The Effect of Different Nutritional Nursing Support on the Nutritional Status and Disease Recovery of Elderly Patients with Gastrointestinal Tumors during the Perioperative Period.

Objective: This study explored the effect of different nutritional nursing support on nutritional status, immune function, postoperative bowel motility, and complications in elderly patients with gastrointestinal tumors during the perioperative period. Methods: 300 patients with gastrointestinal tumors treated in the Department of Gastroenterology and anorectal surgery of Hangzhou First People's Hospital Affiliated with the Medical College of Zhejiang University from February 2018 to March 2020 were selected as the research objects in this study. Patients were divided into the early enteral nutrition (EEN) and total parenteral nutrition (TPN) groups (150 cases in each group) according to the principle of odd and even admission numbers. The patients in the EEN and TPN groups were given enteral nutrition nursing support and parenteral nutrition nursing support, respectively. The nutritional status, immune function, postoperative bowel motility, and complication rate of the two groups were evaluated 7 days after the operation. Results: The nutritional indexes decreased 3 days after the operation and gradually recovered 7 days after the operation in both groups with different nutritional nursing support. The Hb, TRF, PAB, and ALB indexes in the TPN group were significantly lower than those in the EEN group (P < 0.01). On the 7th day after the operation, the indexes of peripheral blood immunoglobulin (IgG, IgM, and IgA) were significantly lower than those in the TPN group, and T lymphocyte subsets (CD4, CD8, and CD4/CD8) demonstrated that the immunological indexes of patients in the EEN group were significantly higher than those in the TPN group (P < 0.01). In terms of intestinal peristalsis, the time of first exhaust and first defecation in the EEN group was significantly shorter than that in the TPN group (P < 0.01) during the perioperative period. Furthermore, both groups had different degrees of complications, while patients demonstrated a lower complication rate in the EEN group compared to those in the TPN group, suggesting a safer postoperative mode. The results of subgroup analysis showed that the nutritional indexes of the gastric cancer group 7 days after operation were significantly higher than those of the colorectal cancer group under EEN and TPN nutritional support modes. Conclusion: Clinical results have suggested that enteral nutrition nursing support can improve the perioperative nutritional status of elderly patients with gastrointestinal tumors by enhancing the immune function and promoting intestinal peristalsis. Meanwhile, the postoperative EEN mode reduces the rate of complications and demonstrates higher safety. Therefore, it has a high clinical application value.

Health-Related Quality of Life (HRQOL) of Gastrointestinal Cancer Caregivers: The Impact of Caregiving

Objective: This study examined the quality of life (QOL) of caregivers for gastrointestinal (GI) cancer patients, and associated factors. Methods: A cross-sectional study was conducted at three referral hospitals in Klang Valley, Malaysia. A total of 323 pairs of patients and caregivers from the oncology units of these hospitals completed questionnaires in Malay. The QOL of caregivers was measured using The Malay Caregiver Quality of Life questionnaire. The independent variables were caregiver and patient factors, care-related factors, the Caregiver Strain Index-Malay, and the Multidimensional Scale of Perceived Social Support-Malay. Simple and multiple linear regression analyses were performed to determine the factors associated with the QOL. Variables with p < 0.05 were considered significant in the multiple analyses. Results: Female caregivers were 68.1% of the total, and 46.4% caregivers were spouses to cancer patients. Their mean age was 44.50 (13.29) years old. About 51.7% were of Malay ethnicity. The mean score for QOL was 80.17 (21.58). Being a male caregiver (beta = 5.165, p = 0.011) and of Indian ethnicity (beta = -9.163, p = 0.001) were strongly associated with caregiver QOL. Male patients contributed higher QOL scores for the caregivers compared to female patients. There was an inverse relationship among caregiving strain, duration of caregiving, and caregiver QOL. Conclusion: The identification of factors that affect QOL will allow healthcare providers to develop appropriate interventions. It is important that caregivers be in good health so as not to compromise the care they provide to their patients.

Multidisciplinary Cancer Care Model: A Positive Association Between Oncology Nurse Navigation and Improved Outcomes for Patients With Cancer.

