Long-term late effects in older gastric cancer survivors: Survival analysis using Cox hazard regression model by retrospective electronic health records.

PURPOSE: Because the population of older gastric cancer survivors (GCSs) is growing, understanding the long-term late effects experienced by these GCSs and their impact on survival outcomes is crucial for optimizing survivorship care. This study aims to identify and characterize these effects and investigate their association with survival outcomes. METHODS: A retrospective analysis of electronic health records was conducted on 9,539 GCSs diagnosed between 2011 and 2017. The GCSs were divided into two age groups (< 65 and ≥ 65 years) and the long-term late effects were categorized by age using Cox proportional hazard models. The impact of clinical factors and age-specific late effects on survival was evaluated in the older GCSs. RESULTS: Among the total GCSs, 37.6% were over and 62.4% were under 65 years of age. Significant differences between the age groups were observed in the cumulative hazard ratios (HRs) for iron and vitamin B12 levels and prognostic nutritional index (PNI) scores. In older GCSs, abnormal iron levels (HR 1.98, 95% CI 1.16-3.41, p = .013) and poor PNI scores (HR 1.59, 95% CI 1.03-2.47, p = .038) were associated with poorer survival outcomes. Additionally, being female was identified as a risk factor for lower survival rates (if male, HR 0.42, 95% CI 0.18-0.98, p = .045). CONCLUSION: This study highlights the typical long-term late effects experienced by older GCSs. By tailoring survivorship care to address nutritional-, age-, and gender-related factors, the overall survival and quality of life of older GCSs can be improved.

Life-Sustaining Treatment Decision in Palliative Care Based on Electronic Health Records Analysis.

AIMS AND OBJECTIVES: This study sought to explore the present status of life-sustaining treatment decisions in a tertiary hospital to improve the life-sustaining treatment decision-making process. BACKGROUND: Life-sustaining treatment decisions are crucial for palliative care because they encompass decisions to withdraw treatments when patients cannot articulate their values and preferences. However, surrogate decisions have settled many life-sustaining treatment cases in South Korea, and this trend is prevalent. DESIGN: We conducted a retrospective, descriptive study employing a review of electronic health records. METHODS: We extracted and analysed electronic health records of a tertiary hospital. Our inclusion criteria included adult patients who completed life-sustaining treatment forms in 2019. A total of 2,721 patients were included in the analysis. We analysed the decision-maker, the timing of the decision, and patients' health status a week before the decision. We followed the STROBE checklist. RESULTS: Among 1,429 deceased patients, those whose families had made life-sustaining treatment decisions totalled 1,028 (70.6%). The median interval between life-sustaining treatment documentation completion to death was three days, more specifically, two days in the family decision group and 5.5 days in the patient decision group. As the decision day neared, there were marked changes in patients' vital signs and laboratory test results, and the need for nursing care increased. CONCLUSIONS: Life-sustaining treatment decisions were made when death was imminent, suggesting that the time required to discuss end-of-life care was generally insufficient among patients, family, and healthcare professionals in Korea. RELEVANCE TO CLINICAL PRACTICE: Monitoring changes in laboratory test results and symptoms could help screen the patients who need the life-sustaining treatment discussion. As improving the quality of death is imperative in palliative care, institutional efforts, such as clinical ethics support services, are necessary to improve the life-sustaining treatment decision-making process for patients, families, and healthcare providers.

[Descriptive Review of Patents in Healthcare and Nursing: Based on Network Analysis].

PURPOSE: The significance of the healthcare industry has grown exponentially in recent years due to the impact of the fourth industrial revolution and the ongoing pandemic. Accordingly, this study aimed to examine domestic healthcare-related patents comprehensively. Big data analysis was used to present the trend and status of patents filed in nursing. METHODS: The descriptive review was conducted based on Grant and Booth's descriptive review framework. Patents related to nursing was searched in the Korea Intellectual Property Rights Information Service between January 2016 to December 2020. Data analysis included descriptive statistics, phi-coefficient for correlations, and network analysis using the R program (version 4.2.2). RESULTS: Among 37,824 patents initially searched, 1,574 were selected based on the inclusion criteria. Nursing-related patents did not specify subjects, and many patents (41.4%) were related to treatment in the healthcare delivery phase. Furthermore, most patents (56.1%) were designed to increase effectiveness. The words frequently used in the titles of nursing-related patents were, in order, "artificial intelligence," "health management," and "medical information," and the main terms with high connection centrality were "artificial intelligence" and "therapeutic system." CONCLUSION: The industrialization of nursing is the best solution for developing the healthcare industry and national health promotion. Collaborations in education, research, and policy will help the nursing industry become a healthcare industry of the future. This will prime the enhancement of the national economy and public health.

