Showing papers in "Cancer Nursing in 2004"

Uncertainty intervention for watchful waiting in prostate cancer.

Abstract: Watchful waiting is a reasonable alternative to treatment for some older men with localized prostate cancer, but it inevitably brings uncertainty. This study tested the effectiveness of the watchful waiting intervention (WWI) in helping men cognitively reframe and manage the uncertainty of watchful waiting. Based on Mishel's Reconceptualized Uncertainty in Illness Theory (Image. 1990; 256-262), the WWI was tested with a convenience sample of 41 men. Experimental subjects received 5 weekly intervention calls from a nurse. Control subjects received usual care. Outcomes were new view of life, mood state, quality of life, and cognitive reframing. Repeated measures of analysis of variance were used to test the effectiveness of the WWI. The sample was 86% Caucasian and 14% African American, with an average age of 75.4 years. Intervention subjects were significantly more likely than controls to view their lives in a new light (P = .02) and experience a decrease in confusion (P = .04) following the intervention. Additionally, intervention subjects reported greater improvement in their quality of life than did controls (P = .01) and believed their quality of life in the future would be better than did controls (P = .01). This study's findings document the benefits of the WWI for patients living with uncertainty.

Validation evidence for Turkish adaptation of Champion's Health Belief Model Scales.

Abstract: Instruments using Health Belief Model constructs in breast cancer screening in previous studies were developed and tested by Champion for American women, and since then, these have been revised twice. Champion's Health Belief Model Scale (CHBMS) has been translated and tested in various studies in other countries and cultures. Also, the current study examined the validity and reliability of the Turkish adaptation of the CHBMS among Turkish women. The instrument was translated using a back-translation technique, which includes the use of a panel of experts and interpreters to translate the items from the source language to the target language and then back-translate them to the source language. The study was conducted in Ordu, a city in north Turkey. A total of 266 Turkish women aged 20 and older working as primary schoolteachers were included in the sample. Analyses included internal consistency, reliability, factor analysis, and known group techniques. After the analysis, 3 items from the Barriers domain, 1 from the Seriousness domain, and 2 from the Motivation domain were deleted from the original scale. So, the final Turkish version of the CHBMS (CHBMS-T) consisted of 36 items that were clustered into 6 subscales: susceptibility (3 items), seriousness (6 items), motivation (5 items), benefits of breast self-examination (BSE) (4 items), barriers to BSE (8 items), and confidence/self-efficacy of BSE (10 items). Internal consistency ranged from 0.69 to 0.83. Construct validity was supported by exploring the factor structure of the instrument using factor analysis and testing known-group techniques. Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for this group of women. It can be used in planning and testing interventions to improve BSE beliefs and practice.

Colorectal cancer knowledge, perceptions, and behaviors in African Americans.

Abstract: Disparities in healthcare among racial and ethnic minorities are associated with poor outcomes. African Americans have the highest incidence of colorectal cancer (CRC) among all racial groups. Using a nonrandom sample of 100 African American men and women, 50 years of age and older, the authors explored CRC knowledge, perceptions, and screening behaviors of African American men and women who resided or worked in an urban low-income housing residence. The extent to which screening may be attributed to demographic, sociopsychological, and structural variables was also investigated. Respondents demonstrated inadequate knowledge of CRC, with a significant difference in mean scores between males and females. Self-report of participation in CRC screening was above the national average, with almost half of the sample reporting fecal occult blood home kit use and more than half of the sample reporting completion of sigmoid and colonoscopy exams and double contrast barium enema exam. A majority perceived CRC as a threat. A very high percentage perceived numerous benefits to CRC screening in preventing CRC susceptibility. Perceived barriers of nearly half of the sample included screening may be painful and afraid to find out something is wrong if I have CRC screening, while more than half did not know how to schedule screening. Barriers and threat were correlated with grade school education. Barriers were negatively correlated with secondary education and post-secondary education and moderately correlated with threat. Predictor variables found in the Health Belief Model accounted for a significant amount of the variance in screening behavior, barriers, and threat. Older African American men and women need more information about CRC in order to increase their awareness of CRC and the importance of screening. There is a need to educate healthcare professionals about the causes, prevention, and detection of CRC and the importance of screening.

Hope and coping in patients with cancer diagnoses.

