Enhancing Mobility and Well-Being in Older Adults with Cancer.

OBJECTIVE: To analyze mobility challenges in older adult with cancer. METHODS: Data from previous literature was extracted and analyzed pertaining to the topic of interest. RESULTS: Mobility issues for the older adult with cancer are multi-factorial and are impacted by age-related changes, comorbidities, cancer itself, and cancer treatment. CONCLUSIONS: Proven benefits have been suggested with mobility assessments, exercise and dietary interventions, and cancer rehabilitation programs however further research is needed to define integration and utilization of programs, facilitation of cancer survivors returning to work, inclusion of socially disadvantaged patients, program compliance, economic aspects, and caregiver involvement to improve quality of life across the cancer continuum. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are in a key role to impact the care of the older adult with cancer with mobility through patient assessment of mobility function, facilitation of patient referrals for supportive services and cancer rehabilitation and execution of nurse-led intervention programs.

Care Processes and Quality-of-Life Outcomes Affecting the Gynecologic Cancer Survivorship Experience.

PURPOSE: To describe and assess physical and psychosocial concerns and care processes related to cancer and treatment in gynecologic cancer survivors. PARTICIPANTS & SETTING: 44 survivors of gynecologic cancer at City of Hope National Medical Center in southern California were enrolled. METHODOLOGIC APPROACH: A descriptive mixed-methods approach was used. Data were collected on survivorship care plan implementation, supportive care referrals, and barriers to receiving care. Participants completed questionnaires assessing quality of life, unmet needs, and other outcomes at three, six, and nine months after enrollment. Changes over time were analyzed, and quantitative and qualitative results were compared. FINDINGS: The most common unmet needs were stress reduction, side effect management, fear of cancer recurrence (FCR), and perception of adequate communication among the care team. Qualitative themes centered around communication, care coordination, FCR, financial distress, and need for information about peer support and healthy lifestyles. IMPLICATIONS FOR NURSING: Nurses play a key role in coordinating care, assessing symptoms, and addressing psychosocial concerns. Providing education and coaching can reduce stress and facilitate survivors' self-management and self-efficacy.

Nursing Considerations for Androgen Deprivation Therapy and Bone Health in Men Affected by Prostate Cancer.

OBJECTIVE: This article reviews the effects of androgen deprivation therapy on bone health and loss of bone mineral density and its effects on risk of fractures for men with prostate cancer, as well as describes the assessment, management, and nursing strategies for patient and caregiver education, prevention strategies, and side effect management. DATA SOURCES: Peer-reviewed articles formed the basis of this article. CONCLUSION: Androgen deprivation therapy has a deleterious effect on bone health, causing loss of bone mineral density and increasing the risk of fractures. The significant decrease in bone mineral density and fractures in elderly men can lead to morbidity, mortality, and poor quality of life. Bone mineral density assessment prior to initiating androgen deprivation therapy should be performed to identify bone issues prior to initiating therapy and to ensure that preventive bone health management strategies are executed. IMPLICATIONS FOR NURSING PRACTICE: Awareness of bone loss factors for men treated with androgen deprivation therapy is important in caring for patients undergoing treatment for prostate cancer. Bone fractures can have a significant impact on activities of daily living and diminish quality of life. Oncology nurses can play a key role in patient and caregiver education regarding the importance of bone health management strategies and the assessment of patient-related risk factors that may limit adherence to treatment recommendations.

Clinical Updates in Nausea and Vomiting.

OBJECTIVE: To review recent updated antiemetic guidelines from national cancer organizations and its impact on chemotherapy-induced nausea and vomiting (CINV) in the prevention and delayed phase of therapy. This article will also describe assessment and nursing strategies for individualized care and timely side effect management. DATA SOURCES: Data sources include peer-reviewed articles sourced in electronic databases. CONCLUSION: CINV is a persistent problem for a large percentage of patients undergoing chemotherapy treatment despite advances in antiemetic therapy and increased use of targeted therapies. CINV management should be based on patient-focused assessment and adherence to national antiemetic guidelines. Ongoing assessment and follow-up are critical to ensure optimum management of side effects to optimized quality of life. IMPLICATIONS FOR NURSING PRACTICE: Awareness of national antiemetic guidelines is important in caring for patients undergoing chemotherapy. CINV can have a significant impact on patients, causing physical effects, treatment delays, and diminished quality of life. Oncology nurses play a key role in assessment of patient-related risk factors, education of patients and caregivers regarding pain medications, side effects, and oral adherence and continued follow-up for early recognition and intervention for uncontrolled CINV.

