Utilising handheld computers to monitor and support patients receiving chemotherapy: results of a UK-based feasibility study

Goals of work Recent changes in cancer service provision mean that many patients spend a limited time in hospital and therefore experience and must cope with and manage treatment-related side effects at home. Information technology can provide innovative solutions in promoting patient care through information provision, enhancing communication, monitoring treatment-related side effects and promoting self-care.Patients and methods The aim of this feasibility study was to evaluate the acceptability of using handheld computers as a symptom assessment and management tool for patients receiving chemotherapy for cancer. A convenience sample of patients (n=18) and health professionals (n=9) at one Scottish cancer centre was recruited. Patients used the handheld computer to record and send daily symptom reports to the cancer centre and receive instant, tailored symptom management advice during two treatment cycles. Both patients’ and health professionals’ perceptions of the handheld computer system were evaluated at baseline and at the end of the project.Main results Patients believed the handheld computer had improved their symptom management and felt comfortable in using it. The health professionals also found the handheld computer to be helpful in assessing and managing patients’ symptoms.Conclusions This project suggests that a handheld-computer-based symptom management tool is feasible and acceptable to both patients and health professionals in complementing the care of patients receiving chemotherapy.     

Evaluation of the feasibility and acceptability of an oral care diary by patients during chemotherapy

BACKGROUND: A significant proportion of patients undergoing chemotherapy for many cancer types may experience oral problems, such as mucositis and any deterioration in the health of the oral cavity can have a significant effect on a person's well-being. Trends towards shorter hospital stays and the increase in out-patient chemotherapy mean that patients are required to adopt increasingly participatory roles in their self-care and are subsequently coping with mouth problems while they are at home without the direct support of oncology health professionals. OBJECTIVES: This study aimed to evaluate the acceptability and feasibility of an oral care diary by patients receiving chemotherapy. DESIGN: An oral care diary was developed to incorporate oral assessment using the Oral Assessment Guide (Eilier, J., Berger, A., Peterson, M., 1988. Development, testing and application of the oral assessment guide. Oncology Nurse Forum 15, 325-330) and guidance about oral self-care. This exploratory study utilised purpose designed pre- and post-study questionnaires and semi-structured interviews to evaluate patients' perceptions and experiences of the oral care diary. SETTING: The study took place in 2-day chemotherapy units in Scotland: 1 in a cancer centre and 1 in a district general hospital. PARTICIPANTS: A consecutive sample of patients (n=45) receiving out-patient chemotherapy for a range of cancer diagnoses participated in the study over 2 cycles of chemotherapy. METHODS: Following recruitment, patients were instructed in the use of the oral care diary to assess their mouth daily while at home on a daily basis. Patients were asked to complete 2 structured purpose designed questionnaires-the first prior to starting diary completion and the second following their participation in the study. Nine patients participated in semi-structured interviews to explore their actual experiences of using the oral care diary in more depth. RESULTS: The participants found the oral care diary acceptable and feasible. Awareness of oral symptoms and related mouth self-care post-chemotherapy improved. CONCLUSIONS: The oral care diary is an acceptable and feasible method of enhancing oral self-care during a course of chemotherapy. Further study is required to evaluate its impact on clinical outcomes.     

Exercise and side effects among 749 patients during and after treatment for cancer: a University of Rochester Cancer Center Community Clinical Oncology Program Study

Goals Despite advances in cancer treatment and symptom management, many patients experience side effects from cancer treatments that cause suffering and impair quality of life (QOL). Exercise is a method for enhancing QOL among cancer patients that shows promise in reducing side effects. However, patient participation in exercise is not well defined. We report on exercise participation during and within 6 months after chemotherapy and radiation therapy, the association of exercise with treatment side effects, and the communication between physicians and patients about exercise in a large (N=749) nationwide sample of cancer patients.Patients and Methods Participants completed measures that included questions concerning exercise during and after treatment, treatment side effects, and communication with physicians regarding exercise. Questionnaires were administered 2 weeks and 6 months after completion of therapy.Results Almost half of the 749 participating patients reported exercising while undergoing chemotherapy and/or radiation, and more than half reported exercising during the 6 months after treatment. Exercise was associated with less severe side effects during and after treatment (p≤0.050). More than 30% of patients reporting exercise did not discuss exercise with a physician; however, those who did were more likely to talk with their oncologist than with their primary care provider.Conclusions Cancer patients report exercising and appear amenable to attempting exercise during and within 6 months after treatment. Research is needed to assess (1) the frequency, intensity, duration, and mode of exercise; (2) randomized controlled trials with exercise and its influence on treatments and side effects; and (3) physician–patient communication regarding exercise during cancer treatment.     