How can we approach preoperative frailty and related factors in patients with cancer? A scoping review.

AIM: To identify factors related to preoperative frailty in patients with cancer and map the tools that measure frailty. DESIGN: A Scoping review. METHODS: This scoping review based on Arksey and O'Malley's framework. Articles from CINAHL, PubMed, EMBASE, and PsycINFO databases published between January 2011 and April 2021. The searched keywords were concepts related to 'cancer', 'frailty' and 'measurement'. RESULTS: While 728 records were initially identified, 24 studies were eventually selected. Research on frailty was actively conducted between 2020 and 2021. Factors related to preoperative frailty were age (22.9%), sex (11.4%), body mass index (11.4%) and physical status indicators (54.3%). The most common result of preoperative frailty was postoperative complications (35.0%). 24 instruments were used to measure frailty. IMPLICATIONS FOR PATIENT CARE: Selecting an appropriate preoperative frailty screening tool can help improve patient postoperative treatment outcomes. IMPACT: There are many instruments for assessing preoperative frailty, each evaluating a multi-dimensional feature. We identified the frailty screening tools used today, organized the factors that affect frailty, and explored the impact of frailty. Identifying and organizing frailty measurement tools will enable appropriate evaluation. REPORTING METHOD: PRISMA-ScR. PATIENT CONTRIBUTION: No patient or public contribution.

Association between Resilience, Professional Quality of Life, and Caring Behavior in Oncology Nurses: A Cross-Sectional Study.

PURPOSE: The degree of caring behavior of oncology nurses is a crucial factor in the care provided to patients with cancer. In this study, we aimed to investigate factors related to oncology nurses' caring behavior, including their resilience and professional quality of life. METHODS: A cross-sectional descriptive study was conducted with 107 oncology nurses at an urban tertiary hospital from May 18 to 24, 2015. We used a self-report questionnaire to measure resilience, professional quality of life, and degree of caring behavior. Data analysis included descriptive statistics, correlations, and multiple regression analysis using SPSS/WIN 20.0. RESULTS: Oncology nurses presented with low levels of resilience and caring behavior, and high levels of compassion satisfaction, burnout, and secondary traumatic stress. There was a statistically significant relationship between the degree of caring behavior, resilience (r = .43, p < .001), compassion satisfaction (r = .51, p < .001), and burnout (r = -.42, p < .001), as well as between secondary traumatic stress and burnout (r = .34, p < .001). Factors associated with oncology nurses' degree of caring behavior were compassion satisfaction (t = 6.00, p < .001) and educational level (t = 3.45, p = .001). CONCLUSION: This study demonstrates that oncology nurses' degree of caring behavior is related to their professional quality of life and education. These findings suggest that enhancing oncology nurses' healthy coping strategies at both the individual and organizational levels can further develop holistic nursing care. Additionally, it is necessary to examine the factors affecting nurses' compassion satisfaction and to try to promote this aspect.

Frailty and its associated factors among older adults with cancer undergoing chemotherapy as outpatients: A cross-sectional study.

