A fast transition: A case study of patients' experiences during the diagnostic and surgical treatment phase of an accelerated brain cancer pathway.

BACKGROUND: Patients receiving a brain cancer diagnosis may face cognitive decline and a poor prognosis. In addition, they suffer from a high symptom burden in a complex cancer pathway. The aim of this study was to investigate the early hospital experiences of brain tumour patients during the diagnostic and surgical treatment phase. METHODS: A descriptive longitudinal single-case study design was used, and data were analysed via systematic text condensation. RESULTS: The patients' experiences of being diagnosed with and treated for brain cancer were interpreted in terms of the central theme: a fast transition into an unknown journey. This theme consisted of the following subthemes: emotionally overwhelmed, putting life on hold and an unfamiliar dependency. CONCLUSIONS: Patients diagnosed with brain cancer struggle with overwhelming emotions due to this sudden life-threatening diagnosis, their fear of brain surgery and their progressing dependence. Patients did not voice their feelings, fears or needs, so these may easily be overlooked and unmet. A proactive and continuous care approach throughout the diagnostic phase is needed to support these patients.

Beyond loss: An essay about presence and sparkling moments based on observations from life coexisting with a person living with dementia.

This is an essay based on a story with observations, about present and sparkling moments from everyday life coexisting with a mother living with dementia. The story is used to begin philosophical underpinnings reflecting on 'how it could be otherwise'. Dementia deploys brutal existential experiences such as cognitive deterioration, decline in mental functioning and often hurtful social judgements. The person living with dementia goes through transformation and changes of self. Cognitive decline progressively disrupts the foundations upon which social connectedness is built, often creating a profound sense of insecurity. The challenge for carers and healthcare professionals is therefore to find ways of clarifying a concept of agency. It will be worthwhile developing the ability of attuning into 'what is there' arising from every corner of the care situation. Understanding and practicing this can strengthen existence and the experience of connectedness and meaning, empowering the person with dementia. It is important to find ways, relational moves, in which carers and healthcare professionals can embed the creativity appearing in mundane everyday situations filled with surplus of meaning, sharing mental landscapes (and embodied relational understanding) with the person living with dementia - seizing and sharing aesthetic moments (verbal and nonverbal) being present together. We argue that carers and healthcare professionals may find this understanding of care useful. This implies looking into a phenomenological-hermeneutic perspective developing competences as well as practical wisdom understanding and being aware of the creative and innovative possibilities (often preverbal and unnoticed small things) in everyday life of what we, inspired by psychoanalyst Daniel Stern, call sparkling moments of meeting, creating experience with the other that is personally undergone and lived through in the present.

Efficacy of open dialogue about complementary and alternative medicine compared with standard care in improving quality of life in patients undergoing conventional oncology treatment (CAMONCO 2): protocol for a randomised controlled trial.

INTRODUCTION: Complementary and alternative medicine (CAM) has been shown to reduce symptoms and adverse effects and improve quality of life of patients undergoing conventional oncology treatment, but CAM might also cause symptoms and adverse effects such as headache and fatigue. Thus, patients need guidance towards safe and healthy use of CAM. According to published results, open dialogue about CAM (OD-CAM) between health professionals and patients as an integral part of anticancer treatment may improve patients' quality of life and well-being. Since the literature on the issue is sparse, the aim of this study is to assess the efficacy of OD-CAM integrated early in conventional oncology treatment versus standard care (SC) in patients undergoing standard anticancer treatment. METHODS AND ANALYSIS: The study is a randomised controlled trial, being conducted at an oncology outpatient clinic in Denmark. 207 patients undergoing curative or palliative oncology treatment for breast, gynaecological, prostate, pulmonary, colorectal, anal or pancreatic cancer will be randomly assigned to SC with or without OD-CAM. A nurse specialist will facilitate the OD-CAM in one or two sessions. The primary endpoint is patient reported quality of life in relation to psychological well-being 8 weeks after enrollment. Secondary endpoints are patient reported level of depression and anxiety, top concerns, and decision regret 8, 12 and 24 weeks after enrolment, and overall survival. ETHICS AND DISSEMINATION: According to the Committee on Health Research Ethics for Southern Denmark, ethics approval of this study is not required (S-20202000-5, 20/1019). The Region of Southern Denmark (Journal no. 20/11100) approved the storing and handling of data. Participants' informed consent will be obtained before inclusion and randomisation. The results of the study, whether positive, negative or inconclusive, will be disseminated through open-access, peer-reviewed publications, stake-holder-reporting and presentations at relevant conferences. TRIAL REGISTRATION NUMBER: NCT04299451.

