Cancer Nursing最新文献

Background: Limited research studies have focused on examining the impact of technology-based interventions in changing symptom clusters among Asian American breast cancer survivors.

Objective: The aim of this study was to understand the longitudinal impact of a technology-based program on the symptom cluster experience of Asian American breast cancer survivors.

Methods: This is a secondary data analysis that used exploratory factor analysis at each time point (baseline, post-1 month, post-3 months) for the control and intervention groups (N = 199).

Results: The number of symptom clusters remained the same, and the same symptoms remained in similar clusters across the 2 groups. The control group experienced psychological cluster, fatigue cluster, and neck/skin cluster at baseline; psychological cluster, fatigue/dizzy cluster, and neck/skin cluster at post-1 month; and psychological cluster, fatigue/dizzy cluster, and somatic cluster at post-3 months. The intervention group experienced psychological cluster, neck cluster, and appetite/itching cluster at baseline; somatic/anticholinergic cluster, psychological/sexual cluster, and appetite cluster at post-1 month; and psychological cluster, neck cluster, and itching cluster at post-3 months. The psychological and neck clusters shared similar core symptoms of feeling nervous, dry mouth, and cough between the control and intervention groups.

Conclusion: The different symptom cluster experiences may be due to the technology-based intervention where the intervention group receives individual/group coaching/support that may have changed symptom clusters over time. Yet, the true efficacy of the intervention on symptom clusters warrants further investigation.

Implications for practice: Clinicians should understand the changes in symptom clusters as well as the presence of core symptoms and take a targeted symptom cluster approach in clinical settings.

Background: Dyadic psychoeducational intervention targets the dyads of cancer patients and caregivers as active participants in partnership, which can potentially address the needs and challenges faced by patients with cancer and their caregivers. However, there is insufficient evidence on the effectiveness of the intervention on psychological health and illness-related outcomes among the dyads.

Objective: To systematically examine the dyadic psychoeducational intervention of cancer patients and their caregivers on psychological health and illness-related outcomes.

Methods: Cochrane Library, EMBASE, CINAHL, PsycINFO, PubMed, Web of Science, and 4 Chinese databases were searched from inception to May 29, 2022. Two investigators independently extracted data and evaluated methodological quality. RevMan 5.4 was used for meta-analysis; heterogeneity was evaluated using Higgins' I2 (%). Standardized mean difference (SMD) with a 95% confidence interval (CI) was used to assess the effects.

Results: Eight randomized controlled trials that involved 1234 dyads were collected. Meta-analysis showed that the intervention was effective in reducing the dyadic depression (patients' SMD, -0.41 [95% CI, -0.78 to -0.04; P = .03]; caregivers' SMD, -0.70 [95% CI, -1.31 to -0.09; P = .03]). It also improved caregivers' quality of life (SMD, -0.29 [95% CI, -0.56 to -0.03; P = .03]), whereas no significant effect was found on patients' quality of life. Dyadic results including anxiety, self-efficacy, disease communication, and appraisals of illness/caregiving were observed.

Conclusion: Dyadic psychoeducational intervention reduced the dyadic depression. It also improved caregivers' quality of life.

Implications for practice: Nurses can apply dyadic psychoeducational intervention in clinical practice. More studies are needed to draw higher-quality conclusions and investigate the effects on psychological health and illness-related outcomes in cancer patients and caregivers.

Background: Music listening interventions have been used to manage preoperative anxiety and postoperative pain in women undergoing breast cancer (BC) using face-to-face mode and music that was relevant to the patients' culture; however, the interventions were not underpinned by any theories.

Objective: To assess the feasibility and preliminary effects of a theory-driven multicomponent music intervention on preoperative and postoperative patient outcomes in African women with BC undergoing mastectomy.

Methods: This study was a multicenter, single-blind randomized controlled trial with qualitative interview. A total of 36 women scheduled to undergo mastectomy were recruited from Nigeria and Malawi and randomly assigned to either the intervention group or the control group. Quantitative data were analyzed using the Mann-Whitney U and Wilcoxon signed rank tests, whereas qualitative data were analyzed using the inductive approach.

Results: The multicomponent music intervention was effective in reducing participants' preoperative anxiety and enhancing satisfaction with care on the day of surgery, reducing postoperative pain at 24 and 48 hours after surgery, and reducing systolic and diastolic blood pressure at 48 hours after surgery. The qualitative data corroborated these findings.