BACKGROUND: Patients with cancer often experience prominent deficiencies in cancer care in the immediate period following initial cancer diagnosis. OBJECTIVES: This article aims to determine whether the inclusion of a gastrointestinal (GI) oncology nurse navigator (ONN) on the multidisciplinary cancer care team is associated with improved quality of care for patients. METHODS: This retrospective study compared randomly selected patients with GI cancer with and without an ONN. Two endpoints, the time from diagnosis to treatment and the average number of missed appointments, were evaluated through a review of healthcare records using the Epic electronic health records system. FINDINGS: Patients with an ONN had a shorter time lapse between diagnosis and treatment commencement (p < 0.001). In this group, the average time spent between initial diagnosis and the start of treatment was 15.15 days, compared to 42.93 days for patients who were not part of the multidisciplinary cancer care model.

Is early integration of palliative care feasible and acceptable for advanced respiratory and gastrointestinal cancer patients? A phase 2 mixed-methods study.

BACKGROUND: There is evidence that early integration of palliative care improves quality of life, lowers spending and helps clarify preferences and goals for advanced cancer patients. Little is known about the feasibility and acceptability of early integration. AIM: Assessing feasibility of early integration of palliative care, and exploring concerns perceived and problems encountered by patients, relatives and oncologists. DESIGN: A phase 2 mixed-methods study ( ClinicalTrials.Gov :NCT02078700). METHODS: Oncologists of two outpatient clinics offered a specialised palliative care intervention integrated with standard oncological care to all consecutive newly diagnosed metastatic respiratory/gastrointestinal cancer patients. We interviewed samples of patients, relatives and oncologists to explore strengths and weaknesses of the intervention. RESULTS: The intervention was proposed to 44/54 eligible patients (81.5%), 40 (90.1%) accepted, 38 (95.0%) attended the first palliative care visit. The intervention was completed for 32 patients (80.0%). It did not start for three (7.5%) and was interrupted for three patients who refused (7.5%). The Palliative Care Unit performed 274 visits in 38 patients (median per patient 4.5), and 24 family meetings with relatives of 16 patients. All patients and most relatives referred to the usefulness of the intervention, specifically for symptoms management, information and support to strategies for coping. Oncologists highlighted their difficulties in informing patients on palliative intervention, sharing information and coordinating patient's care with the palliative care team. CONCLUSION: Early integration of palliative care in oncological setting seems feasible and well accepted by patients, relatives and, to a lesser extent, oncologists. Some difficulties emerged concerning patient information and inter-professional communication.

Attitudes Among Nurses Toward the Integration of Complementary Medicine Into Supportive Cancer Care.

PURPOSE/OBJECTIVES: To explore the attitudes of nurses treating patients with cancer regarding the use of complementary and integrative medicine (CIM) therapies to reduce symptoms and improve quality of life (QOL). 
. DESIGN: Prospective and descriptive.
 
. SETTING: 12 hospital and community care settings in Israel. 
. SAMPLE: 973 nurses working in oncology and non-oncology departments.
. METHODS: A 26-item questionnaire was administered to a convenience sample of nurses treating patients with cancer. 
. MAIN RESEARCH VARIABLES: Interest in CIM integration and training in supportive cancer care.
. FINDINGS: Of the 973 nurses who completed the questionnaire, 934 expressed interest in integrating CIM into supportive cancer care. A logistic regression model indicated that nurses with a greater interest in integration tended to be older, believed that CIM improved patients' QOL, and had no structured postgraduate oncology training. Nurses who believed CIM to be beneficial for QOL-related outcomes were more likely to express interest in related training. The goals of such training include improving QOL-related outcomes, such as anxiety, insomnia, gastrointestinal symptoms, and pain. 
. CONCLUSIONS: Most nurses working with patients with cancer are interested in the integration of CIM into supportive cancer care. 
. IMPLICATIONS FOR NURSING: Most nurses would like to undergo training in CIM to supplement conventional care. CIM-trained integrative nurses can help promote the integration of patient-centered CIM therapies in supportive cancer care settings.

Gastrointestinal Cancers: Screening and Early Detection.

OBJECTIVE: To present an overview of current practices in the screening and early detection of gastrointestinal cancers. DATA SOURCES: Literature reviews. CONCLUSION: Screening for gastrointestinal cancers is less than desirable, particularly in underserved populations. There are inadequate methods of screening for early detection of esophageal and gastric cancers. IMPLICATIONS FOR NURSING PRACTICE: Education of patients is needed to reinforce the importance of screening for gastrointestinal cancers.

