The Effects of Nurse-Led Supportive Care Program on Quality of Life in Women with Breast Cancer Receiving Adjuvant Chemotherapy: A Randomized Controlled Pilot Study.

OBJECTIVES: This study was to evaluate the effects of nurse-led supportive care program on quality of life in women with breast cancer receiving adjuvant chemotherapy. METHODS: The study was carried out a parallel group randomized controlled pilot study with repeated-measures design in general surgery unit of a training and research hospital. Forty-two women with newly diagnosed breast cancer were randomly assigned to the intervention and control groups. The intervention group received nurse-led supportive care program for 8 weeks, 4 weeks in face-to-face sessions and 4 weeks through phone sessions. The control group received only routine treatment. The women in both groups completed the EORTC-QLQ-C30 (version 3.0) Quality of Life questionnaires at baseline and ninth week. RESULTS: There was a significant increase in the mean global health status and functional status scores of the women with breast cancer in the intervention group compared to the women in the control group in the ninth week compared to the baseline. The women in the intervention group had a lower mean symptom status score in the ninth week than the women in the control group and there was a statistically significant difference in the change in the mean scores of the groups over time. CONCLUSIONS: Our nurse-led supportive care program is an effective, safe and acceptable method to support women with BC receiving adjuvant chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: The nurse-led supportive care program can be used as a reliable and effective nursing intervention to increase the quality of life of women breast cancer receiving adjuvant chemotherapy. CLINICAL TRIAL REGISTRATION: NCT05399160.

Radiotherapy dose escalation with concurrent chemotherapy in locally advanced cervix cancer is feasible

Background. To test the feasibility of radiotherapy dose escalation using volumetric arc therapy (VMAT) and image-guided radiotherapy (IGRT) with concurrent chemotherapy in locally advanced cervix cancer (LACC) and compare this with whole-pelvis three-dimensional conformal radiation therapy (CRT) in terms of clinical toxicity. Methods. Database was reviewed for all LACC patients treated during 2011 and 2012. Twenty patients who were treated with escalated dose of radiotherapy using VMAT were selected for analysis. A matched cohort of 40 patients who had 3DCRT between 2005 and 2008 was selected as control. Mean basal hemoglobin, average weekly hemoglobin, and maximal drop in hemoglobin were measured for both 3DCRT and VMAT groups and treatment toxicity scored according to RTOG criteria. Charts were also reviewed for other acute and late toxicities including the rate of compliance with prescribed treatment. Results. Mean age was 46 (30-63) and 47 years (33-67), mean tumor size was 5.5 and 5 cm and blood transfusion rate was 55 and 45 % in CRT and VMAT groups, respectively. Hemoglobin toxicity (Grade I-II) was encountered in 97.5 and 90 % (p 0.0.3) while Grade I-III Leukopenia was 90 and 70 % (p 0.02), respectively. There was no Grade 3 or 4 GI or GU toxicity. Conclusion. VMAT/IGRT with dose escalation is feasible in LACC without excessive toxicity as compared to CRT "Box". We propose a randomized control trial of this novel approach of higher radiation dose and volume against the standard prescription based on CRT (AU)

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Endocrine therapy in breast cancer: the neoadjuvant, adjuvant, and metastatic approach.

OBJECTIVES: To review the rationale for endocrine therapy in the neoadjuvant, adjuvant, and metastatic breast cancer setting and to highlight clinical considerations unique to this treatment. DATA SOURCES: Contemporary literature, clinical guidelines, and national statistics. CONCLUSION: Endocrine therapy represents an important strategy in the management of both early and advanced hormone positive breast cancer. Additional research is required to better define the role of neoadjuvant therapy and the optimal duration of treatment. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a pivotal role in the identification and management of endocrine therapy-associated symptoms. Prompt symptom intervention may improve therapy adherence and ultimately, may improve long-term disease outcomes.