Impact of Open Dialogue about Complementary Alternative Medicine-A Phase II Randomized Controlled Trial.

Complementary alternative medicine (CAM) may reduce the symptom burden of side effects to antineoplastic treatment but also cause new side effects and non-adherence to conventional treatment. The aim of this RCT was to investigate the impact of open dialogue about complementary alternative medicine (OD-CAM) on cancer patients' safety, health and quality of life (QoL). Patients undergoing antineoplastic treatment were randomly assigned to standard care (SC) plus OD-CAM or SC alone. The primary endpoint was frequency of grade 3-4 adverse events (AE) eight weeks after enrollment. Secondary endpoints were frequency of grade 1-4 AE, QoL, psychological distress, perceived information, attitude towards and use of CAM 12 and 24 weeks after enrollment. Survival was analyzed post hoc. Fifty-seven patients were randomized to the OD-CAM group and fifty-five to the SC group. No significant difference in frequency of grade 3-4 AEs was shown. The same applied to grade 1-4 AEs and QoL, psychological distress and perceived information. A tendency towards better QoL, improved survival and a lower level of anxiety was found in the OD-CAM group. OD-CAM is not superior to SC in reducing the frequency of AEs in patients undergoing antineoplastic treatment. OD-CAM does not compromise patient safety; it may reduce psychological stress and improve QoL and overall survival.

Spouse Caregivers' Experiences of Suffering in Relation to Care for a Partner With Brain Tumor: A Qualitative Study.

BACKGROUND: Spouses often undertake the main caring role for a partner with primary malignant brain tumor (PMBT). Yet, demanding and challenging caring responsibilities especially because of the partner's cognitive declines can affect the spouse caregiver's well-being. OBJECTIVE: The aim of this study was to investigate spouses' experiences of suffering in their role as main caregiver of a partner with PMBT. METHODS: A hermeneutical qualitative design was used to collect and analyze data. Ten spouses (aged 36-76 years) were interviewed in depth twice 1 year apart, using semistructured interview guides. RESULTS: The spouse caregivers' experiences of suffering in their role as their partner's main caregiver were interpreted according to 3 central themes: "Enduring everyday life," "Being overlooked and hurt," and "Being acknowledged and feeling good." CONCLUSION: Spouse caregivers of a partner with PMBT are suffering from exhaustion and suppression of their own emotions to endure the caring responsibilities. They need support to manage their everyday hardship; however, their experiences seem to be easily overlooked. This causes disappointment and hurts their dignity. Acknowledgment through simple acts of practical help or time to talk are consoling and alleviate their experiences of suffering. IMPLICATIONS FOR PRACTICE: An intervention that supports healthcare professionals to facilitate the spouse caregivers' suffering is welcoming. The focus of the intervention may involve a sensitive awareness toward the spouse caregiver's individual resources and limitations and the relational and communicative competences of the healthcare professionals in their encounters with spouse caregivers that avoid hurting the spouse caregiver's dignity.

Existential phenomenology as a unifying philosophy of science for a mixed method study.

