Growth and development of oncology nursing in Asia.

Oncology nursing is increasingly recognized around the world as being vitally important for an effective cancer control system. Granted, there is variation between and among countries/regions regarding the strength and nature of that recognition, but oncology nursing is clearly seen as a specialty practice and as a priority for development in cancer control plans, especially for high resource countries/regions. Many countries/regions are beginning to recognize that nurses are vitally important to their cancer control efforts and nurses require specialized education and infrastructure support to make a substantial contribution. The purpose of this paper is to highlight the growth and development of cancer nursing in Asia. Several brief summaries are presented by nurse leaders in cancer care from several Asian countries/regions. Their descriptions reflect illustrations of the leadership nurses are providing in cancer control practice, education, and research in their respective countries/regions. The illustrations also reflect the potential for future development and growth of oncology nursing as a specialty given the many challenges nurses face across Asia. The development of relevant education programs following basic nursing preparation, the establishment of specialty organizations for oncology nurses, and engagement by nurses in policy activity have been influential factors in the growth of oncology nursing in Asia.

Change and predictors of symptom distress in breast cancer patients following the first 4 months after diagnosis.

BACKGROUND/PURPOSE: Breast cancer patients may encounter a wide range of physical and psychosocial distress symptoms during diagnosis, while awaiting treatment, and during treatment. This study of newly diagnosed breast cancer patients explores: (1) changes in symptom distress over 4 months; and (2) factors predicting changes in symptom distress. METHODS: A prospective longitudinal design was used to collect data from breast cancer patients in northern Taiwan. A set of questionnaires was used to measure anxiety, symptom distress, social support, and demographic and treatment-related characteristics. Repeated measures analysis of variance (RM-ANOVA) with least significant difference (LSD) was used to examine differences in symptom distress, state anxiety, and social-support levels across four time-points. Generalized estimating equation (GEE) is used to determine predictors for the change in symptom distress. RESULTS: Participants showed mild overall symptom distress during treatment that increased from cancer diagnosis to treatment phases, with a peak at 4 months after diagnosis. Insomnia was the most commonly identified distressful symptom over time. Changes in overall symptom distress were significantly predicted by state anxiety, health professional support, and time since cancer diagnosis. CONCLUSION: Change in symptom distress following the first 4 months after diagnosis was predicted by state anxiety, health professional support, and time. Patients should receive social support and be trained in problem-solving skills to relieve distressful symptoms from diagnosis through treatment.

Education and psychological support meet the supportive care needs of Taiwanese women three months after surgery for newly diagnosed breast cancer: a non-randomised quasi-experimental study.

BACKGROUND: Few studies have comprehensively examined the effectiveness of information and psychosocial support on all dimensions of cancer patients' supportive care needs. OBJECTIVES: To investigate the effects of education and psychological support on anxiety, symptom distress, social support, and unmet supportive care needs of Taiwanese women newly diagnosed with breast cancer over 3 months after surgery. DESIGN: Two-group, non-randomised quasi-experimental design. SETTING: The general surgical outpatient department of the largest teaching medical centre in northern Taiwan. PARTICIPANTS: Women newly diagnosed with breast cancer (N=80) were divided into experimental (n=40) and control (n=40) groups. METHODS: The experimental group received education and psychological support in the form of individual face-to-face and telephone follow-up sessions; the control group received routine care. Data were collected during the patients' first postoperative visit (baseline), 1 month after surgery, and 3 months after surgery. RESULTS: After adjusting for covariates, the levels of symptom distress and unmet needs for participants in the experimental group were lower at 1 and 3 months after surgery than for those in the control group, with the results at 3 months achieving significance. However, the sexuality needs for both groups were not significantly different at 1 and 3 months. Furthermore, levels of state anxiety were significantly lower for the experimental group at 1 and 3 months than for the control group. CONCLUSION: The education and psychological support components of our intervention programme effectively improved the unmet supportive care needs of patients newly diagnosed with breast cancer 3 months after surgery. Following prolonged treatment, women with breast cancer still have physical, psychological, and information care needs. Thus, clinical healthcare personnel should continually and actively provide culturally sensitive, individualised, and accessible information and psychological support to these patients.

