Terminal Bleeding in Angiosarcoma.

Introduction: Terminal bleeding, a distressing symptom experience for patients, caregivers, and health professionals, occurs in a subset of patients in the palliative care setting. Terminal bleeding is often thought of as a large-volume catastrophically fatal event, but it can also occur for a longer period of time and still be the precipitating event for a patient's death. Case Report: We present the case of terminal bleeding in an 87-year-old patient with angiosarcoma, a rare aggressive vascular neoplasm that can occur anywhere in the body but tend to occur more frequently in the head and neck. Discussion: The patient's advanced age and aggressive disease presented challenges in managing the symptoms and precluded many of the conventional recommended interventions to manage bleeding. Conclusion: This case report speaks to the need for multidisciplinary planning that takes prognosis, performance status, previous therapies, and patient preferences into account when caring for patients with advanced cancer.

Impact of port site scar on perception of patients with breast cancer: patient-reported outcomes.

PURPOSE: As the number of survivors continues to increase with improvements in breast cancer treatment, greater emphasis has been placed on the aesthetic outcome following breast surgery. Effort is made to minimize scarring on the breast, yet patients who require a port for treatment inevitably have a scar on the upper chest from the port itself. We hypothesized that patients with breast cancer are conscious of their port scars, and if given a choice would prefer placement of the port in the arm rather than the chest. METHODS: Female breast cancer patients treated at our Breast Center who had a port placed from 2009 to 2015 were asked to complete a 20-question, anonymous survey via SurveyMonkey® reporting demographics and treatment information, and a validated Patient Scar Assessment Questionnaire (PSAQ). RESULTS: Of 139 identified, 105 had email information available for contact, and 67 (64%) patients responded. Of the 67, 37 (55%) had undergone arm placement and 30 (45%), chest. Sixty (92%) patients report noticing their scars; 44 (69%) believed that their scar was noticeable to others; and 22 of the 44 (50%) made an effort to hide their scar. Thirty-seven patients were offered options for port site placement, and 24 (65%) chose placement in the arm (p = 0.057). CONCLUSION: Most patients are conscious of their port scars and if offered the choice choose placement in the arm rather than the chest. Upper extremity port placement should be further explored as an alternative approach for patients with breast cancer to improve port scar consciousness.

Evaluation and outcome measures in patient navigation.

OBJECTIVES: To review evaluation and outcome measures, including patient-reported outcomes, for assessing the impact of patient navigation. DATA SOURCES: Published peer-reviewed papers, systematic reviews, clinical reports, research and clinical experience. CONCLUSION: Research is demonstrating that patient navigation has beneficial outcomes across the cancer care continuum. More research is needed on outcomes of patient navigation by oncology nurses, to include baseline assessments that identify the areas of program focus, ongoing evaluation, and achievement of desired outcomes. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses who provide patient navigation as care coordinators, navigators, case managers, or team members have the potential to affect many positive outcomes in oncology care. Nursing research is needed to define oncology nursing patient navigation interventions and associated outcomes.

The concept of presence in group psychotherapy: an operational definition.

PURPOSE: The paper aims to operationally define the concept of presence, as developed and exhibited by the therapist leading a psychotherapy group, and illustrated with case examples. CONCLUSIONS: A group therapist, who addresses tangible, basic group survival needs, while integrating knowledge of psychotherapeutic processes, authentic and effective interpersonal communications, and genuine concern for individual members and the group as a whole, is best situated to enact presence in the context of group psychotherapy. PRACTICE IMPLICATIONS: Establishing presence can be achieved in a systematic way with an understanding of the meaning of being present at each step in the development of the group psychotherapeutic process.

Mindful movement program for older breast cancer survivors: a pilot study.

BACKGROUND: Older breast cancer survivors (BCSs) are at risk for late and long-term treatment effects on quality of life (QOL), including lower physical functioning and fear of recurrence. Two promising approaches to address this include dance/movement therapy and mindfulness. OBJECTIVE: The purpose of this 2-group randomized controlled pilot feasibility study was to test short-term effects of a 12-week Mindful Movement Program (MMP) intervention combining mindfulness with self-directed movement on QOL and mindfulness in female BCSs 50 years or older and at 12 months or more following treatment. METHODS: Consented participants were randomized to an experimental group (EG) (12 weekly MMP sessions) or a control group (no sessions). All completed questionnaires 3 times. The EG participants kept home practice diaries. Analysis was conducted after intervention for immediate effects on outcome variables and 6 weeks later for maintenance of effects. RESULTS: Participants (n = 49) ranged in age from 50 to 90 years (average, 65.6 years) and were at 9.8 years since diagnosis (range, 1-32 years), and the majority were white, unpartnered, and retired. After intervention, EG participants showed improved QOL via decreased fear of recurrence and increased mindfulness attitude. At 6 weeks, initial effects were retained. CONCLUSIONS: The MMP appears to benefit older BCSs by reducing fear of recurrence and improving mindfulness attitude. Although these findings are promising, a larger study is needed to determine more specifically what short- and long-term effects are possible. IMPLICATIONS FOR PRACTICE: The combination of self-directed movement and mindfulness, as tested here, may be a valuable tool for promoting health and well-being in older long-term survivors of breast cancer.