Abstract: This descriptive correlational study explored hope and coping in patients with various cancer diagnoses. Four groups of patients with gastrointestinal/ genitourinary, breast, head and neck, or hematologic malignancies completed the Herth Hope Scale, the Jalowiec Coping Scale, and a basic demographic form. Subjects were recruited from the oncology outpatient clinic of a large mid-Atlantic teaching institution. Information about tumor site and stage was obtained from a chart review. Fifteen different malignancies were represented. Seventy-one percent of the 183 participants had metastatic or recurrent disease. No significant differences were found in the levels of hope or coping style use and coping effectiveness by type of cancer. The level of hope was relatively high, even in those patients who knew that their disease was in an advanced stage. A positive relationship was found between hope and coping style use (P =.013) and coping effectiveness (P <.001) in all 4 groups. The findings demonstrate that the level of hope was high and was positively related to coping in patients with cancer, regardless of gender, age, marital status, education, or site of malignancy. These findings support the need for nurses to continue to practice hope-inspiring behaviors, to implement hope-fostering interventions, and to avoid hope-hindering practices among their patients.

Adolescents with cancer: experience of life and how it could be made easier.

Abstract: This study is about what adolescents with cancer think about their life situation, the support they get, and the information they receive about their illness The data for this qualitative and descriptive study were collected in 3 focus group interviews with 20 adolescents aged 13 to 18 years attending a cancer adjustment camp Interpretation was based on the method of inductive content analysis The adolescents' experiences of their current situation were analyzed into 5 categories: views on life here and now, negative experiences of self because of the illness, resources recognized in self, difficulties caused by the illness in relation to life around them, and resources identified in the world around They made very little, if any, conscious effort to plan ahead for the future The information received by the adolescents concerned their illness and its treatment here and now, various practical matters, as well as the future impacts of the illness and its treatments Most of this information focused on the here and now, whereas the adolescents' information needs were mainly oriented to the future As for the adolescents' chances to take part in making decisions about their care and life, the analysis yielded 6 categories: joint decision making, inadequate chances for decision making, independent decision making, illusion of decision making, reluctant to make decisions, and excluded from decision making Finally, the adolescents' hopes for improvement were focused on staff activities, physical care facilities, chances to discuss and work through their experiences of the illness, and the support received from society

Exploring social cognitive theory constructs for promoting exercise among breast cancer patients.

Abstract: Physical activity during breast cancer treatment can significantly reduce treatment-related fatigue and improve quality of life. Unfortunately, the majority of women with breast cancer either do not exercise at all or exercise below recommended levels. Little is known about how to enhance physical activity among breast cancer patients. The social cognitive theory, a useful framework for the design of physical activity interventions, has not been studied among breast cancer patients. Our study purpose was to explore physical activity knowledge, attitudes, and behaviors among breast cancer patients during adjuvant therapy utilizing social cognitive theory constructs in preparation for a larger, survey study and future intervention research. Twelve breast cancer patients attended 1 of 3 focus group sessions. Focus group questions were based on the social cognitive theory constructs of self-efficacy, environment, behavioral capability, expectations, expectancies, self-control and performance, observational learning, and reinforcement. The focus group participants generally felt confident in their ability to exercise during treatment if fatigue, time management, and social networking were addressed. The majority of participants had not been given information related to exercise by their physicians during treatment. The participants felt that exercise was more beneficial than harmful during treatment, with the 2 most important benefits identified as reduced fatigue and the potential for improved survival. The use of reinforcements by participants was minimal. The participants consistently expressed the desire for education and guidance by knowledgeable staff during an exercise program. Walking was the most acceptable exercise modality. Social cognitive theory may be a useful framework for future study of exercise behavior among breast cancer patients and measurement of constructs related to this theory should be included in such studies. Future exercise intervention studies should consider the unique barriers and program preferences of breast cancer patients while focusing on self-efficacy, outcome expectations/ expectancies, observational learning, and reinforcements.

Psychosocial interventions for patients with head and neck cancer: past, present, and future.