Distress is Interdependent in Patients and Caregivers with Newly Diagnosed Incurable Cancers.

BACKGROUND: Individuals with advanced, incurable cancer often experience high physical and psychological symptom burden. Family and friend caregivers are at risk for emotional distress. PURPOSE: The aim of the study is to investigate the interrelationship of distress in patient-caregiver dyads at the time of newly diagnosed incurable cancer. METHODS: From May 2011 to July 2015, within 8 weeks of diagnosis of advanced lung or noncolorectal gastrointestinal cancer, 350 patients and 275 family caregivers were enrolled in a randomized controlled trial of early palliative care. Actor-partner interdependence modeling was used to examine relationships between dyad's self-reported anxiety and depressive symptoms on the Hospital Anxiety and Depression Scale at baseline. RESULTS: Comparing patients with caregivers, patients reported more depressive symptoms (M diff = .84; t[274] = 3.17, p = .002, d = .22) and caregivers reported more anxiety symptoms (M diff =1.62, t[274] = 4.91, p < .001, d = .39). Dyads' anxiety symptoms were positively associated, as were depressive symptoms (rs = .21, ps ≤ .001). Actor-partner interdependence modeling showed that patients' anxiety symptoms were positively associated with their own depressive symptoms, with an equal effect for caregivers (actor effect ßs = 0.52, ps < .001). Patients' own anxiety was concurrently positively associated with their caregivers' depressive symptoms, with an equal effect for caregivers to patients (partner effect ßs=0.08, ps=.008). CONCLUSIONS: In the context of newly diagnosed incurable cancer, caregivers experience more pronounced anxiety, while patients report greater depressive symptoms. Findings indicate that anxiety and depressive symptoms are interrelated among dyads facing newly diagnosed incurable disease. Results emphasize the importance of addressing distress in both patients and caregivers. Future research should discern when dyadic versus individual psychosocial interventions would be optimal. TRIAL REGISTRATION NUMBER: The trial was registered with the ClinicalTrials.gov database (NCT02349412) https://clinicaltrials.gov/ct2/show/NCT02349412 .

Applying the Chronic Care Model to Support Ostomy Self-Management: Implications for Oncology Nursing Practice.

BACKGROUND: Living with an ostomy requires daily site and equipment care, lifestyle changes, emotional management, and social role adjustments. The Chronic Care Ostomy Self-Management Training Program (CCOSMTP) offers an ostomy self-management curriculum, emphasizing problem solving, self-efficacy, cognitive reframing, and goal setting. OBJECTIVES: The qualitative method of content analysis was employed to categorize self-reported goals of ostomates identified during a nurse-led feasibility trial testing the CCOSMTP. METHODS: Thirty-eight ostomates identified goals at three CCOSMTP sessions. The goals were classified according to the City of Hope Health-Related Qualify of Life Model, a validated multidimensional framework, describing physical, psychological, social, and spiritual ostomy-related effects. Nurse experts coded the goals independently and then collaborated to reach 100% consensus on the goals' classification. FINDINGS: A total of 118 goals were identified by 38 participants. Eighty-seven goals were physical, related to the care of the skin, placement of the pouch or bag, and management of leaks; 26 were social goals, which addressed engagement in social or recreational roles and daily activities; and 5 were psychological goals, which were related to confidence and controlling negative thinking. Although the goals of survivors of cancer with an ostomy are variable, physical goals are most common in self-management training.

Novel intervention with acupuncture for anorexia and cachexia in patients with gastrointestinal tract cancers: a feasibility study.

