Examining Associations Among Sexual Health,Unmet Care Needs,and Distress in Breast and Gynecologic Cancer Survivors

ObjectivesThis study evaluated breast and gynecologic cancer patients’ sexual function, unmet needs related to sexuality, and distress.Data SourcesSecondary analyses of a cross-sectional survey study evaluated measures of sexual function (Female Sexual Function Index [FSFI]), unmet needs (Supportive Care Needs Scale), and distress (Patient Health Questionnaire). χ² test, t tests, and analysis of variances (ANOVAs) tested bivariate relationships. Subgroup comparisons were made based on the Female Sexual Function Index sexual dysfunction diagnostic cut-off score (<26.55; lower scores indicate greater dysfunction). A regression model tested associations between sexual function and unmet needs with distress as the outcome variable.ConclusionClinically significant sexual dysfunction was common in this cohort of women. In multivariate modeling, worse sexual function and greater unmet sexuality needs related to greater distress. Future work should explore reasons behind the high levels of sexual dysfunction and unmet needs in female survivors.Implications for Nursing PracticeIt is important to routinely screen for sexual health concerns among female cancer survivors at all phases of the cancer trajectory including years posttreatment.     

Breast Cancer Follow-Up: Strategies for Successful Collaboration between Cancer Care Specialists and Primary Care Providers

Nurse practitioners working in family or primary care often need to incorporate specialty care knowledge into their practice. Knowledge of breast cancer staging, treatment, common side effects, and possible long-term sequelae is critically important for primary care nurse practitioners caring for women with a history of breast cancer. The unique considerations of breast cancer staging, treatment, and long-term effects are reviewed in this article. The importance of optimal communication between the cancer care provider and the primary care providers is highlighted.     

Providing Leadership Through Patients as Partners: Improving Australian Colorectal Survivorship Care Through Perspectives from a Nurse Who Became a Cancer Patient

ObjectiveTo provide contemporary real-world, real-life insights into gaps in supportive care experiences for people affected by colorectal cancer. For the first time, this article includes a patient as a coauthor, with the aim to identify future priorities to improve care and recovery in colorectal cancer survivorship.Data SourcesElectronic databases, peer-reviewed literature, and real-life professional and personal experiences were used.ConclusionThere are several problematic areas in providing supportive care for people affected by colorectal cancer that could be improved by wider access to colorectal specialist nurses, coordinated multidisciplinary teams, patient collaboration, linking survivorship care outcomes to national standards, and developing supported self-management care plans.Implications for Nursing PracticeA patient-led insight has underscored some fundamental failings in current service delivery among people affected by colorectal cancer. Partnering with consumers in research and service redesign is essential to stratify future priorities to optimize care and person-centered recovery.     

Tryptophan and Kynurenine Pathway Metabolites and Psychoneurological Symptoms Among Breast Cancer Survivors

BackgroundAmong breast cancer survivors, pain, fatigue, depression, anxiety, and sleep disturbance are common psychoneurological symptoms that cluster together. Inflammation-induced activation of the tryptophan-kynurenine metabolomic pathway may play an important role in these symptoms.AimsThis study investigated the relationship between the metabolites involved in the tryptophan-kynurenine pathway and psychoneurological symptoms among breast cancer survivors.DesignCross-sectional study.SettingParticipants were recruited at the oncology clinic at the University of Illinois Hospital & Health Sciences System. Participants/Subjects: 79 breast cancer survivors after major cancer treatment.MethodsWe assessed psychoneurological symptoms with the PROMIS-29 and collected metabolites from fasting blood among breast cancer survivors after major cancer treatment, then analyzed four major metabolites involved in the tryptophankynurenine pathway (tryptophan, kynurenine, kynurenic acid, and quinolinic acid). Latent profile analysis identified subgroups based on the five psychoneurological symptoms. Mann-Whitney U tests and multivariable logistic regression compared targeted metabolites between subgroups.ResultsWe identified two distinct symptom subgroups (low, 81%; high, 19%). Compared with participants in the low symptom subgroup, patients in the high symptom subgroup had higher BMI (p = .024) and were currently using antidepressants (p = .008). Using multivariable analysis, lower tryptophan levels (p = .019) and higher kynurenine/tryptophan ratio (p = .028) were associated with increased risk of being in the high symptom subgroup after adjusting for BMI and antidepressant status.ConclusionThe tryptophan-kynurenine pathway and impaired tryptophan availability may contribute to the development of psychoneurological symptoms.     

