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.

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.

Fear of Cancer Progression: Findings From Case Studies and a Nurse-Led Intervention.

BACKGROUND: Fear of cancer recurrence or progression (FOP) is a significant concern for cancer survivors. With the advent of new targeted therapies and immunotherapy, many patients with advanced cancer are living longer while dealing with uncertainty and fears related to cancer progression. Although some level of FOP is normal and adaptive, high levels adversely affect quality of life and healthcare costs. OBJECTIVES: This article describes a nurse-led intervention for managing FOP in two patients with advanced gynecologic cancer. The intervention teaches skills for managing worry, challenging unhelpful beliefs, and modifying unhelpful coping behaviors. METHODS: Preliminary findings from the two case studies are presented, including a comparison of post-treatment FOP scores to baseline scores. FINDINGS: The participants reported feeling more focused, less overwhelmed, and more in control of their worries. Both participants achieved statistically reliable improvements in FOP scores.

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.

Transforming the death sentence: elements of hope in women with advanced ovarian cancer.

PURPOSE/OBJECTIVES: To describe the experience of hope in women with advanced ovarian cancer. RESEARCH APPROACH: Grounded theory methodology with interviews. SETTING: Oncology clinics in the northeastern United States. PARTICIPANTS: 20 women aged 42-73 who had completed initial chemotherapy and had no evidence of recurrence. METHODOLOGIC APPROACH: A personal data form and focused interview guide supported data collection. The core variable and related themes were identified using the constant comparative process. Demographic and treatment information was analyzed using descriptive statistics. MAIN RESEARCH VARIABLES: The process of hope in women with advanced ovarian cancer. FINDINGS: Facing the death sentence emerged as the main concern. The core variable in dealing with the concern was transforming the death threat. The three phases of the trajectory were shock (reverberating from the impact), aftershock (grasping reality), and rebuilding (living the new paradigm). Healthcare provider communication and spirituality influenced women's abilities to transform the death sentence. Support and perceived control emerged as key dimensions of the core variable. CONCLUSIONS: Women experience significant distress and trauma symptoms associated with a diagnosis of ovarian cancer. Hope was linked closely to the core variable and was necessary for finding meaning in the experience. Women with high support and perceived control seemed most hopeful and able to transform the death sentence. INTERPRETATIONS: Evidence-based interventions and strategies are needed to foster improved provider communication, symptom management, and peer support for women facing ovarian cancer. Future nursing research should focus on strategies that enhance support, perceived control, hope, and spirituality.

Palliative and end-of-life care: policy analysis.

PURPOSE/OBJECTIVES: To present an overview of policy issues affecting hospice and palliative care focusing on the nursing home and hospital settings and to discuss factors affecting end-of-life care, policy initiatives, recent legislation, and nursing implications. DATA SOURCES: Published articles; technical, advisory, and research reports (from government, professional, and private organizations); newsletters; textbooks; meeting minutes; online references; and legislative documents. DATA SYNTHESIS: Improvements are needed in end-of-life care, especially with regard to access, delivery, and financing of such services. Legal, organizational, and reimbursement policies, as well as healthcare professional education, have been identified as areas that need improvement. The nursing shortage and variable reimbursement policies for nursing services have a significant impact on access to quality end-of-life care, especially for underserved populations. CONCLUSIONS: A need exists for further research, including demonstration projects to test new ways to deliver and integrate hospice and palliative care throughout the illness continuum. Education and research are needed regarding symptom management, communication and decision making, caregiver support, and other end-of-life issues. Nursing interventions, palliative care networks, and other models that promote a coordinated approach to care delivery have been shown to decrease costs and improve quality of care. IMPLICATIONS FOR NURSING: Nurses play a key role in advancing improvements in palliative and end-of-life care through their involvement in educational, quality improvement, research, and legislative initiatives. Nursing activities in these areas may contribute to improved access, lower costs, and improved quality of care in advanced illness.