PURPOSE/OBJECTIVES: To investigate the feasibility of using acupuncture as a complementary intervention to existing treatments and to evaluate the efficacy of acupuncture in improving appetite and slowing weight loss with patients with gastrointestinal (GI) tract cancers. 
 DESIGN: One-group pre- and postintervention feasibility study. 
 SETTING: Outpatient clinic for patients with cancer and a community setting, both in Florida. 
 SAMPLE: A convenience sample of seven adults with GI cancer.
 METHODS: Eight acupuncture sessions were provided during eight weeks. Data were collected using the visual analog scale (VAS) for appetite, Simplified Nutritional Appetite Questionnaire (SNAQ), Karnofsky Performance Status, and bioelectrical impedance analysis. 
 MAIN RESEARCH VARIABLES: Appetite, weight, attrition rate.
 FINDINGS: Seven patients with a mean age of 61 years completed the intervention. Acupuncture was well accepted, feasible, and safe without any reported side effects. Appetite showed improvement, with an average score of 3.04 on the VAS and 4.14 on SNAQ compared to the preintervention scores. The average weight loss was 1.32% compared to the baseline during an eight-week period. 
 CONCLUSIONS: The acupuncture intervention was feasible and indicated positive outcomes. Because of the small sample size and lack of a control group, statistical significance of effectiveness was not determined. Acupuncture seemed to improve appetite and slow weight loss in patients with GI cancers, so additional studies with a larger sample size and a variety of cancers are warranted. 
 IMPLICATIONS FOR NURSING: Oncology nurses are uniquely able to equip patients with information about complementary therapy modalities, such as acupuncture, which is a promising way to improve appetite and slow weight loss in patients with GI cancers.


Understanding compassion literacy in nursing through a clinical compassion cafe.

This article presents a method of reconnecting and reaffirming with nurses the importance of compassion in health care by using a clinical compassion cafe, which describes nine steps that provide a forum to reaffirm clinicians' core values. This process has the potential to engage clinical staff in a different modality removed from the usual didactic approaches.

Gastrointestinal nurse navigation: implementation of a novel role.

Gastrointestinal (GI) cancer is the second most frequent cancer diagnosis in the United States, and the care for patients with GI cancer is multifaceted, with each clinical encounter impacting patients' overall experience. Patients and families often navigate this complicated journey on their own with limited resources and knowledge; therefore, innovative, patient-centered, and quality-focused programs must be developed. The purpose of this article is to discuss the development of GI nurse navigators (NNs) and the important role they have in providing coordinated evidence-based cancer care and in the benchmarking of quality metrics to allow more transparency and improve GI cancer care. This article provides a foundation for developing a GI NN role within the context of a newly developed multidisciplinary GI cancer program, and identifies the importance of tracking specific quality metrics. This innovative model is useful for healthcare organizations and nursing practice because it identifies the importance of a nurse in the navigator role, as well as highlights the numerous functions the NN can provide to the GI multidisciplinary team and patients.

Preventive effect of electrical acupoint stimulation on lower-limb thrombosis: a prospective study of elderly patients after malignant gastrointestinal tumor surgery.

BACKGROUND: Lower deep venous thrombosis (DVT) is one of the major complications of patients with tumors or patients undergoing major surgery. Electrical acupoint stimulation, an established technique of traditional Chinese medicine (TCM), can be well combined with Western medicine to reduce the incidence of postoperative DVT, especially in elderly patients. OBJECTIVE: The objectives of this study were to assess the efficiency of electrical acupoint stimulation in the prevention of postsurgery DVT in elderly patients with gastrointestinal malignant tumors and to validate an effective and safe nursing approach that integrates TCM and Western medicine. METHODS: A total of 120 patients (none aged <60 years) who underwent malignant gastrointestinal tumor surgery between July 2005 and May 2007 were randomly divided into 3 groups: routine nursing group (group C1), graduated compression stockings group (group C2), and electrical acupoint stimulation group (group T). Hemorheological parameters (blood viscosity, etc) were measured and compared before and after surgery. RESULTS: Compared with groups C1 and C2, group T showed a significant difference in blood viscosity and blood flow velocity (P < .05). However, there were no statistical differences among groups C1, C2, and T in other hemorheological parameters. CONCLUSIONS: By speeding up the blood flow in patients' lower limbs, electrical acupoint stimulation showed a great potential to prevent symptomless DVT in elderly patients after malignant gastrointestinal tumor surgery. IMPLICATIONS FOR PRACTICE: Western medical care combined with TCM can reduce the occurrence of lower DVT in elderly patients suffering from gastrointestinal cancer. This approach may help nurses to plan effective care for elderly patients.

Feasibility pilot on medication adherence and knowledge in ambulatory patients with gastrointestinal cancer.