Changes and predictors of unmet supportive care needs in Taiwanese women with newly diagnosed breast cancer.

PURPOSE/OBJECTIVES: To investigate changes in unmet supportive care needs and factors affecting those needs in Taiwanese women with newly diagnosed breast cancer. DESIGN: Prospective longitudinal survey. SETTING: Two general surgery outpatient departments at a large medical center in northern Taiwan. SAMPLE: 124 women with newly diagnosed breast cancer. METHODS: Needs were assessed with the Supportive Care Needs Survey-Short Form at diagnosis (T1) and one month (T2), two months (T3), and three months (T4) after diagnosis. MAIN RESEARCH VARIABLES: Supportive care needs. FINDINGS: Women had moderate-to-high levels of unmet needs, with the highest being in the health system and information domain at each time point. Levels in the domains of psychological, health system and information, and sexuality needs were higher (p < 0.001) at T1 than at T2, T3, and T4. However, levels of unmet physical and daily living needs increased significantly over time (p < 0.001). Unmet supportive care needs were significantly predicted by younger age and higher levels of education, symptom distress, trait anxiety, state anxiety, and time since diagnosis. CONCLUSIONS: Supportive care needs changed significantly over time and were predicted by personal characteristics, as well as physical and emotional factors. IMPLICATIONS FOR NURSING: Oncology nurses should assess the needs of patients with breast cancer and provide them with individualized, culturally sensitive informational, social, and emotional support from breast cancer diagnosis through the first four months of treatment.

Body image and its predictors in breast cancer patients receiving surgery.

BACKGROUND: Negative body image may reduce patients' ability to cope with breast cancer after surgery. OBJECTIVES: The purposes of this study were to (1) assess breast cancer patients' perceived level of symptom distress, anxiety, depression, disease impact, and body image and (2) evaluate factors associated with body image in breast cancer patients during the postoperative period. METHODS: A cross-sectional and correlational design was used to collect data for this study, conducted in northern Taiwan. A set of questionnaires was used to measure body image, symptom distress, anxiety, depression, psychological impact of disease, and demographic and disease-related information. Stepwise regression was conducted to determine significant factors related to body image. RESULTS: Surgical procedure and age were found to be important factors related to body image concerns. Patient receipt of mastectomy and younger age were associated with greater body image concerns. CONCLUSION: The average age of breast cancer patients is declining in Taiwan, and body image problems in these patients are growing. Several factors are significantly related to body image distress among these patients. IMPLICATIONS FOR PRACTICE: By understanding variables associated with breast cancer patients' body image, health professionals can coordinate interventions to improve these women's body image. Among women with breast cancer, those who have received mastectomy and those who are younger are particularly vulnerable to body image concerns. Nursing assessment of body image indicators and implementation of strategies to increase self-confidence and self-acceptance are needed for high-risk women.

Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: a randomized clinical trial.

To date, patients with bony metastases were only a small fraction of the samples studied, or they were entirely excluded. Patients with metastatic cancers, such as bone metastases, are more likely to report pain, compared to patients without metastatic cancer (50-74% and 15%, respectively). Their cancer pain results in substantial morbidity and disrupted quality of life in 34-45% of cancer patients. Massage therapy (MT) appears to have positive effects in patients with cancer; however, the benefits of MT, specifically in patients with metastatic bone pain, remains unknown. The purpose of this randomized clinical trial was to compare the efficacy of MT to a social attention control condition on pain intensity, mood status, muscle relaxation, and sleep quality in a sample (n=72) of Taiwanese cancer patients with bone metastases. In this investigation, MT was shown to have beneficial within- or between-subjects effects on pain, mood, muscle relaxation, and sleep quality. Results from repeated-measures analysis of covariance demonstrated that massage resulted in a linear trend of improvements in mood and relaxation over time. More importantly, the reduction in pain with massage was both statistically and clinically significant, and the massage-related effects on relaxation were sustained for at least 16-18 hours postintervention. Furthermore, massage-related effects on sleep were associated with within-subjects effects. Future studies are suggested with increased sample sizes, a longer interventional period duration, and an objective and sensitive measure of sleep. Overall, results from this study support employing MT as an adjuvant to other therapies in improving bone pain management.

