Psychological impact of high-quality nursing care on patients with esophageal cancer during perioperative period: A protocol of systematic review.

BACKGROUND: This study is designed to systematically assess the psychological impact of high-quality nursing care (HQNC) on patients with esophageal cancer during perioperative period (ECPP). METHODS: Several electronic databases will be searched to collect randomized controlled trials (RCTs) or case-control studies (CCSs) on HQNC in the management of ECPP from inception to present: Cochrane Library, PUBMED, EMBASE, SinoMed, Web of Science, WANGFANG, and China National Knowledge Infrastructure. We will not apply any language limitation to all literature searches. Two authors will independently perform literature selection, data extraction and literature quality evaluation. All disagreements will be resolved by a third author through discussion. Cochrane risk of bias tool will be employed to assess trial quality, and RevMan 5.3 software will be utilized to carry out statistical analysis. RESULTS: This study will summarize the current evidence to appraise of the psychological impact of HQNC in the management of ECPP. CONCLUSION: The findings of this study may help to explicit whether HQNC is effective on psychological problem in ECPP. It will also provide scientific evidence for the clinical practice and future researches. STUDY REGISTRATION: INPLASY202080071.

Becoming a family caregiver of a patient living with cancer.

BACKGROUND: There is insufficient information on how the burden of caregiving is affected when the family caregiver is a health professional. Studies are needed to investigate this issue. AIMS: The purpose of this study was to reveal difficulties experienced by a nurse family caregiver offering care to a family member diagnosed with end-stage cancer and how she coped with these difficulties. METHODS: This was an autoethnographic study. FINDINGS: Findings were grouped under three headings: being both a researcher and a subject; effects of caregiving; and coping. CONCLUSIONS: Offering care to a cancer patient has many physiological and psychological effects. If a family caregiver is a health professional, his/her caregiving burden can be even higher. Cultural values affect both life and coping ways of caregivers. It should be kept in mind that family caregivers need support from health professionals whatever their occupations are. Support to caregivers plays an important role in their coping.

Perioperative Nursing of Patients with Reoperation of Recurrent Parathyroid Carcinoma Invading the Upper Digestive or Respiratory Tract.

OBJECTIVE: The aim of this study was to summarize the perioperative nursing care of patients with recurrent parathyroid carcinoma. METHODS: A retrospective analysis of 10 patients with recurrent parathyroid carcinoma was performed. The clinical data, diagnosis, treatment process, and nursing process (including clinical nursing intervention of various complications) were analyzed. The nursing experience and methods were discussed, summarized, and analyzed. RESULTS: A total of 10 patients were reviewed (male : female 7 : 3; aged 48.6 ± 14.60 years). The mean interval between the initial operation and reoperation was 2.23 ± 1.65 years. The mean number of operations was 4.00 ± 1.41. Invasion of the trachea or esophagus was evident in 7 patients, larynx in 6 patients, recurrent laryngeal nerve in 1 patient, and cyclic cartilage in 2 patients. Serum calcium range was 3.20-4.68 mmol/L, and parathyroid hormone (PTH) range was 860-2830 pg/ml at admission. 6 patients underwent prophylactic tracheostomy, 2 patients underwent partial laryngectomy, and 2 patients underwent total laryngectomy. 1 patient experienced temporary water-electrolyte disorder and hypoproteinemia. The median serum calcium was 2.28 mmol/L (1.66-3.18 mmol/L) and median PTH level was 82.60 pg/ml (63.70-900.00 pg/ml) postoperatively. Serum PTH and calcium were still higher than the upper limit of normal in 2 patients after surgery. 2 of the other 8 patients relapsed within 8-11 months, and 6 patients remained normal for 11-40 months. CONCLUSION: For patients with reoperation of recurrent parathyroid carcinoma, high-quality, reasonable, and careful perioperative nursing ensured a successful operation and optimized outcome.

Symptom clusters and related factors in oesophageal cancer patients 3 months after surgery.

