Cancer Nursing最新文献

Background: Postoperative pharyngeal pain is common in patients with thyroid cancer undergoing day-case surgery, with approximately 60%-90% affected. Wrist-ankle acupuncture (WAA) offers a potential alternative but lacks clinical validation in day surgery settings.

Objective: This study aimed to assess the effectiveness and safety of WAA in reducing postoperative pharyngeal pain in patients with thyroid cancer undergoing day-case surgery.

Methods: Seventy-two patients undergoing thyroidectomy were randomized into the WAA experimental group (n = 36) or the control group (n = 36). The WAA experimental group received standardized care plus subcutaneous needle insertion at wrist points (Upper 1 and Upper 6) postoperatively, whereas the control group received standard care alone. Pain was assessed using the visual analog scale at 3, 4, 9, and 27 hours, and predischarge. Secondary outcomes included the Houston Pain Outcome Instrument and the 15-item Quality of Recovery scale.

Results: At 9 and 27 hours post surgery, the experimental group reported significantly lower pain scores ( P < .001); satisfaction with pain control was also significantly higher ( P < .001). The WAA group had minor adverse events and no serious complications. Additionally, the experimental group experienced better postoperative sleep and overall health ( P < .05).

Conclusions: Wrist-ankle acupuncture significantly relieves postoperative sore throat in patients with thyroid cancer during day surgery. This work establishes a foundation for integrating WAA into modern surgical recovery pathways. However, larger randomized controlled trials are needed to determine effectiveness across different institutions and populations.

Implications for practice: Wrist-ankle acupuncture offers a nonpharmacological alternative for pain management in thyroid cancer surgery. Further studies are needed to confirm its broader applicability and effectiveness in diverse patient populations.

Background: Induction chemotherapy not only can effectively reduce tumor load and improve disease symptoms in patients with multiple myeloma (MM) but can also lead to toxic side effects, which increase symptom burden. Cross-lagged panel network analysis provides a novel insight into symptom influence mechanisms during multiple time periods.

Objectives: The aims of this study were to analyze the complexity and dynamic changes of symptoms experienced by patients newly diagnosed with MM in relation to the courses of chemotherapy and provide evidence for effective and precise symptom management.

Methods: A total of 175 patients newly diagnosed with MM were selected to complete the Memorial Symptom Assessment Scale-Chinese version at baseline and the first 4 courses of chemotherapy. Exploratory factor analysis was used to extract symptom clusters. Cross-lagged panel networks were constructed to identify crucial nodes in the network and explore predictive and interactive effects among symptoms.

Results: Four symptom clusters were extracted: psychological distress, disease behavior, fatigue-lack of appetite, and abdominal distension-constipation. During T0 → T1, "feeling irritable" exhibited the highest out-EI (outgoing expected influence), predicting T1 "difficulty falling asleep" and "nausea." During T1 → T2 and T2 → T3, "weight loss" predicted T2 "lack of energy" and "loss of appetite," and predicted T3 "worry," "feeling nervous," and "feeling irritable," respectively. During T3 → T4, "feeling nervous" predicted "pain," "loss of appetite," and "lack of energy" during T4.

Conclusion: "Tension" and "irritability" in the psychological symptom cluster and "weight loss" in the fatigue-related symptom cluster were "high output centrality symptoms" predicting other symptoms and the dynamic change of the whole network.

Implications for practice: Our findings provide a theoretical intervention target for nursing intervention with patients with MM.

Background: Breast cancer is a leading cause of cancer-related morbidity and mortality and imposes substantial financial strain on individuals and society. Minoritized groups, particularly Black/African American (AA) women, face a heightened risk of financial toxicity during treatment, even after accounting for socioeconomic differences.

Objective: The aim of this study was to explore and provide meaningful interpretations of the financial experiences of Black/AA breast cancer survivors (BCSs).

Methods: We conducted a systematic search to synthesize qualitative studies, published from 2009 to 2024, on the financial experiences of Black/AA BCSs during treatment. The Meta-Ethnography Reporting Guidance was used to follow Noblit and Hare's 7 phases of meta-ethnography. Quality assessment of the studies was done using the Joanna Briggs Institute critical appraisal tool.

Results: Five studies involving 135 participants (102 Black women), aged 28 to 80 years, were analyzed. Five themes were formed: (1) insurance/systemic gatekeeping and the conditionality of care, (2) psychological stress, (3) reduced adherence and possible missed appointments, (4) from bills to barriers, and (5) coping strategies to manage financial burden.

