European Journal of Oncology Nursing

Editorial Board

2012-04-01

Dealing with a troublesome body: A qualitative interview study of men’s experiences living with prostate cancer treated with endocrine therapy

Bente Ervik, Kenneth Asplund — 2011-05-09

Abstract: Purpose: Endocrine therapy for prostate cancer causes substantial side effects, and previous studies have focused on the impacts on sexuality and masculinity. Little is known about how men experience bodily alterations in everyday life through the course of the prostate cancer and treatment. The aim of this study was to show how men with prostate cancer experience bodily changes and how these alterations influence daily life.Method: The study was conducted via qualitative interviews with a phenomenological hermeneutic approach. We interviewed ten men (aged 58–83) with prostate cancer who received endocrine therapy as the primary treatment method.Results: The results showed that five themes were important for the men’s experiences of their bodily alterations throughout the course of the illness: “something is ‘wrong’”, “when the body becomes troublesome”, “to be well or to be ill”, “dealing with the alterations” and “to talk about cancer and the intimate details”. Initially, the shock of receiving a cancer diagnosis and the physical changes in their bodies were at the forefront of many patients’ minds. Eventually, the impact of the side effects became more evident, which caused problems in everyday life. Yet, the men were able to reflect on the impact of treatment on their everyday lives.Conclusion: This study showed that hormone treatment has a significant influence, both directly and indirectly, on the bodies of prostate cancer patients. The experiences of men with prostate cancer may lead to feelings of loss of identity on an existential level.

Recordings of consultations are beneficial in the transition from curative to palliative cancer care: A pilot-study in patients with oesophageal or head and neck cancer

2011-05-20

Abstract: Purpose: There is reluctance in providing incurable cancer patients with recordings of their consultation. In this pilot-study, we explored the feasibility and utility of providing consultation recordings when patients are told a new diagnosis of non-curable cancer, and the impact of the recordings on quality of life and the openness to discuss cancer-related issues in the family.Method: Seventeen patients with a new diagnosis of incurable oesophageal or head and neck cancer were randomized to receive a CD (n = 10) or no CD (n = 7) of their consultation in which the diagnosis was told and the decision to provide only palliative care was discussed. Data were collected before consultation and 1 week and 1 month afterwards. After 1 month, patients allocated to the control group were offered to receiving the CD of their consultation as well.Results: No major technical or procedural problems were encountered. Three-quarters of the patients appreciated receiving the CD, which was listened to by 8/10 patients and by 10/10 others in the CD group. After 1 month, two-thirds of the patients in the control group also asked to receive the CD. We found a trend towards a poorer quality of life but an improved openness to discuss cancer-related issues, in the CD group.Conclusion: The provision of a CD recording on the consultation in which the transition from a curative to a palliative care stage was communicated is feasible and was well-received by most cancer patients and their family. These findings require however verification in a study with a larger sample size.

Common, important, and unmet needs of cancer outpatients

2011-05-10

Abstract: Purpose: To maximize patient well-being, health and social care should, whenever possible, address individual patient needs. The present study aims firstly, to identify prevalent, salient and unmet needs amongst cancer outpatients, and secondly, to explore socio-demographic and clinical influences on expressed need.Methods: One-hundred and ten outpatients registered at a UK cancer treatment centre completed a self-report questionnaire measuring the presence, salience and degree to which 80 need items were met. Six broad cancer sites were represented: urology, colorectal, breast, gynaecology, haematology, and head and neck.Results: The mean number of needs reported was 27. The top five needs concerned the treatment, care and health information patients receive from healthcare professionals, all of which were rated as well met. Least met needs included receiving genetic information, information about lifestyle changes, help with worries about spread or recurrence, and parking near treatment centres. Salient needs showed greater variation across the sample and were often unmet, for example the need for genetic information, and the need for information about symptoms/indicators of recurrence. Gender (female), age (younger), having an informal caregiver, and cancer site all affected aspects of need; whereas time since diagnosis and type of treatment did not.Conclusions: Acknowledging these influences on patient need could help guide patient-centred support services with potential gains to patient satisfaction and well-being.