AIM: To explore symptom clusters experienced by patients with oesophageal cancer 3 months after surgery and examine whether symptom clusters are related to demographic, clinical and quality of life variables. BACKGROUND: There are multiple symptoms in patients with oesophageal cancer after surgery, which seriously affect their quality of life. Exploring the mechanics of concurrent symptoms such as symptom clusters may facilitate the development of strategies to reduce the impact of these symptoms and improve quality of life. DESIGN: Cross-sectional survey. The STROBE Statement was chosen as the EQUATOR checklist. METHODS: A convenience sample of 128 oesophageal cancer patients was followed up at 3 months after surgery. Participants completed the demographic questionnaire, the M. D. Anderson Symptom Inventory for Gastrointestinal Cancer, the Functional Assessment of Cancer Therapy-General and the Connor-Davidson Resilience Scale. Exploratory factor analysis, stepwise regression and correlation analysis were applied. RESULTS: Four symptom clusters were identified: dysphagia-psychological, chemoradiotherapy side-effect, digestive tract reconstruction and fatigue-sleep. Gender, stage of disease and resilience influenced the dysphagia-psychological symptom cluster. Gender, stage of disease, resilience and treatment were significant factors affecting the chemoradiotherapy side-effect and fatigue-sleep symptom clusters. Gender, stage of disease, resilience and anastomotic position were significant factors influencing the digestive tract reconstruction symptom cluster. The correlations between symptom clusters and quality of life were significant, with the highest correlation between the dysphagia-psychological cluster and quality of life. CONCLUSIONS: Nurses should pay more attention to symptom management in patients with oesophageal cancer 3 months after surgery by focusing on four symptom clusters. It is necessary to implement individualised care depending on the influence factors including gender, stage of disease, resilience, treatment and anastomotic position. RELEVANCE TO CLINICAL PRACTICE: These findings will help develop targeted interventions to facilitate further symptom management for transitional nursing from the peri-operative phase to long-term rehabilitation.

Gastroesophageal cancer patients need earlier palliative intervention - Using data to inform appropriate care.

PURPOSE: To evaluate demographics of survival in patients with gastroesophageal cancer so that it informs nursing practice. METHOD: Data on 2215 patients diagnosed with gastroesophageal cancer who presented to a specialist referral centre between the years 2000 and 2011 were extracted from a Public Health repository. Survival time was calculated and analysed against clinical and lifestyle factors to reveal whether they had an impact on survival outcomes. RESULTS: Over 60% of patients had died within the first year, 39% of these died within the first 6 months. Survival outcomes were reduced in advancing age, and in those patients who present as 'emergency' cases. One quarter of patients were seen by a GP, but were not referred urgently through the two week wait system, to specialist care. Thus, gastroesophageal cancer patients need specific and appropriate treatment options, including earlier referrals to palliative care provision. There is also a need for cancer specific education and information at community and clinical levels. CONCLUSIONS: The globally applied one and five-year statistics applied to cancer survival studies do not adequately capture rates of early demise with gastroesophageal cancer. This study presents a novel approach to statistical analysis, based on patient derived data. It identifies factors linked to earlier deaths. However, rather than a focus on early presentation and diagnosis (which are essential) - it also reveals a significant need to consider early referrals for palliative care and nursing interventions to alleviate pain and suffering in patients with poor prognosis.

A System-Based Nursing Approach to Improve Outcomes in the Postoperative Esophagectomy Patient.

OBJECTIVE: To review essential nursing implications in the care of postoperative esophagectomy patients. DATA SOURCES: Peer-reviewed literature, institutional experience, journal articles. CONCLUSION: Utilizing a system-based approach to assess the post-esophagectomy patient will assist the nurse in ensuring safe and comprehensive care. IMPLICATIONS FOR NURSING PRACTICE: Nursing care measures to reduce perioperative esophagectomy morbidity includes aggressive fluid management, pain management, use of epidural analgesia, and early ambulation. Therefore, nurses play a significant role in improving the outcomes for the esophagectomy patient.