Conclusion: The study's findings indicated that the theory-driven multicomponent music intervention was feasible, acceptable, and effective in reducing preoperative anxiety and postoperative pain, optimizing vital signs, and enhancing satisfaction with care among African women with BC undergoing mastectomy.

Implication for practice: The study's findings indicate that nurses in clinical settings can integrate the intervention into the plan of care of women with BC beginning with their surgery booking visit.

Background: In the era of evolving and emerging therapies, adolescents and young adults (AYAs) living with advanced cancer experience a high degree of uncertainty, making palliative care and end-of-life (PCEOL) discussions difficult. Clinical conversations determine values/preferences that guide shared decision-making and goals of treatment, including end-of-life care when cancer progresses. Initiating PCEOL conversations is challenging for clinicians.

Objective: This study describes the development and validation of an instrument that measures AYA readiness to engage in PCEOL clinical conversations.

Methods: A Ready-to-Talk Measure (R-T-M) was developed, guided by the revised conceptual model of readiness across 3 domains (awareness, acceptance, and willingness). Content experts evaluated validity, and 13 AYAs with advanced cancer participated in cognitive interviews. Acceptability (item applicability, clarity, interpretation, sensitivity, missingness) and experiences (benefit, burden) were analyzed.

Results: The scale content validity index was ≥0.90 for each domain. Forty-two of the 55 R-T-M items were acceptable without any change. Three items were deleted. Ten items were modified, and 3 were added. Adolescents and young adults wanted more items about friends/siblings and about AYA unique qualities for clinicians to know them better. Adolescents and young adults acknowledged benefit through talking about difficult, relevant topics.

Conclusion: Ready-to-Talk Measure validity was strengthened by deleting or modifying unclear or misinterpreted items and by adding items. Next steps include psychometric analysis to determine reliability/dimensionality and stakeholder input to make the R-T-M a clinically useful tool.

Implications for practice: Ready-to-Talk Measure assessment of readiness to engage in PCEOL conversations while identifying unique preferences of AYAs holds promise for facilitating ongoing discussions.

Background: Breast cancer (BC) and its treatments decrease patients' psychological well-being. Peer support is one form of social support, but little is known about what gives rise to peer support.

Objective: The purpose of this study was to examine how peer support is constructed among recently diagnosed BC patients.

Methods: Eighteen women were randomly picked from 130 women who had received phone calls from a trained peer supporter and were invited to group interviews. In the interviews, patients discussed their cancer, peer support experiences, and social support. The transcribed data were analyzed using Braun and Clarke's thematic analysis approach.

Results: The construction of peer support among newly diagnosed BC patients was complex. It depended on the needs of the patient and the success of interactions. Once they had received a diagnosis, the lives of the patients changed suddenly, and patients dove into the I-we-others consideration and had a need to talk. Interaction with peer supporters gave them a chance to share their stories. At their best, interactions led to belonging, caring, and a sense of security.

Conclusions: The need to be heard and seen is strong in a patient's changing health situation. Peer support plays an important role in high-standard care and in strengthening patients' self-determination.

Implications for practice: Hospitals should create chances for supportive communication, and the supportive communication should be easily accessible and successful. The training of peer supporters should ensure that they have reflected on their own BC process and know how to consider the needs of newly diagnosed patients.

Background: Cancer-related fatigue (CRF) is a common symptom, and exercise has shown potential in alleviating CRF. However, there is a need for diverse exercise options tailored to individual patient needs.

Objective: To evaluate the overall effects of a combined walking and resistance band exercise intervention in relieving CRF among cancer patients through randomized controlled trials.

Methods: Comprehensive searches were conducted in multiple databases to identify relevant studies up until March 2023. Inclusion criteria required the intervention to involve walking combined with elastic band training, with a clear exercise protocol description. The primary outcome was CRF, and secondary outcomes included walking steps, distance, mood distress, and quality of life. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models.

Results: Ten trials were included. The intervention group showed significant improvements in CRF (SMD, -0.40; 95% CI, -0.60 to -0.20), mood distress (SMD, -0.30; 95% CI, -0.53 to -0.07), and daily walking steps (SMD, 0.52; 95% CI, 0.07-0.96) compared with the control group. Although the 6-Minute Walk Test and quality of life did not show significant differences, a trend toward improvement was observed in the intervention group. Adverse events related to the intervention were infrequent.

