Showing papers in "Cancer Practice in 1996"

Quality of life in breast cancer.

Abstract: Purpose Currently, 1,721,700 women are living with breast cancer in the United States. As the number of survivors of breast cancer continues to rise, so must our knowledge about unique quality-of-life concerns. This article reports the results of a study on quality of life in women with breast cancer and validates the model of quality of life in this population. Description of study To explore these concerns and to validate a breast cancer quality-of-life model, 21 survivors of breast cancer, across three age strata (younger than 40 years, 40 to 60 years, and older than 60 years), were interviewed and asked to complete quantitative surveys on pain and quality of life. Results Across all age groups, unique issues of survivorship include those related to physical, psychological, social, and spiritual well-being. In the domain of physical well-being, the areas of worst outcome were in menstrual changes and fertility, fatigue, and pain. In the domain of psychological well-being, predominant needs were in the areas of fear of the spread of cancer, distress from surgery, recurrence, fear of second cancer, impact on self-concept, and fear of future tests. The social well-being subscale identified the greatest disruption in the area of family distress. The spiritual well-being subscale showed greatest disruption in the area of uncertainty, although other aspects of this domain were usually rated in a positive direction (e.g., importance of religious activities). Clinical implications The data demonstrated the need for further research, assessment, and intervention across each of the quality-of-life domains. There is a significant need to address physical problems; however, the psychological domain demonstrated the greatest area of distress. The multidimensional needs of breast cancer survivors emphasize the need for multidisciplinary collaboration.

The functioning of single women with breast cancer and their school-aged children.

Abstract: Although there are significant numbers of single women with breast cancer who are rearing children, there is no known study of their own or their school-aged children's adjustment to the illness. The purposes of this study are: 1) to describe the adjustment of single women to early stage breast cancer; 2) to contrast their responses to a comparable sample of married/partnered women; 3) and to document the psychosocial functioning of school-aged children when their single mother has breast cancer. Results obtained from questionnaire data from 22 single and 101 married/partnered women revealed that single women had significantly higher rates of depression; reported significantly higher numbers of illness-related pressures on their family; had a significantly higher proportion of young children scoring in the abnormal range on measures of self-worth and social acceptance; and reported lower quality in parenting their children. Interviews with single women revealed that many were burdened by feelings of self-deprecation because of their breast cancer, and many felt alone with the disease through the initial diagnosis period, during treatments, and through recovery. Evidence from this pilot study suggests that single women need early and immediate linkage into an informational and educational network and a viable adult support network.

Side effects burden in women with breast cancer.

Abstract: PURPOSE This article describes the side effects burden of 307 women who were receiving treatment for breast cancer. The study provides a description of the impact of side effects burden on adult role activities (self-help), self-care, psychological adjustment, and quality of life. DESCRIPTION OF STUDY Data to describe the side effects burden characteristics of 307 women receiving treatment for breast cancer were drawn from the Self-Help Intervention Project. Data were collected after medical treatment was underway and treatment-related side effects were evidenced. The impact of side effects burden on adult role activities (self-help), self-care, psychological adjustment, and life quality is described. RESULTS Fatigue was the most common side effect as well as the most problematic. Number of side effects and increase in side effects were moderately correlated (P < 0.0001) in a negative direction with fatigue and depression. Self-care behaviors also were associated negatively with the extension of side effects and with fatigue and depression (P < 0.001). Psychological adjustment was associated with difficulty sleeping, anxiety, and depression. Overall life quality was noted to be negatively related to depression as was present life quality. CLINICAL IMPLICATIONS Data support the need for clinical interventions that are individualized to women's side effects experience. Additional research is underway to test the effectiveness of the interventions specified by the overall study.

Concordance of cancer patient and caregiver symptom reports.