The effect of a nurse led telephone supportive care programme on patients' quality of life, received information and health care contacts after oesophageal cancer surgery-A six month RCT-follow-up study.

BACKGROUND: Following oesophagectomy, a major surgical procedure, it is known that patients suffer from severely reduced quality of life and have an unmet need for postoperative support. Still, there is a lack of research testing interventions aiming to enhance the patients' life situation after this surgical procedure. AIM: The aim of the study was to evaluate the effect of a nurse led telephone supportive care programme on quality of life (QOL), received information and the number of healthcare contacts compared to conventional care following oesophageal resection for cancer. METHOD: The study was designed as a randomized controlled trial (RCT) aiming to test the effect of a nurse led telephone supportive care program compared to conventional care. Patient assessments were conducted at discharge, 2 weeks, 2, 4 and 6 months after discharge and comprised evaluation of QOL, received information and the number of health care contacts. Statistical testing were conducted with repeated measurements analysis of variance to test if there were differences between the groups during follow-up. RESULT: The results show that the intervention group was significantly more satisfied with received information for items concerning the information they received about things to do to help yourself, written information and for the global information score. The control group scored significantly higher on the item regarding wishing to receive more information and wish to receive less information. No effect of the intervention was shown on QOL or number of health care contacts. CONCLUSION: Proactive nurse-led telephone follow-up has a significant positive impact on the patients' experience of received information. This is likely to have a positive effect on their ability to cope with a life that may include remaining side effects and adverse symptoms for a long time after surgery.

Coping styles and social support among depressed Chinese family caregivers of patients with esophageal cancer.

OBJECTIVES: To determine the coping styles of family caregivers of patients with esophageal cancer and examine the relationships between depression, coping styles and social support. METHODS: A descriptive and correlational survey was conducted in three university-affiliated oncology and thoraco-cardiac surgery departments in Shiyan, China. A convenience sample of 301 Chinese family caregivers of hospitalized patients with esophageal cancer were asked to respond to a set of four questionnaires including: Socio-demographic questionnaire, Center for Epidemiological Studies Depression, Brief COPE Inventory, and Multidimensional Scale of Perceived Social Support. RESULTS: For the positive coping style, male caregivers used more problem-coping than female caregivers. However, for negative coping, both male and female caregivers used maladaptive coping styles. There were significant correlations between emotion-focused coping styles with adaptive coping, maladaptive coping, depression and social support. CONCLUSIONS: Family caregivers play a major role in caring for cancer patients and suffer from various psycho-social problems. What is lacking in the literature was to address the cultural differences in cancer caregiving burden, roles, and appropriate interventions to help them face the multiple demands of caregiving. Therefore, a need to develop and evaluate interventions using randomized clinical trials and sensitive instruments to measure the effectiveness of the intervention on patients' and caregivers' outcomes.

Factors relating to quality of life after esophagectomy for cancer patients in Taiwan.

BACKGROUND: Little is known regarding the short-term quality of life (QoL) and predictive factors for QoL after esophagectomy for cancer in Eastern countries. OBJECTIVE: The aims of this study were to assess QoL and symptoms within 1 and 6 months after surgery for esophageal cancer (EC) and to identify factors predictive of QoL within 6 months after esophagectomy in Taiwan. METHODS: A longitudinal, prospective design was used, where convenience samples of 99 patients who had undergone esophagectomy for cancer were recruited from 2 medical centers in northern Taiwan. All participants responded to a questionnaire with a QLQ-C30 (Quality of Life Questionnaire-Cancer) core and a QLQ-OES18 (esophageal module of the European Organization for Research and Treatment [EORTC] QLQ-C30) module in structured interviews at baseline and 1 and 6 months after surgery. RESULTS: The results showed significant decline in social function and global QoL; fatigue, insomnia, eating problems, reflux, and dry mouth were major problems within 6 months. Body mass index, body weight loss before surgery, activity performance status, and anastomosis site showed no significant association with the function and symptom aspect of QoL. Surgical complications, advanced cancer, neoadjuvant therapy before surgery, and tumor location other than at the EC junction had significant deleterious effects on several aspects of QoL. CONCLUSIONS: This study describes the demographics of EC and short-term changes in QoL and also the predictive impact factor for QoL after surgery for EC. IMPLICATIONS FOR PRACTICE: Knowledge of risk factors for poor postoperative QoL would be useful for health providers in detecting and prioritizing problems and treatment options in a busy clinical site.

