No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Little research has explored the degree to which specific intervention components predict improved health outcomes for cancer patients and their family caregivers. The present study examined relations of intervention components (i.e., coping skills) to symptoms in a telephone symptom management (TSM) intervention delivered concurrently to symptomatic lung cancer patients and their family caregivers. Guided by Social Cognitive Theory (SCT) and cognitive behavioral therapy (CBT) frameworks, patient-caregiver dyads were taught coping skills including: a mindfulness exercise (i.e., noticing sounds and thoughts), pursed lips breathing, guided imagery, cognitive restructuring, and assertive communication. Symptom measures were administered at baseline and 2 and 6 weeks post-intervention. The measures assessed patient and caregiver depressive and anxiety symptoms as well as patient pain severity, distress related to breathlessness, and fatigue interference. Data were examined from patient-caregiver dyads enrolled in TSM (N = 51 dyads). Patients and caregivers were predominantly female (55% and 73%, respectively) and Caucasian (87%). The average patient was 63 years of age (SD = 8) and the average caregiver was 56 years of age (SD = 14). Seven autoregressive panel models tested relations of coping skills to symptoms. All models had at least adequate fit to the data (χ2 ps > 0.05, RMSEA values < 0.06). For patients, more assertive communication practice during the intervention was related to less pain severity, fatigue interference, and depressive and anxiety symptoms at 6 weeks post-intervention. Additionally, more guided imagery practice during the intervention was related to less fatigue interference and anxiety at 6 weeks post-intervention. In contrast, more cognitive restructuring practice during the intervention was related to more distress related to breathlessness and depressive and anxiety symptoms at 6 weeks post-intervention. Similarly, more practice of a mindfulness exercise during the intervention was related to more fatigue interference and anxiety at 6 weeks post-intervention. For caregivers, more guided imagery practice was related to more anxiety at 2 weeks post-intervention. All other pathways from coping skills to symptoms at 2 and 6 weeks post-intervention were non-significant for both patients and caregivers. Findings suggest intervention effectiveness may have been reduced by competing effects of certain coping skills. For lung cancer patients, future studies should consider focusing on assertive communication and guided imagery, as these two coping skills were most consistently associated with reduced symptoms. However, more studies are needed to better understand these findings and particular caution should be used when applying CBT-based interventions that have not been validated in lung cancer populations.

The evolution of Patient Reported Outcomes (PROs), has made an essential impact on patient-centered symptom management. PROs enable us to measure the patient‘s feels about their symptoms during treatment. ePROs (electronic PROs) are interfaces that allow a patient or health care provider to manage symptoms using an application such as mobile computing applications. The growth of mobile technologies in the healthcare sector has enabled us to take advantage of features like data manipulation, portability and standardization enable a better patient-driven symptom management. The Pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) is a paper-based symptom management guideline designated for nurses. The objective of COSTaRS is to help and improve the decision-making process and create a consistent symptom management reporting system. Although this tool introduces numerous advantages in cancer symptom management, it also induces a number of issues for patients due to being overwhelming. Moreover, a noticeable portion of drawbacks originates from the paper-based nature of COSTaRS. In addition, cancer care symptom management mobile applications do not offer proper evidence-based centered symptom management system to the users. The purpose of this study is to design and developed the mobile version of COSTaRS for patients and caregivers. We identify problems with the current paper-based structure and related academic and non-academic works and then, we design and evaluate a mobile version of COSTaRS that takes advantage of advances in mobile technology. We leverage COSTaRS knowledge to create a mobile application for symptom management. We create an evidence-based platform for cancer treatment-related symptom management. A usability testing has been conducted for evaluation of the COSTaRS mobile application. The results of this study verify the usability of COSTaRS mobile application.

