurse-facilitated preparation and life completion intervention (Outlook) in an Australian palliative care patient population.
Patients discussed their life story, forgiveness, and heritage and legacy over 3 audiotaped sessions. Preintervention/postintervention outcome measures included the Memorial Symptom Assessment Scale, Functional Assessment of Cancer Therapy-Spirituality Well-being, Profile of Mood States, Quality of Life at End of Life Scale, and Center for Epidemiological Depression Scale. Participant feedback was subjected to thematic analysis to understand the patient experience of receiving the intervention.
Ten palliative care patients with advanced cancer completed the study. Patients reported the intervention and assessments to be acceptable and feasible and to be overall positively received although with nonsignificant improvements in measures of "meaning and peace" and "preparation for end of life."
A nurse-facilitated preparation and life completion intervention is acceptable and feasible for palliative care patients with advanced cancer in Australia.
Implications for practice:
Outlook is a novel, portable, and feasible tool for use by nurses when addressing existential and spiritual domains of care with patients with advanced cancer.
Investigations of spiritual interventions for cancer patients are disproportionately few compared to the reported importance of religion to Americans. We report on the implementation and evaluation of a spiritual, community-based intervention developed with interdenominational community clergy. Approximately 1200 people attended a total of 3 gatherings: 2 at Roman Catholic and another at a Protestant Church. Respondents to questionnaires evaluating attendee characteristics and satisfaction (n = 209) were predominantly women (85%); 50% were patients and 45% were aged 60 years and older. Men were more likely to be currently under treatment for cancer, while women were more likely to be past patients or friends. Fewer than 2% felt anger or anxiety; attendees felt the service was very (90%) or somewhat (9.5%) helpful and expressed appreciation for cancer program clinician attendance and for hospital sponsorship of the event. Components in order of preference were prayer, music, Scripture, and litany. Logistic regression models reveal that music was most appreciated by previously treated patients, and prayer by currently treated patients. Secular healthcare systems can offer a religious service that comforts and links attendees to a broader community, including clergy and cancer program clinicians. Surveys can identify service components that appeal to differing groups and can facilitate service development.
Socioeconomic, attitudinal, and psychological factors associated with acceptance or refusal of recommendations for chemotherapy were investigated in 64 consecutive patients with solid tumors or lymphoma who agreed to participate in this study. Patients filled out the Brief Symptom Inventory (BSI) and a questionnaire that investigated selected factors. Patients also were asked if they believed in, used, had used, or planned to use alternative-complementary treatments for their cancer. Eight patients refused chemotherapy against the advice of their oncologist. Frequency, percentage, mean, standard deviation, and range was coded, and differences between the groups of those who accepted and those who rejected recommendations for chemotherapy were analyzed by chi-square, using unpaired t test and the Wilcoxon two-sample test. There was a significant increase in anxiety in the total study population as compared with patients who did not have cancer. In addition, all the BSI scores except those for anxiety were higher in patients who refused chemotherapy, and the difference was statistically significant.
The purpose of this study was to compare the incidence of infection in patients having venous access ports (VAP) accessed using commercially prepared kits with patients having VAPs accessed using a nursing protocol developed by RNs in the outpatient chemotherapy unit. The RN-developed protocol allowed venous access devices to be approached without sterile gloves and with minimal equipment, a technique which is more time efficient and cost effective. A convenience sample of 26 outpatients was randomly assigned to two groups. Patients in Group I, accessed using the commercially prepared kits, were accessed a total of 69 times. Patients in Group II, accessed using the nursing protocol, were accessed a total of 102 times. The two groups were compared for occurrence of infection as identified by elevated white blood count (WBC); febrile episode (greater than 100.4 degrees F); or drainage, pain, redness, swelling, or warmth at the port site. Data collected over a period of 6 months indicated no documented infection in either group. Results from this study will be used to support changes in nursing practice.
Heparin solution is routinely used to maintain the patency of infusion devices. Literature supports the alternative use of normal saline solution for flushing and locking intravenous infusion devices especially for pediatric patients. There is uncertainty regarding safety and efficacy of this policy for intermittent locking of implanted ports.
This study evaluates efficacy and safety of normal saline solution for intermittent locking procedures of implanted ports.
This is a retrospective observational cohort study of 610 implanted ports receiving 2 different locking solutions conducted at the National Institute for Cancer Research, IST Genova, Italy, from January 2007 to August 2009. Group A (n = 297) received heparinized solution (10 mL/500 U heparin), whereas group B (n = 313), 10 mL normal saline. Primary endpoint was irreversible port occlusion. Minimum follow-up was 12 months. The role of age, type of tumor, disease stage, access site, access body side, catheter tip position, and concomitant use of parenteral nutrition and chemotherapy was evaluated in secondary aim.
: Results fail to show statistically significant differences in implanted ports survival free from failure for occlusive events between the use of heparinized solution and that of normal saline for the maintenance of port patency, both in univariate (P = .9) and in multivariate analyses (P = .7).
Normal saline solution seems to be as effective as heparinized solution for keeping patent implanted ports in adult cancer patients.
Switching from heparinized solution to normal saline for catheter intermittent lock of ports seems a safe procedure.
After implanting > 150 totally implantable venous catheters, 40 patients were interviewed about their experiences by telephone using a standard questionnaire. There were 25 women and 15 men, all having or having had chemotherapy for nonresectable advanced cancer, 26 of them by means of a portable pump. Almost all patients thought that the advantages of the Port-a-Cath (PAC) outweighed its disadvantages; they were not hindered in their daily activities, and none of the patients experienced problems with sexual intercourse because of the PAC. Drawbacks of the method are that 40% of the patients found the operation for insertion of the PAC to be more painful than they had expected. Although PAC reduced the fear of repeated peripheral vein puncture, puncture of the PAC was viewed as painful by 15 of the 40 patients. We conclude that a PAC seems to be preferable to an external catheter but that pre- and postoperative patient information needs to be improved.