Androgen receptor inhibitor treatments: Cardiovascular adverse events and comorbidity considerations in patients with non-metastatic prostate cancer.

OBJECTIVES: Prostate cancer and cardiovascular (CV) disease share several risk factors, with the incidence of both rising with increasing age. Systemic prostate cancer therapies may increase CV risk. For example, gonadotropic releasing hormone agonists have been associated with increased development of CV risk factors, and potentially with CV disease. For men with non-metastatic castration-resistant prostate cancer (nmCRPC), the opportunity to mitigate CV risk by appropriate selection of therapy (i.e., use of newer agents such as androgen receptor inhibitors) may be possible. The phase 3 PROSPER, SPARTAN, and ARAMIS trials for enzalutamide, apalutamide, and darolutamide, the 3 approved androgen receptor inhibitors for men with nmCRPC, were all associated with increased metastasis-free survival in patients with metastatic castration-resistant prostate cancer (mCRPC). Our objective in writing this review is to improve awareness of the relationship between long-term androgen deprivation and increased risk for CV disease and inform treatment decision making for patients with mCRPC who also have CV comorbidities. METHODS: The PubMed database was searched from 2010 to November 5, 2019 for articles pertaining to androgen receptor inhibitors, androgen inhibition, apalutamide, darolutamide, enzalutamide, CV, and CaP. RESULTS: We found literature describing the relationship between androgen inhibition and CV disease and risks. Given the increased risk of CV disease due to exposure to gonadotropic releasing hormone agonist therapy alone, understanding the potential for additional CV risks is important for patients with CV comorbidities when an androgen receptor inhibitor is added to their treatment. Another important consideration is the possibility of drug-drug interactions with comedications. CONCLUSION: Management strategies for patients with mCRPC also treated for comorbidities including CV disease require appropriate selection of therapy, diet, and exercise to meet the needs of the individual patient profile.

Bone health effects of androgen-deprivation therapy and androgen receptor inhibitors in patients with nonmetastatic castration-resistant prostate cancer.

BACKGROUND: Osteoporosis is a skeletal disorder characterized by compromised bone strength, resulting in increased fracture risk. Patients with prostate cancer may have multiple risk factors contributing to bone fragility: advanced age, hypogonadism, and long-term use of androgen-deprivation therapy. Despite absence of metastatic disease, patients with nonmetastatic castrate-resistant prostate cancer receiving newer androgen receptor inhibitors can experience decreased bone mineral density. A systematic approach to bone health care has been hampered by a simplistic view that does not account for heterogeneity among prostate cancer patients or treatments they receive. This review aims to raise awareness in oncology and urology communities regarding the complexity of bone health, and to provide a framework for management strategies for patients with nonmetastatic castrate-resistant prostate cancer receiving androgen receptor inhibitor treatment. METHODS: We searched peer-reviewed literature on the PubMed database using key words "androgen-deprivation therapy," "androgen receptor inhibitors," "bone," "bone complications," and "nonmetastatic prostate cancer" from 2000 to present. RESULTS: We discuss how androgen inhibition affects bone health in patients with nonmetastatic castrate-resistant prostate cancer. We present data from phase 3 trials on the three approved androgen receptor inhibitors with regard to effects on bone. Finally, we present management strategies for maintenance of bone health. CONCLUSIONS: In patients with nonmetastatic castrate-resistant prostate cancer, aging, and antiandrogen therapy contribute to bone fragility. Newer androgen receptor inhibitors were associated with falls or fractures in a small subset of patients. Management guidelines include regular assessment of bone density, nutritional guidance, and use of antiresorptive bone health agents when warranted.

A nurse-led intervention for fear of cancer progression in advanced cancer: A pilot feasibility study.

PURPOSE: To assess the feasibility, acceptability, and preliminary effects of a nurse-led intervention for managing fear of cancer progression in advanced cancer patients. METHODS: A single group mixed methods study was conducted in patients with stage III or IV gynecologic or lung cancer (n = 31) with dysfunctional levels of fear of progression or distress. The intervention consisted of seven videoconferencing sessions with skills practice. Feasibility measures included enrollment rate, attendance, attrition, and home practice adherence. Acceptability was based on exit interview responses. Content analysis was used to analyze the qualitative data. Participants completed quantitative questionnaires assessing fear of progression and secondary outcomes at baseline, eight, and 12 weeks. Linear mixed model analysis was used to assess changes in outcome measures. RESULTS: The average enrollment rate was seven participants/month over 4.5 months. Participants attended a mean of 5.3 of seven sessions. Attrition rate was 30%. The analysis showed improvements over time in fear of progression and exploratory outcomes. Participants reported feeling calmer and more focused. The skills practice helped to manage anxiety and fears. Themes included: Struggling with fears, Refocusing the fears, and Realizing/reaffirming what is important in life. The most beneficial components included the values clarification exercise, detached mindfulness and worry postponement practices. CONCLUSION: The intervention was acceptable; most feasibility criteria were met. Preliminary data suggest that the intervention reduced fear of progression and improved secondary outcomes. The intervention required a significant time commitment by participants, which may have contributed to increased attrition. To decrease burden, we will shorten the intervention.