Conclusion: A combined walking and resistance band exercise intervention can effectively alleviate CRF and improve mood distress and daily walking steps among cancer patients.

Implications for practice: This exercise option may provide an additional strategy to manage CRF. Further research is needed to explore the optimal exercise prescription for individual patients.

Background: Caregivers of patients with cancer are susceptible to profound psychological distress and low quality of life owing to the substantial demands of caregiving. The comprehensive needs of caregivers are closely linked to their quality of life. However, little is known about the relationship between these factors.

Objective: This study aimed to determine whether comprehensive needs mediate the relationships between psychological stress and quality of life in caregivers of patients with cancer.

Methods: A cross-sectional design was used to recruit 382 participants through convenience sampling. Psychological stress, comprehensive needs, and quality of life were measured using a questionnaire.

Results: Psychological stress was associated with higher comprehensive needs ( r = 0.30, P < .01) and lower quality of life ( r = -0.20, P < .01). Comprehensive needs were negatively associated with quality of life ( r = -0.28, P < .01). Mediation analysis findings revealed that both the indirect effect of psychological stress on quality of life via comprehensive needs ( β = -0.10; P < .001) and its direct effect on quality of life ( β = -0.16; P < .01) were statistically significant, suggesting a partial mediatory effect of comprehensive needs between psychological stress and quality of life.

Conclusions: Our findings suggest that reducing psychological stress can improve quality of life by promoting satisfaction with comprehensive needs.

Implications for practice: Interventions that help reduce psychological stress and meet the comprehensive needs of caregivers of patients with cancer can improve their quality of life.

Background: Immune checkpoint inhibitors (ICIs) were approved to treat advanced melanoma (AM) because of meaningful clinical benefit. These early data reported that ICI therapy is generally well tolerated, and despite symptoms, patients reported a high global health-related quality of life (HRQOL).

Objective: Immune checkpoint inhibitors are widely used in the oncology community; the aim of this systematic review was to evaluate current data on ICI therapy and its impact on HRQOL of patients with AM.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed during this systematic review to identify and select studies from the PubMed, OVID, EMBASE, and Cochrane databases. Selected studies were downloaded into Covidence and analyzed for trends in how ICI therapy impacts HRQOL in patients with AM. Multiple tools were used to assess the quality of the studies.

Results: The 16 studies included 12 quantitative, 2 qualitative, and 2 mixed-methods studies. The quality of the studies was moderate (n = 7) or strong (n = 9). Symptoms that impacted HRQOL were fatigue, endocrine dysfunction, rash, diarrhea, cognitive impairment, emotional impact (anxiety and depression), and financial toxicity. Suicidal ideation and 1 attempt were reported in 2 studies, which had not been previously published.

Conclusion: Patient-reported symptoms due to ICI negatively impacted HRQOL. Anxiety and depression are prevalent. Current QOL instruments do not capture the entire patient experience.

Implications for practice: Patients need to be asked if their symptoms are impacting their HRQOL. Further prospective research is needed to develop or adjust current patient-reported outcome instruments to adequately capture the impact of ICIs on HRQOL.

Background: Nasopharyngeal carcinoma (NPC) has serious effects on the daily lives and psychosocial adjustment of survivors. In particular, psychosocial problems are a prominent concern.

Objective: The aim of this study was to understand the lived experiences of NPC survivors regarding psychosocial adjustment.

Methods: A qualitative design using individual semistructured interviews was conducted with 20 NPC survivors. Each participant was asked open-ended questions about their lived experience with psychosocial adjustment. The data were then subjected to thematic analysis.

Results: The following 4 themes, which had subthemes, were identified from the data: (1) grappling with discomforts (symptoms distress of late toxicities, impaired body image, and returning-to-work restrictions), (2) struggling with uncertainty (disease attribution with self-blame, contradictory rehabilitation information, fear of cancer recurrence, and distance from medical staff), (3) changing social patterns (special favors, social isolation, and social discrimination), and (4) cultivating positive change (healthy lifestyle and positive mindset).

Conclusions: Nasopharyngeal carcinoma survivors experience many obstacles, as well as positive changes, during psychosocial adjustment. This study highlights the pressing need to consider NPC survivors' concerns about their psychosocial adjustment.

Implications for practice: Medical staff should provide NPC survivors with sufficient rehabilitation information to help them deal with possible late toxicities and mitigate their uncertainty and misunderstanding. Effective public education measures are needed to address misunderstandings about cancer in Chinese cultural settings.