Abstract: Purpose This study investigated whether family caregiver reports of cancer patients' symptoms (specifically: nausea, pain, poor appetite, insomnia, fatigue, cough, constipation, and diarrhea) were in concordance with patient reports, and whether variables such as patient depression, caregiver depression, caregiver optimism, and perceived impact of caring on caregiver health would explain discrepancies in patients' and caregivers' reports. Description of study A sample of 216 patients and their family caregivers was recruited through six community-based cancer treatment centers located in lower Michigan. Data on the study variables were obtained from two separate, multifaceted survey instruments completed by the patients and their family caregivers, respectively. Results The rate of agreement between patient and caregiver was highest for fatigue and lowest for insomnia, whether the entire sample, male caregivers, or female caregivers were considered. Female caregivers had a higher percentage agreement with their patients, and a higher level of association between patient and caregiver responses than male caregivers, uniformly for all symptoms. The overall accuracy of caregiver reports was approximately 71% and seemed to be relatively independent of the number of symptoms reported by the patient. Clinical implications Health professionals caring for patients with cancer must recognize that patient and caregiver reports of patient symptoms may not always be in agreement. Awareness of variables that may cloud family caregivers' observations is needed, so that accurate symptom reporting occurs, and appropriate management can be initiated to enhance quality of life for the patient as much as possible. It is also important for health professionals to educate family caregivers about the nuances of symptom distress presentation and to teach caregivers techniques to elicit accurate information so that timely, appropriate palliative management can be initiated.

Advocacy: the cornerstone of cancer survivorship.

Abstract: Purpose This article describes a cancer-related advocacy skill set that can be acquired through a learning process. Overview Cancer survivorship is a process rather than a stage or time point, and it involves a continuum of events from diagnosis onward. There exists little consensus about what underlying processes explain different levels of long term functioning, but skills necessary for positive adaptation to cancer have been identified from both the professional literature and from the rich experiences of cancer survivors. Clinical implications Healthcare practitioners need to be more creative and assertive in fostering consumer empowerment and should incorporate advocacy training into care plans. Strategies that emphasize personal competency and increase self-advocacy capabilities enable patients to make the best possible decisions for themselves regarding their cancer care. In addition, oncology practitioners must become informed advocacy partners with their patients in the public debate about healthcare and cancer care delivery.

Children's experiences with mothers' early breast cancer.

Abstract: This article describes children's experiences with mothers' early stage breast cancer, a neglected area of study. Of 55 families from a larger study, 12 families had children between the ages of 2 and 21 years living at home. Family interviews, including the children when possible, at diagnosis and four additional times over the first year, were transcribed and content-analyzed. Two major themes emerged: awareness (entailing the child's cognitive awareness and emotional/behavioral response) and dependence. The child's developmental level influenced his or her understanding and the nature of the demands on the child and family. Because of the dependency needs of preschoolers, a chief concern for their parents was child care. Parents thought preschoolers were too young to understand so they gave simple explanations. Minor behavior problems were noted. More information was shared with school-aged children who believed their mother's situation was serious. Although children's concerns decreased, they remained evident months later. Effects of stress were noted. Home and caregiving demands usually increased and often interrupted adolescent's moves to independence and created role confusion and increased tension. Implications for parents and health professionals about interacting with children are suggested.

Quality of life of primary caregivers of hospice patients with cancer.

Abstract: PURPOSE The purpose of this study was to evaluate the quality of life of a group of adults who were serving as primary caregivers for 118 hospice patients with cancer who were receiving hospice home care in west central Florida. DESCRIPTION OF STUDY The Caregiver Quality of Life Index, used in the study, includes items related to physical, emotional, social, and financial well-being. The Caregiver Quality of Life Index was administered within 48 hours of admission to hospice and after 3 weeks of hospice care (during week 4). RESULTS Quality of life scores remained stable from admission to week 4. Item scores were highest for social well-being (74.7 and 69.7) and lowest for physical well-being (60.6 and 63.7). No significant differences were found in item scores from admission to week 4. CLINICAL IMPLICATIONS Quality of life of primary caregivers is negatively affected by caregiving, but the support provided by hospice care may help to ameliorate these effects. Health providers who are alert to caregiver needs and knowledgeable about the work of the multidisciplinary hospice team will be more likely to refer patients and caregivers to appropriate hospice care.