Abstract: A diagnosis of head and neck cancer, like any cancer diagnosis, is often accompanied by much fear and uncertainty. In addition, patients with head and neck cancer face difficulties in eating, chewing, drinking, breathing, speaking, as well as changes in appearance. Simultaneously, the burden of head and neck cancer is often manifested in psychosocial dysfunction, which can have a negative impact on quality of life. Although a phenomenon well recognized, little is known about many factors that influence or impact psychosocial dysfunction in individuals with head and neck cancer. Even less is known about the effective management of psychosocial dysfunction. To date, there is evidence to suggest that psychosocial interventions generally provide an overall positive effect. Moreover, some intervention studies, such as education alone, have failed to achieve the desired results. In addition, some studies suggest an advantage of cognitive- behavioral therapy over other forms of psychological treatment. With the growing impetus to investigate factors associated with psychosocial dysfunction, and considerable advancement in the development and validation of many global and disease-specific measures, there is an opportunity for further research to develop an appropriate clinical intervention program for such patients.

Reliability and validity of the breast cancer screening belief scale among Turkish women.

Abstract: Breast cancer is the second leading cause of cancer deaths in Turkish women, and the use of breast self-examination (BSE) and mammography remains low in Turkey. Therefore, we need to identify the beliefs, influencing BSE and mammography, and a valid and reliable tool to measure constructs. The Champion's health belief model scale (CHBMS) is a valid and reliable tool to measure beliefs about breast cancer, BSE, and mammography in an English culture. The purpose of this study was to assess the psychometric characteristics of a Turkish version of the CHBMS related to breast cancer, BSE, and mammography. A convenience sample of 656 women was recruited from 3 health centers and 2 maternal and child health centers in Istanbul. The CHBMS was translated to Turkish, validated by professional judges, back translated, and tested. Factor analysis yielded 7 factors for BSE: confidence, seriousness, barriers-BSE, health motivation 1 and 2, susceptibility, and benefits-BSE. For mammography scale, 6 factors were identified: seriousness, benefits-mammography, barriers-mammography, health motivation 1 and 2, and susceptibility. All items on each factor were from the same construct. Cronbach alpha reliability coefficients ranged from.75 to.87 for the subscales. The Turkish version of the CHBMS showed adequate reliability and validity for use in Turkish women. It could easily be used to evaluate the health beliefs about breast cancer, BSE, and mammography. Further refinement is required to study Turkish women's health beliefs and breast cancer screening behaviors in various settings.

Symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal cancer

Abstract: This study aims to describe symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal tract (GIT) cancer, and to identify the extent to which demographic, physical, and psychosocial factors predict their quality of life. A convenience sample of 146 newly diagnosed GIT cancer patients recruited from 3 major hospitals in Shanghai completed a self-report questionnaire. The questionnaire was designed to obtain demographic and medical data and measures of symptoms, psychological distress, social support, health-related quality of life (HRQoL), and global quality of life (GQoL). Measures developed in English were translated into Chinese using the procedure advocated by WHO. The results showed that the most common signs and symptoms reported were fatigue, pain, and weight loss; 28% of the patients were depressed; and overall, patients had a moderate quality of life. Comparative analyses found some difference on measures for demographic and diagnostic subgroups. Depression, symptom distress, and social support accounted for 44% of the total variance for HRQoL, while perceived financial difficulty and symptom distress accounted for 20% of the total variance for GQoL. Findings from this research give insights into the importance of quality of life assessment, symptom management, and intervention to improve the quality of life of Chinese cancer patients. It also raises questions about measures of quality of life that are culturally relevant.

Substantial changes in life: perceptions in patients with newly diagnosed advanced cancer and their spouses.

Abstract: There are few studies on patients' perceptions of their situation after being recently diagnosed with an advanced gastrointestinal cancer and those of their spouses. Fourteen patients and their spouses were interviewed separately. The interviews were analyzed using a phenomenographic approach. The analysis indicated that the response categories for patients and spouses were roughly the same, but the number of patients and spouses who made statements differed between categories. All informants perceived substantial changes in life. This included negative physical, mental, and practical changes as well as positive changes. Mental changes included 3 categories: despair, why, and uncertainty. The informants described several ways of handling these changes in life. The most frequently reported by patients were that "one shouldn't complain" and by spouses to "hope," and by all informants to "make the best of it." Other ways of handling the situation were reconciliation, avoidance, preparation for death, seeking support, and isolation. In conclusion, more patients than spouses seemed to accept their situation because fewer patients complained and instead prepared for death, whereas more spouses felt despair, used hope and avoidance, and were preoccupied with practical matters. These findings suggest that spouses are a vulnerable group and healthcare staff should be just as aware of their situation as that of the patients.