Virtual reality bringing a new reality to postthoracotomy lung cancer patients via a home-based exercise intervention targeting fatigue while undergoing adjuvant treatment.

BACKGROUND: Little is known about rehabilitation for postthoracotomy non-small cell lung cancer (NSCLC) patients. This research uses a perceived self-efficacy-enhancing light-intensity exercise intervention targeting a priority symptom, cancer-related fatigue (CRF), for postthoracotomy NSCLC patients. This article reports on phase II of a 2-phase study. Phase I focused on initiation and tolerance of exercise during the 6 weeks immediately after thoracotomy, whereas phase II addressed maintenance of exercise for an additional 10 weeks including participants initiating and completing chemotherapy and/or radiation therapy. OBJECTIVE: The objective of this study was to investigate the feasibility, acceptability, and preliminary efficacy of an exercise intervention for postthoracotomy NSCLC patients to include those initiating and completing adjuvant therapy. INTERVENTIONS/METHODS: A single-arm design composed of 7 participants postthoracotomy for NSCLC performed light-intensity exercises using an efficacy-enhancing virtual-reality approach using the Nintendo Wii Fit Plus. RESULTS: Despite most participants undergoing chemotherapy and/or radiation therapy, participants adhered to the intervention at a rate of 88% with no adverse events while giving the intervention high acceptability scores on conclusion. Likewise, participants' CRF scores improved from initiation through the conclusion of the intervention with perceived self-efficacy for walking at a light intensity continuously for 60 minutes, improving significantly upon conclusion over presurgery values. CONCLUSIONS: Postthoracotomy NSCLC patients maintained exercise for an additional 10 weeks while undergoing adjuvant therapy showing rehabilitation potential because the exercise intervention was feasible, safe, well tolerated, and highly acceptable showing positive changes in CRF self-management. IMPLICATIONS FOR PRACTICE: A randomized controlled trial is needed to further investigate these relationships.

Comparison of the effects of a supervised exercise program and usual care in patients with colorectal cancer undergoing chemotherapy.

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Educational needs and strategies of pediatric oncology nurses in low- and middle-income countries. An International Society of Pediatric Oncology- Pediatric Oncology in Developing Countries Nursing Working Group Initiative.

BACKGROUND: There is no existing pediatric oncology nursing curriculum written specifically for low- and middle-income countries (LMICs), where 80% of children with cancer reside. In 2012, the International Society of Pediatric Oncology Nursing Working Group sought to address this gap with a 3-phase study. OBJECTIVE: Phase 1: identify educational priorities of LMIC nurses providing oncology care. Phase 2: solicit educational strategies from expert pediatric oncology nurses. Phase 3: develop a culturally adaptable modular curriculum framework based on LMIC nurses' priorities. METHODS: A cross-sectional sample of LMIC nurses were surveyed (including Africa, Latin America, Asia). Next, 2 rounds of a Delphi survey were sent to expert pediatric oncology nurses from high-income countries with experience working in LMICs. A 2-day workshop was conducted to develop the framework. RESULTS: Low- and middle-income country nurses' survey responses indicated a similar need for specialty training (eg, chemotherapy and psychosocial support). Delphi survey participants agreed on educational strategies (eg, group discussions and peer teaching). Finally, 5 LMIC nurses committed to creating curriculum modules. CONCLUSIONS: There is an urgent need for a curriculum framework created and field tested in LMICs. The International Society of Pediatric Oncology 3-phase project was a successful strategy for initiating this ongoing process. IMPLICATIONS FOR PRACTICE: Translating or modifying existing oncology nursing curricula from high-income countries for use in LMICs is no longer adequate. Engaging LMIC nurses who care for children and adolescents with cancer in curriculum development, recognizing local cultures, traditions, and priorities and harnessing the LMIC nurses' knowledge, experience, and resources are the logical solution for a relevant curriculum.

Feasibility and acceptability of the patient-reported outcomes measurement information system measures in children and adolescents in active cancer treatment and survivorship.

