Sentinel and networked symptoms in patients with breast cancer undergoing chemotherapy.

PURPOSE: It was designed to identify the symptom clusters and sentinel symptoms among patients with breast cancer receiving chemotherapy at the community level, and to explore core and bridge symptoms at the global level. METHODS: A cross-sectional survey was conducted using the MD Anderson Symptom Inventory. Patients with breast cancer receiving chemotherapy, recruited from the "Be Resilient to Breast Cancer" project between January 2023 and December 2023, were included in the study. Symptom clusters and their sentinel symptoms were identified using exploratory factor analysis and Apriori algorithm. Core and bridge symptoms were identified using network analysis. RESULTS: A total of 468 patients with breast cancer participated in the current study. At the community level, three symptom clusters and their corresponding sentinel symptoms were identified: a gastrointestinal symptom cluster (with nausea as the sentinel symptom), a psycho-sleep-related symptom cluster (with distress as the sentinel symptom), and a neurocognition symptom cluster (with dry mouth as the sentinel symptom). At the global level, fatigue emerged as the core symptom, while disturbed sleep and lack of appetite as bridge symptoms. CONCLUSION: Addressing nausea, distress, and dry mouth are imperative for alleviating specific symptom clusters at the community level. Furthermore, targeting fatigue, disturbed sleep, and lack of appetite are crucial to break the interactions among diverse symptoms at the global level.

Perspectives of Patients With Relapsed and Refractory Acute Myeloid Leukemia and High-Risk Myelodysplastic Syndrome on Patient-Clinician Communication About Prognosis and the Future.

Background: Patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) experience unpredictable disease trajectories and high prognostic uncertainty, which serve as barriers to patient-clinician communication about prognosis and their values and preferences for the future in the event of worsening health. Little is known about patients' day-to-day lived experiences and how this shapes their willingness to engage in such conversations. Objectives: To explore participant perspectives on living with their illness and patient-clinician communication about prognosis and the future. Design: This is a qualitative study using semi-structured interviews. Setting/Subjects: Patients with relapsed and refractory (R/R) AML and high-risk MDS from a northeastern U.S. cancer center. Data Collection: Interviews were transcribed verbatim and thematic analysis was used to generate findings. Results: Of the 14 participants, the mean age was 66 years, 79% were men, 93% were White, married, and had AML. The overarching theme that describes the experience was "Taking One Day at a Time" in a Fog of Uncertainty. Uncertainty was a universal perception related to the challenges for clinicians to predict prognosis. To cope with uncertainty, most participants tried to focus on the present and maintain normality in everyday life. Participants valued encouragement and positivity in patient-clinician communication, however, the majority were not ready to discuss prognosis and the future in the event of worsening health. Of note, 7 of 14 participants died within three months after the interview. Conclusions: These data describe a unique perspective of patients with R/R AML and high-risk MDS that clinicians could use to enhance communication strategies.

The interplay between stigma and sleep quality in breast cancer: A cross-sectional network analysis.

PURPOSE: Stigma, a subjective internal shame, arises from the association of cancer with death. Sleep quality can be considered a product of stigma. However, the extent of overlap or difference between the two remains unclear. METHODS: In total, 512 survivors with breast cancer were recruited from the "Be Resilient to Breast Cancer" project between May and August 2023. This study estimated the stigma, sleep quality, and their relationship by conducting a cross-sectional network analysis. The social impact scale and Pittsburgh Sleep Quality Index scale were employed in this study. RESULTS: The core symptom for stigma from the network analysis was alienation by people (Strength = 1.213, Betweenness = 13, Closeness = 0.00211). The core symptom for sleep quality were the sleep quality (Str = 1.114, Bet = 17, Clo = 0.01586). Regarding the combination network, results showed that self-isolation and daytime dysfunction were the bridge nodes and that daytime dysfunction was positively associated with feeling less capable than before (according to self) (r = 0.15). CONCLUSION: Our study demonstrates the core symptoms in different symptomatic networks, which can be targeted for treatment personalization and aid in the improvement of sleep quality and stigma in breast cancer patients.

Brain connectomics improve prediction of 1-year decreased quality of life in breast cancer: A multi-voxel pattern analysis.