Prostate cancer is the most commonly diagnosed cancer and second leading cause of death in American men. Patients with localized prostate cancer may experience unique and multidimensional symptoms that are distressful from treatment and thereafter. This cross-sectional correlational study aimed to investigate the relationships among stress, symptoms, symptom distress, and symptom self-management and identify the effective strategies of symptom self-management in men with localized prostate cancer following prostatectomy or radiation therapy.Eight saliva samples and 3 questionnaires (Perceived Stress Scale, Symptom Indexes, and Strategy and Effectiveness of Symptom Self-Management) were obtained from each participant between 1 and 3 months following their first prostate cancer treatment. The sample consisted of 53 men with localized prostate cancer. Mean salivary cortisol concentrations for the entire sample ranged from 0.3 to 0.08 ug/dL. Cortisol was secreted in a circadian rhythm with heightened activity in the early morning and lowered activity late in the day. The circadian pattern of cortisol secretion was similar in both the prostatectomy and radiation therapy groups, although the values were slightly different. Two areas Under the Curve (AUC) of salivary cortisol were calculated. Three cortisol circadian rhythms were identified, but the majority of the sample had a typical negative consistent circadian rhythm.Patients with localized prostate cancer who underwent radical prostatectomy or radiation therapy had low perceived stress. Perceived stress was positively correlated with AUCg, noon salivary cortisol concentrations, and afternoon salivary cortisol concentrations. Subjects reported a moderate degree of symptoms and symptom distress on urinary, bowel, and sexual dysfunction 1-3 months following treatments. The most effective strategies of urinary symptom management were pad and kegel exercise; the most effective strategy of bowel symptom management was rest or endure; the most effective strategies of sexual dysfunction management included express their feelings or find alternative ways to express their affection. The symptom self-management strategies were significantly and positively correlated with symptom self-management effectiveness.Symptom distress and AUCg were significant and strong predictors of symptom self-management. Findings can help health care providers develop effective strategies for symptom self-management that enhance health related quality of life among men with localized prostate cancer.

The objective of this pilot study was to examine the feasibility of using Bowenwork as a complementary intervention for symptom management of breast cancer treatment-related lymphedema in women breast cancer survivors. The aims of the investigation were to 1) determine recruitment and retention rates 2) determine adherence to the intervention, 3) assess the safety and comfort level of the intervention 4) describe the effects of the six week intervention on lymphedema symptoms. A quasi-experimental, repeated measure design was chosen for this pilot study. Twenty-one community-dwelling women breast cancer survivors were recruited from three cities in Arizona, United States. The intervention was delivered in four consecutive sessions five to ten days apart. Baseline and post-intervention questionnaires were completed by the participants. Quality of life was measured with the SF-36 and the FACT-B questionnaires. The FACT-B was also used to measure functional status. Pain was measured with the Brief Pain Inventory. A paired t-test analysis was performed on the baseline and post intervention data. An ANOVA was performed on repeated physical measures (arm circumference and range of motion).Ninety-five percent of the women who enrolled completed the study. Adherence to the intervention and home exercises was high, at 100% and 95% respectively. The intervention was evaluated as safe without any reported major changes in medical condition or level of discomfort that required discontinuation from the study. A paired t-test analysis on the scores from SF-36 (mental health) and the FACT-B (quality of life and functional status) improved significantly following the Bowenwork intervention (p<.05). An ANOVA revealed a statistical significantly improvement in arm circumference and range of motion (p<.05).Bowenwork was shown to be an effective management strategy that improved mental health, increased quality of life and daily functional status, in addition to reducing arm circumference and increasing range of motion in women breast cancer survivors with lymphedema. A future full-scale study is needed to further explore these findings.

This early phase study examined the effects of a series of ten standard-protocol acupuncture treatments over four weeks in 12 healthy, but symptomatic, menopausal women. Two biologic markers, heart rate variability to evaluate effects of acupuncture on the autonomic nervous system as it relates specifically to the heart, and interleukin 6, a proinflammatory cytokine, to capture physiologic impact of acupuncture on the immune-inflammatory response, were collected.Women who exhibited significant menopausal symptoms, as measured by a minimum score of 22 out of a possible 44 points on the Menopause Rating Scale (MRS), underwent 10 sessions of a standard acupuncture point protocol intervention over a four-week period. Symptoms were evaluated for 28 days using the MRS. After the intervention was complete, one final open-ended question was asked of each participant to explore subjective experiences not captured by the validated instrument. Physiologic measurements included a 30-minute continuous measure of electrocardiogram data before and during acupuncture, as well as pre and post acupuncture measures of serum interleukin 6 at the first and final acupuncture treatment. Heart rate variability was assessed using spectral analysis, and interleukin 6 changes were measured using ELISA. Analysis included linear regression, Wilcoxon Signed Ranks test and Spearman correlation coefficients.After the acupuncture intervention, menopausal symptoms improved significantly. Heart rate variability did not show consistent or predictable intra or inter-subject changes, however several components of HRV, interleukin 6 and symptoms were found to have significant correlations.A larger study was deemed feasible. Menopause symptoms improved. Heart rate variability showed no consistent changes or trends. Interleukin 6 decreased in seven subjects, between the first and tenth acupuncture treatment, but did not reach statistical significance.This small project suggests that heart rate variability, when measured at each acupuncture treatment, does not change in a consistent or predictable manner. Rather, acupuncture may provide a modulating influence that depends on the body's functional state at each treatment.

