Oncology Nursing

Active Smoking at the Time of A Lung Cancer Diagnosis Rebecca H Lehto Asia-Pacific Journal of Oncology Nursing 2019 6(3):207-208

Factors in Cancer-Related Fatigue Self-Management Behaviors of Outpatients Undergoing Chemotherapy Ikuko Chiba, Tomoyo Sasahara, Michiyo Mizuno Asia-Pacific Journal of Oncology Nursing 2019 6(3):209-211

Adverse Events of Oncologic Immunotherapy and Their Management Fedricker Diane Barber Asia-Pacific Journal of Oncology Nursing 2019 6(3):212-226 Over the past two decades, immunotherapy has emerged as a promising treatment option for patients with cancer. However, newer versions of immunotherapy, such as checkpoint inhibitors, may be associated with unusual adverse effects (AEs) that can range in severity from mild to life-threatening. Unlike common AEs of conventional chemotherapy, which have a predictable nadir or cyclic pattern after administration, AEs of these newer immunotherapies are variable, depending on the type of immunotherapy, route of administration, and mechanism of action. The onset and resolution of these AEs may be present at any time, during administration of treatment, a few weeks after administration of treatment, or several months after completion of treatment. Therefore, improving outcomes in patients undergoing oncologic immunotherapy requires oncology nurses' knowledge and understanding of various immunotherapy agents, as well as early recognition and management of potential AEs, especially AEs associated with checkpoint inhibitors and other therapies that manipulate T-cell activation causing autoimmune toxicity. This article draws upon current evidence from systematic reviews, meta-analyses, and expert consensus guidelines to provide a brief overview of common immunotherapies used in cancer and management of their associated AEs.

Evaluation of the True Endpoint of Clinical Trials for Cancer Cachexia Tateaki Naito Asia-Pacific Journal of Oncology Nursing 2019 6(3):227-233 Cachexia is an old disease but a new research area that has recently been vigorously investigated. The diagnostic and staging criteria for cancer-associated cachexia have been established through an international consensus report (CR) published in 2011, which may greatly influence the designs and interventions of future clinical trials. However, no standard treatment has been established so far. This may be partially due to the lack of a widely accepted common endpoint for clinical trials. This review aimed to summarize designs and endpoints of 65 randomized controlled trials for cancer cachexia in the past 16 years and seek clinically relevant patient-centered outcomes for future clinical trials. Compared with trials before the CR, trials after the report revealed that the study populations tended to be at the earlier stage of cachexia and included patients with precachexia or those at risk for cachexia. Nonpharmacological interventions have been widely tested, and functional endpoints have increasingly been selected in combination with standard endpoints of body mass or lean body mass. Disability-free survival has recently been used as a functional endpoint in clinical trials in several research fields. It might be also a suitable patient-centered outcome responsive to multiple physical changes in cancer cachexia, and patients might find it more acceptable than other classical endpoints. More efforts would be needed to identify an optimal measurable endpoint and establish a better combination of pharmacological and nonpharmacological interventions to improve the functional prognosis for patients with cancer cachexia.

Utilizing the Advances in Digital Health Solutions to Manage Care in Cancer Patients Andreas Charalambous Asia-Pacific Journal of Oncology Nursing 2019 6(3):234-237 In recent years, the clinical context for cancer has changed, and it is now characterized by extended survival rates and more diverse and complex cancer trajectories and symptomatology. The changes in the landscape of cancer care also include a shift towards the home setting or the outpatient setting with an increased amount of care being delivered at home or transferred to the patients themselves and their family caregivers. These changes have also impacted the type and amount of information required by the patients and their caregivers as well as the type of care needs that are to be addressed by health-care professionals. Finally, the transitions within the health-care setting might also create a caring gap that the patient is left to deal with independently or with minimal support. These changes have led to the emergence of innovative digital/technological solutions for supporting patients during their cancer care continuum.