This article discusses how existential phenomenology may serve as a frame in a mixed-methods study of changes in weight and body composition among women in adjuvant treatment for breast cancer. In accordance with ontologically and epistemologically fundamental assumptions in nursing, we link mixed-methods and existential phenomenology from the perspective of the French philosopher Maurice Merleau-Ponty and his notion of a unified body subject. Letting this perspective permeate our philosophy, methodology and issues at the method level in mixed-method research undermines the distinction between first- and third-person perspective when applying and integrating different data sources in a mixed-methods study. Applying Merleau-Ponty's third way, the women's bodily experiences appear as gestalt; a 'figure' against a ground of existential threats that are grasped through insight from data integrating in joint displays, which revealed the women's experiences on a deep existential level. Existential phenomenology as a frame in mixed-method studies can speak not only to nurses but also to a multidisciplinary audience in a shared attempt to deepen the understanding of a patient's healthcare problem.

The position of home-care nursing in primary health care: A critical analysis of contemporary policy documents.

Internationally, primary health care has in recent years gained a more central position in political priorities to ensure sustainable health care for the population. Thus, more people receive health care locally and in their own homes, where home-care nursing plays a large role. In this article, we investigate how home-care nursing is articulated and made visible in contemporary Norwegian policy documents. The study is a Fairclough-inspired critical discourse analysis seeking to uncover the position of nursing in the prevailing political ideologies on current primary health care. In the documents, we identified several complementary and conflicting understandings about home-care nursing. Home-care nursing is presented as a basic part of a municipality's health services, but at the same time, its content and contribution are unclear and almost invisible. We argue that the absence of nursing leads to significant perspectives being left out and tie this to the fact that some patient groups and tasks seem to be disadvantaged. The political placement of home-care nursing in the health-care landscape is thus not just about nursing as a professional practice but also concerns fundamental care values in our society in relation to disadvantaged groups and work tasks.

Ethical dilemmas embedded in performing fieldwork with nurses in the ICU.

BACKGROUND: Background: In general, qualitative research design often involves merging together various data collection strategies, and researcher's may need to be prepared to spend longer periods in the field to pursue data collection opportunities that were not foreseen. Furthermore, nurse researchers performing qualitative research among patients and their relatives often experience unforeseen ethical dilemmas. AIM: This paper aimed to explore aspects of ethical dilemmas related to qualitative nursing research among patients and their relatives in the intensive care unit (ICU). RESEARCH DESIGN: This paper is based on a qualitative researcher's personal experience during a hermeneutic phenomenological study involving close observation and in-depth interviews with 11 intensive care nurses. Data were collected at two ICUs in two Norwegian university hospitals. ETHICAL CONSIDERATIONS: The study was approved by the Norwegian Social Science Data Services (NSD). The Regional Committee for Medical and Health Research Ethics (REK) granted dispensation to the project regarding health personnels confidentiality of the patients who were present during the observation (2012/622-4). FINDINGS: Close observation with nurses in the ICU requires the researcher to balance being a qualitative researcher, an ICU nurse and a sensitive fellow human being open to the suffering of the other-that is, being embodied, engaged and affected by sensitive situations and simultaneously constantly stepping back and reflecting on the meaning of those situations. CONCLUSIONS: The qualitative researcher's ethical awareness also entails knowing and acknowledging his or her own vulnerability, which becomes apparent in the researcher-participant relationship and settings in which being a fellow human always overrules the researcher's role in ethical dilemmas.

Home-care nurses' distinctive work: A discourse analysis of what takes precedence in changing healthcare services.

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients' homes. This greatly impacts nurses' work in home care, making their work increasingly diverse and demanding. In this study, we explore home-care nursing through a critical discourse analysis of focus group interviews with home-care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home-care nurses' work. Changes have made nurses' work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses' work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses' work to help shape the further development of home-care nursing.

Caring responsibility from the perspectives of older persons whose adult children are their caregivers.

