Do Spiritual Well-Being and Pain Intensity Predict Physical or Mental Components of Health-Related Quality-of-Life Scale in Patients With Multiple Myeloma?

BACKGROUND: Multiple myeloma is a complex disease and supportive care is important for improving quality of life. Management of disease treatment symptoms, bone disease, renal dysfunction, infection, anemia, pain, and coagulation disorder are specific issues. Spirituality, or spiritual well-being, is one of the most fundamental and essential concepts for coping with the difficulties and stress caused by cancer. AIMS: This study explores whether spiritual well-being, pain, and other demographic factors predict the physical and mental components of quality of life in MM subjects. METHODS: This cross-sectional descriptive study was conducted with 92 multiple myeloma patients registered with the Cancer Warriors Association in Turkey. The data were collected using the Personal Information Form, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12, the Numeric Rating Scale for Pain, and the Short Form-12 Health-Related Quality of Life Scale. RESULTS: The mean age of the patients was 54.4 ± 10.7 years. It was found that the mean total pain score in the previous week was 3.9 ± 2.6, while the mean total The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 score was 28.1 ± 9.8. Their mean Short Form-12 total physical component score was 39.1 ± 25.4; whereas the Short Form-12 total mental component score was 45.5 ± 24.8. According to this model, 56.7% of the physical component score was explained by vertebroplasty, The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 total score and subscale of peace and the pain intensity experienced in the previous week. According to multiple linear regression analysis, bone-sparing therapy and FACIT-Sp-12-Total and subscale peace significantly predicted the Mental component score (p < .05). CONCLUSIONS: Cancer pain remains undertreated, and patients with myeloma are no exception. Pain and spiritual well-being scores were significant predictors of physical and mental component scores of quality of life in this group of patients. According to this result, pain-reducing practices should be implemented to improve the quality of life in MM patients and the spiritual needs of the patients should be met.

The effects of Ankaferd hemostat on preventing oral mucositis in colorectal cancer patients receiving chemotherapy.

INTRODUCTION: New agents are introduced each day to be used in the prevention and treatment of mucositis in cancer treatment. One of those agents is the Ankaferd hemostat. Ankaferd hemostat has pleiotropic effects and anti-infective characteristics in tissue healing. METHODS: The study was designed as a randomized controlled experimental study. The sample of the study comprised a total of 66 patients (33 patients in the Ankaferd hemostat group and 33 patients in the sodium bicarbonate group) with colorectal cancer who received FOLFOX combination chemotherapy treatment in the first cycle of chemotherapy to prevent mucositis. Participants who met the criteria were randomly assigned to the groups. Before the patient received chemotherapy, ECOG performance score and Oral Mucositis Grading Scale were applied on the 7th day and 15th day. The Ankaferd hemostat group brushed teeth at least twice a day for 2 min and gargled with Ankaferd hemostat twice for 2 min for 2 weeks. The sodium bicarbonate group brushed teeth at least 2 min a day and gargled with sodium bicarbonate 4 times for 2 min for 2 weeks. The Consolidated Standards of Reporting Trials diagram was used to illustrate the randomization of patients. RESULTS: When the Ankaferd hemostat group is compared with the sodium bicarbonate group, there is a significant difference in favor of the Ankaferd hemostat group in the mucositis grade on the 7th day and 15th day after chemotherapy (p < 0.05). In the binary logistic regression analysis, among the factors affecting the formation of mucositis on the 7th day, only neutrophil and thyroid-stimulating hormone (TSH) were included in the model, while only the TSH variable is statistically significant. CONCLUSIONS: It was determined that Ankaferd hemostat is effective in preventing oral mucositis due to chemotherapy in adult patients diagnosed with colorectal cancer. In addition, it has been suggested to conduct new studies on the effectiveness of Ankaferd hemostat in the prevention of mucositis in different groups. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (ID: NCT05438771, Date: 25.06.2022).

Experiences of nurses working with COVID-19 patients: A qualitative study.