An exploration of Papanicolaou smear history and behavior of patients with newly diagnosed cervical cancer in Taiwan.

BACKGROUND: Papanicolaou (Pap) smear is an effective preventive measure in reducing cervical cancer incidence and mortality. The national health insurance made free annual cervical screening available to all Taiwanese women 30 years or older. OBJECTIVE: The objective of this study was to increase knowledge about Pap smear screening history, attitudes, and behavior in Taiwanese women with newly diagnosed cervical cancer. METHODS: One hundred forty-one women with newly diagnosed cervical cancer were prospectively enrolled between January 2007 and June 2008. Data were collected via a questionnaire survey, which included (1) demographic and socioeconomic characteristics, (2) reasons for receiving or not receiving a Pap smear test, and (3) knowledge of and sources of information on Pap smears. RESULTS: Of the 141 patients, 62 (44.0%) had never had a Pap smear before diagnosis, 10 (7.1%) did not know about the Pap smear, and only 30 (21%) reported having had more than 3 Pap smears in their lifetime. Stepwise logistic regression identified perceived potential pain, fear of embarrassment, and the number of sexual partners of the male consort as independently associated with the number of previous Pap smears (0 vs > or =1). CONCLUSION: Our results highlight the need for a better understanding of women's knowledge and experiences with Pap smear screening and developing more comfortable methods of cervical cancer screening. IMPLICATIONS FOR PRACTICE: Education strategies should be focused on improving access to never-users. The need for a better understanding of women's experiences with Pap smear screening is highlighted.

Effect of supportive care on the anxiety of women with suspected breast cancer.

AIM: This paper is a report of a study of the effect of supportive care on anxiety levels of women with suspected breast cancer during the diagnostic period. BACKGROUND: Informational and psychosocial support has been shown to improve care outcomes for women with breast cancer. However, little is known about the effect of supportive care on women's psychological status during the breast cancer diagnostic period. METHODS: For this longitudinal quasi-experimental study, 122 participants were recruited from a large teaching hospital in Taiwan. The experimental group (n = 62) received a supportive care programme that included health education pamphlets about breast cancer diagnosis and treatment, three face-to-face sessions of informational and emotional support, and two follow-up telephone consultations. The control group (n = 60) received routine care. Data were collected from October 2006 to April 2007 using the State-Trait Anxiety Inventory at baseline (notification of need for breast biopsy), before biopsy, and after receiving biopsy result (diagnosis). FINDINGS: After adjusting for covariance of breast discomfort, regular breast self-examination, and biopsy result, the anxiety levels of women receiving supportive care were significantly lower before biopsy (P = 0.017) and after diagnosis (P = 0.001) than those of women receiving routine care. CONCLUSION: Supportive care that incorporates informational and emotional support and follow-up telephone consultations can decrease anxiety levels of women with suspected breast cancer. These findings can serve as a reference for clinical nursing staff to improve care quality during the breast cancer diagnostic period by providing women with individualized and culturally sensitive care.

Supportive care for Taiwanese women with suspected breast cancer during the diagnostic period: effect on healthcare and support needs.

PURPOSE/OBJECTIVES: To investigate the effect of supportive care on healthcare and support needs for women with suspected breast cancer during the diagnostic period. DESIGN: A quasiexperimental design with two nonrandomly assigned groups. SETTING: Two general surgery outpatient departments at a large teaching hospital in Taiwan. SAMPLE: Experimental and control groups included 62 and 60 women with suspected breast cancer, respectively. METHODS: The experimental group received supportive care, including health education pamphlets regarding breast cancer diagnosis and treatment; three sessions of individual, face-to-face health education and emotional support; and two follow-up telephone counseling sessions. The control group received routine care. Data were collected upon notice of need for breast biopsy, before biopsy, and after biopsy results were revealed. MAIN RESEARCH VARIABLES: Healthcare and support needs. FINDINGS: Levels of healthcare and support needs before breast biopsy and after results were revealed were significantly lower for the experimental group than the control group. Supportive care and biopsy results predicted healthcare and support need levels after diagnosis confirmation, explaining 57% of the total variance. CONCLUSIONS: Supportive care incorporating information, emotional support, and continuous follow-up care improved the degree to which women with suspected breast cancer perceived that their healthcare and support needs were met. IMPLICATIONS FOR NURSING: Supportive care, when individually designed and culturally sensitive, can help clinical nurses improve quality of care for clients with suspected breast cancer during the diagnostic period.