老年人自我护理能力与社区护理服务需求相关性研究

目的：了解老年人自我护理能力和社区护理服务需求现状,并探讨老年人自我护理能力与社区护理服务需求的相关性,为完善社区老年护理服务内容提供依据。方法：采用便利抽样的方法,在无锡市梁溪区金星街道中便利选取1 023名老年人作为研究对象,应用一般资料调查表、自我护理能力测量表和社区护理服务需求调查表进行测量。结果：老年人自我护理能力得分为（112.71±17.86）分,社区护理服务需求得分为（82.80±16.63）分。老年人自我护理能力与社区护理服务需求之间呈负相关(r=-0.05～ -0.13,P<0.05)。结论：老年人社区护理服务需求与自我护理能力之间存在负相关。社区护士应根据老年人自我护理能力水平,不断完善和开展有针对性的社区老年护理服务,以提高社区老年护理服务水平。     

Impacts of self-care education on adverse events and mental health related quality of life in breast cancer patients under chemotherapy

ObjectiveAs a consequence of its high incidence, breast cancer has become a severe health risk in women. Chemotherapy is one of the main treatments for breast cancer, but causes a decline in life quality of patients. Self-care is a non-medical intervention and has been reported to improve the life quality of colorectal cancer patients. We aim to explore whether self-care is also effective in breast cancer.Materials and methods85 breast cancer patients under chemotherapy participated in this research, among whom 44 patients received the self-care education. The physical and mental conditions of patients before and after chemotherapy were evaluated by Anxiety Inventory, Rotterdam Symptom checklists and QLQ-C30.ResultsThe result showed that the occurrence rates of symptoms were significantly reduced after self-care measures. Anxiety Inventory and Rotterdam Symptom checklists indicated that self-care measures could improve both the physical and mental conditions of patients. The Global Quality of Life (QoL) from QLQ-C30 questionnaire further confirmed the effectiveness of self-care measures in breast cancer patients.ConclusionsBased on the results, self-care measures are effective in improving the physical and mental conditions of breast cancer patients under chemotherapy. Self-care measures play an important role in improving patients’ life quality.     

伽玛刀治疗胰腺癌现状与展望

复习近几年胰腺癌伽玛刀治疗相关文献并结合笔者所在科室近几年所治疗的病例资料,对胰腺癌伽玛刀治疗方式方法、生存情况、现状及发展作一个充分的了解。随着基础、临床研究、放射治疗设备和技术的发展、进步,胰腺癌伽玛刀治疗得到了很大的发展并取得了良好疗效。胰腺癌伽玛刀治疗的发展虽然有了长足的进步,但为了更好地提高疗效、降低不良反应,还有许多工作需要开展。     

癌症患者放化疗前后血小板参数的变化分析

目的分析探讨癌症患者放化疗前后血小板参数的变化及临床意义。方法用Sysmex XT-2000I全自动五分类血液分析仪测定31例癌症患者放化疗前后静脉血的血小板数（PLT）、血小板比积（PCT）、血小板平均体积（MPV）、血小板体积分布宽度（PDW）和大体积血小板比率（PLCR）,并与健康对照组比较。结果癌症患者放化疗前各参数与健康对照组间比较差异无统计学意义（P〉0．05）,而PLT、MPV、PCT、PLCR在放化疗后患者组均显著低于放化疗前（P〈0．01或P〈0．05）,PDW与放化疗前比较,差异无统计学意义（P〉0．05）。结论癌症患者放化疗后血小板参数的测定对观察其骨髓抑制状况和病情估计有一定的临床意义。     

妇科化疗患者自我护理能力与健康行为的相关性研究

目的 探讨妇科化疗患者自我护理能力与健康行为的现状,并分析其相关性.方法 采用自我护理能力量表(ESCA)和健康促进生活方式量表(HPL)对90例妇科化疗患者进行问卷调查,分析两者的相关性.结果 妇科化疗患者的自我护理能力得分为(112.17 ±17.46)分,健康行为得分为(123.21 ±20.23)分,自我护理能力与健康行为呈正相关(r=0.275 ～0.705,P＜0.05).结论 护士应注意采取有效的护理措施提高妇科化疗患者的自我护理能力,从而促进其采取一些健康行为,降低妇科化疗患者的肿瘤复发率,提高带瘤生存者的生存质量.     