PURPOSE: Whether brain connectomics can predict 1-year decreased Quality of Life (QoL) in patients with breast cancer are unclear. A longitudinal study was utilized to explore their prediction abilities with a multi-center sample. METHODS: 232 breast cancer patients were consecutively enrolled and 214 completed the 1-year QoL assessment (92.2%). Resting state functional magnetic resonance imaging was collected before the treatment and a multivoxel pattern analysis (MVPA) was performed to differentiate whole-brain resting-state connectivity patterns. Net Reclassification Improvement (NRI) as well as Integrated Discrimination Improvement (IDI) were calculated to estimate the incremental value of brain connectomics over conventional risk factors. RESULTS: Paracingulate Gyrus, Superior Frontal Gyrus and Frontal Pole were three significant brain areas. Brain connectomics yielded 7.8-17.2% of AUC improvement in predicting 1-year decreased QoL. The NRI and IDI ranged from 20.27 to 54.05%, 13.21-33.34% respectively. CONCLUSION: Brain connectomics contribute to a more accurate prediction of 1-year decreased QoL in breast cancer. Significant brain areas in the prefrontal lobe could be used as potential intervention targets (i.e., Cognitive Behavioral Group Therapy) to improve long-term QoL outcomes in breast cancer.

Prognostic Communication Between Parents and Clinicians in Pediatric Oncology: An Integrative Review.

Background: Prognostic communication between clinicians and parents in pediatric oncology is complex. However, no review has exclusively examined research on prognostic communication in pediatric oncology. In this review, we synthesize the evidence on prognostic communication in pediatric oncology and provide recommendations for future research. Methods: We conducted an integrative review searching six databases for studies on prognostic communication in pediatric oncology as of August 2022. We applied descriptive and narrative approaches to data analysis. Results: Fourteen quantitative and five qualitative studies were included. All studies were conducted in Western developed countries. In total, 804 parents of 770 children with cancer were included. Across studies, parents were predominately female, Non-Hispanic White, and had high school or higher levels of education. Most parents reported that prognostic communication was initiated in the first year after their children's diagnosis. High-quality prognostic communication was positively associated with trust and hope and negatively associated with parental distress and decisional regret. In qualitative studies, parents suggested that prognostic communication should be open, ongoing, and delivered with sensitivity. Most studies were of moderate quality. The main gaps included inconsistent definitions of prognostic communication, and a lack of comprehensive and validated measurements, high-quality longitudinal studies, and diverse settings and participants. Conclusions: Clinicians should initiate high-quality prognostic communication early on in clinical practice. Future research should consider conducting high-quality longitudinal studies, developing prognostic communication definitions and measurements, and conducting studies across settings with diverse populations.

Heterogeneity in resilience patterns and its prediction of 1-year quality of life outcomes among patients with newly diagnosed cancer: An exploratory piecewise growth mixture model analysis.

PURPOSE: This study was designed to explore the impact of a new cancer diagnosis on resilience of patients and whether the resilience patterns could predict Quality of Life (QoL) in the first year. METHODS: An exploratory linear piecewise growth mixture modeling (PGMM) with one hypothetical dot (3 months since diagnosis, T1) was employed to identify different resilience patterns and growth in 289 patients with different cancer diagnoses at five assessment occasions (T0-T4). Logistic regression analysis was performed to select potential predictors and receiver operating characteristic (ROC) curve analysis was utilized to test PGMM's discriminative ability against 1-year QoL. RESULTS: Five discrete resilience trajectories with two growing trends were identified, including "Transcendence" (7.3%), "Resilient" (47.4%), "Recovery" (18.7%), "Damaged" (14.9%) and "Maladaption" (11.8%). Advanced stage, colorectal cancer, and receiving surgery therapy were significant predictors of negative resilience trajectories ("Damaged" or "Maladaption"). Discriminative ability was good for PGMM (AUC = 0.81, 95%CI, 0.76-0.85, P < 0.0001). CONCLUSION: Heterogeneity is identified in resilience growth before and after 3 months since diagnosis. 26.7% newly diagnosed patients need additional attention especially for those with advanced colorectal cancer and receiving surgery therapy.

Measuring resilience by cognitive diagnosis models and its prediction of 6-month quality of life in Be Resilient to Breast Cancer (BRBC).