Depressive distress among the spouses of terminally ill cancer patients.

Abstract: Bereaved spouses comprise a population at risk for psychological distress. Evidence suggests that spouses 55 years of age and younger are at increased risk of morbid outcomes, including major depressive episodes. Although the emotional impact of the sudden loss of a spouse has been well studied, less attention has been paid to the psychological impact of loss that is foreseeable, as in the case of a serious illness. In this study, data were obtained from pre-death interviews with 103 well spouses of terminally ill cancer patients. Subjects were white, 55 years of age or younger, and living with the patient and their child(ren) aged 7 to 16 years old. Depressive distress was assessed using the Brief Symptom Inventory. Fifty eight percent of males and 42% of females had scores for depressive distress in a clinically significant range. Regression analyses revealed gender was the most important predictor of the level of depressive distress reported, followed by patient's functional status and whether the well spouse quit work as a result of the patient's illness. The number of children 18 years or younger living in the household was inversely related to the level of depressive distress. The results of this analysis suggest that a large proportion of well spouses of patients with cancer who are also the parents of school-aged children may experience significant depressive distress during the terminal phase of their spouse's illness. These findings are important for planning future programs and improving existing ones for the spouses of terminal cancer patients.

Telephone support groups: a nontraditional approach to reaching underserved cancer patients.

Abstract: Purpose This article explores the initiation and clinical issues of a long-term telephone support group serving a population of people with cancer who are homebound, isolated, or otherwise unable to travel to a central location. It explores social, interpersonal, and intrapsychic issues and themes, and compares telephone and face-to-face groups. Description of program Five years ago, Cancer Care, Inc. created its first and only ongoing telephone support group to respond to the needs of homebound people with cancer. Approximately 30 clients have been members of the group since its inception. The group meets weekly for 1 hour through a conference call set up by an outside telephone company operator. Membership is stable at 12 clients ranging in age from 44 to 86 years. Findings Anonymity appears to have facilitated bonding and increased self-disclosure. A high level of continuity in group members' participation was reached. Group members learned to become advocates for themselves and were successful in reaching out to others outside of the group. Clinical implications Due to changes in the economic climate and increased comfort with technology, the formation of support groups that meet and are facilitated through the telephone is a viable, and sometimes the only, practical option. A telephone support group connects a group of people who cannot normally be together, allows patients to use a resource to which they would not have access otherwise, and helps them transcend physical limitations.

The nurse as exemplar: smoking status as a predictor of attitude toward smoking and smoking cessation.

Abstract: The smoking behavior of oncology nurses is of particular concern, not only because of the personal risk, but also because of the negative influence the behavior may have on the public. A survey of 316 female oncology nurses in Texas was conducted to assess smoking prevalence in this sample and the manner in which smoking status impacts the attitudes of these nurses toward their roles as exemplars and advocates for nonsmoking. The prevalence of smoking in this sample of oncology nurses was 7%, with an additional 26.2% being ex-smokers, supporting a downward trend in smoking among oncology nurses. Differences among oncology nurses who were smokers, ex-smokers, or nonsmokers concerning their attitudes toward smoking were investigated. Nonsmokers and ex-smokers showed a more positive attitude toward their roles as exemplars and in counseling the public about the health hazards of smoking.

Comparison of methods to determine the prevalence and nature of oral mucositis.

