Reproducibility of random periareolar fine needle aspiration in a multi-institutional Cancer and Leukemia Group B (CALGB) cross-sectional study.

BACKGROUND: Random periareolar fine needle aspiration (RPFNA) is a research technique developed to assess short-term breast cancer risk in women at increased risk of breast cancer. Although there is increasing acceptance of RPFNA, neither the reproducibility nor the inter-institutional compatibility of RPFNA has been established. To address these key limitations, the Cancer and Leukemia Group B (CALGB) Prevention Group tested the reproducibility of RPFNA in a multi-institutional cross-sectional study. METHODS: Sixty-three high-risk women from five CALGB institutions (Duke, Ohio State, Roswell Park, Dana Farber, and Vermont) underwent RPFNA from July 1, 2007 to June 30, 2008. Duplicate bilateral RPFNA was performed on each woman by a single investigator on a single day. Masood Cytology Index score was assessed by a single blinded cytopathologist. RESULTS: There was a high degree of statistical agreement in the Masood Cytology Index scores of duplicate RPFNA samples from the same breast, with a Spearman correlation coefficient of 0.8312 (P < 0.0001). Importantly, although there was agreement in duplicate samples from the same breast, there was lack of agreement between duplicate samples from the opposite breast. CONCLUSIONS: This multi-institutional study shows that RPFNA is a highly reproducible measure of breast cytology in a cooperative group cross-sectional trial. RPFNA did not show a high degree of agreement between breasts, suggesting that breast cancer risk and progression may occur at different rates in individual breasts from a single woman. These studies provide proof-of-principle for future RPFNA-based cooperative group prevention studies.

Pilot study of rosiglitazone therapy in women with breast cancer: effects of short-term therapy on tumor tissue and serum markers.

PURPOSE: Peroxisome proliferator-activated receptor gamma (PPARgamma) is a steroid nuclear receptor that is activated by natural compounds such as specific fatty acids and synthetic drugs such as thiazolidinedione antidiabetic agents. Expressed in normal and malignant mammary epithelial cells, activation of PPARgamma is associated with antiproliferative effects on human breast cancer cells in preclinical studies. The purpose of this study was to test the hypothesis that PPARgamma ligand therapy might inhibit tumor growth and progression in human breast cancer. EXPERIMENTAL DESIGN: We conducted a pilot trial of short-term (2-6 weeks) treatment with the thiazolidinedione rosiglitazone in 38 women with early-stage (T(is)-T(2), N(0-1), M(0)) breast cancer, administered between the time of diagnostic biopsy and definitive surgery. RESULTS: Short-term treatment with rosiglitazone (8 mg/d) did not elicit significant effects on breast tumor cell proliferation using Ki67 expression as a measure of cell proliferation and surrogate marker of tumor growth and progression. In pretreatment tumors notable for nuclear expression of PPARgamma by immunohistochemistry, down-regulation of nuclear PPARgamma expression occurred following rosiglitazone administration (P = 0.005). No PPARG mutations were identified, and the incidence of P12A and H446H polymorphisms did not differ relative to U.S. controls (P = 0.5). Treatment with rosiglitazone resulted in increased serum adiponectin (P < 0.001), decreased insulin levels (P = 0.005), and increased insulin sensitivity (P = 0.004). Rosiglitazone was well tolerated without serious adverse events. CONCLUSION: Our data indicate that short-term rosiglitazone therapy in early-stage breast cancer patients leads to local and systemic effects on PPARgamma signaling that may be relevant to breast cancer.

Breast cancer in 2007: incidence, risk assessment, and risk reduction strategies.

Research continues to advance breast health practices, risk assessment, risk reduction strategies, and early detection of breast cancer. Nurses must maintain a current knowledge base to appropriately screen, educate, and counsel women in their fight against the number-one cause of cancer in women and the second-largest source of cancer death in women in the United States (Jemal et al., 2007).

Self-Reported Distress: Adult Acute Leukemia Survivors During and After Induction Therapy.

BACKGROUND: Data suggest that acute leukemia survivors experience moderate to severe distress that does not significantly decline from diagnosis through survivorship.
. OBJECTIVES: The purpose of this study is to assess acute leukemia survivors' level and source of self-reported distress from active cancer treatment through six months post-treatment.
. METHODS: A cross-sectional group-comparison design was used. Male (n = 60) and female (n = 40) survivors aged 19-84 years were accrued from a National Cancer Institute-designated cancer center. Patients were sampled at four time points. FINDINGS: Self-reported distress was elevated for all groups. Highest distress scores were found during induction therapy.

Lesbians and Gay Men's Vacation Motivations, Perceptions, and Constraints: A Study of Cruise Vacation Choice.