Consistency Between Preference and Use of Long-Term Care Among Caregivers of Stroke Survivors

ABSTRACT Effective arguments have been made for the importance of expanded attention to understanding how family preferences influence decisions to choose long-term care. The effects of preference on the utilization of long-term care deserve further research, especially on a longitudinal basis. The family members of 582 first-time stroke patients from the neurology departments of four teaching hospitals in Taiwan were categorized into two groups based on their attitudes toward type of long-term care, i.e., a preference for nursing home care (n₁= 324) or a preference for home care (n₂= 258). The consistency rate between preference and utilization of the type of long-term care was estimated by the division of number of families preferring one type of long-term care by the number of families actually utilizing the services preferred. Results indicated that the consistency rate for those with nursing home preference was 8.3% while the consistency rate for those with home care preference was 94.2%. Accessibility of nursing home facilities near family residences was significantly associated with whether those preferring nursing home services actually utilized them, and the odds ratio was 20.8. The family manpower available for caregiving at home was tremendously associated with whether families utilized home care when home care was preferred; the odds ratio was 33.3. The preference for the type of long-term care was a strong predictor of the utilization when home care was preferred, yet not when a nursing home was preferred. The low consistency between preference and utilization for nursing homes preferred is due to the low accessibility of nursing home facilities in Taiwan. How to provide sufficient support to families for caregiving at home, and how to deal with the barrier of accessibility to nursing home services should be two major concerns for those who are planning and operating the long-term care system and for those trying to design institutional services and noninstitutional services as alternatives.     

胃癌幸存者社会疏离现状及其影响因素分析

[摘要]目的：研究胃癌幸存者社会疏离现状和影响因素,为临床医护干预提供依据。方法： 采用便利抽样法选择2017年01月至2022年12月间我院治疗的胃癌幸存者,采用一般疏离量表调查患者其社会疏离现状,通过单因素分析和多重线性回归分析胃癌幸存者社会疏离影响因素。结果：胃癌幸存者社会疏离评分为45.39±6.55分,SDS评分为56.33±8.34分,社会支持评分为31.23±3.27分。抑郁自评量表（SDS）评分与社会疏离总分及其4个维度评分均呈正相关,社会支持与社会疏离总分及其4个维度评分均呈负相关,SDS与社会支持总分及其3个维度评分呈负相关（均P＜0.05）。单因素和多重线性回归分析显示：临床分期、治愈后时间、家庭人均月收入、放化疗情况、SDS评分、社会支持评分均为胃癌患者社会疏离独立影响因素（均P＜0.05）,性别不为其影响因素（P＞0.05）。其中临床分期Ⅲ~Ⅳ期、放疗或化疗或放疗+化疗、SDS评分均为胃癌幸存者社会疏离风险因素均P＜0.05）,治愈后时间≥3年、家庭人均月收入≥5000元、社会支持评分为患者社会疏离保护性因素（均P＜0.05）。结论：胃癌幸存者社会疏离水平较高,针对患者社会疏离影响因素,临床、患者、社会应该及时干预,提高患者融入家庭、回归社会的能力。     

PS1-10: Spiritual Well-being and the Challenges of Living With an Ostomy: Resilience, Adaptation and Loss Among Colorectal Cancer Survivors

Background Spiritual well-being (SpWB), defined as hopefulness, inner peace, and sensing a reason to be alive, is integral to health related quality of life (HRQOL). It is only partially related to spirituality and religiosity. The challenges of colorectal cancer (CRC) and subsequent bodily changes can affect SpWB. We explored expressions of SpWB reported by CRC survivors with ostomies. Methods We recruited all adult CRC survivors (>=5 years) with permanent ostomies who were members of Kaiser Permanente Northwest, Northern California, or Hawai'i during 2000-2006 to complete a mailed survey (n=283). We asked participants to respond to an open-ended question about the greatest challenge they encountered in having an ostomy. Responses from the 62% (176 of 283) of patients who answered this question were analyzed based on the City of Hope HRQOL model for content related to SpWB, and to identify and categorize the SpWB themes found. Results The responses of 51% (90 of 176) of participants contained SpWB content. Seventeen SpWB themes were identified, reflecting positive, negative, and ambivalent dimensions. Some responses contained multiple themes but each theme was coded only once for each person. Fifty-three of 90 people (59%) expressed positive themes which included "positive attitude" "appreciate life more" "helping others helps me" "strength through religious faith" "leading an active life" and "I am fortunate." Negative themes included "struggling to cope" "not feeling 'normal'" and "loss" and were least common, expressed by only 28 of 90 people (31%). Ambivalent themes were most common (67%; 60 of 90 individuals) and included "learning acceptance" "ostomy is the price for survival" "reason to be around despite suffering" and "continuing to cope and function despite challenges." Discussion These CRC survivors with ostomies infrequently cited negative SpWB as a major challenge, though the greatest number of SpWB responses were ambivalent. More commonly, SpWB themes were mentioned as a source of resilience or part of the struggle to adapt to their altered body after cancer surgery. SpWB interventions should be broadly constructed to include the many types of SpWB, as opposed to narrowly defining SpWB only in terms of spirituality or religiosity.     