Abstract: PURPOSE Chemotherapy-induced oral mucositis may cause considerable patient morbidity. Its prevalence has been reported as ranging from 30% to 39%, although a prevalence as high as 75% has been reported with 5-fluorouracil. This variation may be a function, in part, of the methods of measurement used across different studies. The first purpose of this study was to determine the prevalence of oral mucositis in a sample of 127 patients receiving specific chemotherapy. The second purpose was to compare different instruments and techniques for assessing oral mucositis. DESCRIPTION OF STUDY A longitudinal design was used to collect data at four monthly chemotherapy cycles during drug nadir. The methods of measuring oral mucositis included interview (conducted monthly x 4); Eiler's Oral Assessment Guide (monthly x 4); Chemotherapy Knowledge Questionnaire and Behavior Checklist (both at the fourth month); Self-Care Behavior Log (ongoing over 4 months); and medical record review (collected at 4 months). RESULTS The mucositis prevalence in this one sample ranged from 30% to 69% depending on the method of measurement. The use of multiple instruments and techniques captured a clinical picture of oral mucositis far more detailed than published reports--a picture not revealed with any one instrument or technique. The chart record severely underdocumented the prevalence of mucositis compared to the interview. This discrepancy could reflect under-reporting by the patients, inadequate history taking at provider visits, or perhaps the documentation of only the more severe mucositis or mouth problems in the medical record. CLINICAL IMPLICATIONS Clinicians and researchers must choose their method of measurement carefully in relation to the purpose of assessment. For subjective tolerance of symptoms, the interview technique may be most useful. To test interventions, the use of a quantitative rating instrument is desirable. Intervention studies using multiple measures may require a combination of subjective and objective measures.

MacDibbs Mouth Assessment. A new tool to evaluate mucositis in the radiation therapy patient.

Abstract: Purpose The purposes of this descriptive, longitudinal study were to evaluate the MacDibbs Mouth Assessment instrument for the assessment of mucositis in the radiation therapy patient being treated for head and neck cancer and to describe the course of radiation-induced mucositis in these patients. Description of study This pilot study used self-report and provider assessment, as well as medical record review, to obtain data about ambulatory radiation therapy outpatients (n = 10). The participants were primarily male, white, middle-aged, married or partnered, unemployed, edentulous, currently smoking, and using alcohol. Results One or more mucositis ulcers were observed in all patients and occurred at an average of 2858.2 cGy. The corresponding Mouth Symptom Score was 5.9 (instrument range 0-21). Interrater reliability for 13 of the 14 items was 100%. The one difficulty encountered with the MacDibbs was in the measurement of ulcers longer than the periodontal probe used to measure them. Clinical implications The MacDibbs should prove useful for clinicians and researchers because it is efficient, easy to use, emphasizes accurate diagnosis of oral changes, has an easily discernible endpoint, and assesses signs and symptoms.

Portraits of cancer survivorship: a glimpse through the lens of survivors' eyes.

Abstract: Cancer survivorship is a tumultuous experience of balancing the elation of surviving life-threatening illness with the demands of chronic health concerns and altered life meaning. Increased awareness of the needs of cancer survivors is enhanced by large studies of this growing population, but also by appreciation of individual stories of survivorship. "Portraits" of survival, in the form of personal narratives, contribute to our understanding of the experience of cancer. Select portraits from a study exploring quality of life in cancer survivorship are shared to convey themes of rendering an old life, transition to a different life, and living an altered life after cancer diagnosis.

Quest. An intervention program for children whose parent or grandparent has cancer.

Abstract: PURPOSE The emotional strains and anxiety experienced by a family system when a parent or significant adult member has cancer are well documented. Furthermore, the literature suggests a need for an intervention program for children whose parent or grandparent has cancer. The current article describes Quest, an intervention program for children and teenagers whose parent or grandparent has cancer. Quest is designed to facilitate positive coping with a parent's or grandparent's cancer diagnosis, increase understanding about cancer, and promote more positive communication about the diagnosis within the family system. DESCRIPTION OF PROGRAM Quest is a 2-hour, biannual evening program targeted to children and adolescents whose parent or grandparent has cancer and structured to include educational information as well as time for expression of feelings. RESULTS The child, parent, and staff evaluations have been overwhelmingly positive and indicate the value of the program. CLINICAL IMPLICATIONS This program might be useful to other clinicians who have limited time to address a small, but important population affected by a cancer diagnosis in a family member. The structure and organization of the program make efficient use of time, yet address major issues affecting the children.

