Using Serious Games to Increase Prevention and Self-Management of Chemotherapy-Induced Nausea and Vomiting in Older Adults With Cancer.

OBJECTIVES: To examine the frequency and types of preventive and self-management behaviors reported by participants, as well as report acceptability and usability data for the electronic Symptom Self-Management Training-Chemotherapy-Induced Nausea and Vomiting (CINV) serious game. SAMPLE & SETTING: 80 adults who were aged 60 years or older and newly diagnosed with cancer were recruited from a community cancer center. METHODS & VARIABLES: Participants were randomized to an intervention or control group. A symptom management checklist was used to record preventive and self-management behaviors used after each chemotherapy treatment at home. Acceptability and usability were assessed using a brief survey. RESULTS: The intervention group reported using more preventive behaviors, and the control group reported using more self-management behaviors. Antiemetics were the most common strategy used, followed by dietary strategies. Participants rated all aspects of the serious game highly for usability and acceptability. IMPLICATIONS FOR NURSING: Oncology providers can help older adults plan for self-managing treatment-related side effects at home. Recording self-management behaviors may reinforce the importance of active prevention and management of CINV.

Symptom Self-Management: Strategies Used by Older Adults Receiving Treatment for Cancer
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BACKGROUND: Older adults are at high risk for cancer treatment-related symptoms but often accept them as inevitable. This may have a negative impact on patient outcomes.
. OBJECTIVES: The purpose of this study is to examine symptom self-management strategies used by older adults receiving cancer treatment, determine the effectiveness of these strategies, and examine relationships between symptom self-management and demographic and treatment characteristics.
. METHODS: 100 adults aged 65 years or older from a community cancer center participated in this descriptive, exploratory study. Demographic, treatment, and self-management data were collected using an investigator-developed tool. Symptom presence was collected using part 1 of the Symptom Representation Questionnaire.
. FINDINGS: Participants reported an average of 7.15 symptoms and 3.36 self-management strategies used at home. Taste changes were managed most, followed by fatigue and bowel changes. On average, strategies used to manage symptoms were moderately effective.

Family Caregiver Knowledge, Patient Illness Characteristics, and Unplanned Hospital Admissions in Older Adults With Cancer.

PURPOSE/OBJECTIVES: To explore factors related to unplanned hospital admissions and determine if one or more factors are predictive of unplanned hospital admissions for older adults with cancer.
. DESIGN: A prospective longitudinal design and a retrospective chart review.
. SETTING: Adult oncology outpatient infusion centers and inpatient units at Orlando Regional Medical Center in Florida.
. SAMPLE: A convenience sample of 129 dyads of older adults with cancer and their family caregivers. 
. METHODS: Family caregiver demographic and side effect knowledge data were collected prospectively during interviews with family caregivers using a newly developed tool, the Nurse Assessment of Family Caregiver Knowledge and Action Tool. Patient demographic and clinical data were obtained through a retrospective chart review. Descriptive statistics and logistic regression analyses were used to evaluate data and examine relationships among variables.
. MAIN RESEARCH VARIABLES: Patient illness characteristics; impaired function; side effects, such as infection, fever, vomiting, and diarrhea; family caregiver knowledge; and unplanned hospital admissions.
. FINDINGS: Unplanned hospital admissions were more likely to occur when older adults had impaired function and side effects, such as infection, fever, vomiting, and diarrhea. Impaired function and family caregiver knowledge did not moderate the effects of these side effects on unplanned hospital admissions. 
. CONCLUSIONS: Findings suggest that the presence of impaired function and side effects, such as infection, fever, vomiting, and diarrhea, predict unplanned hospital admissions in older adults with cancer during the active treatment phase. Side effects may or may not be related to chemotherapy and may be related to preexisting comorbidities. 
. IMPLICATIONS FOR NURSING: Nurses can conduct targeted assessments to identify older adults and their family caregivers who will need additional follow-up and support during the cancer treatment trajectory. Information gained from these assessments will assist nurses to provide practical and tailored strategies to reduce the risk for unplanned admissions.

Symptom Experience in Older Adults Undergoing Treatment for Cancer.

PURPOSE/OBJECTIVES: To explore the symptom experience of older adults receiving cancer chemotherapy in an outpatient treatment setting.
. DESIGN: Exploratory, descriptive, cross-sectional study.
 SETTING: A community cancer center in the southeastern United States.
. SAMPLE: 100 adults aged 65 years or older undergoing treatment for cancer.
 METHODS: Data were collected from participants at a chemotherapy treatment visit using structured questionnaires. Descriptive statistics were used to examine data. T tests and analysis of variance were used to compare symptoms among groups, and Pearson correlations were used to examine relationships among variables.
 MAIN RESEARCH VARIABLES: Cancer treatment-related symptoms, comorbid illnesses, mental health function, and physical function.
. FINDINGS: Older adults experience a high number of cancer treatment-related symptoms with moderate severity. The most common symptoms included fatigue, bowel disturbances, lack of appetite, hair loss, and drowsiness. Numbness and tingling were the most severe symptoms experienced. The presence of comorbid illness and poor mental functioning affects the number of symptoms experienced.
 CONCLUSIONS: Opportunities exist for clinicians to take steps to assess and manage symptoms common to older adults before serious complications and negative outcomes occur. Future research is needed.
 IMPLICATIONS FOR NURSING: Nurses should consider comorbidities and poor mental functioning in older adults when assessing treatment-related symptoms. Being proactive and assessing and managing symptoms early during treatment may improve outcomes for older patients.
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