Radiation Fibrosis Syndrome: The Evergreen Menace of Radiation Therapy Abhishek Purkayastha, Neelam Sharma, Arti Sarin, Sharad Bhatnagar, Nilotpal Chakravarty, Hari Mukundan, Virender Suhag, Sankalp Singh Asia-Pacific Journal of Oncology Nursing 2019 6(3):238-245 Fibrosis is a descriptive appellation referring to the obliteration of normal tissue components replaced by matrix and disorganized and varied collagen fibrils that result in the loss of organ function and frequent tissue contraction leading to death or significant deterioration in the quality of life. Radiation fibrosis syndrome (RFS) is a progressive fibrotic tissue sclerosis with various clinical symptoms in the irradiation field. It is usually a late complication of radiation therapy and may occur weeks or even years after treatment. It may affect the musculoskeletal, soft tissue, neural tissue, and cardiopulmonary systems. RFS is a serious and lifelong disorder that, nevertheless, may often be prevented when identified and rehabilitated early. Genetic factors likely play a significant role in the development of chronic fibrotic response to radiation injury that persists even after the initial insult is no longer present. Management of this syndrome is a complex process comprising medication, education, rehabilitation, and physical and occupational therapy. A bibliographical search was carried out in PubMed using the following keywords: “radiation fibrosis,” “radiation fibrosis syndrome,” and “radiation-induced fibrosis.” We also reviewed the most relevant and recent series on the current management of RFS, and the reviewed data are discussed in this article. This review discusses the pathophysiology, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders as late effects of radiation treatment.

Medication Safety: A Need to Relook at Double-Checking Medicines? Gek Phin Chua, Kim Hua Lee, Gemma Diente Peralta, John Heng Chi Lim Asia-Pacific Journal of Oncology Nursing 2019 6(3):246-252 Objective: To present a structured evaluation process that provides evidence that the single-checking (SC) system is not only a viable option in reducing medication errors, but also has the added advantage of increasing staff satisfaction. Methods: The structured evaluation involved one work improvement process and conducting a survey establishing registered nurses' (RNs') attitude toward SC of medicines. The survey questionnaire included 12 questions with a 5-point Likert scale. Results: In spite of the increased number of patients, the number of medication errors actually reduced (P < 0.001; two-sample test of proportions) with the implementation of SC of medication for competent and experienced staff. A survey was conducted to establish RNs' attitudes toward SC of medicines 3 years post SC implementation. RNs viewed the single-nurse checking protocol positively. In particular, the nurses considered single-nurse checking as an encouragement to update their drug knowledge and as a time-saving measure, enhancing the quality of patient care. Nonetheless, they also expressed concerns on single-nurse checking. Conclusions: The findings provide evidence that SC system is a viable way to reducing medication errors and also confer the added advantage of staff satisfaction. Assuring quality and safety involves the need to challenge the status quo based on revealed evidence.

Falls and Functional Impairments in Breast Cancer Patients with Chemotherapy-Induced Peripheral Neuropathy Hiroko Komatsu, Kaori Yagasaki, Yasuhiro Komatsu, Hideko Yamauchi, Teruo Yamauchi, Toshio Shimokawa, Ardith Z Doorenbos Asia-Pacific Journal of Oncology Nursing 2019 6(3):253-260 Objective: We investigated the incidence of falls and functional impairments in breast cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). Additionally, we examined whether taxane-induced peripheral neuropathy was associated with the patients' falls and functional impairments. Methods: We conducted a cross-sectional study including 88 patients with breast cancer who received taxane-based chemotherapy and were recognized as having peripheral neuropathy symptoms (Common Terminology Criteria for Adverse Events Grade ≥1). Patients completed the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity questionnaire for neuropathy and described falls from the onset of the taxane-based chemotherapy to the time of the survey. Functional impairments were defined using the Activities of Daily Living subsection of the Vulnerable Elder's Scale. Data were analyzed using descriptive statistics and logistic regression. Results: Of the participants, 40.9% experienced falls and 38.4% reported functional impairments. Most falls occurred on flat ground. Bone fracture due to falls was observed in 11.4% of the participants. Logistic regression revealed that CIPN was not significantly associated with the reported incidence of falls. However, it was significantly associated with functional impairments (odds ratio, 6.415; 95% confidence interval: 1.271–32.379; P = 0.024). Conclusions: CIPN was associated with functional impairments, but not with the incidence of falls. Patients should be informed prior to the onset of anticancer therapy that CIPN is a risk factor for functional impairments.