Patterns of symptoms following surgery for esophageal cancer.

PURPOSE/OBJECTIVE: To explore patterns of symptoms before and after surgery for cancer of the esophagus. DESIGN: Longitudinal, descriptive study. SETTING: An urban comprehensive cancer center in the northeastern United States. SAMPLE: 218 patients with cancer of the esophagus undergoing esophagectomy. METHODS: Symptoms were assessed by self-report before surgery, at the first postoperative visit, and at 6 and 12 months postsurgery. MAIN RESEARCH VARIABLES: Symptoms and demographic and clinical variables, including stage, treatment, gender, and comorbidities. FINDINGS: Patients with esophageal cancer reported numerous symptoms before and after esophagectomy. Several patterns of symptoms were identified. General cancer symptoms (e.g., pain, cough, shortness of breath, weight loss) were reported as worse after surgery but recovered to baseline by one year. A second pattern of esophageal-specific symptoms (feeling full too quickly, feeling bloated, nausea, and diarrhea) worsened after surgery and did not recover to baseline by one year. Reflux was the only symptom that did not worsen after surgery but did worsen significantly during the first year of recovery. CONCLUSIONS: Patients with esophageal cancer experienced multiple prolonged symptoms following surgical treatment for their disease. General cancer symptoms resolved by one year post-treatment, whereas esophageal-specific symptoms worsened after surgery and did not recover to baseline. IMPLICATIONS FOR NURSING: Identification of symptom patterns preoperatively and during recovery can assist nurses in developing intervention protocols to minimize long-term complications for patients with esophageal cancer. KNOWLEDGE TRANSLATION: Patients with esophageal cancer are at risk for multiple prolonged symptoms following surgery. Symptom assessment should occur often after surgery and include a broad range of symptoms.

[Esophageal cancer: common health problems and health management].

Esophageal cancer is the 9th leading cause of cancer death in Taiwan. Lack of obvious symptoms or signs during its early stages means that patients are often already in the terminal stage or metastasis at their first diagnosis. A diagnosis of cancer greatly impacts both patients and their families. The purpose of this paper is to explore the current diagnostic methods and treatments used for esophageal cancer. We discuss the effects of physical, psychological and social problems such as dysphagia, fatigue, pain, uncertainty, and social isolation. We also explore the nursing interventions related to these problems. Understanding the health issues related to esophageal cancer will not only help nurses who take care of patients with esophageal cancer provide holistic care, it will also reduce patients' suffering through the treatment and recovery process. By applying interventions that effectively address the physical, psychological, and social realms, healthcare professionals can help patients feel more secure when dealing with related problems. This will improve patients' dignity, value and quality of life through their cancer journey.

Effects of psychological nursing intervention on personality characteristics and quality of life of patients with esophageal cancer.