BACKGROUND: 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). OBJECTIVE: 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. METHODS: Eight- to 18-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. RESULTS: 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. CONCLUSIONS: 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. IMPLICATIONS FOR PRACTICE: 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.

Analysis of risk factors for central venous catheter-related complications: a prospective observational study in pediatric patients with bone sarcomas.

BACKGROUND: The incidence of central venous catheter (CVC)-related complications reported in pediatric sarcoma patients is not established as reports in available literature are limited. The analysis of risk factors is part of the strategy to reduce the incidence of CVC complications. OBJECTIVE: The objective of this study was to determine the incidence of CVC complications in children with bone sarcomas and if defined clinical variables represent a risk factor. METHODS: During an 8-year period, 155 pediatric patients with bone sarcomas were prospectively followed up for CVC complications. Incidence and correlation with clinical features including gender, age, body mass index, histology, disease stage, and use of thromboprophylaxis with low-molecular-weight heparin were analyzed. RESULTS: Thirty-three CVC complications were recorded among 42 687 CVC-days (0.77 per 1000 CVC-days). No correlation between the specific clinical variables and the CVC complications was found. A high incidence of CVC-related sepsis secondary to gram-negative bacteria was observed. CONCLUSIONS: The analysis of CVC complications and their potential risk factors in this sizable and relatively homogeneous pediatric population with bone sarcomas has led to the implementation of a multimodal approach by doctors and nurses to reduce the incidence and morbidity of the CVC-related infections, particularly those related to gram-negative bacteria. IMPLICATIONS FOR PRACTICE: As a result of this joint medical and nursing study, a multimodal approach that included equipping faucets with water filters, the reeducation of doctors and nurses, and the systematic review of CVC protocol was implemented.

The nurse's role in managing chemotherapy-induced nausea and vomiting: an international survey.

BACKGROUND: Nurses play a substantial role in the prevention and management of chemotherapy-induced nausea and vomiting (CINV). OBJECTIVES: This study set out to describe nurses' roles in the prevention and management of CINV and to identify any gaps that exist across countries. METHODS: A self-reported survey was completed by 458 registered nurses who administered chemotherapy to cancer patients in Australia, China, Hong Kong, and 9 Latin American countries. RESULTS: More than one-third of participants regarded their own knowledge of CINV as fair to poor. Most participants (>65%) agreed that chemotherapy-induced nausea and chemotherapy-induced vomiting should be considered separately (79%), but only 35% were confident in their ability to manage chemotherapy-induced nausea (53%) or chemotherapy-induced vomiting (59%). Only one-fifth reported frequent use of a standardized CINV assessment tool and only a quarter used international clinical guidelines to manage CINV. CONCLUSIONS: Participants perceived their own knowledge of CINV management to be insufficient. They recognized the need to develop and use a standardized CINV assessment tool and the importance of adopting international guidelines to inform the management of CINV. IMPLICATIONS FOR PRACTICE: Findings indicate that international guidelines should be made available to nurses in clinically relevant and easily accessible formats, that a review of chemotherapy assessment tools should be undertaken to identify reliable and valid measures amenable to use in a clinical settings, and that a CINV risk screening tool should be developed as a prompt for nurses to enable timely identification of and intervention for patients at high risk of CINV.

The Latin American Center for Pediatric Oncology Nursing Education: development, implementation, and accomplishments.

