Empowering Lung Cancer Survivors in Post-Treatment Survivorship Care Using Participatory Action Research.

PURPOSE: To explore the experiences of lung cancer survivors (LCSs) and their informal and professional caregivers with post-treatment care and to empower them to implement action-based study findings. PARTICIPANTS & SETTING: Participants were recruited using purposeful and snowball sampling from patients at a National Cancer Institute-designated cancer center in the northeastern United States. METHODOLOGIC APPROACH: This study used a participatory action research (PAR) four-phase design. Phase 1 was a focused ethnography; phase 2 consisted of a core group of participants deciding on an action, which was implemented in phase 3; and phase 4 consisted of an evaluation of the action. FINDINGS: The study found 28 categories, eight patterns, and three themes. The themes were the need for resources and education, involvement in mentoring and advocacy, and the value of living versus surviving. The action was creating two flyers focused on resources and advocacy for post-treatment support for LCSs. All participants agreed with the themes and action. Tobacco management and smoking-related stigma for LCSs were the only topics of dissent. IMPLICATIONS FOR NURSING: Oncology nurses can use PAR to empower survivors in their post-treatment care. Future PAR cycles should focus on creating support groups and alleviating stigma for LCSs and their caregivers.

Psychosocial needs of older patients with metastatic breast cancer treated at community centers.

INTRODUCTION: Psychosocial status contributes to overall quality of life (QOL) for patients with cancer as psychosocial distress is commonly seen in this population. We sought to describe the psychosocial needs of older adults with metastatic breast cancer (MBC) treated in the community. We evaluated the correlation between the patient's psychosocial status and the presence of other geriatric abnormalities in this patient population. MATERIALS AND METHODS: This is a secondary analysis of a completed study evaluating older adults (≥65 years) with MBC treated at community practices who received a geriatric assessment (GA). This analysis evaluated psychosocial factors collected during GA, including depression assessed by Geriatric Depression Scale (GDS), perceived social support (SS) assessed by Medical Outcomes Study Social Support Survey (MOS), and objective social supportassessed by demographic variables (living situation and marital status). Perceived SS was further subdivided into tangible social support (TSS) and emotional social support (ESS). Kruskal-Wallis tests, Wilcoxon tests, and Spearman's correlations were used to assess the relationship between psychosocial factors, patient characteristics, and geriatric abnormalities. RESULTS: One hundred older patients with MBC were enrolled and completed GA with a median age of 73 years (65-90). Almost half of the participants (47%) were either single, divorced, or widowed and 38% lived alone, demonstrating a significant number of patients with objective social support deficits. Patients with HER2+ or triple negative MBC had lower overall SS scores compared to patients with ER/PR+ or HER2- MBC (p = 0.033). Patients on fourth line of therapy were more likely to screen positive for depression compared to patients on earlier lines of therapy (p = 0.047). About half (51%) of the patients indicated at least one SS deficit on the MOS. A higher GDS and lower MOS score correlated with greater total GA abnormalities (p = 0.016). Evidence of depression correlated with poor functional status, decreased cognition, and a high number of co-morbidities (p < 0.005). Abnormalities in functional status, cognition, and high GDS are associated with lower ESS (p = 0.025,0.031,0.006 respectively). DISCUSSION: Psychosocial deficits are common among older adults with MBC treated in the community and are associated with the presence of other geriatric abnormalities. These deficits require a thorough evaluation and management to optimize treatment outcomes.

Prospective Comparison of Geriatric Assessment and Provider's Assessment of Older Adults With Metastatic Breast Cancer in the Community.

BACKGROUND: Geriatric assessment (GA) is recommended for evaluating fitness of an older adult with cancer. Our objective was to prospectively evaluate the gaps that exist in the assessment of older adults with metastatic breast cancer (OA-MBC) in community practices (CP). METHODS: Self-administered GA was compared to provider's assessment (PA) of patients living with MBC aged ≥65 years treated in CP Providers were blinded to the GA results until PA was completed. McNemar's test was used to detect differences between PA and GA. RESULTS: One hundred patients were enrolled across 9 CP (median age 73.9). Geriatric assessment detected a total of 356 abnormalities in 96 patients; of which, 223 required interventions. African American and widowed/single patients were more likely to have abnormalities identified by GA. On average, across 100 patients, PA did not detect 25.5% of GA-detected abnormalities, mostly in functional status, social support, nutrition, and cognition. These differences were less pronounced among providers with more clinical experience. Patients with abnormal Timed Up and Go tests more likely had additional abnormalities in other domains, and more abnormalities that were not identified by PA. Providers were "surprised" by GA results in 33% of cases, mainly with cognitive or social support findings, and reported plans for management change for 39% of patients based on GA findings. CONCLUSIONS: Including a GA in the care of OA-MBC in CP is beneficial for the detection of multiple abnormalities not detected by routine PA.

Lung Cancer Survivor Experiences With Post-Treatment Care: An Integrative Review.

PROBLEM IDENTIFICATION: Lung cancer survival rates are improving, and survivors may have unmet post-treatment care needs. Oncology nurses' understanding of these needs can guide development of holistic survivorship care. LITERATURE SEARCH: A comprehensive search of CINAHL®, PubMed®, and Embase® databases was performed to explore lung cancer survivor experiences with post-treatment care. DATA EVALUATION: The final sample included 25 studies that were critically appraised for methodologic quality. SYNTHESIS: Eight themes were identified. IMPLICATIONS FOR RESEARCH: Issues, such as race, gender, and stigma, represent barriers to holistic lung cancer survivorship care. Little mention of care coordination emphasizes the need for research in this area. Understanding the interplay of symptom and healthy lifestyle management is needed.