Objective: The application of advanced Cognitive Diagnosis Models (CDMs) in the Patient Reported Outcome (PRO) is limited due to its complex statistics. This study was designed to measure resilience using CDMs and its prediction of 6-month Quality of Life (QoL) in breast cancer. Methods: A total of 492 patients were longitudinally enrolled from Be Resilient to Breast Cancer (BRBC) and administered with 10-item Resilience Scale Specific to Cancer (RS-SC-10) and Functional Assessment of Cancer Therapy-Breast (FACT-B). Generalized Deterministic Input, Noisy "And" Gate (G-DINA) was performed to measure cognitive diagnostic probabilities (CDPs) of resilience. Integrated Discrimination Improvement (IDI) and Net Reclassification Improvement (NRI) were utilized to estimate the incremental prediction value of cognitive diagnostic probabilities over total score. Results: CDPs of resilience improved prediction of 6-month QoL above conventional total score. AUC increased from 82.6-88.8% to 95.2-96.5% in four cohorts (all P < 0.001). The NRI ranged from 15.13 to 54.01% and IDI ranged from 24.69 to 47.55% (all P < 0.001). Conclusion: CDPs of resilience contribute to a more accurate prediction of 6-month QoL above conventional total score. CDMs could help optimize Patient Reported Outcomes (PROs) measurement in breast cancer.

A qualitative study of sleep in young breast cancer survivors: "No longer able to sleep through the night".

Sleep disturbance is common among women with breast cancer and is associated with greater symptom distress and poorer outcomes. Yet, for the unique subgroup of young women with breast cancer (YWBC), there is limited information on sleep. To address the gap in our understanding of sleep health in YWBC, we explored their perspective on sleep quality, sleep changes over time, contributing factors, and any strategies used to promote sleep. As part of an explanatory sequential mixed method study, we recruited a sub-sample of 35 YWBC (≤ 50 years of age at the time of diagnosis) from the larger quantitative study phase. These participants were within the first 5 years since diagnosis and completed primary and systemic adjuvant therapy. We conducted virtual semi-structured interviews, transcribed them verbatim, and analyzed data with an interpretive description approach. YWBC experience difficulty falling asleep, waking up at night, and not feeling refreshed in the morning. They attributed interrupted sleep to vasomotor symptoms, anxiety/worry, ruminating thoughts, everyday life stressors, and discomfort. The sleep disturbance was most severe during and immediately after treatment but persisted across the 5 years of survivorship. The participants reported trying pharmacologic and non-pharmacologic strategies to improve the quantity and quality of their sleep. Future research would benefit from longitudinal designs to capture temporal changes in sleep and develop interventions to improve sleep health. Clinically, assessment of sleep health is indicated for YWBC related to the prevalence of disturbed sleep. IMPLICATIONS FOR CANCER SURVIVORS: Early access to sleep assessment and management, ideally before cancer treatment, would be beneficial for young breast cancer survivors. In addition, cancer treatment plans should include physical and psychological symptoms, especially those reported by women in this study: vasomotor symptoms, anxiety and worry, discomfort, and pain.

Resilience index improves prediction of 1-year decreased quality of life in breast cancer.

BACKGROUND: Resilience is important in cancer survivorship and has great potential to predict long-term quality of life (QoL) in breast cancer. The study was designed to develop a new prediction model to estimate pretest probability (PTP) of 1-year decreased QoL combing Resilience Index (RI) and conventional risk factors. METHODS: RI was extracted from 10-item Resilience Scale Specific to Cancer (RS-SC-10) based on the Principal Component Analysis (PCA). Patients were enrolled from Be Resilient to Breast Cancer (BRBC) and the prediction model was developed based on a sample of 506 consecutive patients and validated in an internal cohort (N1 = 314) and two external cohorts (N2 = 223 and N3 = 189). Integrated Discrimination Improvement (IDI) and Net Reclassification Improvement (NRI) were utilized to estimate the incremental value of RI. RESULTS: RI improved prediction above conventional risk factors. AUC increased from 0.745 to 0.862 while IDI and NRI were 8.39% and 18.44% respectively (P < 0.0001 for all). Five predictors were included in the final model: RI, age, N stage, M stage, and baseline QoL. The new model demonstrated good calibration ability in the internal and external cohorts resulting in C-indexes of 0.862 (95%CI, 0.815-0.909), 0.828 (95%CI, 0.745-0.910), 0.880 (95%CI, 0.816-0.944), and 0.869 (95%CI, 0.796-0.941). CONCLUSION: RI contributed to a more accurate estimation for PTP of 1-year decreased QoL above conventional risk factors and could help optimize decision making of treatment for breast cancer. IMPLICATIONS FOR CANCER SURVIVORS: A promising prognostic indicator of RI could improve QoL-related management in Chinese patients with breast cancer.