Social support and coping in Chinese patients undergoing cancer surgery.

Abstract: Patients undergoing cancer surgery experience the threats from both cancer and surgery. The unique sociocultural characteristics of Hong Kong Chinese may affect their perception of social support and how they face these threatening experiences. Sixty eligible patients were recruited from 2 regional hospitals in Hong Kong. They were asked to respond to a set of questionnaires, including Norbeck Social Support Questionnaire (NSSQ), Informational Support Questionnaire, and Jalowiec Coping Scale, following cancer surgery. The results showed that although family members and spouse/partner represented the largest source of social support network, the overall quantity of social support received by Chinese patients after cancer surgery was low. Positive correlations were found between coping effectiveness with tangible support (r = 0.31, P <.05) and coping effectiveness with informational support (r = 0.52, P <.01). The findings of this study support the link between social support and successful coping following cancer surgery. Tangible and informational supports appear more relevant to effective coping than emotional support during the postoperative period. Inclusion of family members in patient care during the postoperative period is crucial. Special attention should be paid to those patients who are older and poorly educated as they may be highly at risk for inadequate social support. Further studies with other cultural groups are suggested in order to better understand the sociocultural factors associated with cancer care.

Patterns of weight and body composition change in premenopausal women with early stage breast cancer: has weight gain been overestimated?

Abstract: The widely documented problem of weight gain during adjuvant breast cancer chemotherapy has decreased in frequency and magnitude. However, adverse changes in body composition remain a problem. This study identified the frequency, magnitude, and patterns of weight and body composition change in a sample of premenopausal breast cancer survivors who were receiving 3 common chemotherapy regimens. The longitudinal study followed 76 women at 2 centers in Ontario, Canada. Measures were obtained at baseline, the start of every other treatment cycle and treatment completion. Participants' mean age was 44.1 years (SD = 5.9). Their mean baseline weight and body mass index were 69.3 kg (SD = 17.0) and 26 kg/m2 (SD = 6.6), respectively. Fifty-five percent maintained stable weights, while 34% gained and 10.5% lost weight. Their mean weight change during treatment was a 1.4-kg gain. Weight gainers and losers gained or lost 3 to 4 times as much fat as fat-free mass, respectively. A researcher's definition of “weight change” will influence the amount of weight gain reported, and the results of this study suggest that previous research may have overestimated the frequency and magnitude of weight gain in this population. Further research is needed to design interventions that match survivors' needs.

Effect of acupressure on nausea and vomiting during chemotherapy cycle for Korean postoperative stomach cancer patients

Abstract: Despite the development of effective antiemetic drugs, nausea and vomiting remain the main side effects associated with cancer chemotherapy. The purpose of this study was to examine the effect of acupressure on emesis control in postoperative gastric cancer patients undergoing chemotherapy. Forty postoperative gastric cancer patients receiving the first cycle of chemotherapy with cisplatin and 5-Fluorouracil were divided into control and intervention groups (n = 20 each). Both groups received regular antiemesis medication; however, the intervention group received acupressure training and was instructed to perform the finger acupressure maneuver for 5 minutes on P6 (Nei-Guan) point located at 3-finger widths up from the first palmar crease, between palmaris longus and flexor carpi radialis tendons point, at least 3 times a day before chemotherapy and mealtimes or based on their needs. Both groups received equally frequent nursing visits and consultations, and reported nausea and vomiting using Rhode's Index of Nausea, Vomiting and Retching. We found significant differences between intervention and control groups in the severity of nausea and vomiting, the duration of nausea, and frequency of vomiting. This study suggests that acupressure on P6 point appears to be an effective adjunct maneuver in the course of emesis control.

Patients' experiences of palliative care in the home : a phenomenological study of a Swedish sample.

Abstract: Patients' experiences of palliative care in the home : a phenomenological study of a Swedish sample.

The effect of childhood cancer on Hong Kong Chinese families at different stages of the disease.