BACKGROUND: The global COVID-19 pandemic has led to massive disruptions in daily life, business, education, lifestyle and economies worldwide. Nurses are a professional group who care directly for COVID-19 patients and thus face direct exposure to the virus. The nurses who work on the front lines during this period put their own well-being at risk to care for these patients. PURPOSE/AIM: The aim of this study was to identify the experiences and challenges faced by nurses working in pandemic clinics in Turkey during the COVID-19 pandemic. METHODS: This qualitative study was based on semi-structured in-depth interviews conducted through the mobile application Whatsapp with 19 nurses who were actively working in pandemic clinics. Due to the pandemic, the snowball sampling method was used to reach the sample group. Interviews were continued until data saturation was achieved. All interviews were audio recorded and later transcribed. The study data were interpreted according to themes identified using thematic analysis. Throughout the study, the authors followed the COREQ checklist. RESULTS: The experiences of nurses caring for COVID-19 patients were summarised into five major themes: psychosocial adaptation, protection, difficulty in care and treatment, access to information and working conditions. CONCLUSION: Nurses caring for COVID-19 patients in Turkey have been affected psychologically, socially and physiologically. They experienced stigmatisation, exhaustion and burnout. One of the biggest challenges for the nurses was difficulty providing physical care and treatment due to the use of personal protective equipment. Nurses want improved compensation in addition to applause from the public. Interventions to help bolster nurses' psychological and physiological strength are recommended. RELEVANCE TO CLINICAL PRACTICE: This study emphasised nurses' psychologically, socially and physiologically affected. Therefore, improvements in financial and moral support would provide psychological reinforcement for nurses during the epidemic. Informing the public is necessary to reduce the stigmatisation of nurses working in pandemic clinics.

The effect of anxiety and spiritual well-being on the care burden of caregivers of cancer patients during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has adversely affected the caregivers of people with all chronic diseases, including people with cancer (PWC). This study was conducted to determine the impact of anxiety and spiritual well-being on the care burden of caregivers of PWC during the COVID-19 pandemic. DESIGN: This cross-sectional descriptive study included 250 caregivers of hematology and oncology patients registered with a cancer support association. All participants completed the following self-report questionnaires: the Spiritual Well-Being Scale (SWBS), Generalized Anxiety Disorder 7-item scale (GAD-7), and the Zarit Caregiver Burden Interview (ZBI). RESULTS: Most (82.4%) of the caregivers expressed fear that their patient may contract COVID-19, and 42.0% stated that they had difficulty getting to the hospital. The caregivers' mean ZBI score was 21.06 ± 14.64, their mean GAD-7 score was 14.51 ± 6.02, and their mean SWBS score was 111.50 ± 16.84. According to the results of regression analysis, SWBS and GAD-7 scores had a significant effect on the ZBI score (p < 0.05). CONCLUSION: In this study, anxiety explained most of the care burden during COVID-19. Therefore, during the COVID-19 pandemic, it may be beneficial to implement practices to promote spirituality and reduce anxiety in caregivers of PWC.

Identification of Psychological and Social Problems in Caregivers of Individuals Diagnosed with Hematologic Malignancy.

OBJECTIVE: Caring for patients with hematological malignancy could lead to many problems in different aspects regarding the lives of caregivers. However, there is limited data on the emotional and social problems of caregivers, who deal with patients of hematological malignancy. The aim of this study is to determine the emotional and social problems in caregivers of individuals diagnosed with hematological malignancy. METHODS: The study was carried out descriptively to identify the emotional and social problems in the relatives of the patients diagnosed with hematological malignancy as their caregivers, as well as the factors affecting these problems. The data of the study were collected with the Introductory Information Form and Identification of Emotional and Social Problems Form that were administered to the relatives of the patients. The data were evaluated by using Spearman's Rho correlation analysis and the Logit analysis in Statistical Package for the Social Sciences software. RESULTS: Among the caregivers, 59.8% were in the age group of 30-51 years, and 66.2% were female. Of the caregivers, 70.1% had difficulty in fulfilling their responsibilities. Spiritual distress had the highest score among the emotional problems, and experiencing caregiver strain had the highest score among the social problems. In the Logit model, the changes in the professional life was the variable that affects the emotional and social problems the most and significantly. In addition, emotional problems were affected by the financial problems at a statistically significant level. CONCLUSIONS: In this study, it is suggested that the caregivers should be provided with certain conveniences in their professional lives based on the fact that the problem, which affected emotional and social problems the most, is the change in the professional life; it is recommended that further studies should be carried out on the caregivers.

Evaluation of Sexual Dysfunction in Patients with Hematological Malignancies.