Exploration of the family’s role and strengths after a young woman is diagnosed with breast cancer: Views of women and their families

Elisabeth Coyne, Judy Wollin, Debra K. Creedy — 2011-05-25

Abstract: Purpose: This exploratory descriptive study examined the role and strengths of the family when supporting the younger woman (<50 years) after a diagnosis of breast cancer. The perspectives of women and family members were sought.Method: Participants were recruited from oncology outpatient units in Australia. Semi-structured interviews guided by the Family Resiliency Framework were undertaken with 14 young women with breast cancer and 11 family members who reflected on the roles of family. Transcripts were analysed individually and in family groupings.Results: Women with breast cancer and their family members experienced a range of emotions during the treatment period. Roles within the family changed as members responded to their circumstances. Analysis of interview transcripts identified the following primary themes; ‘just being there’, ‘paradox of help’ and ‘buffer from society’. A secondary theme related to support, specifically ‘the changing role of support for family members’, highlighting the strengths and experiences of family.Conclusion: Recognition needs to be given to the complexity of changing roles experienced by young women with breast cancer and their families. Young women with breast cancer require unique forms of support because of the nature of their experience. Family roles were shaped through a shared sense of commitment and open communication amongst members. Families may demonstrate a range of strengths but are also vulnerable during this stressful period. Health professionals need to be aware of the possible needs of families, assess their adaptation to changing circumstances, and intervene through the provision of information, and counselling to enhance coping.

Health-related quality of life in cancer patients between baseline and a three-year follow-up

In Gak Kwon, Eunjung Ryu, Gie Ok Noh, Yung Hee Sung — 2011-07-18

Abstract: Purpose: The aim of the study was to identify health-related quality of life (QOL) in persons diagnosed with cancer and to determine differences between the QOL over a 3-year period.Methods: We investigated the QOL in cancer patients at baseline and 3 years later using the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30) and the ECOG (Eastern Cooperative Oncology Group) Performance Status. Initially 216 participants (85 women, 131 men) were enrolled, and at the 3-year follow-up there were 126 (52 women, 74 men).Results: Scores on the function and symptom scales changed significantly between the baseline and the 3-year follow-up. Physical, role, and social functions improved, whereas problems with constipation worsened. The global QOL of the participants at the 3-year follow-up was lower than that of baseline, but it was not statistically significant. The QOL in cancer patients improved from the baseline to the 3-year follow-up.Conclusion: The results could serve as a guideline for nurses interpreting the perspective of QOL in their own groups of patients, and improve the understanding of the significance of mean QOL scores and develop nursing interventions in the future.

Dependency in elderly people newly diagnosed with cancer – A mixed-method study

Bente Appel Esbensen, Bibbi Thomé, Thordis Thomsen — 2011-06-09

Abstract: Purpose: This study, based on data from an empirical investigation, combines quantitative and qualitative approaches in a mixed-method design to explore dependency in elderly people newly diagnosed with cancer.Methods and sample: 101 elderly people newly diagnosed with cancer were included in the quantitative part, with 16 in the qualitative part. A questionnaire concerning quality of life and dependency issues was developed. For the qualitative part, open-ended interviews were conducted to get closer to the experience of dependency.Results: Combining the two methods was seen as complementary. Involvement of the patient in decision-making related to contact with the primary and secondary health-care systems is an important element in reducing the perception of dependency and maintaining the Quality of Life (QoL) of elderly cancer patients. A more precise intervention in this patient population can be achieved by assessing, Activities of Daily Living (ADL) in the elderly. Receiving assistance from children seems to increase perceived dependency and to affect QoL negatively.Conclusions: The results of this mixed-method study indicate that dependency had a negative influence on the elderly with cancer. Being dependent on others was experienced as deterioration. Fatigue represents a significant risk factor for decreased functional ability and is experienced as a reminder of being old and the situation as being out of control. Patients may benefit from health-care professionals acquiring a complete picture of dependency and cancer-related fatigue in the elderly through a systematic assessment, where for example, functional limitations related to fatigue can be determined.

Self-perceived burden in patients with cancer: Scale development and descriptive study

Miki Oeki, Tamiko Mogami, Hiroshi Hagino — 2011-05-27

Abstract: Purpose: The purpose of this study was to develop a Japanese version of the Self-Perceived Burden Scale (SPBS) for patients with cancer, to confirm its validity and reliability, and to elucidate the features of Self-Perceived Burden in Japanese patients with cancer.Methods: Firstly, study team members carried out repeated translation and back translation. After that, scale development involved several phases including item development, construct validity testing, criterion-related validity testing, and reliability testing. A questionnaire that included the SPBS was distributed to 310 patients with cancer. Responses were received from 226 (72.9%) patients and final analysis was performed on data from 210 of these.Results: Exploratory factor analysis indicated that the 18-item version (α = 0.96) of the scale consisted of a single main factor. A 9-item abbreviation (α = 0.93) was therefore proposed. The convergent correlations of the SPBS with the FACIT-Sp and GHQ-12 scales showed significant correspondence. The construct of SPB was distinct from the "social and family well-being" FACIT-Sp subscale. Performance status, disease duration, living arrangement, and main caregiver were significantly related to the SPBS.Conclusion: We developed a Japanese version of the SPBS for cancer patients and demonstrated its validity and reliability, which makes it possible to study SPB in cancer patients in Japan. Our study revealed that cancer patients in Japan also feel SPB, in a way that relates specifically to their cultural background.