PURPOSE/OBJECTIVES: To evaluate the feasibility of face-to-face education, a nurse-initiated telephone call, and patient use of medication diaries to support patients' self-reported medication adherence and knowledge of oral chemotherapy. DESIGN: Descriptive, feasibility pilot study. SETTING: An outpatient oncology unit at a National Cancer Institute-designated comprehensive cancer center. SAMPLE: 30 patients with gastrointestinal cancer who were prescribed at least one oral chemotherapy agent. METHODS: Participants received verbal and written education and a nurse-initiated educational telephone call within 72 hours of receiving education. Each was asked to complete a medication diary at home during the first cycle and the eight-item Morisky Medication Adherence Scale (MMAS-8) at the end of the first cycle of oral chemotherapy. MAIN RESEARCH VARIABLES: Verbal and written education, telephone contacts, drug diary, self-reported medication adherence, and patient knowledge. FINDINGS: Most patients (n = 29) received both verbal and written education, participated by telephone (n = 25), and completed the medication diaries (n = 21) correctly. Seventeen participants documented side effects within the first 72 hours of treatment initiation, with eight participants needing additional assistance with management of side effects. At the end of the first cycle of therapy, MMAS-8 adherence scores were high (X = 7.89, SD = 0.55). CONCLUSIONS: This study demonstrated the feasibility of a nurse-initiated educational and monitoring protocol for patients with gastrointestinal cancer receiving oral chemotherapy. In addition, the adapted MMAS-8 was a feasible adherence measure. IMPLICATIONS FOR NURSING: Pilot findings support targeted nurse interventions with face-to-face and telephone education to enhance self-monitoring and adherence for patients with gastrointestinal cancer receiving oral chemotherapy.

Marking time: the temporal experience of gastrointestinal cancer.

This study uses Heideggerian Phenomenology to explore the lived experience of gastrointestinal cancer and treatment with a curative intent. Eighteen patients and carers engaged in in-depth, conversational style interviews. Four recurring themes that spoke of the temporal significance of the cancer diagnosis included a recall of intricate details around significant dates; waiting; a changing pace of perceived time and being-towards-death. Fear and anxiety around cancer progression and recurrence underlie these themes. The meaning of time altered so that it was experienced as a precious commodity to be consciously managed in the context of their changed present and future. Being-towards-death was constituted of fear, but allowed the person to redefine meaning and purpose in their life. These insights will better prepare health professionals to guide discussions and provide perspective for the concerns of patients and families, particularly in relation to waiting times for tests and cancer interventions.

Update on the management of neuroendocrine tumors: focus on somatostatin antitumor effects.

Although neuroendocrine tumors (NETs) have been recognized as a family of complex malignancies since 1907, major progress has been made only in the past 20 years in understanding and managing the disease. The detection and reported incidence of NETs have increased fivefold since 1973, suggesting that the tumors may be more common than previously believed. NETs arise predominantly in the gastrointestinal tract but can occur in any tissue containing endocrine precursor cells and can secrete hormone peptides that exert clinical symptoms of flushing and diarrhea. With the introduction of the somatostatin analog (SSA) octreotide in 1987, symptom management of NETs improved by diminishing morbidities and mortality associated with carcinoid syndrome. Clinical results suggest that the SSA agents octreotide and lanreotide also may provide antitumor benefits in addition to their suppression of carcinoid syndrome. Oncology nurses should be aware of the expanded role of SSA agents for symptom management and tumor control in patients with NETs and communicate treatment benefits, side-effect management, and effective adherence with patients for the optimal clinical management of NETs.

Practical management of imatinib in gastrointestinal stromal tumors.

Gastrointestinal stromal tumors (GISTs) have an incidence of 7-15 occurrences per million people. Tyrosine kinase inhibitors (TKIs) have significantly improved clinical outcomes as part of multidisciplinary disease management. The authors will review developments in the management of GISTs, including diagnosis, risk stratification, prognosis, and treatment with imatinib. Imatinib is recommended for postsurgical adjuvant therapy and, where appropriate, neoadjuvant therapy. Clinical practice guidelines recommend first-line imatinib for metastatic and unresectable GISTs based on trials showing efficacy at the standard dose (400 mg per day) and at higher doses of 600-800 mg per day. Oncology nurses play a key role in patient management through (a) patient education about GISTs and their treatment including the use of imatinib, (b) timely scheduling of radiologic follow-up to assess treatment response, (c) monitoring treatment adherence, (d) helping to sustain imatinib dose intensity by monitoring toxicities and drug interactions and by counseling patients to prevent treatment interruptions, and (e) collaborating with the multidisciplinary medical team to pursue imatinib dose escalation or other treatment options if patients have primary or acquired mutation-based resistance to imatinib.

