International cancer care: what is the role of oncology nursing?

Comprehensive cancer care continues to improve in the United States, but many developing countries carry a high cancer burden. With limited resources, nurses in such countries often are unable to improve cancer detection and treatment or relieve patient suffering. The Oncology Nursing Society has developed collaborative relationships with many international organizations to educate nurses around the world. Global partnerships have the potential to improve cancer care internationally and encourage more oncology nurses to use their expertise and become "citizens of the world."     

Counselling of patients with HIV-related diseases: what is the role of the nurse?

• ? The need for counselling of patients with HIV-related diseases has been clearly demonstrated in the literature.
• ? This study aimed to elicit nurses', perception of their role in such counselling.
• ? Nurses did not have a uniform understanding of the term ‘counselling’, viewing it mostly as ‘information-giving’, however listening skills and allowing the person to deal with their own problems and fears were also central issues.
• ? The doctor was seen as the most important health professional when it comes to counselling of AIDS patients. The nurse is viewed as a ‘number two’, surprisingly perceived as more important than priests, psychologists and social workers, despite being thought of as not being well trained and consequently not having the necessary skills for counselling interventions.
• ? As a result, there was a clear need and wish for more general education on AIDS and counselling issues.

     

Biochemical markers for preterm labor and birth: what is their role in the care of pregnant women?

Two biochemical tests, one for oncofetal fibronectin (fFN) and the other for estriol found in maternal saliva (SalEst) have been developed to improve the ability to predict preterm labor and birth. Fetal fibronectin is a protein secreted by the trophoblast and not normally present in vaginal and cervical secretions late in pregnancy. The presence of fFN between 22 and 37 weeks gestation may be a marker for preterm labor. Salivary estriol is a form of estrogen produced in the placenta from fetal precursors. Normally, estriol rises during pregnancy--the rise being accelerated 3 to 5 weeks prior to both term and preterm births. Both tests have high negative predictive values. This may serve to prevent unnecessary treatment of women with uterine contractions who are not truly in preterm labor. The fFN specimen is collected during vaginal examination. Sexual intercourse or vaginal examination within the prior 24 hours, vaginal bleeding, and uterine contractions may lead to a false positive test. Salivary estriol may be collected by the woman in her own home; however, specific instructions about eating, drinking, smoking, and the timing of saliva collection must be followed. Further study of both tests is required to determine their potential for reducing rates of preterm birth.     

The mechanisms responsible for exercise intolerance in early-stage breast cancer: What role does chemotherapy play?

In this narrative review of the literature, we discuss the influence of chemotherapy treatment on peak aerobic power (VO_2peak) for women with breast cancer and the mechanisms for exercise intolerance. In specific, we examine the central, peripheral, and oxygen transport mechanisms responsible for exercise intolerance in women living with breast cancer. Our findings indicate that reduced ventricular contractility, reduced left ventricular (LV) compliance, and increased afterload are (in part) responsible for exercise intolerance secondary to chemotherapy treatment. It appears that changes in central haemodynamics and morphology often occur preceding clinical diagnosis of cardiotoxicity (LV ejection fraction <55%), which explain the attenuated exercise tolerance for this population. Patients with breast cancer are unable to make use of the Frank–Starling mechanism to increase stroke volume in response to an increase in end-diastolic volume. They may be able to increase preload during exercise conditions; however, reduced LV filling mechanics (in part due to an increase in pericardial restraint) and decreased contractile reserve may ultimately contribute to a reduced exercise tolerance for women with breast cancer. Recent evidence indicates that peripheral maladaptations and alterations in haemoglobin concentration are additional mechanisms that may limit VO_2peak and exercise tolerance in patients with breast cancer.     

Urologic and gynecologic health problems among Zimbabwean women: what is the role of poverty?

A summary of the cultural and geopolitical climate described in the companion article, "Mwatambudzeni's Short Life," is provided (Kanchense, 2007). The multiplicity and complexity of factors, as well as some of the governmental policies and attitudes that have contributed to the environment in which a young pregnant woman can so easily suffer death during childbirth are explained. Some of the root causes of poverty among Zimbabwean women are described, and the pathophysiological consequences of cultural practices, and health and social policies are explored. Recommendations for improving overall urologic health among Zimbabwean women are provided.     

Geropsychiatric inpatient care: what is state of the art?

Although dedicated geropsychiatric units have been available for many years, little information is available about them as a group. This article describes a survey that was developed to learn what type of resources, policies, or procedures geropsychiatric inpatient units employed to promote best nursing care practices. Physical changes to the unit and enhanced staff training were components of the current units and were consistently identified as needing enhancement to move to the next level of excellence. An unanticipated outcome was survey respondents' interest in becoming a part of a network of individuals who provide inpatient geropsychiatric care.     

The evolution of supportive care needs trajectories in women with advanced breast cancer during the 12 months following diagnosis

Purpose

This longitudinal study examined if the evolution of supportive care needs differed over the first year following the diagnosis of advanced breast cancer and examined factors differentiating these trajectories.