Abstract: In Hong Kong the incidence of cancer is 144.3 per 1,000,000 children and is the first cause of disease-related death among children aged between 1 and 14 years. The diagnosis of cancer in a child poses a threat to the family unit, with many families experiencing difficulties as they cope with the demands of their child's illness. The purpose of this descriptive study was to explore the effects of cancer on the child, parents, and siblings during different stages of the disease. An in-depth individual interview was undertaken with 13 Chinese parents, 10 children, and 11 well siblings. Thematic analysis of the qualitative data identified 5 key areas including knowledge and understanding of the nature of the disease, being truthful, responses to the disease, changing family relationships, and changes in family life. This article focuses on the findings of 2 of these key areas: knowledge and understanding of the nature of the disease and being truthful. The findings indicate that all parents were fully aware of the diagnosis, treatment, and prognosis of their child's disease. The child's knowledge of the disease varied, depending in part on parents' willingness to tell their children about the disease and its prognosis. Most parents were reluctant to share information about the disease with their children. Children, however, were found to have considerably more knowledge about the disease than parents reported, indicating a gap in communication between parents and children. The findings indicate the importance of disclosure about the disease within the family and the need for practitioners to facilitate information sharing among family members within this population group.

Knowledge of the limitations associated with prostate cancer screening among low-income men.

Abstract: This correlational pilot study measured limitations of prostate cancer screening, using a revised Knowledge of Prostate Cancer Questionnaire. Knowledge in 81 low-income men is reported. The Knowledge About Prostate Cancer Screening Questionnaire consists of 12 questions, with scores ranging from 0 to 12. Concepts measured include limitations, symptoms, risk factors, and screening age guidelines. The Total Knowledge Score had a mean of 6.60, with a standard deviation of 3.00, indicating that knowledge was low. Half of the men knew that "some treatments for prostate cancer can make it harder for men to control their urine." More than half of the men knew that, "some treatments for prostate cancer can cause problems with a man's ability to have sex." Married men, low-income men, and Caucasian men had significantly lower Total Knowledge Scores than unmarried, higher income, and African American men. Implications for practice and research are discussed.

Spouses' perceptions of and reactions to living with a partner who has undergone surgery for rectal cancer resulting in a stoma

Abstract: The aim of this study was to illuminate spouses' perceptions of living with a partner who had been diagnosed with rectal cancer followed by surgery resulting in a stoma. The focus group interview was chosen as method of data collection. Two focus group interviews consisting of 2 meetings each were conducted. A qualitative content analysis was used. Five themes emerged: difficulties of being involved; living with uncertainty; learning to live in a new way; the altered body; and the search for explanations. There were feelings of anxiety about the partner's serious condition and the possible spread of the cancer. After the rehabilitation period, the stoma influenced the spouses' lives in many ways but they coped with the problems together with their partners and helped them adapt to their changed circumstances. This study indicates that the spouses were very much involved in caring for the patient suffering from rectal cancer by protecting them and showing empathy. However, the dependence on the stoma affected and restricted their family and social life.

Assessment of fatigue in and care needs of Turkish women with breast cancer.

Abstract: Using Piper's Integrated Fatigue Model, this research project was planned to determine the level of fatigue experienced by Turkish women with breast cancer undergoing adjuvant chemotherapy, to discover the factors affecting fatigue, and to provide a reference by means of which an effective nursing care for such patients could be planned. In assessing the level of fatigue and factors affecting it, a patient information form, the Piper Fatigue Scale, and the Rotterdam Symptom Checklist were used. The reliability tests performed afterwards showed that the scales are appropriate tools for use in Turkish women with breast cancer. Before treatment, psychological symptoms' distress was higher than physical symptoms' distress. However, following treatment, the latter was found to be closer to the former. When pretreatment and posttreatment physical and psychological symptoms were compared, it was noticed that fatigue, nausea, anorexia, vomiting, constipation, depression, and loss of hope for the future were among the symptoms observed to increase the most in the posttreatment period. Different from the other studies, we determined that all of the patients experienced fatigue 7 to 10 days after the chemotherapy cycle and the sensory/affective fatigue scores were high. Breast cancer patients undergoing chemotherapy experienced a moderate level of fatigue, which was influenced by level of income, stage of disease, and symptoms related to chemotherapy, showing compliance with similar studies. Following up patients individually and keeping the treatment-related symptoms under control were noticed to help prevent fatigue.

African American women's breast memories, cancer beliefs, and screening behaviors.