Objective: To explore adult cancer symptom management by home care nurses. Scoping review: A scoping review was conducted to describe interventions used by nurses for cancer symptom management in the home care setting. Five included studies revealed that home care nursing contributed to positive client- and system-level outcomes. Study: A mixed-methods descriptive study explored usability of a set of 13 cancer treatment-related symptom management protocols for nurses in the home care setting. Thirty-eight nurses in home care participated. Qualitative and quantitative data indicated the protocols were highly usable. Several barriers suggested they would be better used as resources to support and train nurses rather than documentation tools. Conclusions: Few studies have evaluated interventions for cancer symptom management by home care nurses. This set of protocols was well-received, but further research is required to determine their effectiveness and interventions for implementing with home care nurses providing cancer symptom management.

Objective: To explore adult cancer symptom management by home care nurses. Scoping review: A scoping review was conducted to describe interventions used by nurses for cancer symptom management in the home care setting. Five included studies revealed that home care nursing contributed to positive client- and system-level outcomes. Study: A mixed-methods descriptive study explored usability of a set of 13 cancer treatment-related symptom management protocols for nurses in the home care setting. Thirty-eight nurses in home care participated. Qualitative and quantitative data indicated the protocols were highly usable. Several barriers suggested they would be better used as resources to support and train nurses rather than documentation tools. Conclusions: Few studies have evaluated interventions for cancer symptom management by home care nurses. This set of protocols was well-received, but further research is required to determine their effectiveness and interventions for implementing with home care nurses providing cancer symptom management.

Background: Cannabis has been legalized in Canada since October 2018 and shown to be effective for chemotherapy-induced nausea (CIN). Purpose: Guided by the Ottawa Model of Research use, the aim was to determine factors influencing oncology nurses discussing cannabis use with patients experiencing CIN. Part I: A literature review to identify oncology nurses’ practices, knowledge, and attitude toward providing guidance on cannabis use for patients with CIN. Twelve articles were included. Results showed that health care professionals were hesitant to provide guidance for patients on using cannabis for medical purposes. But no studies specifically focus on nurses and CIN. Part II: A descriptive, cross-sectional study was conducted using survey methods. Twenty-five Canadian oncology nurses responded to the survey. Half (n=11) correctly answered the knowledge question about the effectiveness of cannabis. Most (n=18) did not feel confident providing guidance on use of cannabis for CIN. The top three barriers identified are social stigma, lack of knowledge, and lack of support in the workplace. Conclusion: Few Canadian oncology nurses discuss cannabis use for CIN. Identified barriers need to be addressed for oncology nurses to be prepared to discuss use of cannabis for CIN.

No / Fatigue is a complex symptom commonly experienced by people with life-limiting illnesses. It has been identified in patients with, for example, cancer, heart failure, respiratory conditions, acquired immunodeficiency syndrome and renal failure. It is often rated by patients as having a greater effect on quality of life than pain. This article will explore the manifestations and consequences of fatigue. It will propose a minimum standard for its assessment and management and describe the implementation and evaluation of an audit, conducted in a hospice environment, designed to evaluate achievement of this standard. Although this audit was carried out in a hospice setting, the aim of the article is also to raise awareness of fatigue in all healthcare settings and to improve the assessment of this debilitating symptom.