Results of a patient education project using a touch-screen computer.

Abstract: PURPOSE The purpose of this project was to increase use of the Physician Data Query and Patient Information File services of the National Cancer Institute in a clinical setting OVERVIEW A patient education demonstration project was conducted at the University of Rochester Cancer Center using a touch-screen computer program called CancerHelp Two computers were purchased, one stationed in the Patient Library at the University of Rochester Cancer Center and one circulated to three affiliated hospitals Demographic information was asked at the beginning of the program and an evaluation was elicited at the end of the program All information was given voluntarily; users of the system could bypass the questions if they wished The computer program was very well received by patients and their families The program was used 1758 times over 6 months CLINICAL IMPLICATIONS A touch-screen computer program can be an effective method for distributing cancer information

Burden of care and lung cancer.

Abstract: Purpose Although direct costs for treatment are important considerations in healthcare planning, the indirect costs of chronic care may have an even more profound impact on families. The burden of care of chronic illnesses is seldom addressed in healthcare policies. This article uses lung cancer as a model to illustrate the burden of care of chronic illness and to examine the many healthcare problems that affect patients, families, and society at large. Overview Lung cancer, as a major cause of morbidity and mortality, and the second most expensive cost of cancer care, will impact more than 1 million Americans and their families in the next decade. In this article, a health services model is used to address burden of care for people with lung cancer. Predisposing factors, enabling factors, and need for healthcare are considered. Lung cancer literature related to emotional status, functional status, and symptom distress are reviewed as they relate to the physical, emotional, and social aspects of the burden of care. Clinical implications The increasing responsibilities of the family in providing care in the face of limited external support, and the consequences of that caregiving, for the patient and family, raise serious concerns for clinicians. With quality of life as the ultimate health outcome, clinicians are challenged to contribute to a research and policy agenda that addresses burden of care.

Psychosocial care of the patient with cancer. A model for organizing services.

Abstract: Purpose Although the need and demand for psychosocial oncology services among patients with cancer is likely to grow, access to psychosocial services varies widely within treatment settings. Surveys and observations by clinicians indicate that these services are inadequate at most sites. There are many obstacles to service organization in this patient population. This article describes a model for delivering integrated psychosocial care that has applicability in cancer centers and other settings. Description of program Psychosocial oncology services in the Comprehensive Cancer Center of Wake Forest University have been systematically organized into two program components: the Cancer Patient Support Program (CPSP) and the Psychosocial Oncology Program. These programs are unique in offering psychosocial support and counseling services that are integrated into the medical care of patients. The CPSP provides services through clinical staff members, core volunteers, and doctoral- and master's-level counseling students. The type of social support provided includes emotional support, help with tasks, informational support, and companionship support. The Psychosocial Oncology Program provides psychological assessment and counseling for patients and family members suffering from more intense psychological disturbance. A doctoral-level licensed practicing psychologist and a part-time master's-prepared counselor, both with responsibilities in the CPSP as well, make up the staff. Clinical implications The key element in any psychosocial oncology program is the healing relationships formed when one person cares for another. In the psychosocial oncology service structure described, patients with cancer and their families have the opportunity to be served on two different levels, depending on the intensity of the psychological disturbance. The time has come for psychosocial services to be offered in all treatment settings. The psychosocial oncology programs described here can be replicated in most cancer centers.

Telephone help line for cancer counseling and cancer information.