Abstract: African American women experience higher breast cancer mortality and lower survival rates compared with white women of comparable age and cancer stage. The literature is lacking in studies that address the influence of past events on current health behaviors among women of diverse cultural groups. This qualitative exploratory study used participant narratives to examine associations between women's memories and feelings concerning their breasts and current breast cancer screening behaviors. Twelve professional African American women, aged 42 to 64 years, shared stories about memories and feelings regarding their breasts. Codes grouped together with related patterns and recurrences revealed categories that encompassed the language and culture of the participants. The categories identified were Seasons of Breast Awareness, Womanhood, Self-Portraits, Breast Cancer and Cancer Beliefs, Breast Cancer Screening Experiences, and Participants' Advice for Change. These categories provide direction for further exploration of barriers to health promotion practices among African American women and women in general.

Symptom occurrence, symptom intensity, and symptom distress in patients undergoing high-dose chemotherapy with stem-cell transplantation.

Abstract: The main aim of this study was to investigate the patients' self-reported symptom occurrence, symptom intensity (SI), and symptom distress (SD) from admission for stem-cell transplantation (SCT) until discharge from the ward. Forty-three patients participated and data were collected at 7 different time-points by using the self-administered Symptom Frequency, Intensity, and Distress questionnaire for SCT (SFID-SCT). The results showed that symptom occurrence followed a curve on which the highest frequencies of symptoms were reported from the day of the SCT (T2) until the end of the protective care period (T5). The mean SI and SD scores became higher when the number of reported symptoms increased. Between T2 and T5, 33% to 54% of the patients reported >10 simultaneous symptoms. Symptoms reported by more than 50% of the patients during T2-T5 were tiredness, loss of appetite, mouth dryness, nausea, sleeping disturbances, diarrhea, and changes of taste. Loss of appetite, tiredness, and mouth dryness were, in descending order, the 3 symptoms reported as most intense and distressing. A statistically significantly higher SD-score was found for the patients undergoing allogeneic SCT on the day before start of the conditioning regimen, as compared to the patients undergoing autologous SCT. Patients reporting no anxiety on admission were found to have higher, mean SD-scores at the end of the hospital stay than anxious patients. The SFID-SCT questionnaire was found to give useful information not only about symptom occurrence but also about SI and SD. To use an instrument that distinguishes between these aspects of the symptom experience may help health care professionals to support the patients through the SCT-process.

Meanings of the phenomenon of fatigue as narrated by 4 patients with cancer in palliative care.

Abstract: The disabling experience of fatigue suffered in connection with incurable cancer is an area within nursing that has generated only limited research interest. The need for a change in focus is presented in the literature: from treating the symptom itself to facilitating living with the fatigue caused by a life-threatening disease. This implies that helping to alleviate fatigue must start from the patients' own understanding and interpretation of this experience. Our study attempts to achieve this understanding through illuminating the meanings of fatigue as experienced by 4 patients with cancer in palliative care. The research interviews were analyzed using a phenomenological-hermeneutic approach inspired by the philosophy of Ricoeur. Our findings indicate a world in which one meaning of fatigue connected with incurable cancer is a lived bodily experience of approaching death. Comprehending fatigue in this way allows us to understand the paradoxes we found in the text, such as struggling in vain against fatigue, and hoping to overcome fatigue but expecting failure. The paradoxes represent a struggle between body and mind, between bodily experiences and intellectual understanding, and have important implications for how we communicate with patients about fatigue.

Lived experience of survivors of leukemia or malignant lymphoma

Abstract: Individuals (n = 18) in remission from acute leukemia or highly malignant lymphoma were asked to narrate their lived experience of falling ill, of being under treatment, and life following this event. The transcribed texts were analyzed from a phenomenological-hermeneutic perspective, expanded by their medical and social history as related in interviews. The analysis revealed 3 themes: (I) Believed in life, fought for it and came through stronger; (II) Life went on, adapted and found a balance in the new life; (III) Life was over, felt out of control and lost belief in life. Participants in the first 2 groups viewed their quality of life as improved and stated that the struggle had been meaningful and that the experience had made them grow, as a person, related to the experience of gaining new insight or strength. The third group of survivors viewed their quality of life as worse. They found no meaning in their experience and evaluated the situation with bitterness. Thus the core of living through having acute leukemia or highly malignant lymphoma seemed to be to find meaning with it and the profound crisis it meant to them. To help people retell their experiences may be one way of processing this life-threatening disease and treatment and may be one way to developing a sense of meaning and to regain balance in life.