OBJECTIVE: Physiological and/or psychological problems that affect the quality of life of the patients occur depending on the diagnosis and treatment of hematological malignancies. Cancer treatment causes sexual problems such as infertility, vaginal dryness, and erectile dysfunction in the patients. Erectile dysfunction and loss of sexual desire are the most common sexual problems of men, while dyspareunia and loss of sexual desire are the most common sexual problems of women. This descriptive study was carried out to evaluate sexual problems and affecting factors in the patients with hematological cancer. METHODS: Between July 1, 2011, and July 31, 2011, 45 sexually active patients who volunteered to participate in the study and whose written consents were obtained were included in the study. The data of the study were collected using the descriptive characteristics form prepared by the researchers based on the relevant literature and the Arizona Sexual Experiences Scale (ASEX). The scale scores range from 5 to 30 and a score of >11 above indicates sexual dysfunction. RESULTS: Sexual dysfunction was observed in 62.2% of the patients. About 80.0% of women and 57.1% of men had sexual dysfunction. Sexual dysfunction was observed to be highest between the ages of 52-71 (81.2%) years. The mean total ASEX score was 15.90 ± 4.25 in women and 13.34 ± 5.37 in men. The ability to reach orgasm subscale score was found to differ by gender in the ASEX scale (P < 0.05). CONCLUSIONS: The prevalence of sexual dysfunction is high in the patients with hematological malignancies. It is recommended to evaluate these patients in terms of the presence of sexual dysfunction, as in the patients with other chronic diseases.

Pain, anxiety, and depression during bone marrow aspiration and biopsy.

OBJECTIVES: This study is performed with the aim of prospectively analyzing the factors that affect pain, anxiety, and depression in cases for whom bone marrow aspiration and biopsy are performed and the relationships among them. METHODS: This study consisted of 90 patients who consulted to Department of Hematology, Faculty of Medicine, Uludag University, and followed-up for bone marrow aspiration and biopsy indication. The data was gathered using a personal information form, Hospital Anxiety Depression scale, and Wong-Baker face pain scale where generally face expressions exist. RESULTS: The average age of the patients who participated in the study was 50.90 years (16.59), and the pain level after the application was 1.98 (1.33). After the application, a positive relationship is determined between the pain level and anxiety (r=-0.79; p=0.02), whereas this has a negative relationship with age (r=0.78; p=0.03). CONCLUSION: As a result, pain develops depending on bone marrow aspiration and biopsy; therefore, taking precautions aimed at alleviating pain and evaluation of pain before and after the application within the scope of total maintenance have been suggested.

Physiological problems in patients undergoing autologous and allogeneic hematopoietic stem cell transplantation.

OBJECTIVE: Stem cell transplantation is usually performed in an effort to extend the patient's life span and to improve their quality of life. This study was conducted to determine the postoperative physiological effects experienced by patients who had undergone autologous and allogeneic stem cell transplantation. METHODS: The research is a descriptive study conducted with a sample of 60 patients at Stem Cell Transplantation Units in Ankara. Percentile calculation and chi-square tests were used to evaluate the data. RESULTS: When a comparison was made between patients who had undergone allogeneic Hematopoietic stem cell transplantation (HSCT) and those who had undergone autologous HSCT, results indicated that problems occurred more often for the allogeneic HSCT patients. The problems included: Digestion (94.3%), dermatological (76.7%), cardiac and respiratory (66.7%), neurological (66.7%), eye (56.7%), infections (26.7%) and Graft Versus Host Disease (5 patients). Furthermore, the problems with pain (50%), numbness and tingling (40%), and speech disorders (3 patients) were observed more often in autologous BMT patients. CONCLUSION: Autologous and allogeneic patients experienced most of physical problems due to they receive high doses of chemotherapy. Therefore, it is recommended that an interdisciplinary support team approach should be usedtohelp reduce and manage the problems that may arise during patient care.

Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic hematopoietic stem cell transplantation for acute leukemia patients: a single center experience.

Due to the high transplant related morbidity and mortality (TRM), relatively younger acute leukemia patients that have a good performance status and no comorbidity are eligible for myeloablative conditioning (MAC) followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT). The outcomes of 84 consecutive adult patients with ALL (n=38) or AML (n=46) who underwent allo-HSCT from their HLA-identical siblings were evaluated retrospectively. The median age at transplantation was 34 (17-58 years) for the whole patient population. Of these, 24 patients received a MAC and 60 patients received a fludarabine-based reduced intensity conditioning regimen (RIC). After a median follow-up of 32 months (range, 1-119), for the entire group, the 3-year estimated overall survival (OS) was 57.5% and the disease-free survival (DFS) was 51.5%. The OS for ALL and AML patients were 53.9% vs 62.1%: and DFS were 50.5% and 53.4%, respectively. The 3-year estimated OS for RIC and MAC patients were 63.2% and 41.7%; and DFS were 57.1% and 34.7%, respectively. In ALL patients, conditioning regimens (RIC vs MAC) led to similar OS and DFS; however, in AML patients both OS (70.1% vs 21.4%) and DFS (59.3% vs 42.9%) were found to be higher in RIC patients compared to MAC recipients. Overall, the TRM at day 100 was 1.7% and has increased up to 5.1% at 1st year. In multivariate analysis, the diagnosis (p=0.03) and RIC regimen (p=0.027) were the prognostic variables for prolonged OS in all patients; and RIC regimen (p=0.031) was the only prognostic factor for prolonged OS in AML patients. The first complete remission (CR1) was correlated with a prolonged DFS as an independent variable for all patients (p=0.09). Eleven of the RIC patients (18.3%) and 6 of the MAC patients (25%) developed acute graft-versus-host disease (GvHD). Seventeen of the RIC patients (33.3%) and 4 of the MAC patients (16.7%) developed chronic GvHD. In conclusion, RIC conditioning regimens may provide a longer OS and DFS, especially in patients with AML who are in first CR, not eligible for MAC conditioning.