Effects of a six-week mobile app versus paper book intervention on quality of life,symptoms, and self-care in patients with fibromyalgia: a randomized parallel trial

BackgroundThe ProFibro application (app) was developed as a Mobile Health resource to promote self-care in fibromyalgia management.ObjectiveThis study aimed to assess the effects of the use of the ProFibro app for six weeks compared to the use of a traditional paper book of similar content to improve health-related quality of life, symptoms, and self-care agency in individuals with fibromyalgia.MethodsForty individuals with fibromyalgia were included in this randomized, single-blind, parallel trial. One group received intervention content using the ProFibro app on a smartphone while the other received similar information using a paper book. Participants were assessed at baseline and after six weeks. The primary outcome was the Revised Fibromyalgia Impact Questionnaire. Secondary outcomes were Widespread Pain Index, Pain Visual Analog Scale, Symptom Severity Scale, and Appraisal of Self-Care Agency Scale – Revised.ResultsNo differences in changes were found between groups at the end of the treatment for any outcome. Both groups showed improvements in symptom severity.ConclusionsThe use of the ProFibro app for six weeks was not more effective than the use of a traditional paper book with similar content for health-related quality of life, symptoms, or self-care agency in individuals with fibromyalgia. Both groups showed improvements from baseline on severity of symptoms, suggesting that the self-care program using a mobile app or a paper book may be beneficial for individuals with fibromyalgia.     

延续护理对2型糖尿病患者自我护理能力和睡眠质量的影响

目的:探讨延续护理对2型糖尿病患者自我护理能力和睡眠质量的影响。方法:选择我院2012年1月~2013年7月2型糖尿病住院患者50例,随机等分为对照组和观察组。对照组给予出院后常规护理,观察组实施出院后延续护理,观察出院3个月后两组自我护理能力和睡眠质量的变化。结果:出院3个月后,观察组自我护理能力测定量表各因子评分明显高于对照组,改良睡眠状况自评量表评分明显低于对照组(P0.05)。结论:延续护理可提高2型糖尿病患者的自我护理能力,改善睡眠质量,值得临床中应用。     

Quality of life and complementary and alternative medicine use among cancer patients in Turkey

AimThe purpose of this study was to assess the relationships between quality of life and use of complementary and alternative medicine (CAM) among Turkish cancer patients.MethodsThis cross-sectional study was conducted in Istanbul University Institute of Oncology, Turkey. Two-hundred patients were invited and informed consent was obtained, however 179 cancer patients completed the study. The Patient Characteristics form, The Nightingale Symptom Assessment Scale and The Functional Assessment of Cancer Therapy Scale were used in the evaluation of the patients’ characteristics and quality of life.ResultsSome form of CAM had been used by 71.5% of the sample. Frequently used CAM methods appeared to be religious practices (68.2%) and only 37.4% of the patients used herbs. However, female patients, single patients, and individuals with metastatic disease and worse quality of life showed a tendency to use CAM more often. More than one-third of our patients began to use CAM immediately after being diagnosed with cancer and factors associated with CAM use varied according to the type of CAM. Although CAM use did not affect the patients’ quality of life, logistic regression analysis revealed that gender, type of cancer diagnosis and education level were important factors to be considered in different CAM therapies.ConclusionCAM use is common in cancer patients in Turkey. More discussion about CAM use should take place between patients and health professionals to inform the patients’ decisions.     