Abstract: PURPOSE A telephone help line for providing cancer counseling and information was started in 1990 at the University Hospital of Uppsala, Sweden. The current study aimed to assess the experience of the telephone help line after 3 years of operation and to compare the results with telephone services in other countries. DESCRIPTION OF STUDY For each telephone call, a standard report form was completed and a short narrative description of the caller's concerns was written. RESULTS During the first 3 years, 735 calls were registered. Most of the calls were made by next of kin (30%) and patients (28%). Most (77%) of callers were women. The issues addressed were mainly medical or psychosocial. The medical questions were, in most cases, related to a patient's illness or treatment. The psychosocial questions dealt with the caller's (patient or next of kin) own anxiety, and these calls developed into supportive dialogues. Patients made more medical inquiries than next of kin, whereas family members were more concerned with psychosocial questions (P < 0.01). Questions relating to breast cancer accounted for a great part of the calls from patients (34%), but significantly less from the relatives (10%; P < 0.0001), whereas the opposite was true for colorectal adenocarcinomas (P < 0.01). These findings are discussed together with cultural differences between Sweden and other countries, particularly the United States. CLINICAL IMPLICATIONS The telephone help line can supply information to patients, next of kin, and the general public on their own premises. Another important task is to function as a link between people with symptoms and appropriate health service.

Cervical cancer incidence and screening: status report on women in the United States.

Abstract: PURPOSE Population-based estimates of cervical cancer incidence and screening are described. DESCRIPTION OF STUDY Data from the Surveillance Epidemiology and End Results and from the 1992 National Health Interview Survey Cancer Control Supplement were used to examine differences in disease rates, stage at diagnosis, and screening practices among population groups. RESULTS The overall age-adjusted incidence rate for invasive cervical cancer was 8.5 per 100,000 women in 1988-1992. Rates for black women were 66% higher than those for white women. At the youngest ages, rates were similar for both races--about 2.0 per 100,000. At older ages, rates diverged, increasing to 17.2 for white women ages 60 to 64 and 47.0 for black women aged 85 and older. Most cervical cancers were diagnosed at the localized stage, and older women and minority women were more likely to be diagnosed with advanced stage disease. Almost 25% of women reported they had not had a Papanicolaou smear test within the past 3 years. Among women younger than 45, whites were more likely than blacks not to have been screened. Among black women, there were regional differences in the use of Papanicolaou test, with those who lived in the South most likely not to be screened. CLINICAL IMPLICATIONS Although rates for some groups appear to be converging, disparities still exist. Targeted approaches to screening, follow-up, and treatment are necessary to ensure that trends in cervical cancer incidence continue to improve.

Quality of life and nutritional support in patients with cancer.

Abstract: Nutritional support is often initiated in patients with cancer who are unable to meet their nutritional needs by the oral route. Much has been written about the effect of nutritional support on physiological outcomes in patients with cancer. However, less is known about the relationship between improvement of nutritional status and quality of life. Trends in the treatment of cancer highlight the need for an examination of home nutrition support and quality of life. The purpose of this article is to describe the state of knowledge about the relationship of home enteral and parenteral nutrition support and quality of life. Research exploring the dimensions of quality of life (physical functioning, psychological status, interpersonal relationships and social functioning, financial concerns, and symptoms, and complications of nutritional support) is presented. Implications for clinical practice and research are identified. The trend for increased numbers of patients on home nutrition support emphasizes the need to understand the patient's and family's experience in managing this treatment in the home.

Gemcitabine. New first-line therapy for pancreatic cancer.

Abstract: Gemcitabine hydrochloride, a pyrimidine antimetabolite, recently was approved as first-line therapy for patients with locally advanced or metastatic adenocarcinoma of the pancreas. This agent also is indicated for use by patients previously treated with 5-FU. Using a new system to measure improvement in disease-related symptoms, two key clinical trials have demonstrated significant clinical benefit responses and a favorable adverse effect profile in patients receiving gemcitabine. With additional experience, the role of gemcitabine in pancreatic cancer, alone or in combination with other antineoplastic agents, will be defined further. The activity of gemicitabine against other malignancies such as ovarian, breast, bladder, small-cell and non-small-cell lung cancers also is being investigated actively.

Influence of others in motivating women to obtain breast cancer screening.