BACKGROUND: Pediatric oncology nurses in low- and middle-income countries have limited access to specialized education and clinical training. This is a major impediment for treating children with cancer and contributes to the disparity in survival rates between high- and low-income countries. The International Outreach Nursing Program at St Jude Children's Research Hospital established full-time nurse educator positions at partner sites throughout Latin America. Experienced nurses were hired as educators; however, they had no formal pediatric oncology education, limited teaching experience, and no mentors as this was a new nursing role in low- and middle-income countries. OBJECTIVE: Our objective was to create a regional education center to prepare nurse educators to succeed in this pioneering role. INTERVENTIONS: The Latin American Center for Pediatric Oncology Nursing Education was created at Calvo Mackenna Hospital in Santiago, Chile, to provide education, resources, and support to educators. Education resources, including a comprehensive orientation program and courses in chemotherapy and central venous line care, were developed. A 4-week on-site comprehensive educator course and an organized support system were implemented. RESULTS: Education, resources, and support have been provided to 13 nurse educators representing 7 Latin American countries. The educators have provided pediatric oncology education to more than 1000 nurses. CONCLUSIONS: The center promotes excellence in pediatric oncology nursing by preparing and supporting educators, who in turn educate the entire nursing staff at partner sites. IMPLICATIONS FOR PRACTICE: Nurse educators equipped with knowledge and skills can improve the quality of care and ultimately survival of patients throughout Latin America.

Dose effects of relaxation practice on immune responses in women newly diagnosed with breast cancer: an exploratory study.

PURPOSE/OBJECTIVES: To determine the dose effects of relaxation practice on immune responses and describe the types of relaxation techniques preferred and the extent of relaxation practice over 10 months. DESIGN: Descriptive, prospective, repeated measures. SETTING: An interdisciplinary breast clinic at a university-affiliated comprehensive cancer center in the United States. SAMPLE: 49 women with newly diagnosed breast cancer and undergoing adjuvant therapy who participated in a stress management intervention. METHODS: Relaxation practice was assessed twice a month for 10 months with immune measurements (e.g., natural killer cell activity; lymphocyte proliferation; interferon [IFN]-γ; interleukin [IL]-2, -4, -6, and -10) at the beginning and end of 10-month practice. MAIN RESEARCH VARIABLES: Relaxation practice (representing the concepts of stress and adherence), relaxation technique, and immune response. FINDINGS: After adjusting for covariates, the extent of relaxation practice significantly contributed to the variance of natural killer cell activity, lymphocyte proliferation, IL-4, and IL-10 responses in a positive direction; the higher the relaxation practice, the higher the immune responses. In comparison, IFN-γ, IL-2, and IL-6 responses were not affected. The deep-breathing method was most preferred by participants, followed by progressive relaxation and imagination or visualization. The mean weekly frequency of relaxation practice was 5.29 (SD = 3.35), and the mean duration of relaxation practice was 19.16 (SD = 10.81) minutes per session. CONCLUSIONS: Persistent relaxation practice may have positive effects on multiple immune responses in a dose-dependent manner. IMPLICATIONS FOR NURSING: Allowing the choice of preferred techniques and emphasizing the importance of long-term adherence, a relaxation program may need to be routinely offered to women under high stress.

Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers.

OBJECTIVE: Women with gynecological cancers have reported poor health-related quality of life (QOL), with complex physical and psychological needs post-surgery and during chemotherapy treatment. There are no studies reporting interventions addressing these needs post-hospital discharge in this population. METHODS: Patients were randomized into two groups. The intervention group received 6 months of specialized care by an Advanced Practice Nurse (APN); in addition, women with high distress were evaluated and monitored by a psychiatric consultation-liaison nurse (PCLN). The attention control group was assisted with symptom management by a research assistant. The effects of the 6-month intervention were evaluated using self-report questionnaires at baseline (24-48 h after surgery), 1, 3, and 6 months post- surgery. QOL assessments included the Center for Epidemiological Studies-Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale, and the Short-Form Health Survey (SF-12). The sample for the longitudinal analysis included 123 who completed QOL outcome measures across three occasions post-surgery. RESULTS: The APN intervention resulted in significantly less uncertainty than the attention control intervention 6 months after surgery. When the sub-group who received the APN plus PCLN intervention was compared with the total attention control group, the sub-group had significantly less uncertainty, less symptom distress, and better SF-12 mental and physical QOL over time. CONCLUSION: Nurse tailored interventions that target both physical and psychological aspects of QOL in women recovering from cancer surgery and undergoing chemotherapy produce stronger outcomes than interventions that target solely one QOL aspect.