OBJECTIVE: This study examined the effects of a psychological nursing intervention on personality characteristics and quality of life of esophageal cancer patients. METHODOLOGY: Esophageal cancer patients (n=86) were randomized into either an intervention group (n=45) or a control group (n=41). Patients in the control group were given routine nursing care, and those in the intervention group were provided with psychological nursing interventions in addition to routine nursing care. Personality characteristics, assessed through Eysenck Personality Questionnaire, and quality of life, assessed through EORTC QLQ-C30, were compared between the two groups. RESULTS: The results showed that personality characteristics were closely related to quality of life. After the psychological nursing intervention, the main factors were neurosis, psychosis or mood instability, and personality stability. However, introverted and extroverted personality characteristics were not associated with quality of life. The psychological nursing intervention was associated with decreased P-scale and E-scale scores of personality characteristics and improved quality of life in each dimension scored. CONCLUSIONS: A psychological nursing intervention can affect the personality characteristics of esophageal cancer patients and improve their quality of life; this approach is worthy of further study and clinical application.

Road map to esophagectomy for nurses.

Esophageal cancer, although considered uncommon in the United States, continues to exhibit increased incidence. Esophageal cancer now ranks seventh among cancers in mortality for men in the United States. Even as treatment continues to advance, the mortality rate remains high, with a 5-year survival rate less than 35%. Esophageal cancer typically is discovered in advanced stages, which reduces the treatment options. When disease is locally advanced, esophagectomy remains the standard for treatment. Surgery remains challenging and complicated. Multiple surgical approaches are available, with the choice determined by tumor location and stage of disease. Recovery is often fraught with complications-both physical and emotional. Nursing care revolves around complex care managing multiple body systems and providing effective education and emotional support for both patients and patients' families. Even after recovery, local recurrence and distant metastases are common. Early diagnosis, surgical advancement, and improvements in postoperative care continue to improve outcomes.

Oesophageal cancer: symptoms, treatment and nursing role.

This article examines the symptoms and treatment of oesophageal cancer. The article focuses on the nurse's role in post-operative care of oesophagectomy patients. Alternative treatments available when surgery is not an option are also identified.

Living with incurable oesophageal cancer. A phenomenological hermeneutical interpretation of patient stories.

PURPOSE: The study explores how patients diagnosed with incurable oesophageal cancer experience living with the illness, and provides insight into and an understanding of the patients' situation, reality and phenomena in their life world. METHOD: The method takes a phenomenological-hermeneutic approach, inspired by the French philosopher Paul Ricoeur's narrative theory on mimesis as the structure and process of the method, and Ricoeur's theory of interpretation for the analysis of patient stories. The stories materialise from narrative interviews, and the phenomena of the patients' life world results in an analysis of these stories. RESULTS: Through the analysis of the narrative interviews, phenomena of the patients' life world appear which are described in themes such as debut of the illness, denial, the person's own suspicion, existential turning point, despair, hope, the body, affirmation of irrevocable illness, acknowledgement of dying, life phenomena, relations and feeling of independence. The understanding of the patients' experiences is augmented and improved through a discussion of the themes in a philosophical perspective, drawing upon theoretical and philosophical viewpoints of Kierkegaard, Løgstrup, Merleau-Ponty, Ricoeur, Benner & Wrubel, and on empirical research. CONCLUSIONS: Based on the phenomena in the ill person's life world brought about by analysis, it seems that incurably ill oesophageal cancer patients find themselves in a complex life situation, in which they need more than an objective estimate and fulfilment of need from hospital service. Our study illustrates some perspectives on the life situation of the incurably ill, which will contribute to the improved development of supportive care in nursing.

[Applying hospice care concepts on a patient with terminal stage esophageal carcinoma: a nurse's experience].

This report describes a nursing care experience with a patient diagnosed with terminal stage esophageal carcinoma. Nursing care was administered from November 8th to 30th, 2007. Patient data was collected and evaluated using direct caring, observation, medical reports and patient interviews covering the physical, psychological, social, and spiritual realms. Patient health problems included pain, ineffective airway clearance, anticipatory grieving and spiritual distress. In line with hospice care concepts, the author employed empathy, companionship, listening, and support to assist the patient to overcome fear and face death. Comfort care and pain control skills were also used to relieve the patient's physical suffering. As such, the author assisted patient to achieve the essence of "good death", i.e., peace of achieved in the physical, psychological, social and spiritual realms.