AIM: To describe lifeworld insights into the phenomenon of caring responsibility from the perspectives of persons aged 80+ years living alone with chronic illness, physical frailty and dependency on adult children. DESIGN: A phenomenological inquiry inspired by Reflective Lifeworld Research. METHOD: Semi-structured lifeworld interviews with 11 persons aged 80+ years were conducted following their discharge. The interviews lasted 35-83 min, were audio-recorded and transcribed verbatim. Both interviews and the analysis followed the epistemological and methodological principles of Reflective Lifeworld Research. FINDINGS: We identified the essential meaning 'It means everything' and four constituents illuminating different aspects inherent in the complex phenomenon of caring responsibility; 'A life-constraining transition,' 'Trusting the children to fill the gaps and be the glue,' 'Tacit responsibility, agreement and acceptance' and 'Depending on the children and knowing they are burdened by you.' CONCLUSIONS: Caring responsibility is based on a trusting relationship and tacit agreements indicating an understanding of interdependence and acceptance of dependence on adult children. However, a paradox appears when older persons express a deep-rooted perception of autonomy and independence as they have difficulties with their growing dependency and feelings of being burdensome. Older persons try to balance the continuum of autonomy, their existential self-image and actual capability. The practical part of caring responsibility seems to dominate and strongly affect the parent-child relationship because the child needs to take care of practical issues related to healthcare management and instrumental activities of daily living, leaving less time for meaningful togetherness. IMPLICATIONS FOR PRACTICE: Older persons want their adult children to be involved and acknowledged when planning care and treatment because they often seem to serve as the 'glue' that makes it possible for the parent to remain in his/her own home.

Open dialogue about complementary and alternative medicine (CAM) integrated in conventional oncology care, characteristics and impact. A systematic review.

OBJECTIVE: To systematically review evidence on the characteristics, experiences and impact of an open dialogue about complementary and alternative medicine (CAM) integrated in oncology care. METHODS: We searched MEDLINE, EMBASE, AMED, Scopus, ProQuest Dissertations and Thesis, Cochrane Central Register, clinicaltrials.gov, forskningsdatabase.dk and PROSPERO. Two reviewers screened title, abstract and full-text articles. Each study was appraised using the Critical Appraisal Skills Programme (CASP) and synthesized narratively. PROSPERO registration CRD42019112242. RESULTS: We retrieved 4736 articles and included 5; 3 received 9 ½, 1 received 9, and 1 received 5 points on the CASP score. Predominately, the open dialogue was one or two individual, patient-centered, face-to-face consultations led by oncology physicians. In one study, it was a tele-phone consultation and in another it was structured counseling led by pharmacists. Integrated information and recommendations about CAM contributed to high level of satisfaction and improvement in concerns, quality of life and well-being. CONCLUSION: Integration of open dialogue about CAM in oncology care including acknowledging patients' preferences, values, wishes and knowledge, and providing information about CAM expands the opportunities for improving patients' health, quality of life and well-being. PRACTICE IMPLICATIONS: Open dialogue about CAM has potentials, but research on how it specifically helps patients, is needed.

A phenomenological-hermeneutic study exploring caring responsibility for a chronically ill, older parent with frailty.

Aim: To provide lifeworld insights into experiences of adult children with caring responsibility for an 80+-year-old chronically ill parent with frailty. Background: Informal care is common in Nordic welfare countries; however, little is known about adult children's experience of caring responsibility in this setting. Design: A phenomenological-hermeneutic study based on Reflective Lifeworld Research. Methods: Diaries and semi-structured interviews with 12 adult children. Results: Caring responsibility is identified as "a condition of life, filled with uncertainty." Three constituents contribute to this phenomenon: (a) balancing love, duty and reciprocity; (b) being the parent's advocate and manager; and (c) experiencing concerns and bodily strain. Conclusion: Adult children work hard to provide care and enhance the well-being of their parent. Heidegger's concept 'Fürsorge' may help us understand how by showing how caring responsibility means balancing different roles vis-à-vis the parent, one's own life and the health and social systems. Caring responsibility changes the relationship between parent and child.

Balancing contradictory requirements in homecare nursing-A discourse analysis.