Abstract: Purpose The purpose of this study was to examine the importance of influence of other people in getting women to obtain breast cancer screening. Description of study A descriptive study of 129 women completed the researcher-developed, Likert-type scale-Influence of Others Scale. A self-report questionnaire was used to obtain frequency of breast cancer screening behaviors (breast self-examination, clinical breast examination, and mammography). Results The Influence of Others Scale had acceptable reliability scores. Comparison of the means and t-test analyses between those who performed the recommended screening behavior with those who had not revealed that the influence of family and friends and the influence of knowing someone with breast cancer were significant for each of the three screening behaviors. Regression analyses revealed that the influence of others was highly significant to the practice of breast self-examination and less so for mammography and clinical breast examination. Clinical implications These findings underscore the potential importance of using specific women's social networks to reinforce breast cancer screening.

Psychosocial stresses and adjustment of nasopharyngeal carcinoma patients in Hong Kong: a panel study

Abstract: Purpose This article reports the results of a study conducted in Hong Kong from November 1992 to May 1994 on patients with nasopharyngeal carcinoma. The objective was to understand stresses and the short-term psychosocial adjustment outcome throughout the course of the illness. Description of study A cognitive appraisal model of stress was used, and short-term psychosocial adjustment outcome was measured by psychological distress, social maladjustment to illness, and health status as perceived by the patients and as viewed by the oncologist. A panel study was adopted as the research design. A total of 125 patients were interviewed in the diagnostic phase, dropping to 119 in the treatment phase and 111 in the post-treatment phase. Data were gathered through face-to-face interviews by a structured instrument, the reliability of which had been evaluated immediately before the start of the study. Results The patients' level of anxiety was highest in the diagnostic phase, and gradually declined in the treatment and the post-treatment phases. Level of depression remained unchanged in the diagnostic and treatment phases, and decreased in the post-treatment phase; social maladjustment to illness and health status were poorest in the treatment phase. Clinical implications Health professionals can sharpen the focus of their work by helping nasopharyngeal carcinoma patients to lower their psychological distress in the diagnostic phase, enhance their social functioning, and improve their health status in the treatment and the post-treatment phases.

Cervical cancer screening and the older woman: obstacles and opportunities.

Abstract: Purpose This article presents information on the incidence of cervical cancer among women aged 50 and older. Guidelines for screening for cervical cancer and recommendations on methods to overcome barriers to screening are discussed. Overview Although the Papanicoloau smear has been used for more than 30 years, invasive carcinoma of the cervix claims the lives of 5,000 women in the United States annually. Older women comprise 25% of patients with carcinoma of the cervix but 40% of the deaths. A disproportionate number of these patients present with locally advanced invasive cancer of the cervix, which explains the poorer survival of these women. Women older than the age of 65 with early stage disease enjoy disease-free intervals comparable to that of younger women. Stage of disease and not age appears to be a major predictor of survival. Clinical implications There are marked differences in age with respect to the use of screening for cervical cancer. However, screening may have a significant impact on morbidity and mortality among older women. Educating patients of the importance of regular screening is paramount, but educating healthcare personnel is also an important component of reducing barriers to effective screening.

Recombinant human erythropoietin treatment of anemic cancer patients.

Abstract: Purpose This article describes the mechanism of anemia in patients with cancer and the potential role of recombinant human erythropoietin in its treatment. Dosing, safety, prediction of response, and reimbursement issues also are discussed. Overview Patients with advanced cancer frequently experience significant, chronic anemia that can contribute to overall morbidity. The causes of this anemia are multifactorial, including blood loss, nutritional deficiencies, hemolysis, bone marrow infiltration by tumors, and the anemia of chronic disease. In addition, myelosuppressive chemotherapy can cause or exacerbate this anemia. Clinical implications Several clinical studies have demonstrated that the use of recombinant human erythropoietin may prevent or ameliorate anemia by significantly increasing the hematocrit in patients who receive chemotherapy. This can reduce the proportion of patients who require erythrocyte transfusions. In addition, responding patients experience an improvement in quality of life.

Method of discovery of breast cancer.