Uncertainty and anxiety during the diagnostic period for women with suspected breast cancer.

A possible diagnosis of breast cancer imposes a huge psychological impact on most women, but few studies have addressed uncertainty and anxiety changes at different diagnostic stages in women with suspected breast cancer. Thus, this longitudinal study examined uncertainty and anxiety and predictive factors for uncertainty in women with suspected breast cancer. Data were collected on uncertainty (Uncertainty in Illness Scale) and anxiety (State Anxiety Inventory) from 127 women at 3 times: upon notice of a breast biopsy, before biopsy, and after diagnosis. The results showed that uncertainty and anxiety levels were significantly higher before than after diagnosis. At the 3 data collection times, uncertainty and anxiety were significantly lower for participants diagnosed with benign tumors than for those with malignant diagnoses. Uncertainty and anxiety were positively, moderately correlated. Uncertainty was predicted by age, marital status, education level, religious status, family history of benign breast tumor, regular breast self-examination, self-perceived probability of receiving a breast cancer diagnosis, and biopsy result. Therefore, nursing professionals should be aware of the uncertainty and anxiety changes and impact of personal attributes on women with suspected breast cancer during the diagnostic period and provide care programs to alleviate their psychological distress.

Healthcare and support needs of women with suspected breast cancer.

AIM: This paper is a report of a study to investigate changes in the healthcare and support needs during the diagnostic period, and factors that affect these needs in women with suspected breast cancer. BACKGROUND: Although the needs of women with breast cancer are well recognized, few studies have examined the needs of women with suspected breast cancer during the diagnostic period. METHOD: This longitudinal study used an investigator-developed, self-administered questionnaire to collect data from 127 women in Taiwan on three occasions: notification of need for breast biopsy, before biopsy and after diagnosis. The data were collected from November 2004 to April 2005. FINDINGS: Participants had high need levels before and after diagnosis, with their top needs in the domains of healthcare services for diagnosis, follow-up and consultation, and information about the disease. They needed disease- and treatment-related information more than emotional support. Need levels were higher (P < 0.01) before diagnosis than after, highest before biopsy, and lowest after diagnosis. Furthermore, needs were higher (P < 0.01) before than after diagnosis for diagnostic services, disease information, and involvement of family and friends. Higher needs were found in married women with more education and no history of benign tumours. Need level did not differ statistically significantly by age, religious status, degree of social support, family history and breast symptoms. CONCLUSION: Need levels of women with suspected breast cancer vary during the diagnostic period, are highest before breast biopsy, and related to personal characteristics and cultural context. Therefore, during this period, nursing staff should provide patients and families with culturally sensitive, individualized, supportive care.

Symptom distress, catastrophic thinking, and hope in nasopharyngeal carcinoma patients.

The purposes of this study were to explore symptom distress, catastrophic thinking (catastrophizing) and hope, and factors predicting hope in Taiwanese nasopharyngeal carcinoma (NPC) patients within 3 years of receiving radiation therapy (RT). Instruments used were the modified Symptom Distress Scale, disease catastrophizing scale (modified from Coping Strategies Questionnaire), and Herth's Hope Index. Adult NPC patients (N = 115; 33 undergoing RT, 44 who completed RT within 1 year, and 38 who completed RT more than 1 year but less than 3 years) were recruited from an outpatient RT center in Northern Taiwan. Although participants' overall symptom distress was mild to moderate, they scored moderate level for several distressful symptoms: dry mouth, fatigue, hearing difficulty, loss of appetite, insomnia, and pain. Patients undergoing RT had greater symptom distress than subjects in the other 2 groups. Regression analysis revealed that catastrophizing was the only predictor of hope. Patients who engaged in catastrophizing reported much lower levels of hope. Particular care and attention are recommended to help NPC patients deal with the top distressful symptoms listed. Nursing interventions to reduce catastrophic thinking and enhance hope are discussed.