The relationship between factors that impair wound healing and the severity of acute radiation skin and mucosal toxicities in head and neck cancer.

Abstract: Purpose To determine which wound-healing factors impact on the severity of radiation skin and oral mucosal reactions in head and neck cancer and to test modifications to the Radiation Therapy Oncology Group (RTOG) acute toxicity scoring system. Methods A consecutive sample of 53 head and neck cancer patients who were scheduled for curative or palliative radiation therapy. Therapy was planned using traditional computerized techniques. A new RTOG subscale for tongue reactions was developed. Information on potential predictors was collected during the first week of treatment. Reactions were observed and documented each week throughout treatment using the RTOG Acute Reaction Scoring System scores of acute oropharyngeal reactions and various personal factors. Results Significant relationships were found between severe skin and oral reactions and age, commencing radiation within 2 months of surgery and smoking. Significant relationships for severe oral mucosal reactions were found with weight at the commencement of treatment, inadequate or poor diet, having had mucositis with previous chemotherapy, and the use of a custom-made Perspex tongue immobilizer. Conclusions Three conclusions can be derived from this study: (1) structures within the oral cavity should be considered separately for toxicity scoring, (2) the newly developed tongue RTOG subscale adds accuracy and specificity to the RTOG acute toxicity scoring system, and (3) wound healing factors are an important component of understanding risk for side effects in head and neck cancer treatment.

Prevention and treatment of oropharyngeal mucositis following cancer therapy: are there new approaches?

Abstract: Oropharyngeal mucositis is an acute and distressing toxic effect of chemotherapy and head and neck irradiation. This oral sequela significantly impairs the daily functioning and quality of life of patients. The biological basis of mucositis is quite complex, involving sequential interaction of chemotherapeutic drugs or irradiation on mitosis of proliferating epithelium, a number of cytokines, and elements of oral microbial environment. Various interventions based on biological attenuation have been tested for mucositis. Such interventions have been reviewed elsewhere; however, most reviews focus on biomedical outcomes. Little attention has been paid to mucositis outcomes with oral morbidity or psychosocial aspects. The purpose of this article is to review the current research studies on the prevention and treatment of oropharyngeal mucositis following chemotherapy, radiotherapy, and bone marrow transplantation with an emphasis on biomedical, oral symptomatic, and functional impairment outcomes. In addition, further avenues of mucositis management, including psychotherapeutic intervention and integrated and stage-based treatment approaches are discussed.

Determining the main risk factors and high-risk groups of breast cancer using a predictive model for breast cancer risk assessment in South Korea.

Abstract: This study was aimed at developing a predictive model for assessing the breast cancer risk of Korean women under the assumption of differences in the risk factors between Westerners and Koreans. The cohort comprised 384 breast cancer patients and 2 control groups: one comprising 166 hospitalized patients and the other comprising 104 nurses and teachers. Two initial models were produced by comparing cases and the 2 control groups, and the final equations were established by selecting highly significant variables of the initial models to test the accuracy of the models in terms of disease probability and predictability. Both the initial models and the final disease-probability models were confirmed to exhibit high degrees of accuracy and predictability. Major risk factors determined by comparing the patients with hospitalized controls were a family history, menstrual regularity, total menstrual duration, age at first full-term pregnancy, and duration of breastfeeding. Major risk factors determined by comparing patients with nurse/teacher controls were age, education level, menstrual regularity, drinking status, and smoking status. The predictive model developed here shows that risk factors for breast cancer differ between Korean and Western subjects in the aspect of breastfeeding behavior. However, identifying the relationship between genetic susceptibility and breast cancer will require further studies with larger samples. In a model with nurse/teacher controls, drinking and higher education were found to be protective variables, whereas smoking was a risk factor. Hence the predictive model in this group could not be generalized to the Korean population; instead, breast cancer incidence needs to be compared among nurses and teachers in a nurse-and-teacher cohort.

Assessing the support needs of women with early breast cancer in Australia.

