Perspectives on comorbidity and cancer in older patients: approaches to expand the knowledge base.

Not only do persons 65 years and older bear a disproportionate burden of cancer, advancing age is associated with increased vulnerability to other age-related health problems. Newly diagnosed older cancer patients who have lived into later years of life may have concurrent ailments (eg, diabetes, chronic obstructive pulmonary disease, heart disease, arthritis, and/or hypertension) that could affect treatment choice, prognosis, and survival. The clinician must often make cancer treatment decisions in the context of an older individual's pre-existing health problems (ie, comorbidity). Ways to produce reliable information on comorbidity that can be effectively used in evaluation of older cancer patients are urgently needed. What is the nature and severity of the older patient's comorbid health problems? How do other age-related conditions influence treatment decisions and the cancer course? How do already compromised older patients tolerate the stress of cancer and its treatment? How are concomitant comorbid conditions managed? At present, no established, valid way to assess comorbidity in older cancer patients exists. Such technology, with a solid conceptual and scientific base, promises a high positive clinical yield to assure quality cancer care for older patients if reliable and valid instruments can be integrated into oncology practice. Much preliminary scientific work must be performed. A synthesis of viewpoints on what to include in comorbidity assessment of older cancer patients and development approaches were expressed in a multidisciplinary working group convened by the National Institute on Aging and the National Cancer Institute. We share the key issues raised regarding complexities of comorbidity assessment and suggestions for scientific inquiry.

Relevance of quality of life to clinical nursing practice.

Assessment of quality of life is an important concept for nurses who practice in oncology settings because the physical, psychological, and social well-being of the patients is affected by the disease and its treatment. The use of valid, reliable, and clinically relevant measures of quality of life will facilitate planning of appropriate care and the evaluation of specific interventions.

Informed consent: an overview.

Informed consent is a process, not an isolated incident. It therefore requires that health care professionals approach the process with expert knowledge, open communication, and a willingness to participate in shared decision-making. Table 2 identifies the major ethical and legal issues of informed consent. Legal precedents and professional collaboration will be necessary to further define and refine informed consent. The complexity of treatment regimens, potential system toxicities, and the chronicity of the disease process have fostered the development of a multidisciplinary team approach to the care of oncology patients. Therefore, collaboration is essential to meet the demands of the informed consent process and provide an optimal environment for the oncology nurse to intervene actively as a patient advocate.

Efforts to recruit the economically disadvantaged to national clinical trials.

Clinical trials are vital for the development of state-of-the-art cancer prevention and treatment. A goal for trial recruitment should be to have a representative sample of the total population by gender, race, culture, ethnicity, and socioeconomic status as appropriate. Increased sensitivity to the unique barriers and access to care issues required to achieve a representative sample are necessary. Knowledge and understanding of recruitment problems and strategies to resolve them are developing; however, much more is needed before we can fully address and resolve all of the relevant issues. Nurses have a key role in identification, education, and recruitment of special populations including the SED to clinical trials.

Women's health advocacy: its growth and development in oncology.

Women's health has become a topic of national importance. Advocacy initiatives by consumers, scientists, government officials, health care professionals, industry, and the media have played a role in helping to set this agenda. Much of the current interest in women's health is the result of the women's movement and its interaction with science, medicine, and health care. Emerging consumerism and increasing public knowledge of medical and scientific topics has led to the emergence of patients as individuals seeking to actively make decisions regarding health care options. Nurses should embrace the advocacy movement and, whenever possible, work with patients and their advocates toward their many shared goals.

Cancer in adults: a focus on prevention and detection in the nurse practitioner's practice.

This article provides a very general overview of the group of diseases called cancer. The clinical practice of the nurse practitioner emphasizes health maintenance and promotion of a healthy life style. This focus can carry over into the survival phase of the cancer experience. Counseling about risk status and risk reduction are an integral part of the total approach to cancer care. These activities can be integrated into standard care delivered by the nurse practitioner.

Cancer in adults: a focus on prevention and detection in the nurse practitioner's practice.

This article provides a very general overview of the group of diseases called cancer. The clinical practice of the nurse practitioner emphasizes health maintenance and promotion of a healthy life style. This focus can carry over into the survival phase of the cancer experience. Counseling about risk status and risk reduction are an integral part of the total approach to cancer care. These activities can be integrated into standard care delivered by the nurse practitioner.

Issues related to informed consent.

With advances in technology has come the promise for improved patient care. However, new and aggressive treatments can carry unexpected and unpredictable risks. Informed consent--a relatively recent concept--ensures that the patient is provided with ample information to make decisions about treatment.