Abstract: PURPOSE The purpose of this study was to determine how breast cancers are found according to the frequency of breast self-examination, mammography, and clinical examinations. Additionally, the means of discovery according to age, race, family history, and educational level was determined. DESCRIPTION OF STUDY The study was a retrospective, descriptive design using a nonprobability sample of 51 women diagnosed with breast cancer during 1991-1992. Anonymous questionnaires were used for data collection. RESULTS Overall, the most frequent method of discovery was mammogram (n = 20; 39%), followed by breast self-examination (n = 18; 35%), accidental palpation by self (n = 7; 14%), clinical examination (n = 3; 5.9%), and by accidental palpation by another person such as husband/lover (n = 3; 5.9%). Only 10 of the 51 women 40 years of age and older followed all American Cancer Society guidelines for breast cancer detection. Of these, 60% of the cancers were found by breast self-examination. Similarly, breast self-examination was the most frequent method for white women, and for women with a high school education or higher. Mammography was the most frequent means for black women, for women with less than a high school education, and for women with a negative family history of breast cancer. Of particular concern was the fact that of the 20 women having mammograms every 1 to 2 years before diagnosis, half (n = 10) had breast cancer found by palpable means. CLINICAL IMPLICATIONS All three breast cancer detection methods--breast self-examination, mammography, and clinical breast examinations--should be emphasized by health professionals given that mammography alone is not 100% accurate.

Providing culturally sensitive care to Egyptians with cancer.

Abstract: PURPOSE This article describes key aspects of Egyptian culture and provides intervention strategies that oncology practitioners may use to provide quality care to Egyptian immigrants and Egyptian-American oncology patients. OVERVIEW The growing diversity of the United States population challenges oncology professionals to provide culturally appropriate care. Egyptian immigrants and Americans of Egyptian descent comprise a unique population whose cultural and religious beliefs impact on decision making and behaviors related to cancer diagnosis and treatment. This population is overwhelmingly Muslim, although a sizeable minority are members of Eastern Christian sects. Dietary restrictions, social conduct, and religious observance are among the areas that require understanding by health providers. CLINICAL IMPLICATIONS Learning about patients' perspectives on health and illness, in light of their cultural values and beliefs, will allow health professionals to enhance the quality of assessments and interventions and provide culturally appropriate care.

Potential mechanisms of interferon neurotoxicity.

Abstract: This article examines potential mechanisms underlying the neurologic toxicities associated with interferon therapy in patients with cancer. The following mechanisms for interferon-related toxicities have been proposed: changes in certain neuroendocrine hormone levels; structural similarities and common pathways between interferon and specific neuroendocrine hormones; and the immunoregulatory effects of interferon. Strategies for the assessment and management of interferon-related neurologic toxicities are discussed. A reduction in dose or discontinuation of interferon may be recommended if interferon neurotoxicity develops. Additional interventions may include reorientation strategies, provision of uninterrupted periods of rest, and safety precautions. Directions for future research are recommended.

Coping responses to the diagnosis of breast cancer in postmastectomy patients.

Abstract: Purpose This study examined coping responses in women diagnosed with Stage I or Stage II breast cancer. Methods A convenience sample of 36 patients with breast cancer was administered the Reaction to Diagnosis of Cancer Questionnaire (RDCQ) at 2 days and 30 days postmastectomy. Results No statistically significant differences were observed in RDCQ scores between 2 days and 30 days postmastectomy (t = -1.57, P = 0.127). However, a significant change in the mean difference of the RDCQ scores was observed in women who had immediate breast reconstruction when compared to those women who did not have reconstruction (t = -2.34, P = 0.037). Additional results indicated that age and RDCQ scores had an inverse relationship, and women who were employed had significantly lower RDCQ scores at 30 days postmastectomy, indicating less positive coping. The variables of marital status, educational level, and number of days since diagnosis were not significant. Clinical implications The results of this study may assist healthcare providers in understanding what affects coping in women diagnosed with early stage breast cancer.