Art, archetypes and alchemy: Images of self following treatment for breast cancer

Catherine Thibeault, Brenda M. Sabo — 2011-05-25

Abstract: Purpose: The loss or alteration of a breast poses a threat to a woman’s selfhood, particularly those aspects that embrace feminine identity such as sexuality and caring. The use of art as a vehicle for recreating a sense of self after breast cancer surgery framed the study that generated the stories reported here. A team of nurse-researchers and professional artists entered into a collaborative partnership aimed at creating life-like prototypes of the torsos of two breast cancer survivors.Method: The authors sought to understand participants’ experiences of healing through the narratives of their breast cancer journeys and their experiences of creating art through the use of their bodies. The participants consented to having interviews and casting sessions audio-taped. The authors used thematic analysis to explore the narratives.Results: The authors present excerpts of stories and comment on how participants articulated the feminine archetype in the form of the Greek goddesses Hestia, Artemis, and Aphrodite. The authors explore the transformative nature of participants’ experiences.Conclusion: The emergence of the goddess archetypes in participants’ narratives was an unanticipated result of the study. The authors invite readers to contemplate these anecdotes and embark on their own quest for deeper knowledge of breast cancer experiences.

Do nurses risk underestimating the problems of patients with frontal lobe neoplasms?

Alvisa Palese, Alessia Romano, Renzo Moreale, Jesse Magee — 2011-05-25

Abstract: Purpose: Although the profile of the problems and risks associated with cancer patients has expanded over the past few years, and so has our available knowledge on the concordance between patients and nurses, there is a lack of evidence concerning neurosurgical patients. In comparison with patients who have neoplasm located in other lobes, those with frontal lobe cancer can suffer from personality changes, disinhibition, apathy, and higher-order attentional difficulties. Such behavior may give rise to a stigma, and consequently, pose a risk to have their problems misunderstood by caregivers, and be at greater risk than they are perceived to be.Objective: To explore the risk of nurses underestimating the problems of patients who were operated on for frontal neoplasm, compared to patients suffering from neoplasms located in other cerebral lobes.Methods: A prospective study was undertaken in 2008 in Italy. Patients admitted to the hospital with brain neoplasm were eligible for the study. For each patient with a frontal lobe neoplasm, a corresponding patient with a cerebral neoplasm located in either the temporal, parietal or occipital lobes was also included. Nurses working in the units involved and providing care to these patients were also included. On the afternoon of the 2nd postoperative day, the researcher interviewed both the patients, and the registered nurses (RNs) responsible for the patients’ care, in regards to pain intensity, dependence in activities of daily living, anxiety and depression, and fear of falling, as each was perceived by patients and nurses. The level of concordance between the patients’ and nurses’ responses was calculated.Results: Forty-six patients were considered (mean age 53.5 years); 23 had surgery for a frontal brain neoplasm and 23 for brain neoplasms located in either the temporal, parietal, or occipital areas. Overall, patients operated on for frontal lobe neoplasms had much of the same risks of underestimation of their problems, as patients with other cerebral neoplasms.Conclusions: Patients with frontal lobe neoplasms seemed, overall, to run the same risk of their problems being underestimated as patients with cerebral neoplasms located at other sites. Neurosurgical nurses tended to overestimate patients’ problems, particularly in cases with neoplasms not located in the frontal lobe. This unexpected finding needs to be addressed with further research, and might warrant a different approach to caring for patients with frontal lobe neoplasms, whose problems are overestimated less, so that they might receive less supportive care.