Emotional Intelligence as A Predictor of Health-Related Quality of Life in Breast Cancer Survivors Sahar Mirzaei, Ahmad Izadi Tame, Robab Anbiaie, Fateme Moradipour, Malihe Nasiri, Camelia Rohani Asia-Pacific Journal of Oncology Nursing 2019 6(3):261-268 Objective: The objective of this study is to explore the predictive role of emotional intelligence (EI) and its elements for health-related quality of life (HRQoL) dimensions in a sample of breast cancer survivors. Methods: This cross-sectional study was conducted in a single oncology clinic at a university hospital. A sample of breast cancer survivors (n = 180) completed three questionnaires: Short-Form Health Survey SF-36 (the RAND 36-item) with 8 dimensions; Cyberia Shrink EI Test (with five elements); and demographic Characteristics. The data were analyzed using SPSS version 20 (IBM Corporation, Armonk, NY, USA). A series of multiple linear regression models were used to analyze the data. Results: EI was a predictor for two dimensions of HRQoL components in survivors: mental (β = 0.45, P < 0.001); and physical (β = 0.27, P < 0.001). However, it was a better predictor for the mental HRQoL than for physical. More specifically, several elements of EI, including self-motivation, self-awareness, and self-control, demonstrated significant variance with a medium effect for prediction of dimensions of HRQoL. “Self-motivation” (β = 0.27, P < 0.001) and “self-awareness” (β = 0.29, P < 0.01) together were the best predictors of the variances of survivors' “general health” (R2 = 28%). “Self-motivation” (β = 0.39, P < 0.001), and “self-control” (β = 0.19, P < 0.05), also together, were the best predictors of the variances of survivors' “emotional well-being” (R2 = 28%). Conclusions: Educational intervention programs should be planned by concentrating on special elements of EI, including self-motivation, self-awareness and self-control, to improve HRQoL dimensions in breast cancer survivors.

Toward A Germinal Theory of Knowing-Revealing-Humanizing as Expressions of Caring in Cancer Palliative Care Chinomso Ugochukwu Nwozichi Asia-Pacific Journal of Oncology Nursing 2019 6(3):269-276 Objective: Survival chances of people with cancer in Nigeria are far worse than those in developed countries. While the chance of finding a lasting solution to cancer in Nigeria is remote, patients living with cancer still need treatment regardless of the terminal outcome, and hence cancer palliative care is necessitated. Caring patterns and expressions differ in diverse contexts. Therefore, this article aimed to present the meanings and expectations of caring and the resulting transformative theory of practice. Methods: A descriptive, qualitative inquiry was conducted with a purposive sample of 12 cancer palliative patients, 9 nurses, 3 physicians, and 5 relatives who were approached for an in-depth interview about their conceived meanings and expectations of caring for or being cared for in the cancer palliative unit. Results: Cancer palliative care in Nigeria is best exemplified through the processes/themes of “knowing,” “revealing,” and “humanizing.” The meaning of care and the expectations of the patients and caregivers were grouped into these three overarching processes which then informed the conceptualization of a germinal theory of knowing-revealing-humanizing (TKRH) as expressions of caring in cancer palliative care. Conclusions: The application of the KRH practice processes is illustrated as a transformative germinal theory of practice. This TKRH as expressions of caring is transformative and can restore positive meanings in the life-world of persons in the cancer palliative care setting.

Alexandros Sfakianakis
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alsfakia@gmail.com