This study explores the push-pull vacation motivations of gay male and lesbian consumers and examines how these underpin their perceptions and purchase constraints of a mainstream and LGBT(1) cruise. Findings highlight a complex vacation market. Although lesbians and gay men share many of the same travel motivations as their heterosexual counterparts, the study reveals sexuality is a significant variable in their perception of cruise vacations, which further influences purchase constraints and destination choice. Gay men have more favorable perceptions than lesbians of both mainstream and LGBT cruises. The article recommends further inquiry into the multifaceted nature of motivations, perception, and constraints within the LGBT market in relation to cruise vacations.

Local treatment of breast cancer.

OBJECTIVES: To describe the local control of breast cancer, including initial biopsy, lumpectomy or mastectomy, and sentinel node biopsy or axillary node dissection, and to discuss the role of radiation therapy following lumpectomy or mastectomy in advanced cancer. DATA SOURCES: PubMed, Scopus, Cochran. CONCLUSION: The local treatment of breast cancer is an essential component of primary breast cancer treatment. Residual cancer cells may increase the risk of recurrent ipsilateral disease. IMPLICATIONS FOR NURSING PRACTICE: Nurses and advanced practice nurses who provide care for cancer survivors should possess the skills to patiently teach information, empathetically understand the flagrant or suppressed emotional turmoil, explain the full complement of treatment options, appreciate the rationale behind choices made, and help patients navigate the educational and decisional byways.

Reconstruction of the breast following mastectomy.

OBJECTIVES: To review immediate and delayed breast reconstructive options following surgery for high-risk or cancer-related unilateral or bilateral mastectomy and examine restorative interventions to promote a positive body image and long-term survivorship. DATA SOURCES: Review of PubMed, Scopus, and Cochran Review. CONCLUSION: For women facing mastectomy, a consultation with a plastic/reconstructive surgeon is a first step toward recovery with restoration of a missing body part. Nursing interventions are integral to physical and psychosocial healing. IMPLICATIONS FOR NURSING PRACTICE: An understanding of the reconstructive process can be beneficial in the care of women facing and recovering from a mastectomy. Psychological and physical issues occur whether the woman is undergoing bilateral prophylactic mastectomies for a high-risk condition or mastectomy as treatment for a malignant tumor.

Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue.

Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors.

Sleep impairment and insomnia in sickle cell disease: a retrospective chart review of clinical and psychological indicators.

PURPOSE: To examine clinical and psychological indicators associated with sleeplessness and insomnia in adult patients with sickle cell. DATA SOURCES: PubMed, Scopus, Cochrane Library. Data were collected from adult sickle cell participants (N = 72) in outpatient clinics at a Midwest National Cancer Institute designated comprehensive cancer center. A retrospective chart review observed for clinical and psychological indicators associated with sleeplessness and insomnia. CONCLUSIONS: Findings included that adults with sickle cell experienced insomnia (47%) and sleep impairment (15%). Significant associations existed between pain and sleep impairment (p = .00), insomnia and pain (p = .00), morning hours of sleep (p = .00), and evening hours (p = .00). Pain may contribute to insomnia or interrupt sleep; daytime sleeping was not conducive to nighttime sleep. Anxiolytics, antidepressants, and long-acting opioids were not associated with insomnia (p = .00, p = .43, and p = .10), respectively; reduction in anxiety may reduce insomnia. Long-acting opioids may provide for improved pain control sleep. IMPLICATIONS FOR PRACTICE: Healthcare providers play a pivotal role in the assessment of sleep impairment or disorders. Effective management is necessary for improved quality of life. Further investigation is warranted to understand the meaning of sleep impairment in adult patients with sickle cell with prospective controlled studies to examine the efficacy of interventions.

Women with breast cancer: self-reported distress in early survivorship.

PURPOSE/OBJECTIVES: To identify and compare levels of distress and sources of problems among patients with breast cancer in early survivorship. DESIGN: Descriptive, cross-sectional. SETTING: A National Cancer Institute-designated comprehensive cancer center. SAMPLE: 100 breast cancer survivors were selected to represent four time points in the cancer trajectory. METHODS: Distress was self-reported using the Distress Thermometer and its 38-item problem list. Analysis of variance and chi-square analyses were performed as appropriate. MAIN RESEARCH VARIABLES: Distress scores, problem reports, and time groups. FINDINGS: Participants scored in range of the cutoff of more than 4 (range = 4.1-5.1) from treatment through three months post-treatment. At six months post-treatment, distress levels were significantly lower. Significant differences were found between groups on the total problem list score (p = 0.007) and emotional (p = 0.01) and physical subscale scores (p = 0.003). CONCLUSIONS: Comparison of groups at different points in the cancer trajectory found similar elevated levels from diagnosis through three months. Distress remained elevated in early survivorship but significantly decreased at six months post-treatment. IMPLICATIONS FOR NURSING: Interventions to reduce or prevent distress may improve outcomes in early survivorship.