Quality of Life and Supportive Care Needs of Gynecologic Cancer Survivors.

Gynecologic cancer survivors experience significant distress that can impact quality of life (QOL). Optimal survivorship care requires an understanding of the survivor's QOL and supportive care needs. The purpose of this study was to describe the QOL and needs of gynecologic cancer survivors. Women with an initial diagnosis of gynecologic cancer within 7 months of completing primary treatment (N = 34) completed the QOL-Cancer Survivor tool and the Cancer Survivors' Unmet Needs Survey. Fear of cancer recurrence was a repetitive theme for both tools. The lowest ranking QOL items were distress from diagnosis and treatment, family distress, and uncertainty about the future. Commonly reported needs included help to reduce stress, manage side effects, cope with fears of cancer recurrence, and gain reassurance that providers were communicating, and providing the very best medical care. Appreciating QOL and needs can facilitate the development of support services specifically tailored to gynecologic survivors.

Cancer Pain Management Considerations in Older Adults.

OBJECTIVE: To address the pharmacokinetics and pharmacodynamics of aging and its impact on the complexities of pain management in older adults with cancer. To describe assessment and nursing strategies for individualized care and side effect management DATA SOURCES: Peer-reviewed articles. CONCLUSION: Cancer pain is a complex problem in older adults because of the variations in aging and alterations in pharmacokinetics and pharmacodynamics. Pain management must be based on thorough assessment, incorporating the unique factors of each patient. Ongoing follow-up is critical to ensure adequate pain control with optimization of functional status. IMPLICATIONS FOR NURSING PRACTICE: Awareness of physiological changes of aging is important in caring for older adults. Oncology nurses can play a key role in the assessment of older adults with cancer and education of patients and caregivers regarding pain medications, side-effects, and oral adherence.

Older Adults With Lung Cancer: Assessment, Treatment Options, Survivorship Issues, and Palliative Care Strategies.

BACKGROUND: Treatment advances offer options for cancer treatment in older adults that are less invasive and have fewer side effects. Geriatric assessment is a key component of treatment planning to identify functional and physiologic status and is the basis of decision making. OBJECTIVES: This article discusses the role of geriatric assessment, treatment options (e.g., surgical, chemotherapy, radiation therapy), survivorship issues, and palliative care strategies for older adults with cancer. METHODS: Literature was reviewed to identify geriatric assessment implications, current treatment strategies, and survivorship and palliative care interventions for older adults with cancer based on a case study approach. FINDINGS: Geriatric assessment is key to identifying deficits and disabilities in older adults with cancer and is a critical component in oncology treatment planning. Evidence-based, less invasive treatment options are available and offer older adults more tolerable oncologic therapies.

Frailty in Older Adults: Assessment, Support, and Treatment Implications in Patients With Cancer

BACKGROUND: Frailty is defined as a disability in those of advanced age, often with comorbidities, poor nutritional status, cognitive decline, and reduced functional status. OBJECTIVES: The purpose of this article is to discuss the concept of frailty, assess the use of a comprehensive geriatric assessment (CGA), and understand the implications for treatment to maintain or enhance physical, functional, and cognitive health of older adult patients with cancer. METHODS: Literature about frailty in older adult patients diagnosed with cancer was reviewed to determine evidence-based assessment and treatment options. FINDINGS: About half of all older adult patients with cancer experience some degree of frailty. CGA is a useful way to evaluate frailty and the extent of limitations. Many frailty-specific tools have been developed. Evidence-based strategies are available to address limitations associated with frailty in older adult patients with cancer.

Establishing an Advanced Practice Nursing Clinic in the Cancer Setting.