[Palliative care in gastroenterology: why do we need it and how do we qualify?]. / Gastroenterologische Palliativmedizin: Warum brauchen wir sie und wie qualifiziert man sich?

The rapid scientific progress in the past years has evoked debates about ethical limitations of technical innovations. Especially, high-end medicine for patients at the end of life gets in the focus of criticism whereas the idea of palliative care gains more importance. Gastroenterologists are an important partner in the setting of palliative care since many malignant tumors are found in the GI-tract; furthermore, about 80 % of all patients with advanced progressive illnesses being in a palliative care situation suffer from gastrointestinal symptoms. Vice versa the importance of palliative care in gastroenterology is indisputable - in case of an unfavourable prognosis the patients may be accompanied until death. A return to the core values of medical competence is essential. In this paper, the curriculum of "palliative care" in Germany shall be introduced. The aim of this work is to explain why it is worthwhile for physicians and especially for gastroenterologists to be trained in palliative care.

The effect of home healthcare on quality of life in patients diagnosed with gastrointestinal cancer.

This study was undertaken to determine the effect of home healthcare on the quality of life (QOL) in patients diagnosed with gastrointestinal cancer. A total of 42 patients, who met eligibility criteria, were enrolled in the study and randomly assigned to either a control group or an experimental group. Control group patients received "usual care" defined as pain control and management through the pain clinic. Experimental group patients received pain control through the clinic plus three home visits. During the home visits, their nursing care was guided by an evidence-based protocol developed by the research team. Data were collected on pain, performance, symptoms, and QOL by using previously developed and validated instruments.Significant differences were found between the two groups on physiological function, psychological concerns, and total stress. In the experimental group, there was a significant decrease in pain and increase in performance from baseline to the final data collection period. For the control group, a significant decrease in QOL over the study period was observed. There were no significant differences between the two groups on pain, performance, QOL, and QOL subscales at the final visit.

The effectiveness of nursing education as an intervention to decrease fatigue in Turkish patients receiving chemotherapy.

PURPOSE/OBJECTIVES: To determine whether a nurse-led educational intervention decreased the perception of fatigue in patients diagnosed with gastrointestinal (GI) cancers (colon, stomach, liver, rectum, pancreas) who were receiving chemotherapy for the first time. DESIGN: Quasi-experimental, descriptive. SETTING: Outpatient department in a large university hospital in Izmir, Turkey. SAMPLE: 35 patients receiving chemotherapy for GI cancers. METHODS: Baseline demographic data were collected using a personal information form developed by the researchers. Fatigue and quality of life (QOL) were then assessed using the Brief Fatigue Inventory, the Piper Fatigue Scale, and the European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ C-30) scale before their first cycle of chemotherapy, on the 10th day after (T1), and again 10 days after the second cycle of chemotherapy (T2). Patients received an individual educational intervention at baseline, T1, and T2 based on the results of their fatigue assessment in accordance with the National Comprehensive Cancer Network (NCCN) cancer-related fatigue guidelines. Patients were given an educational booklet on fatigue prior to treatment and symptom specific booklets as required at T1 and T2. MAIN RESEARCH VARIABLES: Subjective reports of patients' fatigue and QOL. FINDINGS: Patients' mean fatigue scores showed a statistically significant decrease and their EORTC QLQC-30 scores were better at T1 and T2 compared with baseline. CONCLUSIONS: Nurse-led educational interventions have the potential to reduce fatigue in patients with GI cancer receiving chemotherapy for the first time. IMPLICATIONS FOR NURSING: The administration of chemotherapy should be preceded by a formal fatigue assessment and the provision of individually tailored educational interventions to reduce the severity of fatigue and improve QOL.