Conclusion: This review highlights substantial financial challenges faced by Black/AA BCSs, extending beyond medical expenses, affecting treatment adherence, psychological well-being, and long-term quality of life.

Implications for practice: Oncology nurses play a critical role in reducing financial disparities by screening for financial distress, providing referrals, and delivering culturally sensitive care. Nurse and peer navigation programs, although not universally accessible, show promise in mitigating financial hardship and improving adherence and survivorship outcomes. Expanding such programs into survivorship care planning is essential to advancing equity in oncology.

Background: Cancer, regardless of type, presents a formidable life challenge affecting patients' psychological well-being. Many perceive cancer diagnosis and treatment as traumatic.

Objectives: This study aimed to estimate posttraumatic stress disorder (PTSD) prevalence in Omani adult cancer patients, identify predictors, and probe its correlation with social support.

Methods: This cross-sectional study enrolled 343 adult cancer patients undergoing treatment from 3 hospitals in the Middle East country of Oman. Posttraumatic stress disorder was assessed via the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , and perceived social support was measured using the Multidimensional Scale of Perceived Social Support.

Results: The prevalence of PTSD among Omani adult cancer patients was 27.4%. Enhanced social support correlated with lower PTSD risk (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.93-0.97; P < .001). Predictors included shorter time since diagnosis (OR, 0.98; 95% CI, 0.97-0.99; P = .017), no psychiatric referral (OR, 0.46; 95% CI, 0.23-0.96; P = .04), and insufficient social support (OR, 0.96; 95% CI, 0.94-0.98; P < .001).

Conclusions: Social support significantly mitigates PTSD risk. Routine assessment and psychiatric referrals, especially for recent diagnoses, can enhance patients' lives. Reevaluating the PTSD diagnostic cutoff score (33) merits consideration for improved clinical use.

Implications for practice: Early PTSD assessment, particularly for low-social support new-diagnosed patients, is crucial for timely intervention. Psychiatric referrals can guide specialized treatments. Stressing social support's role can guide healthcare providers, including oncology nurses, in supporting patients effectively.

Background: Recipients of allogeneic hematopoietic stem cell transplant (HSCT) may encounter difficulties in adhering to their post-transplant medication as prescribed to avoid complications. Despite the relevance of patients' perspectives to inform the clinical practice, to date, no summary regarding their lived experience of oral medication adherence (MA) has been produced.

Objective: To summarize the lived experience of MA by recipients of allogeneic HSCT as documented in qualitative studies.

Methods: A systematic review and meta-synthesis of qualitative research was performed. Six databases were searched up to June 27, 2023. Four qualitative studies met eligibility and were included: those designed and conducted with scientifically sound methodologies and those regarding adult patients who had undergone allogeneic HSCT and required an oral medication regimen in the post-transplant phase. Data were extracted and synthesized using thematic analysis.

Results: Four analytical themes were identified: "The initiation is a challenge," "Time as a new issue," "Internal and external obstacles threaten medication adherence," and "Different strategies are the answer to medication non-adherence."

Conclusions: Medication adherence in patients after HSCT is a complex phenomenon wherein different factors play a role. When designing targeted interventions to improve MA, it is imperative to start with patients' experiences and perspectives.

Implications for practice: Patients developed different strategies to deal with obstacles to MA that may inform daily practice. Before discharge, healthcare professionals should emphasize to both patients and carers the importance of MA.

Background: Patients with advanced cancer may experience symptom clusters during treatment (eg, fatigue, pain, sleep disturbance, depression). Understanding the characteristics and factors associated with symptom cluster classes among this patient population is essential for effective symptom management.

Objective: The aims of this study were to identify symptom cluster(fatigue-pain-sleep disturbance-depression) classes and explore influencing factors in patients with advanced cancer during the treatment.

Methods: A cross-sectional survey was conducted in an oncology department of a tertiary hospital in China from September 2020 to March 2021. Cancer patients (stage III/IV) 18 years or older completed the questionnaires on pain, fatigue, sleep disturbance, depression, physical activity, and exercise self-efficacy. Latent class analysis and multinomial logistic regression were used.

Results: Three hundred sixty-five patients who were male (65.2%) and younger than 60 years (59.5%) completed questionnaires. Three symptom cluster classes were identified: class 1 ("low symptom burden" class), class 2 ("fatigue-insomnia" class), and class 3 ("high symptom burden" class), with a percentage of 54.5%, 38.6%, and 6.8%, respectively. The quality-of-life score, introversion/extroversion, economic burden, Karnofsky Performance Status, albumin level, and exercise self-efficacy were significantly different among the 3 classes ( P < .05).