OBJECTIVES: To explore the roles of the Advanced Practice Nurse (APN), specifically the Nurse Practitioner (NP) in oncology and the issues, resources, and planning involved in establishing an NP clinic in the cancer setting. DATA SOURCES: Published peer reviewed literature, web-based resources, and cancer-related professional resources. CONCLUSION: The number of cancer patients is increasing and demands for oncology services are rising. With a shortage of oncologists projected over the next decade, the oncology NP can play a key role in providing oncology services across the cancer continuum. IMPLICATIONS FOR NURSING PRACTICE: Oncology APNs in the role of Nurse Practitioner (NP) can facilitate and enhance the delivery of oncology care. Traditional and innovative opportunities exist for the NP including the establishment of a NP clinic in the cancer setting; ultimately providing needed oncology services and quality care for patients with cancer.

Case Study Research Methodology in Nursing Research.

Through data collection methods using a holistic approach that focuses on variables in a natural setting, qualitative research methods seek to understand participants' perceptions and interpretations. Common qualitative research methods include ethnography, phenomenology, grounded theory, and historic research. Another type of methodology that has a similar qualitative approach is case study research, which seeks to understand a phenomenon or case from multiple perspectives within a given real-world context.

Cultural Competency in Nursing Research.

According to data from the U.S. Census Bureau (2010), the demographics of the United States will change dramatically in the next 50 years. Non-Caucasians will more than double from 116.2 million in 2012 to 241.3 million by 2060, representing 57% of the U.S. population (U.S. Census Bureau, 2010). The Asian population also is expected to double in the next five years and comprise 8% of the U.S. population (U.S. Census Bureau, 2012). The United States also is becoming an aging population. By 2060, about one in five residents will be aged 65 years and older (U.S. Census Bureau, 2012). Individuals aged 85 years and older will more than triple to 18.2 million and represent 4% of the U.S. population (U.S. Census Bureau, 2012). 
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Conducting pilot and feasibility studies.

Planning a well-designed research study can be tedious and laborious work. However, this process is critical and ultimately can produce valid, reliable study findings. Designing a large-scale randomized, controlled trial (RCT)-the gold standard in quantitative research-can be even more challenging. Even the most well-planned study potentially can result in issues with research procedures and design, such as recruitment, retention, or methodology. One strategy that may facilitate sound study design is the completion of a pilot or feasibility study prior to the initiation of a larger-scale trial. This article will discuss pilot and feasibility studies, their advantages and disadvantages, and implications for oncology nursing research. 
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Update on research-based interventions for anxiety in patients with cancer.

Anxiety may begin at the moment a person is diagnosed with cancer and may fluctuate throughout the cancer trajectory as physical illness improves or declines. The purpose of this article is to present current evidence for nurses to implement interventions to reduce anxiety in patients who have cancer. The PubMed and CINAHL® databases were searched to identify relevant citations addressing interventions that treat or prevent anxiety symptoms in patients with cancer. Based on available evidence, the interventions addressed herein are categorized according to the Putting Evidence Into Practice (PEP®) rating schema. Interventions include pharmacologic and nonpharmacologic approaches to care, and meet criteria for three PEP categories: likely to be effective, effectiveness not established (the largest category of results), or effectiveness unlikely.

Using electronic surveys in nursing research.

Computer and Internet use in businesses and homes in the United States has dramatically increased since the early 1980s. In 2011, 76% of households reported having a computer, compared with only 8% in 1984 (File, 2013). A similar increase in Internet use has also been seen, with 72% of households reporting access of the Internet in 2011 compared with 18% in 1997 (File, 2013). This emerging trend in technology has prompted use of electronic surveys in the research community as an alternative to previous telephone and postal surveys. Electronic surveys can offer an efficient, cost-effective method for data collection; however, challenges exist. An awareness of the issues and strategies to optimize data collection using web-based surveys is critical when designing research studies. This column will discuss the different types and advantages and disadvantages of using electronic surveys in nursing research, as well as methods to optimize the quality and quantity of survey responses.

Computer-assisted qualitative data analysis software.

Advances in technology have provided new approaches for data collection methods and analysis for researchers. Data collection is no longer limited to paper-and-pencil format, and numerous methods are now available through Internet and electronic resources. With these techniques, researchers are not burdened with entering data manually and data analysis is facilitated by software programs. Quantitative research is supported by the use of computer software and provides ease in the management of large data sets and rapid analysis of numeric statistical methods. New technologies are emerging to support qualitative research with the availability of computer-assisted qualitative data analysis software (CAQDAS).CAQDAS will be presented with a discussion of advantages, limitations, controversial issues, and recommendations for this type of software use.