Senior peer counseling by telephone for psychosocial support after breast cancer surgery: effects at six months.

PURPOSE/OBJECTIVES: To evaluate the efficacy of senior peer counseling by telephone for supplemental psychosocial support of older women after breast cancer surgery. DESIGN: Experimental, randomized block, longitudinal. SETTING: A community-based senior service agency and a community hospital-based breast surgical oncology practice in an urban area of California. SAMPLE: 142 women newly diagnosed and scheduled for surgery for stage 0-III breast cancer (X age = 61.8, range = 50-94). METHODS: Participants were stratified by age and randomized to receive telephone calls from a peer counselor (a) once per week for five weeks beginning within 72 hours postsurgery, (b) once weekly for five weeks beginning six weeks postsurgery, and (c) by request. Assessments were conducted before surgery, postintervention, and six months after surgery. Questionnaires included the Hospital Anxiety and Depression Scale, the Interpersonal Relationship Inventory, and the Brief COPE. MAIN RESEARCH VARIABLES: Anxious mood, social support, and coping by seeking instrumental support. FINDINGS: At six months, significant main effects of age were noted for social support, fear of recurrence, and resource use. Significant independent effects of age and intervention were noted for coping by seeking instrumental support. After controlling for age, a significant interaction effect of intervention and time was observed for coping by seeking instrumental support. CONCLUSIONS: Peer counseling may affect instrumental support seeking and appears to be differentially received by age group. Additional study is needed to better understand who benefits most and how from peer counseling. IMPLICATIONS FOR NURSING: Trained senior peer counselor volunteers, supervised by a skilled clinical team, may be a useful adjunct in addressing psychosocial needs of women after breast cancer surgery.

Participant perceptions of a mindful movement program for older women with breast cancer: focus group results.

BACKGROUND: Little attention has been directed to the longer-term survivorship phase for older breast cancer survivors (BCSs) who often continue to struggle with late and long-term adverse effects of treatment including lower physical functioning, fear of recurrence, stress and anxiety, neuropathies, and pain. Creative and accessible strategies are needed that offer support to this population of cancer survivors. OBJECTIVE: The purpose of this study was to examine participant perceptions of the effects of a Mindful Movement Program intervention on quality of life and mindfulness through focus groups. This was part of a pilot feasibility study testing the intervention with older women at more than 1 year after treatment for breast cancer. METHODS: Eight to 9 weeks after completion of 12 weekly, 2-hour mindful movement sessions, focus groups were held with 3 experimental group cohorts of participants who had attended on average 10.4 classes. Focus group interviews were recorded, transcribed verbatim, and analyzed using qualitative techniques for recurrent themes. RESULTS: Four themes emerged from the direct quotes of the participants: freedom, rediscovering, body sense in moving, and in the moment. Participants also contributed opinions about program delivery. CONCLUSIONS: Participants described how the Mindful Movement Program experience affected their lives. Their feedback indicated that the intervention yielded positive results and was feasible for a variety of older BCSs. IMPLICATIONS FOR PRACTICE: Research with a wider group of participants is needed. Preliminary indications are that mindful movement may offer an acceptable strategy for increasing activity and decreasing stress among older BCSs.

Measuring oncology nurses' psychosocial care practices and needs: results of an Oncology Nursing Society psychosocial survey.