A Focus Group Study of Retirement-Age Nurses: Balancing Tension and a Love of Nursing in a Changing Healthcare Environment.

OBJECTIVE: The aims of this study were to explore the experience of retirement-age nurses and identify decision-making factors and innovations to enhance retention. BACKGROUND: A national shortage of nurses has created challenges to preserving quality patient care and level of nursing competency and managing turnover costs. METHODS: A qualitative study using focus groups was conducted of nurses 55 years or older who were working or recently retired. Data were audiotaped and transcribed verbatim, with content analysis used to code in an iterative process until consensus was reached. RESULTS: The tension of balancing the love of patient care within a changing healthcare system was described. Patient acuity, competing roles, and the centrality of computers were stressors and integrally related. Flexibility in work schedules and new practice models were important to retirement decision making for work-life balance and retention. CONCLUSION: Passion for patient care dominated decisions to continue working. Innovations in practice models and scheduling offer opportunities to enhance the retention of experienced nurses.

Struggling, Adapting, and Holding Each Other Up: A Qualitative Study of Oncology Nurses During the First Year of the COVID-19 Pandemic.

PURPOSE: To explore the experience of oncology nurses during the first year of the COVID-19 pandemic. PARTICIPANTS & SETTING: 21 RNs, advanced practice RNs, and physician associates from inpatient and ambulatory care settings at a comprehensive cancer center in the northeastern United States. METHODOLOGIC APPROACH: A qualitative study using interpretive description was conducted through semistructured interviews. Data were recorded and transcribed verbatim, reviewed for accuracy, and coded into themes following an iterative process of analysis. FINDINGS: The theme of "Doing It Together: Struggling, Adapting, and Holding Each Other Up" describes the experience of oncology nurses during the first year of the COVID-19 pandemic. The following three themes provide further insight: "Struggling With Constant Change and Uncertainty," "Managing Workload Intensity," and "Experiencing Emotional Distress." As the year progressed, "Identifying Benefits and Finding Hope" began to emerge. IMPLICATIONS FOR NURSING: The findings suggest a need for programs to help nurses cope with the continuing effects of the COVID-19 pandemic, mental health and well-being resources, and nursing guidelines for telehealth and relocation to other units.

Factors associated with sleep health in young women after breast cancer treatment.

Young women with breast cancer (YWBC) report physical and psychological symptom distress after therapy but little is known about their sleep health. The purpose of this study was to identify sociodemographic, clinical, and psychosocial factors associated with sleep health and assess the potential role of appraisal of illness and coping on sleep health. An adapted cognitive appraisal and coping conceptual framework guided the study. We used a cross-sectional design with 159 women who were diagnosed with stage I-III breast cancer ≤50 years old. Sleep health was measured by the Pittsburgh Sleep Quality Index (PSQI). The mean age was 43.6 years (SD = 6.8), the majority of whom were non-Hispanic White (84%) and completed chemotherapy or radiotherapy (>70%). More than half of participants (55%) reported poor sleep health (PSQI > 8), and those with worse family functioning and from a racial/ethnic minority group were significantly more likely to have poor sleep health. Cognitive appraisal had a minimal mediation effect for anxiety on sleep health, and coping did not mediate the effect of any psychosocial variables on sleep health. Poor sleep health is a significant clinical problem in YWBC. Further research is needed to explore sleep health disparities among diverse cancer survivors and to examine sleep health in the context of family. Sleep assessment, management, and appropriate referrals to sleep providers should be part of routine survivorship care.

Decreasing 30-Day Readmission Rates in Patients With Heart Failure.