Caso clínico: paciente gastrectomizada en tratamiento con quimioterapia y radioterapia / Case report: a gastrectomized patient under treatment with chemotherapy and radiotherapy

El tratamiento adyuvante del cáncer gástrico incluye radioterapia y quimioterapia. La paciente de este caso fue intervenida de una gastrectomía el 10 de noviembre de 2006. Inició tratamiento de quimioterapia adyuvante esquema McDonald el 2 de enero 2007, finalizando el 1 de junio de 2007. Inició la radioterapia el 6 de febrero 2007 y finalizó el 16 de marzo 2007. El plan de cuidados que se presenta fue diseñado siguiendo el modelo de cuidados de Virginia Henderson vigente en el Hospital Reina Sofía, utilizando las taxonomías NANDA, NOC y NIC a partir de los diagnósticos enfermeros “riesgo de infección”, “temor” y “disposición para mejorar conocimientos”. En la evolución se identificaron2 diagnósticos enfermeros más: “deterioro de la mucosa oral” y “de la integridad cutánea”

The adjuvant treatment of gastric cancer includes radiotherapy and chemotherapy. The patient underwent gastrectomy on November 10, 2006 and began adjuvant chemotherapy (McDonald scheme) on january 2, 2007, finishing on june 1, 2007. Radiotherapy was started on February 6, 2007 and finished on March 16, 2007. The care plan presented was designed following the Virginia Henderson model and is routinely used at the Reina Sofía Hospital. This care plan follows the NANDA, NOC and NIC taxonomies and is based on the following nursing diagnoses: risk of infection, fear, and disposition to improve knowledge. During the clinical course, two new nursing diagnoses were identified: deterioration of oral mucosa and skin integrity

[Results of a study on fatigue in breast cancer patients receiving adjuvant chemotherapy: the first four days after treatment are the worst]. / Ergebnisse einer Untersuchung von Fatigue bei Brustkrebspatientinnen mit adjuvanter Chemotherapie: Die ersten vier Tage nach dem Zyklus sind am belastendsten.

A large number of breast cancer patients receiving adjuvant chemotherapy is suffering from fatigue. Until now there has been a lack of knowledge concerning the course of fatigue in breast cancer patients between two cycles of adjuvant chemotherapy. Therefore a prospective cohort study was conducted including 151 breast cancer patients from six hospitals in The Netherlands. The object of the study was to investigate the course of fatigue between the third and the fourth cycles of adjuvant chemotherapy, and to prove whether that course is influenced by different chemotherapy schedules. The patients were treated either with a doxorubicin containing schedule (21 or 28 days) or with a combination of cyclophosphamide, methotrexate, and 5-fluorouracil (CMF, 28 days). To assess fatigue patients were asked to write a diary cotaining the Shortened Fatigue Questionnaire (SFQ) from the beginning of the third cycle to the start of the fourth one. All days after completion of the third chemotherapy treatment were analysed. The main hypothesis to be tested was that the maximum fatigue level occurs in the first four days after treatment. Results revealed a chaotic pattern of fatigue between both cycles of chemotherapy in each of the treatment group. Smooth (splines) curves showed an average highest level of fatigue on day 3 post treatment. For the regimens with 28-days-intervalls another peak of fatigue was registered on day 11. A significant larger number of patients experienced maximum fatigue levels before day 5. The course of fatigue in the CMF group was significantly different compared with both doxorubicin groups. Women of the CMF group experienced lower fatigue peaks than patients of other groups. The results confirm the main hypothesis. The first days after treatment with chemotherapy are the worst ones for breast cancer patients. The course of fatigue is significantly related to the type of chemotherapy. Knowing these effects patients can better prepare oneself and their daily living for the time of adjuvant chemotherapy.