Fatigue in patients undergoing chemotherapy, their self-care and the role of health professionals: A qualitative study

2011-05-30

Abstract: Purpose: Fatigue affects most chemotherapy recipients, who commonly experience it as distressing. Previous publications showed that cancer patients frequently lacked information and education regarding fatigue; and while most engaged in self-care activities, it remained unclear why they chose specific activities or how effective those were. We explored cancer chemotherapy recipients’ current perspectives regarding fatigue, with particular attention to related communication with health professionals, self-care activities, and perceived effectiveness of these measures. This study was part of a larger project that explored patients’ symptom experiences during chemotherapy over three months.Method: In this qualitative study, 19 patients with lymphomas, breast, lung or colorectal cancer participated concurrently with treatment at a Swiss tertiary care hospital’s oncology outpatient clinic. Data on patients’ fatigue experiences were collected via individual interviews following their third cycle of chemotherapy. Grounded Theory methodology guided data analysis.Results: At the start of their chemotherapy, health professionals informed patients that common side effects included fatigue. While all participants experienced different dimensions of fatigue, then, all were willing to endure it for the sake of an expected improvement in their conditions. Individuals’ fatigue experiences depended largely on their particular life and illness circumstances. Most engaged in fatigue-related self-care activities and managed the symptom on their own. Communication with or input from health professionals was virtually absent during chemotherapy.Conclusions: Adequate and systematic information regarding fatigue and related self-care strategies need to be implemented at the beginning of chemotherapy, along with continuous assessment and individual guidance of patients throughout their treatment.

Strategies for assessing and managing the adverse events of sorafenib and other targeted therapies in the treatment of renal cell and hepatocellular carcinoma: Recommendations from a European nursing task group

2011-06-06

Abstract: Purpose: As a group of European nurses familiar with treating patients with renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC) using targeted/chemo- therapies, we aimed to review strategies for managing adverse events (AEs) associated with one targeted therapy, sorafenib.Method: Focusing on the AEs we considered the most difficult to manage (hand–foot skin reaction [HFSR], diarrhoea, fatigue and mucositis/stomatitis), we reviewed the literature to identify strategies relevant to sorafenib. Given the paucity of published work, this included strategies concerning targeted agents in general. This information was supplemented by considering the wider literature relating to management of these AEs in other tumour types and similar toxicities experienced during conventional anti-cancer therapy. Together with our own experience, this information was used to compile an AE management guide to assist nurses caring for patients receiving sorafenib.Results: Our collated experience suggests the most commonly reported AEs with sorafenib and other targeted agents are HFSR, diarrhoea, fatigue, rash and mucositis/stomatitis; these generally have an acute (appearing at ∼0–1 months) or delayed onset (appearing at ∼3 months). Most management strategies in the literature were experience-based rather than arising from controlled studies. However, strategies based on controlled studies are available for HFSR and mucositis/stomatitis.Conclusions: Evidence, especially from controlled studies, is sparse concerning management of AEs associated with sorafenib and other targeted agents in RCC/HCC. However, recommendations can be made based on the literature and clinical experience that encompasses targeted and conventional therapies, particularly in the case of non-specific toxicities e.g. diarrhoea and fatigue.

Quality of life in children and adolescents surviving cancer

2011-09-26

Abstract: Purpose: To explore subjective and proxy reported QoL (Quality of Life) in children and adolescents surviving cancer three years after diagnosis compared with healthy controls.Method: Case-control study including 50 children and adolescents diagnosed with cancer between January 1, 1993 and January 1, 2003 and treated at the Paediatric Department of St. Olav’s University Hospital in Trondheim, Norway. Data were collected using The Inventory of Life Quality in Children and Adolescents (ILC) and the KINDL QoL questionnaires (parent and self-reports), as well as by collecting data for any somatic late effects and psychological problems from the medical records of children surviving cancer.Results: Adolescents surviving cancer as a group assessed their QoL as similar to that of their peers. However, adolescents surviving brain tumours or those with late effects reported lower QoL and an increased number of QoL domains perceived as problematic, even many years after diagnosis and treatment. Parents generally report a poorer QoL for their children surviving cancer and a greater number of QoL domains experienced as problematic compared with parent controls.Conclusion: To improve the child’s total functioning and well-being we conclude that when planning long-term follow-up care, rehabilitation of children and adolescents with cancer, especially for survivors with brain tumours, and with late effects should particularly take into account their subjectively perceived and proxy reported QoL, in addition to their psychological problems and psychosocial functioning.

Noticeboard 2012

2012-02-20

Individual nurses and other health professionals and conference organisers are invited to submit details of conferences, workshops, study days and lectures to: Anita Margulies BSN, RN (EONS Executive Board Member)

Oncology Nursing Bibliography

2012-02-03

Advances in oncology care: targeted therapies. BEATTY K, WINKELMAN C, BOKAR JA, MAZANEC P. AACN Adv Crit Care 2011;22(4):323-34; quiz 35-6 New treatment modalities in advanced thyroid cancer. KAPITEIJN E, SCHNEIDER TC, MORREAU H, GELDERBLOM H, NORTIER JW, SMIT JW. Ann Oncol 2012;23(1):10-8