BACKGROUND: Heart failure affects approximately 6.2 million adults in the United States and has an estimated national cost of $30.7 billion annually. Despite advances in treatment, heart failure is a leading cause of hospital readmissions. Nonadherence to treatment plans, lack of education, and lack of access to care contribute to poorer outcomes. LOCAL PROBLEM: For patients with heart failure, the mean readmission rate is 21% nationally and 23% in New York State. Before the pilot heart failure program began, the 30-day readmission rate in the study institution was 28.6%. METHODS: A multidisciplinary team created a heart failure self-care pilot program that was implemented on a hospital telemetry unit with 47 patients. Patients received education on their disease process, medications, diet, exercise, and early symptom recognition. Patients received a follow-up telephone call 48 to 72 hours after discharge and were seen by a cardiologist within a week of discharge. RESULTS: The 30-day readmission rate for heart failure decreased by 16.6% after implementation of the pilot program, which improved patient adherence to their medication and treatment plan and resulted in a reduction of readmissions. DISCUSSION: Patients in the pilot program represented diverse backgrounds. Socioeconomic factors such as the lack of affordable, healthy food choices and easy access to resources were associated with worse outcomes. CONCLUSIONS: The evidence-based heart failure program improved knowledge, early symptom recognition, lifestyle modification, and adherence to medication, treatment plan, and follow-up appointments. The multidisciplinary team approach to the heart failure program reduced gaps in care and improved coordination and transition of care.

Sleep health in young women with breast cancer: a narrative review.

PURPOSE: The purpose of this narrative review was to synthesize the evidence on sleep health in young women with breast cancer and provide recommendations for clinical practice and research. METHODS: Multiple databases were searched (OVID Medline, OVID PsycINFO, OVID Embase, and Scopus) using the search terms "breast neoplasm", "young women", "sleep", "sleep disturbance", "sleep problems", "sleep deficiency", and "insomnia". There were 467 titles and abstracts screened, and 82 full-text papers were reviewed, yielding 11 research publications for inclusion. RESULTS: Sleep problems are prevalent among young women with breast cancer and are associated with vasomotor symptoms of menopause and psychological symptom distress. The evidence, however, is weak due to methodological and design aspects of the studies. CONCLUSIONS: Poor sleep health in women with breast cancer is a clinically relevant problem that persists after treatment. As sleep is multidimensional and multifactorial, future research should evaluate sleep with objective sleep measures as well as self-reports; consider longitudinal designs; include factors that potentially contribute to poor sleep quality, such as physical and psychological symptom distress, family stressors, and competing life demands for this age group; and explore the perspective of this younger population of survivors on sleep. For clinical practice, survivorship visits should incorporate sleep assessment for all breast cancer survivors, especially younger women.

Exploring the effects of genomic testing on fear of cancer recurrence among breast cancer survivors.

OBJECTIVE: Fear of cancer recurrence (FCR) is the greatest unmet psychosocial need among breast cancer survivors (BCS). The Oncotype Dx® test predicts the 10-year risk of distant recurrence and benefit of adjuvant chemotherapy among women with early stage hormone receptor-positive breast cancer. Despite the test's clinical utility, psychosocial responses are poorly understood. METHODS: A descriptive cross-sectional study was conducted to explore associations between Oncotype Dx® test results (Recurrence Score [RS]) and FCR, health-related quality of life (HRQOL), distress, anxiety, depression, illness representation and perceived risk. Bivariate analyses were used to examine the associations between variables followed by multiple linear regression to examine predictors of FCR. RESULTS: Greater FCR was associated with higher distress, anxiety, depression, illness representation and poorer HRQOL. BCS's with a high Oncotype Dx® RS reported higher overall fear (p = 0.013) and greater perceived consequences of their cancer (p = 0.034) compared to BCS's with a low RS. Using multiple linear regression, anxiety ( ß  = 0.21, p = 0.016), greater emotional response (ß  = 0.45, p < 0.001) and perceived consequences ( ß  = 0.18, p = 0.039) of illness explained 58% of the variance (p < 0.001) in FCR. CONCLUSION: BCS's with higher risk of recurrence may experience higher FCR. However, for FCR, modifiable factors such as anxiety and illness representation (greater emotional response and perceived consequences of illness) may be more important than non-modifiable factors such as Oncotype Dx® test results and age. Further research is needed to develop personalized interventions to improve BCS's outcomes.

"I had to fight for my VBAC": A mixed methods exploration of women's experiences of pregnancy and vaginal birth after cesarean in the United States.