Aim: To explore prevailing discourses on nursing competence in homecare nursing to boost understanding of practice within this field. Design: A qualitative study with a social constructivist perspective. Methods: Six focus-group interviews with homecare nurses in six different municipalities in Norway. Adapting a critical discourse analysis, data were linguistically, thematically and contextually analysed in the light of theories on competence, institutional logic and discourses. Results: The analysis found homecare nursing to be a diverse and contradictory practice with ever-increasing work tasks. Presented as binary oppositions, we identified the following prevailing discourses: individualized care versus organizing work; everyday-life care versus medical follow-up; and following rules versus using professional discretion. The binary oppositions represent contradictory requirements that homecare nurses strive to balance. The findings indicate that medical follow-up and organizational work have become more dominant in homecare nursing, leaving less time and attention paid to relational and everyday-life care.

Ethical dilemmas experienced by spouses of a partner with brain tumour.

BACKGROUND: Caring for a partner with primary malignant brain tumour can be a dramatic life-changing event. Primary malignant brain tumour is known to give poor life expectancy and severe neurological and cognitive symptoms, such as changed behaviour and personality, which demand greater caring responsibilities from spouses. AIM: The aim of the study is to explore ethical dilemmas spouses experience in the everyday care of a partner in treatment for primary malignant brain tumour. RESEARCH DESIGN, PARTICIPANTS AND RESEARCH CONTEXT: A phenomenological and hermeneutic qualitative descriptive design was adopted as a method for collecting and analysing data. Ten spouses were interviewed twice using an in-depth, semi-structured interview guide. The interviews took place at the spouses' homes or at the hospital. ETHICAL CONSIDERATION: Ethical matters were considered throughout the research process. Permission from The National Committee on Health Research Ethics and the Danish Data Protection Agency was obtained. FINDINGS: The analysis showed that the spouses perceived daily ethical dilemmas in caring for a partner with primary malignant brain tumour. Their life as well as their partner's life had changed considerably. The main theme that emerged therefore was 'oscillating in a changing relationship'. This theme was further elaborated in three subthemes that in more detail demonstrated the dilemmas: 'doing the right thing in unpredictable daily situations'; 'torn between patience and guilt'; and 'living in a time of uncertainty, hope and despair'. CONCLUSION: Caring for a partner with changed behaviour and personality due to primary malignant brain tumour may involve exhausting ethical caring dilemmas. Spouses' married life may change to a semi-professional asymmetrical relationship, which is challenged by the oscillation between acting responsibly for their partners' well-being and caring dilemmas with no answer for what the right thing to do is. Mixed feelings of right and wrong, patience and guilt, hope and despair seem to be spousal companions through their partners' progressing illness.

Investigating Changes in Weight and Body Composition Among Women in Adjuvant Treatment for Breast Cancer: A Scoping Review.

BACKGROUND: Despite several investigations, findings on weight changes during and after adjuvant treatment for breast cancer are diverse and point in several directions. OBJECTIVE: The aims of this study were to investigate changes in weight and body composition associated with contemporary anticancer medication and to examine factors that might influence the assessment and diversity of the findings. METHODS: This article used the method of a scoping review to map the body of literature. From searching the databases PubMed, CINAHL, and EMBASE using MeSH terms, CINAHL terms, and Emtree, as well as free text, 19 articles were selected for further investigation. RESULTS: The scoping review illustrates how findings in weight and body composition changes fluctuate over time as illustrated in 4 measure points: short term, 1 year, 18 months/2 years, and long term. The studies displayed differences regarding study designs, sample sizes, treatment regimens, measure points and techniques, and cutoff values for assessing weight changes, which make it difficult to synthesize findings and provide strong evidence for use in clinical practice. CONCLUSION: Synthesizing findings over time illustrates the need for attention on younger premenopausal women given chemotherapy. Weight need to be monitored for at least 2 years as short-term changes may be caused by increased body water, whereas long-term changes seem to be related with increased fat mass essential for risking recurrence and early death. IMPLICATIONS FOR PRACTICE: The diversity in methods discloses the need for the research community to reach consensus regarding study designs for future research in this area.