PURPOSE: Frailty can affect cancer treatment decisions and outcomes. Depression, fatigue, and cognitive impairment often experienced by patients with cancer are expected to be associated with frailty. We aimed to identify frailty and its related factors in older adults with cancer undergoing chemotherapy. METHODS: We conducted a cross-sectional descriptive study in a Korean urban tertiary hospital. A structured self-report questionnaire was used including frailty and its related variables and measured heart rate variability (HRV). Multinomial logistic regression was performed to identify the factors related to frailty. RESULTS: Data from 124 out of 136 patients with stomach, colorectal, and lung cancers were analyzed. Approximately 90% of the participants were in the pre-frail and frail groups. There were significant differences among the three groups in terms of depression (p = 0.006) and HRV (p = 0.041). The factor associated with higher frailty levels was depression across groups (pre-frail odds ratio (OR): 1.31, 95% CI: 1.14-1.51; frail OR: 1.29, 95% CI: 1.11-1.49). However, only deficits observed or commented on by others were retained as factors significantly associated with higher frailty in the pre-frail group (OR: 2.40, 95% CI: 1.40-4.13). In contrast, increased HRV (OR: 0.35, 95% CI: 0.13-0.95) was associated with lower frailty levels in the frail group. CONCLUSION: It is important to classify older adult patients with cancer into pre-frail and frail groups so that interventions can be provided on time. Understanding the characteristics associated with frailty in older adult patients with cancer can positively affect their health-related quality of life and treatment outcomes.

What are the late effects of older gastric cancer survivors? A scoping review.

Objective: Older gastric cancer survivors account for a high proportion of cancer survivors. To improve their quality of life, a cancer survivorship care plan with a consideration of the late effects is required. This study aimed to understand the extent and type of evidence in relation to the late effects in older gastric cancer survivors. Methods: We conducted a scoping review based on the JBI scoping review framework. We explored articles in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), SCOPUS, Web of science, Excerpta Medica dataBASE (EMBASE), Research InformationSharing Service (RISS), Korean Medical dataBASE(KMBase), and National Digital Science Library (NDSL) databases published from January 1, 2012, to December 31, 2021. The keywords used for search are "gastric cancer", "aged", "survivors", and "late effect or long-term effect or late symptom or time factors". While 439 records were initially identified, 14 articles were eventually selected based on the inclusion criteria. Results: Most studies were conducted in 2019 (4 studies, 28.6%), and more than half (8 studies, 57.1%) were conducted in Asia. In total, six definitions of cancer survivors were found in the studies. The most common age range in the studies was 60-64 years (7 studies, 50.0%). The second primary cancer risk was the most common late effects (5 studies, 20.8%). Among 14 studies, there was only one study of intervention study (7.1%). Conclusions: It is time to shift the focus from survival to care that improve the quality of life after treatment. We suggest future studies to define cancer survivors, set the age criteria and characterize the late effects in older gastric cancer survivors.

Cancer treatment-related cardiac dysfunction in breast cancer survivors: A retrospective descriptive study using electronic health records from a Korean tertiary hospital.

PURPOSE: The population overlap of breast cancer and cardiovascular diseases (CVDs) has increased due to early breast cancer detection and treatment and aging population trends. Moreover, breast cancer patients are at an increased risk for CVDs consequent to cancer treatments. We aimed to understand the characteristics of breast cancer patients with pre-existing CVDs and of those diagnosed with CVDs after receiving chemotherapy, and cancer treatment-related cardiac dysfunction's occurrence among Korean breast cancer patients with CVDs. METHODS: This retrospective descriptive study, which collected clinical data from electronic health records from a Korean tertiary hospital, included 1200 female breast cancer patients with CVDs, aged 15-75 years. RESULTS: A total of 45.7% had pre-existing CVDs, and 91.6% were classified as very high-risk for cardiotoxicity in the pre-existing CVDs group. Among the 1200 breast cancer patients with CVDs, only 439 patients had left ventricular ejection fraction (LVEF) data during their cancer treatment, and 121 received baseline assessment for LVEF. Of the 439 patients with LVEF data, 134 patients have been classified into cancer treatment-related cardiac dysfunction (CTRCD), and the median period from cancer diagnosis to CTRCD occurrence was 26.5 months. CONCLUSION: Despite the high cardiotoxicity risk of breast cancer patients with pre-existing CVDs, baseline studies of the risk assessment before chemotherapy were insufficient to support the prevention and early detection of cardiotoxicity. Therefore, it is paramount to consider how nurses focus on risk stratification before chemotherapy and support the regular monitoring of breast cancer survivors' cardiac functioning, to maintain optimal health status.