Quality of life during clinical trials: conceptual model for the Lung Cancer Symptom Scale (LCSS)

To appreciate the full benefits of treatment for lung cancer, especially in trials that fail to show improvements in survival, data recording the quality of life must be captured and refined to produce meaningful information. A conceptual model for quality of life for lung cancer patients was tested to obtain information about the dimensions of the quality-of-life construct for ongoing development and testing of a subjective measure for clinical trials. Using a longitudinal study design, the stability of predictive factors of the physical and functional dimensions of quality of life were examined using regression analysis. A patient-rated quality-of-life measure, the Lung Cancer Symptom Scale (LCSS), was administered to 144 non-smallcell lung cancer patients at baseline, day 29, and day 71 of a chemotherapy trial. The range of explained variance for all three components of the lung cancer model over three assessment points was as follows: symptomatic distress 41%–53%, activity status 48%–52%, and overall quality of life 35%–53%. The three dimensions fluctuated slightly during intervention, but were relatively stable factors across all three times of evaluation. The LCSS model explained nearly half of the variance for quality of life experienced by lung cancer patients during therapy with a new chemotherapeutic agent. These findings provide support that the physical and functional dimensions are important predictors of quality of life for individuals with lung cancer. Meaningful subjective quality-of-life data can be obtained to evaluate an intervention by using a disease-and sitespecific quality-of-life measure for individuals with lung cancer, based on a reproducible conceptual model such as the LCSS, which is suitable for serial measurement for the progressive disease of lung cancer.     

门诊PICC患者家庭功能与自我护理能力和健康行为的相关性研究

目的：探讨门诊PICC患者的家庭功能情况,及其与自我护理能力和健康行为的相关性。方法：运用横断面调查的方法,采用一般资料调查表、家庭功能评定量表、自我护理能力测定量表和健康促进生活方式量表对PICC门诊进行导管维护的130名患者进行调查。结果：患者的家庭功能评定量表总分为（2.30±0.31）分,自我护理能力测定量表总分为（2.18±0.41）分,健康促进生活方式量表总分为（2.55±0.38）分。患者的家庭功能得分与自我护理能力、健康行为呈负相关（P<0.05）。结论：门诊PICC患者的家庭功能可影响自我护理能力和健康行为,应进一步提高患者的家庭功能。     

Association between fatigue and other cancer-related symptoms in patients with advanced cancer

GOALS OF WORK: Although fatigue is the chronic symptom most commonly experienced by patients with advanced cancer, little research has been done on the associations and correlates of fatigue in this population. The aim of this study was, therefore, to determine whether fatigue scores, as measured by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), are associated with age, gender, type of cancer diagnosed, pain, and other cancer-related symptoms measured using the Edmonton Symptom Assessment Scale (ESAS). MATERIALS AND METHODS: We retrospectively reviewed the FACIT-F (when a higher score denotes lower fatigue) and ESAS (when a lower fatigue score denotes lower fatigue intensity) scores of 268 patients with advanced cancer who had been previously enrolled in clinical trials of therapies for fatigue. To determine associations between variables, we performed univariate and multivariate analyses on the data. RESULTS: We found no univariate association between fatigue score and gender, ethnicity (p = 0.31), or type of cancer diagnosed. Performance status was associated with fatigue (p < 0.0001). On multivariate analysis, we found, however, significant association between fatigue and pain (r = -0.20, p = 0.0012), nausea (r = -0.13, p = 0.04), anxiety (r = -0.27, p < 0.0001), fatigue and depression (r = -0.19, p = 0.0019), drowsiness (r = -0.24, p = 0.0002), dyspnea (r = -0.17, p = 0.007), anorexia (r = -0.29, p < 0.0001), insomnia (r = -0.25, p < 0.0001), and feelings of well-being (r = -0.37, p < 0.0001). Using backward stepwise logistic regression analysis, independent correlative factors associated with fatigue include well-being (p = .0003), drowsiness (0.006), anorexia (0.01), and anxiety (0.03). However, this model only explained 21% of the variation in the intensity of fatigue. CONCLUSIONS: Although we found that fatigue is significantly associated with the severity of psychological symptoms (anxiety and depression) and physical symptoms (pain, dyspnea, insomnia, anorexia, and drowsiness), additional research is required to confirm that these are indeed the main associations of fatigue and, by doing so, enable physicians to better characterize fatigue in patients receiving palliative care.