BACKGROUND: Vaginal birth after cesarean (VBAC) is safe, cost-effective, and beneficial. Despite professional recommendations supporting VBAC and high success rates, VBAC rates in the United States (US) have remained below 15% since 2002. Very little has been written about access to VBAC in the United States from the perspectives of birthing people. We describe findings from a mixed methods study examining experiences seeking a VBAC in the United States. METHODS: Individuals with a history of cesarean and recent subsequent birth were recruited through social media groups. Using an online questionnaire, we collected sociodemographic and birth history information, qualitative accounts of participants' experiences, and scores on the Mothers on Respect Index, the Mothers Autonomy in Decision Making Scale, and the Generalized Self-Efficacy Scale. RESULTS: Participants (N = 1711) representing all 50 states completed the questionnaire; 1151 provided qualitative data. Participants who planned a VBAC reported significantly greater decision-making autonomy and respectful treatment in their maternity care compared with those who did not. The qualitative theme: "I had to fight for my VBAC" describes participants' accounts of navigating obstacles to VBAC, including finding a supportive provider and traveling long distances to locate a clinician and/or hospital willing to provide care. Participants cited support from providers, doulas, and peers as critical to their ability to acquire the requisite knowledge and power to effectively self-advocate. DISCUSSION: Findings highlight the difficulties individuals face accessing VBAC within the context of a complex health system and help to explain why rates of attempted VBAC remain low.

"Finding the Balance": A Qualitative Study of the Experience of Nurses and Patients with Diabetes on an Insulin Pump in the Hospital.

PURPOSE: The purpose of this study was to explore experiences of hospitalized patients as they transition insulin pump self-management from home to hospital and the experience of nurses caring for them. Patients are often more knowledgeable about the pump than their nurses, which could lead to undiscovered challenges. Little is known about the hospital experience related to insulin pump therapy from nurses' and patients' perspectives. METHODS: A qualitative approach with interpretive descriptive design and purposive sampling was used. Eligible patients were ≥18 years of age, able to read and speak English, and admitted to non-ICU settings ≥20 hours. Eligible nurses cared for at least 1 patient using an insulin pump. Patients and nurses were interviewed separately. Interviews were audiotaped and transcribed verbatim. Data were analyzed using a constant comparative method. Coding was performed independently and jointly to reach consensus on emerging themes. RESULTS: Hospitalized patients and nurses had an array of perceptions highlighting challenges and adaption to "finding the balance" in managing diabetes when patients wore their insulin pumps. There were 4 interrelated themes representing a continuum of trust to lack of trust, control versus lack of control, effective communication to limited communication, and staff knowledge to lack of knowledge. CONCLUSIONS: Results of this study provide valuable insights into the challenges for both patients and nurses. A standardized approach to caring for this population is necessary. These findings can inform the development of nursing education programs and policies aimed at improving their experiences.

Metabolic Syndrome, Exercise, and Cardiovascular Fitness in Breast Cancer Survivors.

Comorbid illness contributes to poorer cancer outcomes and higher mortality. Metabolic syndrome (MetS) includes a cluster of risk factors that are associated with an increased risk of comorbidities. Routine physical activity represents a risk reduction strategy for cancer survivors. From 148 participants in a 12-month randomized control trial (RCT) of a fitness center exercise intervention compared to home physical activity group, a subset analysis was conducted to explore the effect of exercise on MetS risk factors. There were 32 (21.6%) breast cancer survivors who met the criteria for MetS at baseline. Over the 12 months, there were significantly fewer participants who met the criteria for MetS (p < .01), and there was significant improvement in individual risk factors, specifically fasting blood sugar (p = .01), and high-density lipoprotein (HDL; p = .02). Cardiovascular fitness was evaluated and greater heart recovery rate (HRR) was negatively associated with waist circumference, triglycerides, systolic blood pressure, fasting blood sugar, and MetS risk (p < .02) and positively associated with HDL (p = .03). Oncology advanced practitioners are uniquely qualified to integrate risk reduction into the management of at-risk oncology patients.

Research Agenda of the Oncology Nursing Society: 2019-2022.

PROBLEM STATEMENT: To define the Oncology Nursing Society Research Agenda for 2019-2022. DESIGN: Multimethod, consensus-building approach by members of the Research Agenda Project Team. DATA SOURCES: Expert opinion, literature review, surveys, interviews, focus groups, town hall, and review of research priorities from other cancer care organizations and funding agencies. ANALYSIS: Content analysis and descriptive statistics were used to synthesize research priority themes that emerged. FINDINGS: Three priority areas for scientific development were identified. IMPLICATIONS FOR NURSING: The Research Agenda can be used to focus oncology nurses' research, scholarship, leadership, and health policy efforts to advance quality cancer care, inform research funding priorities, and align initiatives and resources across the ONS enterprise.