Patients' experiences and care needs during the diagnostic phase of an integrated brain cancer pathway: A case study.

AIMS AND OBJECTIVES: To identify and describe patients' experiences and care needs throughout the diagnostic phase of an integrated brain cancer pathway. BACKGROUND: A malignant brain tumour is a devastating diagnosis, which may cause psychical symptoms and cognitive deficits. Studies have shown that the shock of the diagnosis, combined with the multiple symptoms, affects patients' ability to understand information and express needs of care and support. Unmet needs have been reported within this group of patients; however, the experiences and care needs of patients going through the diagnostic phase of a standardised integrated brain cancer pathway have not previously been explored. DESIGN: A case study design was used to provide detailed information of the complex needs of patients being diagnosed with a malignant brain tumour. METHODS: Research interviews and direct participant observation of four patients during hospital admission, brain surgery and discharge were conducted in a Danish university hospital. Systematic text condensation was used to analyse the data material. RESULTS: Four major themes were identified: information needs, balancing hope and reality while trying to perceive the unknown reality of brain cancer, not knowing what to expect and participants' perceptions of the relationship with the healthcare providers. The analysis revealed that participants were in risk of having unmet information needs and that contextual factors seemed to cause fragmented care that led to feelings of uncertainty and loss of control. CONCLUSIONS: Brain tumour patients have complex care needs and experience a particular state of vulnerability during the diagnostic phase. Through personal relationships based on trust with skilled healthcare providers, participants experienced an existential recognition and alleviation of emotional distress. RELEVANCE TO CLINICAL PRACTICE: Patients receiving a brain tumour diagnosis experience unmet care needs in several areas during their hospital stay. There is a need for interventions from healthcare providers.

Theoretical development in the context of nursing-The hidden epistemology of nursing theory.

This article is about nursing theories, the development of nursing knowledge and the underlying, hidden epistemology. The current technical-economical rationality in society and health care calls for a specific kind of knowledge based on a traditional Western, Socratic view of science. This has an immense influence on the development of nursing knowledge. The purpose of the article was therefore to discuss the hidden epistemology of nursing knowledge and theories seen in a broad historical context and point to an alternative epistemology for a future context. It is a question about which nursing theories and what nursing knowledge should be developed in order to benefit patients and relatives of the future. We suggest that future knowledge development in nursing be developed in an interchange between theory and practice and guided by philosophy like a kind of pendulum where all three elements are treated as equals. We suggest a framework for the development of nursing knowledge based on a caring-ethical practice, a theory on life phenomena in suffering and relationship-based nursing, and thereby, we may be able to help patients to be cured, to recover, to be alleviated or comforted when suffering.

Assessing changes in a patient's condition - perspectives of intensive care nurses.

AIM: To explore the phenomenon of assessing changes in patients' conditions in intensive care units from the perspectives of experienced intensive care nurses. BACKGROUND: Providing safe care for patients in intensive care units requires an awareness and perception of the signs that indicate changes in a patient's condition. Nurses in intensive care units play an essential role in preventing the deterioration of a patient's condition and in improving patient outcomes. DESIGN AND METHODS: This hermeneutic phenomenological study conducted close observations and in-depth interviews with 11 intensive care nurses. The nurses' experience ranged from 7 to 28 years in the intensive care unit. Data were collected at two intensive care units in two Norwegian university hospitals. The analysis was performed using the reflective methods of van Manen. FINDINGS: An overarching theme of 'sensitive situational attention' was identified, in which the nurses were sensitive in relation to a patient and understood the significance of a given situation. This theme was further unfolded in four subthemes: (1) being sensitive and emotionally present, (2) being systematic and concentrating, (3) being physically close to the bedside and (4) being trained and familiar with the routines. CONCLUSIONS: Nurses understand each patient's situation and foresee clinical eventualities through a sensitive and attentive way of thinking and working. This requires nurses to be present at the bedside with both their senses (sight, hearing, smell and touch) and emotions and to work in a concentrated and systematic manner. Knowledge about the unique patient exists in interplay with past experiences and medical knowledge, which are essential for nurses to understand the situation. RELEVANCE TO CLINICAL PRACTICE: Clinical practice should develop routines that enable nurses to be present at the bedside and to work in a concentrated and systematic manner. Furthermore, providing safe care requires nurses to be sensitive and attentive to each patient's unique situation.