Abstract: The purpose of the current study was to access the degree to which the support needs of women with a newly diagnosed, early invasive, primary breast cancer and their families are being met. A random sample of 544 women diagnosed with early breast cancer was recruited to participate in a telephone survey via state and territory cancer registries. Sixteen percent of women reported not receiving enough support during their diagnosis and treatment, and only 65% of these women reported that their families received enough support. The primary sources of support for women and their families were medical practitioners (eg, surgeons, oncologists, and general practitioner) with very few women or family members utilizing mental health professionals. Given the importance of adequate support when being diagnosed and treated for breast cancer, urgent attention needs to be paid to training medical professionals in providing appropriate support and referrals for their patients.

Issues in Internet survey research among cancer patients.

Abstract: Considering the increasing number of cancer patients who are online, it is clear that the Internet will provide an important research medium and/or setting for oncology nurses in the near future. Despite increasing Internet usage in nursing research and practice, issues in using the Internet among cancer patients as a research tool have rarely been explored and discussed. The purpose of the article is to propose future directions for Internet research among cancer patients based on discussions of practical issues raised in an Internet survey study among 40 online cancer patients. The issues raised through the research process include (a) ethical issues, (b) recruitment issues, (c) issues in Web site development and maintenance, and (d) data entry and analysis issues. On the basis of the discussions of these issues, some future directions for Internet survey studies are proposed, including dealing with ethical issues, getting computer expertise, using motivational strategies, and using national and international approaches.

Pain Measurement in Older Adults With Head and Neck Cancer and Communication Impairments

Abstract: The ability to communicate the presence of pain by means of verbal and nonverbal communication is crucial to facilitate the assessment of pain. Patients with communication impairment (CI) are limited in their ability to verbally report their pain and, consequently, mechanisms to elicit information about the pain experience must incorporate simple and valid methods to accomplish this goal. Pain measurement and the impact of the pain experience in older adults with CI are areas that have been studied on a limited basis in nursing. This study compared the effectiveness of 3 pain assessment tools in measuring pain intensity in the older adults with head and neck cancer and with CI. Multivariate repeated-measures analysis of variance revealed that there were no significant differences in the mean pain intensity scores when subjects used the Numeric Rating Scale, the Faces Pain Scale, and the Visual Analogue Scale at 3 different time intervals. The highest correlation coefficients between pain measurement tools were identified during the third time when the pain measurement tools were used to rate pain intensity. Subjects identified the Numeric Rating Scale as the preferred method to rate pain intensity. Canonical correlation analysis demonstrated that among the demographic variables evaluated in the study, education explained the largest variance in composite of the pain measurement scales.

The role of religious coping in adjustment to prostate cancer.

Abstract: This study explored the role of religious coping in men's long-term adjustment to prostate cancer. Thirty-four men with prostate cancer completed questionnaires on demographic and illness factors, religious and general coping, and physical, social, and emotional functioning. Results showed that religious coping was related to poorer role, social, and emotional functioning for these cancer survivors. In contrast, religious coping was related to positive aspects of cognitive appraisal and to both active and avoidance forms of general coping. Notably, religious coping may be used to help cancer survivors "block out" their everyday experience of the prostate cancer and its related complications. Such results suggest that religious coping functions in a complex manner within the context of long-term prostate cancer survival.

Measurement of symptom distress in women with early-stage breast cancer.

Abstract: While symptom distress can alter the cancer experience, it is difficult to define and measure. This study's aims were (1) to determine whether the McCorkle Symptom Distress Scale (SDS) or the Rhodes Adapted Symptom Distress Scale (ASDS) was the more accurate measure of symptom distress in women with breast cancer; (2) correlate both scales with a visual analogue scale (VAS) measuring anxiety, a symptom frequently reported clinically; (3) determine tool preference; and (4) establish when during the first cycle of chemotherapy the highest levels of symptom distress were experienced. One hundred twenty women were recruited and measurement of symptom distress (SDS and ASDS) and anxiety (VAS) taken at the start of chemotherapy (Time 1), at the nadir (Time 2), and at the end of the cycle (Time 3). Both instruments were highly correlated and detected change over time; none was correlated with the VAS anxiety scale. Symptom distress scores were generally low, with fatigue, appearance, insomnia, and concentration causing the greatest distress. Other factors like functioning, body image, and menopausal symptoms cited as contributors to symptom distress levels were not measured and could account for low scores and perhaps suggest that symptom distress may not be accurately measured in today's women with early-stage breast cancer.