Providing Palliative and Hospice Care to Children,Adolescents and Young Adults with Cancer

ObjectivesTo describe palliative, concurrent, and hospice care in pediatric oncology in the United States (US), we present a clinical scenario illustrating palliative and hospice care, including eligibility for concurrent care, insurance coverage and billing, barriers to accessing quality pediatric palliative and hospice care, and implications for oncology nursing practice.Data SourcesPeer-reviewed articles, clinical practice guidelines, professional organizations, and expert clinical opinion examining pediatric oncology, palliative care, and hospice care.ConclusionUnderstanding the goals of palliative and hospice care and the differences between them is important in providing holistic, goal-directed care.Implications for Nursing PracticeOncology nurses play a pivotal role in supporting the goals of pediatric palliative care and hospice care and in educating patients and their families. Nurses form trusting relationships with pediatric oncology patients and their families and are in a position to advocate for best palliative care practices as disease progresses to end of life, including when appropriate concurrent care or hospice.     

Myocardial Strain and Strain Rate in Monitoring Subclinical Heart Failure in Asymptomatic Long-Term Survivors of Childhood Cancer

We studied the role of global myocardial strain and strain rate in monitoring subclinical heart failure in a large group of asymptomatic long-term survivors of childhood cancer. Global strain (rate) parameters of survivors were compared with those in healthy controls and were related to conventional echocardiographic parameters, N-terminal-pro-natriuretic peptide (NT-pro-BNP) levels and clinical parameters. Two-dimensional (2-D) echocardiography was performed in 111 survivors and 107 healthy controls. Blood samples were taken from survivors to determine NT-pro-BNP levels. We showed that global myocardial strain, strain rate and time to peak systolic strain in asymptomatic survivors of childhood cancer were significantly lower compared with healthy controls (p values <0.0001) and were significantly related to several systolic and diastolic left ventricular parameters. Whether myocardial strain and strain rate are superior to conventional echocardiography in the early detection of subclinical heart failure needs to be explored in further longitudinal prospective studies. (E-mail: A.Mavinkurve@cukz.umcn.nl)     

The Role of Nurses in the Quality of Cancer Care Management: Perceptions of Cancer Survivors and Oncology Teams

ObjectivesThis study aimed to explore the perceptions of cancer survivors and oncology professionals of quality in cancer care and the role of oncology nurses in prompting and maintaining quality across the cancer care continuum.Data SourcesSemistructured in-depth interviews were conducted with 16 cancer survivors and 22 healthcare professionals between August and October 2021. The interviews were transcribed and analyzed using ATLAS.ti v8 software according to a thematic analysis method based on grounded theory. The COnsolidated criteria for REporting Qualitative research (COREQ) was used to guide the report of the study.ConclusionFour main themes emerged from the interviews, which are outlined as follows. (1) Patient participation in the cancer care plan: shared information and decision-making; (2) emotional and support aspects in cancer care; (3) continuity in cancer care: from being a patient at the hospital to a survivor in the community; and (4) cancer care management. Cancer survivors pointed to elements that can increase the quality of cancer care, including the ongoing provision of information, support in decision-making, and continuity of care. Oncology staff interviewees mentioned the need for a single staff member to manage the cancer care plan and serve as a case manager for patients and survivors.Implications for Nursing PracticeNurses have a central role in achieving the highest possible quality of cancer care for the growing number of survivors and their families. It is recommended to expand the role of oncology nurses, providing them the training and competencies needed to formally declare them as care managers throughout the continuum of cancer care.     