Incorporation of eicosapentaenioic and docosahexaenoic acids into breast adipose tissue of women at high risk of breast cancer: a randomized clinical trial of dietary fish and n-3 fatty acid capsules.

SCOPE: The fatty acid profile of dietary lipids is reflected in mammary adipose tissue and may influence mammary gland biology and cancer risk. To determine the effects of fish consumption on breast adipose tissue fatty acids, we conducted a study of fish versus n-3 PUFA supplements in women at increased risk of breast cancer. METHODS AND RESULTS: High risk women were randomized to comparable doses of marine n-3 PUFAs as canned salmon + albacore or capsules for 3 months. Pre- and posttreatment fatty acid profiles were obtained by GC. Dietary fish (n = 12) and n-3 PUFA capsules (n = 13) yielded increased eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in plasma (p < 0.0001), erythrocyte membranes (p < 0.0001), and breast fat (p < 0.01) at 3 months. Women taking capsules had higher plasma and erythrocyte membrane EPA changes (∼four versus twofold, p = 0.002), without significant differences in DHA. Increases in breast adipose EPA, DHA were similar for both groups. Higher BMI correlated with smaller changes in plasma, erythrocyte membrane EPA, and breast adipose EPA, DHA. Adherence was excellent at 93.9% overall and higher in the fish arm (p = 0.01). CONCLUSION: Fish provides an excellent source of n-3 PUFAs that increases breast adipose EPA, DHA similar to supplements and represents a well-tolerated intervention for future studies of the impact of n-3 PUFAs and dietary patterns on breast cancer.

Distress screening in chronic disease: essential for cancer survivors.

Distress is a psychological state that is often observed in patients with chronic disease. Many cancers are considered chronic in nature, with patients experiencing long, disease-free states and intervals of metastatic disease. Distress can negatively affect the biopsychosocial balance in cancer survivors and impede their progress along the cancer trajectory. Distress can also affect medical and psychological outcomes and hinder advancement into long-term survivorship. Distress may contribute to disease progression, although despite research findings, health-care providers seldom screen for indications of persistent or unresolved distress. This article discusses research findings related to the prevalence of distress in multiple chronic diseases. Validated instruments used to screen for distress in cancer survivors, such as the Distress Thermometer and symptom checklist from the National Comprehensive Cancer Network, are reviewed. With the availability of brief and concise instruments to screen for distress, providers have the ability to provide holistic and comprehensive care for cancer survivors. The overall financial impact of cancer-related distress is understudied, although similar psychological studies indicate that prevention or elimination of distress is beneficial. Cancer is a lifelong, chronic disease; patients have ongoing needs and varied sources of distress. As the number of cancer survivors exponentially increases, their psychosocial needs will likewise expand.

Accelerated partial breast irradiation.

Local therapies to treat newly diagnosed breast cancer include a lumpectomy with radiation therapy or a mastectomy. The 20-year data from studies about the safety and efficacy of lumpectomy with full-breast radiation therapy support the safety of this regimen and its role to decrease the risk of ipsilateral recurrence and increase long-term survivorship of women with breast cancer. Accelerated partial breast irradiation (APBI) provides radiation therapy to the tumor bed but spares the remaining breast tissue. APBI accelerates the time required to complete the therapy regimen, with a range of one intraoperative session to five consecutive days compared to five to seven weeks. Several techniques exist to administer APBI, including the insertion of a balloon into the lumpectomy space. Of interest is the widespread use of APBI in community and academic settings that has preceded outcomes of large, randomized clinical trials. Because of selection bias in a number of small, single-institution, nonrandomized studies, published data are of limited value to ensure APBI as a standard of care.

Oncology nurses' knowledge of survivorship care planning: the need for education.

PURPOSE/OBJECTIVES: To survey nurses about their knowledge of cancer survivorship care. DESIGN: Descriptive, cross-sectional. SETTING: Midwestern comprehensive cancer center. SAMPLE: 223 registered and advanced practice nurses. METHODS: Online survey of survivorship knowledge using a 50-item questionnaire derived from the Institute of Medicine report and related publications. MAIN RESEARCH VARIABLES: Concepts of survivorship care and common long-term symptoms. FINDINGS: Most nurses reported having knowledge about healthy lifestyle habits; more than 50% of nurses reported having knowledge about chemotherapy, surgery, and radiation therapy, as well as side effects of fatigue, depression, limitations of daily activities, and weight gain; less than 50% of nurses reported having knowledge of impact on family, biologic agents, lymphedema, immunizations or vaccinations, and osteoporosis screening; less than 40% of nurses reported having knowledge about marital and partner relationships, osteoporosis prevention and care, sexuality, side effects of bone marrow transplantation, employment issues, and angiogenesis agents; and less than 25% of nurses reported having knowledge on genetic risks, as well as fertility, financial, and insurance issues. CONCLUSIONS: Oncology nurses at an academic comprehensive cancer center reported gaps in knowledge consistent with previous studies about knowledge of survivorship care. IMPLICATIONS FOR NURSING: The Institute of Medicine has challenged oncology providers to address cancer survivorship care planning. Gaps in cancer survivorship knowledge are evident and will require focused education for this initiative to be successful.