Eculizumab before and after allogeneic hematopoietic stem cell transplantation in a patient with paroxysmal nocturnal hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by the triad of intravascular hemolysis, venous thrombosis, and cytopenia. Treatment of PNH is generally supportive. Bone marrow transplantation is the only curative therapy for PNH, but is associated with significant morbidity and mortality. Herein, we present a patient with PNH that received eculizumab, a humanized monoclonal antibody that blocks activation of the terminal complement at C5, before and immediately following allogeneic peripheral stem cell transplantation. Prior to hematopoietic stem cell transplantation eculizumab treatment markedly reduced hemolysis and transfusion requirement; however, 1 d post transplantation a hemolytic episode occured, which was successfully stopped with eculizumab re-treatment. Afterwards the patient did not require additional transfusions. The results of this study indicate that early administration of eculizumab may be a safe and effective therapy for hemolytic episodes associated with allogeneic peripheral stem cell transplantation in patients with PNH.

Serological response to influenza vaccine after hematopoetic stem cell transplantation.

Vaccination is the best strategy to prevent influenza infection that is a potential cause of morbidity and mortality in immunosuppressed patients. Here, we evaluated the factors that may affect serological response to influenza vaccine in patients who have undergone hematopoetic stem cell transplantation (HSCT). Sixty-one HSCT recipients were included in the study during the 2007-2008 influenza season. Serum samples prior to vaccination and 6-10 weeks after vaccination were collected. Samples were assayed for antibodies to influenza virus A/H1N1, A/H3N2, and B strains by hemagglutination-inhibition assay. The patients were followed in terms of clinical symptoms up to the next influenza season and for adverse effects within a month after vaccination. Overall, pre-vaccine seroprotection rate against all vaccine antigens (A/H1N1, A/H3N2, and B antigens) was 45.1%, post-vaccine seroprotection rate 91% and seroconversion rate was 28.3%. Seroconversion rates were found to be low against B in patients who were vaccinated in the late influenza season (p = 0.018; respectively). Five patients (10.9%) had no immune response against H1N1. Adverse events were reported in 19.6% (n = 9/46) of the patients. In conclusion, the patients should be vaccinated as early as possible in the influenza season, before they are exposed to the virus.

Determination of burnout levels of nurses working in stem cell transplantation units in Turkey.

Although burnout has been researched widely with regard to nurses working in different settings, until now it has not been investigated among stem cell transplantation unit nurses. This study's aim was to determine the burnout level of 57 nurses who were working in stem cell transplantation units in Turkey. The research instruments that were used included a form of demographic characteristics and the Maslach Burnout Inventory. For all the hematopoietic stem cell transplantation nurses, the mean subscale scores for emotional exhaustion were the highest, followed by personal accomplishment and then depersonalization. The burnout level rose with increasing age and duration on the job. Interventions to reduce burnout are needed at both the administrative and organizational levels. In addition, it is essential to address and prevent the problems that are related to burnout, especially among nurses who work in the same unit for a long time.

The burnout and exhaustion levels of nurses working in haemodialysis units.

AIM: The aim of the study was to determine the burnout and exhaustion levers of nurses working in haemodialysis units. METHOD: The study was a cross-sectional and descriptive one. A total of 95 nurses working at the 17 dialysis centres in the centre of the Ankara Province were included. The data were collected using a questionnaire defining the socioeconomic characteristics of the nurses and the Maslach Burnout Inventory (MBI) and evaluated using the Mann-Whitney U test. RESULTS: Haemodialysis nurses' emotional burnout score was 16.03 +/- 6.28, the depersonalisation score 4.72 +/- 3.20 and the personal accomplishment score 20.97 +/- 4.61. Their emotional burnout and personal accomplishment level was significantly higher in those considering leaving the profession, nurses who did not find the profession suitable and those working in units where no precautions were taken against infectious disease (p < 0.05). CONCLUSION: It may be suggested that taking precautions at units, providing better working conditions, defining the duties of nurses and providing further dialysis education for nurses may decrease burnout rates.