Understanding the Essential Meaning of Measured Changes in Weight and Body Composition Among Women During and After Adjuvant Treatment for Breast Cancer: A Mixed-Methods Study.

BACKGROUND: Changes in weight and body composition among women during and after adjuvant antineoplastic treatment for breast cancer may influence long-term survival and quality of life. Research on factual weight changes is diverse and contrasting, and their influence on women's perception of body and self seems to be insufficiently explored. OBJECTIVE: The aim of this study was to expand the understanding of the association between changes in weight and body composition and the women's perception of body and selves. METHODS: A mixed-methods research design was used. Data consisted of weight and body composition measures from 95 women with breast cancer during 18 months past surgery. Twelve women from this cohort were interviewed individually at 12 months. Linear mixed model and logistic regression were used to estimate changes of repeated measures and odds ratio. Interviews were analyzed guided by existential phenomenology. RESULTS: Joint displays and integrative mixed-methods interpretation demonstrated that even small weight gains, extended waist, and weight loss were associated with fearing recurrence of breast cancer. Perceiving an ambiguous transforming body, the women moved between a unified body subject and the body as an object dissociated in "I" and "it" while fighting against or accepting the body changes. CONCLUSIONS: Integrating findings demonstrated that factual weight changes do not correspond with the perceived changes and may trigger existential threats. IMPLICATIONS FOR PRACTICE: Transition to a new habitual body demand health practitioners to enter a joint narrative work to reveal how the changes impact on the women's body and self-perception independent of how they are displayed quantitatively.

Changes in Weight and Body Composition Among Women With Breast Cancer During and After Adjuvant Treatment: A Prospective Follow-up Study.

BACKGROUND: Antineoplastic adjuvant treatment for breast cancer can cause changes in women's weight and body composition and influence their general health and survival. OBJECTIVE: The aim of this study is to investigate the extent and patterns of change in weight and body composition after current standard adjuvant antineoplastic treatment for breast cancer. METHODS: Data on weight and body composition from 95 women with breast cancer Stage I to III were obtained during 18 months on a bioelectric impedance analyzer. Changes and odds ratio (OR) were calculated by a linear mixed model and logistic regression. RESULTS: At 18 months, there was an increase in weight of 0.9 kg (95% confidence interval [CI], 0.3-1.5; P = .003) and an average positive association of 0.35 kg/cm increased waist circumference (95% CI, 0.29-0.42 kg; P < .0001). Relative weight changes ranged from -12.7% to 20.5%. Weight gains related to increased body fat were observed mainly in premenopausal women receiving chemotherapy (1.4 kg; 95% CI, 0.4-2.4; P = .007). For menopausal status, OR was 2.9 (95% CI, 1.14-7.1; P = .025), and for chemotherapy, OR was 2.6 (95% CI, 1.03-6.41; P = .043). The OR for weight loss in Stage III breast cancer was 12.5 (95% CI, 1.21-128.84; P = .034) and 4.3 (CI, 1.07-17.24; P = .40) for comorbidity. CONCLUSIONS: Results demonstrate that weight changes in a pooled sample are overestimated. However, premenopausal women receiving anthracycline-based chemotherapy show a tendency toward a body composition with increasing fat mass. IMPLICATIONS FOR PRACTICE: A scheduled assessment of changes in weight and body composition is relevant at 18 months after treatment. To compare future studies, common measuring and cutoff points are needed.