Methods

Two hundred twenty-eight of 276 Chinese women with advanced breast cancer were assessed while they were awaiting or receiving initial chemotherapy, then again at 6 weeks, 3 months, 6 months, and 12 months post-baseline. Supportive care needs (SCNS-34-Ch), psychological distress (Hospital Anxiety and Depression scale), symptom distress (MSAS-Ch), and patient satisfaction (PSEQ-9) were assessed at baseline; supportive care needs were reassessed at each follow-up assessment. Latent growth mixture modeling explored if trajectories differed within each of four need domains: health system, information, and patient support (HSIPS); psychological; physical daily living (PDL); and sexuality needs. Logistic regression identified factors predicting trajectory patterns.

Results

Two distinct trajectories were identified for HSIPS and sexuality need domains and three distinct trajectories for psychological and physical daily living need domains. Most women showed stable low levels of HSIPS (78.9 %), psychological (82.4 %), PDL (83.7 %), and sexuality (97.4 %) supportive care needs. One in five and one in eight women showed high initial supportive care needs in HSIPS and psychological and PDL domains, respectively. With the exception of sexuality needs, trajectory patterns were predicted by physical symptom distress. Women in the high-decline group reported greater physical symptom distress.

Conclusions

Most Chinese women with advanced breast cancer showed low stable supportive care needs. Physical symptom distress predicted high supportive care needs. Interventions should focus on optimizing symptom assessment and management.     

Palliative care for patients with cancer: what are the educational needs of community pharmacists?

Aims The objective of this study was to determine the educational needs of community pharmacists in Australia related to palliative cancer care, to guide the development of an online educational program for pharmacists.Methods Questionnaires were posted to a random sample of community pharmacies in Australia. The questionnaire sought information pertaining to pharmacists: demographics; educational needs by rating the importance of learning more about 18 palliative cancer care topics and self-perceived level of knowledge of them; preference for format(s) for the program; willingness to participate in the program; and perception regarding their practice of palliative cancer care. Results were analysed using Statistical Package for the Social Sciences (SPSS) version 11.5 software.Main results A questionnaire return rate of 10.3% was achieved. The characteristics of respondents were reflective of community pharmacy practice in Australia when compared with the latest available labour force figures by the Australian Institute of Health and Welfare. Pharmacists rated all 18 topics as important/essential, and their level of knowledge of them as poor/good. Pharmacists preferred information provided in these formats: text (89.8%), case studies (80.6%) and multi-choice questions (69.4%). Most pharmacists (85.2%) indicated that they would participate in the program. The majority of pharmacists (71.3%) reported that they deliver palliative cancer care services; usually less-than-monthly (24.1%) or weekly (21.3%).Conclusions Educational needs of community pharmacists in palliative cancer care were identified. The information gathered will assist in guiding the development of an online educational program for pharmacists to improve their knowledge and skills in palliative cancer care.     

Today's approach to esophageal cancer. What is the role of the primary care physician?

Esophageal cancer is a devastating disease. Patients are most likely to first present to a primary care physician, who should immediately undertake an initial diagnostic and staging evaluation. The approach then should become multidisciplinary, involving surgical and medical oncologists, radiation oncologists, and gastroenterologists. Optimal therapy of esophageal cancer continues to evolve. While multimodality therapy remains controversial, studies are ongoing to determine the best approaches to improve survival. Further studies to define the role of surveillance endoscopy in certain high-risk patients are warranted.     

Management of breast cancer: is there a role for somatostatin and its analogs?

Somatostatin and related peptides are a family of peptides which are ubiquitous and function as endogenous growth inhibitors. Analogs have been developed through the introduction of a D-amino acid in the position 8 of somatostatin moiety which is more resistant to the action of endogenous peptidases than the parental moiety. Both somatostatin and its analogs interact with specific receptors on the cell surface. The five receptor subtypes, SSTR-1 to SSTR-5, which have been characterized so far, have a different affinity for somatostatin and its analogs. This and the fact that receptors are not homogeneously expressed in tissues account for the different activity of these compounds, all of which have demonstrated tumoristatic properties both in vitro and in vivo. The interaction of somatostatin and of somatostatin analogs with specific SSTR receptors is crucial to the antiproliferative mechanisms exerted by these compounds in vitro and in some animal models and the various pathways have been reviewed in detail. However, inhibition of angiogenesis and suppression of lactogenic hormones might represent alternative mechanisms, in particular in breast cancer. The rationale for the use of somatostatin and its analogs in breast cancer patients and to combine these peptides with antihormones, like antiestrogens or prolactin-lowering drugs, or cytotoxics has been reviewed together with the results obtained in phase II and comparative trials. The reasons for the limited efficacy shown by these compounds either when used alone or when used in combination with other drugs have also been critically reviewed in the perspective of new trials.     

Palliative care: what is it?

Palliative care developed during the hospice movement. Hospice was associated as a rest place for weary travelers in ancient times, many of whom were ill. Hospice first became associated with the dying in France in 1842; the first modern hospice, St. Christopher's Hospice, was established in London by Dame Cicely Saunders in 1967. It was the first facility founded as a "place" to care for the dying. In 1974, the first U.S. hospice was established in Connecticut based on a home care model. In 1975, Balfour Mount, MD, founded the Palliative Care Service in The Royal Victoria Hospital in Montreal; the concept of "palliative care" in North America was established (Sheehan & Forman, 1996). The traditional view of palliative care indicates that symptomatic and supportive care are generally withheld until all attempts to treat the underlying disease and other medical problems are exhausted. Many times, palliative care is offered with little time left for living. Palliative care should be considered in conjunction with active treatment, and, as death nears, palliative care becomes more important as active treatment while cure become less important.