Diagnosis and treatment of prostate cancer.

Nurses are often key workers for patients with prostate cancer and are responsible for ensuring men have the support they need throughout their cancer journey. This article provides an overview of the patient pathway.

Outcomes evaluation of a weekly nurse practitioner-managed symptom management clinic for patients with head and neck cancer treated with chemoradiotherapy.

PURPOSE/OBJECTIVES: To determine whether improved monitoring through close follow-up with a nurse practitioner (NP) could enhance treatment compliance and decrease frequency of hospitalizations. DESIGN: Retrospective chart review. SETTING: An academic National Cancer Institute-designated comprehensive cancer center. SAMPLE: 151 patients aged 45-65 years diagnosed with stage III or IV oropharyngeal cancer. METHODS: Patients were nonrandomized to one of two groups: a prechemotherapy clinic group and a weekly NP-led clinic group. After examination of descriptive statistics, multiple linear and logistic regressions were used to compare groups across patient outcomes. MAIN RESEARCH VARIABLES: Hospitalization, chemotherapy dose deviations, and chemotherapy treatment completion. FINDINGS: The average number of visits during traditional treatment was three and, after initiation of the NP-led clinic, the number was six. The hospitalization rate was 28% in the traditional clinic group compared to 12% in the NP-led group. The rate of chemotherapy dose deviations was 48% in the traditional clinic group compared to 6% in the NP-led clinic group. Forty-six percent of patients in the traditional clinic group received the full seven scheduled doses of chemotherapy compared to 90% of patients seen in the NP-led clinic group. CONCLUSIONS: A weekly NP-led symptom management clinic reduces rates of hospitalization and chemotherapy dose deviations and increases chemotherapy completion in patients receiving intensive chemoradiotherapy for oropharyngeal cancer. IMPLICATIONS FOR NURSING: Patients receiving chemoradiotherapy benefit from close monitoring for toxicities by NPs to successfully complete their treatment and avoid hospitalization. KNOWLEDGE TRANSLATION: Early interventions to manage toxicities in patients with head and neck cancer can improve outcomes. NPs are in a key position to manage these toxicities and, when symptoms are controlled, costs are reduced.

Central nervous system injury and neurobiobehavioral function in children with brain tumors: a review of the literature.

BACKGROUND: Children with brain tumors present a complex set of factors when considering treatment decisions, including type and location of tumor and age of the child. Two-thirds of children will survive, but historically have had poorer neurocognitive and quality-of-life outcomes when compared with survivors of other childhood cancers. Delaying or forgoing cranial radiation completely is thought to lead to improved neurobiobehavioral outcomes, but there is still relatively little research in this area. OBJECTIVES: The objectives of this study were to review and consolidate what is known about the effects of cranial radiation and chemotherapy on normal brain tissue and to synthesize that information relative to neurobiobehavioral findings in children with brain tumors. METHODS: A literature search using PubMed and PsycINFO from 2000 to 2011 was done using a variety of terms related to childhood brain tumor treatment and outcome. A total of 70 articles were reviewed, and 40 were chosen for inclusion in the review based on most relevance to this population. RESULTS: Both cranial radiation and certain chemotherapy agents cause damage to or loss of healthy neurons, as well as a decrease in the number of progenitor cells of the hippocampus. However, in general, children treated with chemotherapy alone appear to have less of a neurobiobehavioral impact than those treated with cranial radiation. CONCLUSIONS: The trend toward delaying or postponing cranial radiation when possible may improve overall neurocognitive and quality-of-life outcomes. IMPLICATIONS FOR PRACTICE: Nurses require knowledge of these issues when discussing treatment with families and with caring for long-term survivors.

Testicular cancer.

OBJECTIVES: To discuss the presentation, diagnosis, chemotherapy, surgical options, nursing management, and long-term outcomes of patients with testicular cancer. DATA SOURCES: Review and research articles, clinical experience. CONCLUSION: Testicular cancer is very treatable and the cure rate is approximately 95%. It is most common in men between the ages of 15 and 35. While early detection, diagnosis, and treatment are all important factors for treating the disease, fertility and quality of life are also important issues to address in patients with testicular cancer. IMPLICATION FOR NURSING PRACTICE: Nurses must provide patient instruction regarding chemotherapy, surgery, fertility, and side effects of treatment. Serving as a patient advocate regarding fertility preservation and promoting quality of life are important factors for health professionals to consider.

Clinical subgroups of a psychoneurologic symptom cluster in women receiving treatment for breast cancer: a secondary analysis.

PURPOSE/OBJECTIVES: To investigate clinical subgroups using an empirically identified psychoneurologic symptom cluster (depressed mood, cognitive disturbance, fatigue, insomnia, and pain) and to examine the differences among subgroups in the selected demographic and clinical variables, as well as in patient outcome (i.e., functional performance). DESIGN: Secondary analysis. SETTING: A university health science center in Salt Lake City, UT, and a National Cancer Institute-designated comprehensive cancer center in Philadelphia, PA. SAMPLE: 282 patients with breast cancer undergoing chemotherapy or radiotherapy. METHODS: Cluster analyses were conducted to identify subgroups. Multinomial logistic regression and one-way analyses of variance were used to examine the differences among subgroups. MAIN RESEARCH VARIABLES: Depressed mood, cognitive disturbance, fatigue, insomnia, pain, and functional performance. FINDINGS: Patients were classified into four distinct subgroups based on their symptom cluster experience: all low symptom, high fatigue and low pain, high pain, and all high symptom. Such patient classification patterns were consistent across the treatment trajectory, although group memberships were inconsistent. After initiating treatment, two additional subgroups emerged: high depressed mood and cognitive disturbance, and high fatigue and insomnia. Subgroups differed in physical performance status at baseline, symptom burden, and treatment modality in a relatively consistent pattern across time points. Patients in the all-high-symptom subgroup experienced the most serious limitations in activities across all time points. CONCLUSIONS: Patient subgroups exist that share the unique experience of psychoneurologic symptoms. IMPLICATIONS FOR NURSING: Findings are useful to determine who needs more intensive symptom management during cancer treatment. Future studies should examine whether specific symptom management strategies are more efficient for certain subgroups.

Cancer nursing: the modern era.

PURPOSE/OBJECTIVES: To identify critical elements of the major shift in cancer nursing practice, education, and the expectations of professional nursing immediately following World War II that were precursors of contemporary oncology nursing preparation and practice. DATA SOURCES: General healthcare, medical, and nursing literature, particularly in the American Journal of Nursing, published after World War II and before the inception of the Oncology Nursing Society (ONS); archival materials in the collection of ONS; nursing history literature; and personal communications. DATA SYNTHESIS: Nurses in a wide variety of practice settings with varied levels of experience, including staff nurses, homecare nurses, and high-level leaders and decision makers of the time, were responsible for bringing attention to and addressing the challenges and joys of cancer nursing. CONCLUSIONS: Professional nursing in general and cancer nursing in particular underwent significant changes and a distinct paradigm shift in cancer nursing education and practice in the period of time surrounding World War II, which promoted the advancement of cancer nursing. IMPLICATIONS FOR NURSING: This historical review provides lessons for contemporary cancer nursing clinicians, executives, researchers, and educators with regard to imagining ways to approach issues, the necessity of collaboration and public-private partnerships, and maintaining the passion for this increasingly complex nursing specialty.