Conclusion: Patients with advanced cancer were classified into 3 distinct classes, with class 1 having the best function. Results from this study reveal that Karnofsky Performance Status, albumin level, and exercise self-efficacy were significant factors for the latent classes of symptom cluster.

Implications for practice: Exercise self-efficacy is important for personalized interventions and improving symptom management efficiency.

Background: As a common psychological problem in cancer patients, illness uncertainty has attracted wide attention from scholars. Some studies have pointed out that the level of social support may affect illness uncertainty in patients with cancer, but the results of these studies remain controversial.

Objective: The aim of this study was to evaluate the correlation between illness uncertainty and social support in patients with cancer using meta-analysis.

Methods: PubMed, Web of Science, EMBASE, EBSCO, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Citation Database were searched for articles published up to 2022. The screening of the literature, data extraction, and quality assessment of the included studies were performed independently by 2 researchers. Stata 17.0 software was used to analyze the overall and moderation effects.

Results: Notably, 41 studies involving 5403 patients were included. The results showed that the illness uncertainty of adults with cancer was moderately negatively correlated with social support ( r = -0.33). Country, publication year, cancer type, and instrument used to measure social support moderated the association between illness uncertainty and social support.

Conclusion: Improving the level of social support can reduce illness uncertainty experienced by adults with cancer to a certain extent.

Implications for practice: This review provides a clear direction for implementing precise interventions to reduce illness uncertainty among adults with cancer. Furthermore, patients with cancer with high morbidity and mortality rates deserve greater attention from healthcare personnel and family caregivers.

Background: Postoperative experiences after breast cancer surgery, such as lymphedema, phantom breast sensations, persistent chronic pain, and changes in body image and sexuality, can negatively impact women's quality of life.

Objective: To investigate women's experiences of sequelae at 3, 6, and 12 months after mastectomy.

Methods: A survey including women ≥18 years, cognitively intact, and Danish speaking was conducted from May 2021 to October 2021. The researchers contacted the participants by telephone using 4 validated questionnaires investigating phantom sensation, body image, quality of life, and sexuality.

Results: Forty-four women were eligible for participation, and 23 (14 women aged ≤65 years and 9 women aged >66 years) were included in the analysis. The results showed an overall decrease in the severity of physical sequelae and an improvement in body image and sexual function. However, the women reported concerns about the future and decreased sexual enjoyment. Nearly half of the women received information about sexuality from healthcare professionals.

Conclusion: The study demonstrated decreased sequelae during the follow-up period. Still, there seem to be unanswered questions concerning the quality of life and the content of information regarding sexuality. The findings require attention and further research to benefit the individual woman and her partner in accommodating the consequences after mastectomy.

Implications for practice: Persistent pain and concerns for the future are present for half of the women after 1 year. Information about possible changes in sexuality is not standard. A nurse-patient dialogue that discusses hospitalization and sexuality on an individual level can be a way to address concerns and challenges.

Background: Internationally, early integration of palliative care in pediatric oncology has been widely recognized. However, little is known about the perspective of Chinese providers in this regard.

Objective: The aim of this study was to explore the perspective of Chinese providers on the early integration of palliative care in pediatric oncology.

Methods: This was a convergent mixed-methods study with a survey among 141 Chinese providers (101 nurses, 38 oncologists, and 2 social workers) and 12 individual interviews (5 oncologists, 5 nurses, and 2 social workers).

Results: Three categories existed by comparison and merging of quantitative and qualitative findings: (1) attitudes toward early integration of pediatric palliative care: 75% of the participants endorsed early integration because it would bring benefits to patients and their families-participants had concerns about misunderstandings of palliative care among other stakeholders; (2) patient-provider interactions relating to early integration: participants held contradictory views toward the impact on and influencers of early integration regarding patient-provider interactions; and (3) participants suggested a system to support early integration by addressing parents' misconceptions and providers' training, and institutional facilitation.

Conclusions: Chinese pediatric oncology providers generally exhibit a reserved willingness toward the early integration of palliative care. They agree that palliative care would be beneficial but have concerns about providing structural support and addressing cultural influencers.

Implications for practice: Findings of this study emphasize the significance of convening stakeholders and establishing a pediatric palliative care-friendly system in a developing country, particularly by addressing structural support, resource allocation, clarified responsibilities, and capacity building.