PURPOSE/OBJECTIVES: To develop and implement a survey of Oncology Nursing Society (ONS) members focused on their current practices and needs in relation to providing psychosocial care. DESIGN: Descriptive, cross-sectional. SETTING: Web-based survey of ONS members. SAMPLE: An invitation was e-mailed to 11,171 ONS members. Of those, 623 followed the link to the electronic survey and 64% of those (n = 401) completed the survey. METHODS: An ONS Psychosocial Project Team was convened in 2009. One of the team's goals was to develop a survey to assess members' needs. The final survey consisted of 24 items, including five items related to demographic characteristics. Response formats included Likert-type scale, yes and no, and open-ended questions. MAIN RESEARCH VARIABLES: Psychosocial care practices, education, and research. FINDINGS: Psychosocial concerns are assessed using a variety of methods. Nurse perceptions regarding primary responsibility for providing psychosocial services differ by group. Barriers to the provision of psychosocial care exist at the individual, institutional, and community levels. CONCLUSIONS: Although nurses assess patients' psychosocial needs, multiple barriers still exist related to interdisciplinary communication; knowledge of the Institute of Medicine's recommendations; and resources at the individual, institutional, and community levels. IMPLICATIONS FOR NURSING: The survey results were presented to the ONS Board of Directors, along with a three-year plan that included recommendations for future development of advocacy, practice, education, and research initiatives. Additional work is needed to effectively support RNs in their provision of psychosocial care to patients and families.

Patient-reported outcome measures suitable to assessment of patient navigation.

BACKGROUND: Patient-reported outcomes (PROs) are measures completed by patients to capture outcomes that are meaningful and valued by patients. To help standardize PRO measures in patient navigation research and program evaluation, the Patient-Reported Outcomes Working Group (PROWG) was convened as part of the American Cancer Society's National Patient Navigator Leadership Summit. METHODS: The PROWG consisted of clinicians, researchers, and program managers from a variety of perspectives who developed a set of recommended PRO measures across the cancer continuum (ie, screening, diagnostic follow-up, treatment, survivorship, end of life) as well as those useful for assessing family caregivers. Measures were recommended based on face validity, responsiveness to navigation, reliability, and construct validity in relevant populations. Other considerations included readability, existence of multiple language versions, the existence of norm groups, and respondent burden. RESULTS: The PROWG reached consensus on measures for use in the domains of treatment adherence; perceived barriers to care; satisfaction with cancer care; satisfaction with patient navigation services; working alliance with patient navigator; perceived knowledge/competence/self-efficacy; functional assessment/symptom burden; global quality of life; specific quality-of-life symptoms (eg, depression, anxiety); and perceived cultural competency of the navigator. In domains where validated measures were found lacking, recommendations were made for areas of needed scale development. CONCLUSIONS: These measures should guide research and programmatic evaluation of patient navigation.

Training senior peer counselors to provide telephone support for newly diagnosed breast cancer survivors.

Volunteers require carefully designed and evaluable training before providing support to newly diagnosed older breast cancer survivors (BCS) after surgery. A training module and 20-h course incorporating discussion, role plays, dyads, and written material were created to supplement core training of senior peer counselors, who provided a telephone support intervention in a randomized controlled trial. Twelve volunteers began the training, ten completed the course, and six of the ten subsequently provided telephone support to 107 BCS. Specialized supplemental training, along with ongoing supervision, effectively prepared volunteers to provide support via telephone to BCS, augmenting professional support.

Long-term morbidity of sentinel node biopsy versus complete axillary dissection for unilateral breast cancer.

BACKGROUND: Postoperative changes after axillary lymph node surgery may significantly alter breast cancer survivors' (BCS) quality of life. Although sentinel lymph node biopsy (SLNB) has less immediate morbidity than axillary lymph node dissection (ALND), its long-term impact on shoulder abduction, arm swelling, and neurosensory changes has not been evaluated. The purpose of this study was to compare long-term morbidity after SLNB or ALND and breast-conservation surgery. METHODS: Female BCS who remained free of disease at least 3 years after ALND or SLNB for Stage I-III unilateral breast cancer completed a symptom questionnaire and a brief neurosensory physical examination of the upper arm and axilla (range of motion, arm circumference, and sensation to light touch with cotton and needle). RESULTS: The mean age of the 187 participating BCS was 62 years. At a mean follow-up of 6.6 years after ALND and 4.9 years after SLNB, most BCS had full abduction; only 10 cases (8 ALND, 2 SLNB) had a >/=2 cm proximal and/or distal circumference difference on the ipsilateral side compared with the contralateral side. ALND was associated with a significantly greater likelihood of subjective arm numbness (P < .001), chest or axillary numbness (P < .001), arm or hand swelling (P < .001), and objective neurosensory changes in the posterior axilla, medial and distal upper arm (P < .001). Operative procedure was the only significant predictor of neurosensory changes (P < .001). CONCLUSION: SLNB is associated with significantly less subjective and objective long-term morbidity than ALND.