The nurse liaison role in the cooperative group setting.

OBJECTIVES: To review the history of nurse involvement within the cooperative group environment, define the role of the nurse liaison, identify challenges for the nurse in interdisciplinary research, and explore future trends of nurse involvement in cooperative group studies. DATA SOURCES: Published articles, government reports, and Web sites. CONCLUSION: Nurse liaisons provide a nursing perspective to the design of cooperative group trials and ensure that nursing and patient feasibility issues about the trial are addressed, and provide guidance to nurses at participating institutions, as well as their home institution. IMPLICATIONS FOR NURSING PRACTICE: The nurse liaison must be committed to their cooperative group role. Because of their proximity in time and space to the patient, nurse liaisons have a unique vantage point that can provide meaningful feedback for all stages of protocol development, implementation, and evaluation.

A mentored cooperative group pilot study: atrophic vaginitis.

OBJECTIVES: To review nursing research initiatives from two cooperative groups and outline a pilot study performed by a junior nurse researcher mentored by cooperative group nurse researchers and institutional physicians. DATA SOURCES: PubMed, Cochrane Library, Scopus, World Wide Web. CONCLUSION: Nursing research can be initiated and led by nurses in the cooperative group setting. The team approach model of research includes several disciplines to examine multiple facets of the same problem, or of multiple problems that a cancer patient may face. This new model will enable a greater number of nurse researchers to investigate symptom management, survivorship, and quality-of-life issues. IMPLICATIONS FOR NURSING PRACTICE: Nurse researchers should be included in every cooperative group study to investigate nurse-sensitive outcomes and issues related to symptom management, survivorship, and quality of life.

Advocacy for survivors with or at risk for lymphedema.

OBJECTIVES: To discuss various advocates and advocacy roles integral to the multidisciplinary oncology lymphedema care team. DATA SOURCES: Review and research articles, and Web sites. CONCLUSION: The professional and lay awareness of lymphedema, risk profiles, patient education, and treatment have improved significantly over the past two decades, although gaps are still present that require attention. IMPLICATIONS FOR NURSING PRACTICE: Nurses must be familiar with the common concepts related to lymphedema, risk profiles, recognition of symptoms, and referral options for the treatment of oncology patients with or at risk for lymphedema.

Safe handling and administration considerations of oral anticancer agents in the clinical and home setting.

The use of hormonal, chemotherapeutic, and targeted biologic oral agents has exponentially increased since the early 2000s. Oral therapies have the advantage of persistent exposure of the cytotoxic drug to tumor cells and the tumor environment. The use of oral anticancer agents provides therapeutic drug treatment for patients with cancer in the comfort of their home or alternative settings, such as retirement homes and assisted living or extended-care facilities. Practices to ensure safe storage, handling, administration, and disposal of oral agents are necessary to prevent additional exposure of hazardous substances to the environment, professionals, patients, family members, and caretakers. Providers should consider potential barriers to adherence and compliance, and develop strategies to ensure optimal therapeutic benefit prior to initiation of oral agents.

Restoring and maintaining urinary function.

OBJECTIVES: To describe surgical urinary diversion methods, nursing management, and survivorship issues in urologic cancer survivors. DATA SOURCES: PubMed, Scopus, Cochran Reviews, Core 25 online texts. CONCLUSION: Options exist for patients that require urinary diversion, although long-term symptoms may persist. IMPLICATIONS FOR NURSING PRACTICE: Nurses must be knowledgeable about obstructive uropathy and understand the surgical options for urinary diversion following a cystectomy; pre- and post-operative needs exist for the cancer patient, family, and caregiver. Following completion of active treatment, a survivorship care plan summarizes active treatment and complications, plans long-term health outcomes and surveillance, and communicates with the primary care provider.

Random periareolar fine-needle aspiration: the new pap smear of the breast?

Random periareolar fine-needle aspiration continues to gain scientific credence in the short-term identification of women at increased risk for breast cancer. As this technique becomes more widely used, APs may seek to be trained in an effort to expand clinical trials, and someday provide a "Pap smear of the breast" for the women who need it most.