Comprehensive Clinical Literature Review of Managing Bone Metastases in Breast Cancer: Focus on Pain and Skeletal-Related Events.

BACKGROUND: Bone metastases are the most common site of metastatic disease in breast cancer and can result in significant pain and an increased risk of skeletal-related events (SREs). Uncontrolled pain can further lead to negative outcomes. OBJECTIVES: The aim is to provide oncology nurses with the latest evidence on the management of bone metastases in metastatic breast cancer (MBC) with a focus on pain and SREs. METHODS: A literature search was conducted using the Embase®, PubMed®/MEDLINE®, CINAHL®, and Cochrane Library databases. Clinical trials, retrospective studies, systematic reviews, meta-analyses, and practice guidelines, as well as one high-level conference abstract, were reviewed. FINDINGS: Options for managing bone metastases in MBC include surgical and interventional strategies, radiation, and bone-modifying agents. Management plans frequently include a combination of these modalities. More information is needed to better define the role of bone-directed therapies in MBC, particularly as they relate to nursing care.

A Pilot Mixed-Methods Study of Malignant Pleural Mesothelioma Symptoms.

OBJECTIVES: To describe symptoms of malignant pleural mesothelioma (MPM), a rare cancer associated with a poor prognosis and significant symptoms, via a pilot mixed-methods study, because it is unclear whether MPM symptom assessment tools accurately characterize these symptoms. SAMPLE & SETTING: Participants with MPM were recruited from a large northeastern U.S. academic medical center with an interprofessional MPM program. METHODS & VARIABLES: A mixed-methods pilot approach was employed using the Lung Cancer Symptom Scale for Mesothelioma (LCSS-Meso) to quantitatively describe MPM symptoms and semistructured interviews to qualitatively capture these symptoms. RESULTS: Seven participants with MPM completed the LCSS-Meso and qualitative interviews. The five symptoms evaluated by the LCSS-Meso were confirmed as symptoms of MPM in participant interviews. However, the presence and severity of some symptoms were either under- or overestimated by the scale. Two additional symptoms, distress and sleep disturbance, also emerged from the qualitative interviews. IMPLICATIONS FOR NURSING: Nurses caring for people with MPM should have a thorough understanding of common symptoms, but they must also explore additional symptoms that are meaningful to each patient.

Use of complementary and integrative health in cancer pain management among patients undergoing cancer treatments: a qualitative descriptive study.

BACKGROUND: Pain is a common symptom in patients undergoing cancer treatment. Despite recommendations for the stronger integration of complementary and integrative health (CIH) in cancer pain management, little is known about the individual experience of using this approach for cancer pain, particularly in certain populations such as African Americans. OBJECTIVE: This study aimed to describe the experiences of using CIH for pain in African American and White patients with cancer undergoing cancer treatments. METHODS: A secondary analysis of qualitative descriptive data from a subsample of patients with cancer in a parent study of their illness concerns was employed. Atlas.ti 8.0 was used for data management and qualitative analysis. Counts of participant-endorsed themes were tabulated to discern differences in themes by group. RESULTS: Of 32 participants (16 African American, 16 White), 22 reported CIH usage for cancer pain management, with equal distribution between groups (11 each). Three themes emerged: Approach to, Reasons for, and Barriers to CIH Use. Psychological approaches were most common (n = 15). Nutritional, physical, and combination approaches were less common and more often employed by White participants. Reasons for CIH use were to reduce opioid consumption or for an opioid adjuvant. Personal limitations and access issues contributed to Barriers to CIH use. CONCLUSIONS: Both African American and White patients used CIH for pain management while undergoing cancer treatments. However, some preferential differences in CIH approaches by race surfaced. Further research into these differences may uncover new ways of addressing disparities in cancer pain management with CIH.

The Lived Experience of Persons With Malignant Pleural Mesothelioma in the United States.

BACKGROUND: Malignant pleural mesothelioma (MPM) is a rare but deadly cancer. Although there is an emerging picture of the individual MPM experience, the United States is underrepresented in this literature. With the United States contributing more deaths from MPM than any other country, findings from this study will enhance a global body of literature on the lived experience of this devastating cancer. OBJECTIVE: The aims of this descriptive phenomenological research study were to explore the lived experience of MPM in the United States and identify unmet patient needs. INTERVENTIONS/METHODS: This was a descriptive phenomenology study employing semi-structured individual interviews with persons with MPM. RESULTS: A total of 7 persons with MPM from a large northeastern US medical center participated. Three major themes about the MPM lived experience emerged: (1) uncertainty/worry about the future, (2) value in relationships, and (3) adapting to a new norm. CONCLUSIONS: Findings from this study are consistent with other MPM research, noting a high symptom burden, lifestyle changes, and feelings of uncertainty about the future. However, participants also expressed feelings of hope and optimism. Particularly salient to the MPM experience was the role of communication with the healthcare team as well as other persons with MPM. IMPLICATIONS FOR PRACTICE: Timely, coordinated, and personalized care as well as skilled communication should be the cornerstone of care for persons with MPM. Supportive care strategies that address uncertainty, the high symptom burden, feelings of isolation, and existential concerns are also integral to quality care.