Cultivating LGBTQ+ Competent Cancer Research: Recommendations from LGBTQ+ Cancer Survivors,Care Partners,and Community Advocates

ObjectiveSexual and gender minority (SGM) or LGBTQ+ communities were designated as a National Institutes of Health (NIH) disparity population in 2016, yet research exploring SGM cancer disparities is still limited. Thus, we sought the insight of LGBTQ+ cancer survivors, care partners, and community advocates to learn their recommendations for cultivating competent and inclusive cancer research for LGBTQ+ individuals.Data SourcesWe conducted a focus group with LGBTQ+ survivors and care partners of LGBTQ+ survivors who were 18 years or older (N = 8) and interviews with community advocates who are leaders in LGBTQ+ cancer (N = 8). The focus group and interviews were recorded, transcribed, and qualitatively analyzed using an inductive thematic analysis.ConclusionQualitative analysis elicited an overarching theme of cultivating competent research for LGBTQ+ individuals, including three subthemes: (i) Cisheteronormativity: An inhospitable ecosystem for LGBTQ+ patients, survivors, and care partners, (ii) Study design: Shifting from invasive ‘othering’ to a sustainable community-driven climate, and (iii) Recruitment and data collection: Ways to cultivate ecosystem health. Cultivating inclusive, competent research with SGM populations is crucial for addressing health disparities and improving cancer survivors’ and care partners’ health.Implications for Nursing PracticeRecommendations from LGBTQ+ survivors, care partners, and community advocates ranged from small alterations to systemic changes, highlighting the multifaceted yet feasible process of cultivating LGBTQ+ competent cancer research. The process of cultivating competent research for LGBTQ+ populations will take substantial investment from researchers, providers, and health systems.     

A Qualitative Exploration of Medication Experience and Factors Contributing to Adherence to Oral-Targeted Therapy Among Lung Cancer Survivors

ObjectivesThe introduction of oral-targeted therapy for cancer improves survival while adherence also presents as a challenge to patients. Current studies on oral anticancer agents are primarily limited to patients from developed countries with breast cancer and chronic myeloid leukemia receiving oral chemotherapy and hormonal therapy. This study explored experience of oral-targeted therapy adherence among Chinese patients with nonsmall cell lung cancer and its contributing factors by using a qualitative research.Data SourcesSemi-structured interviews with 16 patients and 7 family caregivers at a tertiary tumor hospital in China were conducted to understand their experience and perceptions of oral-targeted therapy. Thematic analysis was applied to generate the themes and to identify underlying factors associated with the adherence.ConclusionThe lung cancer survivors struggled with ambivalence between survival and relief during taking targeted anticancer medication and showed diverse models of nonadherence, including intentionally or unintentionally intermittent medication and overadherence. Three main themes were identified: (1) cancer-related distresses, (2) inadequate social support, and (3) forgetfulness, together with seven subthemes, representing factors impeding patients’ medication adherence. The themes demonstrate complicated and interrelated factors from personal, interpersonal, sociocultural, and structural forces contributing to patients’ poor adherence.Implications for Nursing PracticeThe findings suggest the imperativeness of reinforcing community- or home-based oral-targeted medication management in which nurses play a principal role to implement strategies of patient education, symptom management, reminder prompts, and monitoring to improve adherence.     

Chemotherapy Use,End-of-Life Care,and Costs of Care Among Patients Diagnosed With Stage IV Pancreatic Cancer

Context

For patients with metastatic cancer and limited life expectancy, potential benefits of chemotherapy must be balanced against harms to quality of life near death and increased out-of-pocket costs of care.

Associations between Health Behaviors,Health Self-Efficacy,and Long-Term Outcomes in Survivors of Childhood Cancer: A Cross-Sectional Study

ObjectivesMany survivors of childhood cancer experience multiple long-term chronic health conditions. Health behaviors are important because they contribute to chronic disease yet are highly modifiable. With growing pressure on cancer services, alternative models of care are required to address survivorship care needs. The authors sought to inform the development of a community-based model of cancer survivorship care for young people. This exploratory cross-sectional study aimed to assess the feasibility of study measures and processes, as well as investigate associations between various modifiable health behaviors, health self-efficacy, quality of life, and persistent symptoms.Data SourcesParticipants were recruited from a long-term follow-up clinic for childhood cancer survivors. A self-report survey was completed, and participants received an activity tracker. Bivariate regression analyses were used to explore the relationship between variables.ConclusionsThe study measures and processes were deemed feasible with >70% of eligible survivors enrolling in the study and completing >70% of study measures. Thirty participants (mean age 22 ± 4.4 years) were enrolled; 83.3% finished treatment ≥5 years previously and 36.7% were overweight or obese. Bivariate regression identified those with higher scores of health self-efficacy were more likely to meet physical activity guidelines, as were those who achieved more sleep and consumed greater servings of vegetables. Meeting the physical activity guidelines, was significantly positively associated with higher quality of life and self-efficacy.Implications for Nursing PracticeInterventions that target health self-efficacy have the potential to improve a range of health behaviors and long-term outcomes for survivors of childhood cancer. Nurses are ideally placed to use this knowledge to support patients with recommendations to optimise their recovery and rehabilitation.