Enhancing Mobility and Well-Being in Older Adults with Cancer.

OBJECTIVE: To analyze mobility challenges in older adult with cancer. METHODS: Data from previous literature was extracted and analyzed pertaining to the topic of interest. RESULTS: Mobility issues for the older adult with cancer are multi-factorial and are impacted by age-related changes, comorbidities, cancer itself, and cancer treatment. CONCLUSIONS: Proven benefits have been suggested with mobility assessments, exercise and dietary interventions, and cancer rehabilitation programs however further research is needed to define integration and utilization of programs, facilitation of cancer survivors returning to work, inclusion of socially disadvantaged patients, program compliance, economic aspects, and caregiver involvement to improve quality of life across the cancer continuum. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are in a key role to impact the care of the older adult with cancer with mobility through patient assessment of mobility function, facilitation of patient referrals for supportive services and cancer rehabilitation and execution of nurse-led intervention programs.

Care Processes and Quality-of-Life Outcomes Affecting the Gynecologic Cancer Survivorship Experience.

PURPOSE: To describe and assess physical and psychosocial concerns and care processes related to cancer and treatment in gynecologic cancer survivors. PARTICIPANTS & SETTING: 44 survivors of gynecologic cancer at City of Hope National Medical Center in southern California were enrolled. METHODOLOGIC APPROACH: A descriptive mixed-methods approach was used. Data were collected on survivorship care plan implementation, supportive care referrals, and barriers to receiving care. Participants completed questionnaires assessing quality of life, unmet needs, and other outcomes at three, six, and nine months after enrollment. Changes over time were analyzed, and quantitative and qualitative results were compared. FINDINGS: The most common unmet needs were stress reduction, side effect management, fear of cancer recurrence (FCR), and perception of adequate communication among the care team. Qualitative themes centered around communication, care coordination, FCR, financial distress, and need for information about peer support and healthy lifestyles. IMPLICATIONS FOR NURSING: Nurses play a key role in coordinating care, assessing symptoms, and addressing psychosocial concerns. Providing education and coaching can reduce stress and facilitate survivors' self-management and self-efficacy.

Nursing Considerations for Androgen Deprivation Therapy and Bone Health in Men Affected by Prostate Cancer.

OBJECTIVE: This article reviews the effects of androgen deprivation therapy on bone health and loss of bone mineral density and its effects on risk of fractures for men with prostate cancer, as well as describes the assessment, management, and nursing strategies for patient and caregiver education, prevention strategies, and side effect management. DATA SOURCES: Peer-reviewed articles formed the basis of this article. CONCLUSION: Androgen deprivation therapy has a deleterious effect on bone health, causing loss of bone mineral density and increasing the risk of fractures. The significant decrease in bone mineral density and fractures in elderly men can lead to morbidity, mortality, and poor quality of life. Bone mineral density assessment prior to initiating androgen deprivation therapy should be performed to identify bone issues prior to initiating therapy and to ensure that preventive bone health management strategies are executed. IMPLICATIONS FOR NURSING PRACTICE: Awareness of bone loss factors for men treated with androgen deprivation therapy is important in caring for patients undergoing treatment for prostate cancer. Bone fractures can have a significant impact on activities of daily living and diminish quality of life. Oncology nurses can play a key role in patient and caregiver education regarding the importance of bone health management strategies and the assessment of patient-related risk factors that may limit adherence to treatment recommendations.

Clinical Updates in Nausea and Vomiting.

OBJECTIVE: To review recent updated antiemetic guidelines from national cancer organizations and its impact on chemotherapy-induced nausea and vomiting (CINV) in the prevention and delayed phase of therapy. This article will also describe assessment and nursing strategies for individualized care and timely side effect management. DATA SOURCES: Data sources include peer-reviewed articles sourced in electronic databases. CONCLUSION: CINV is a persistent problem for a large percentage of patients undergoing chemotherapy treatment despite advances in antiemetic therapy and increased use of targeted therapies. CINV management should be based on patient-focused assessment and adherence to national antiemetic guidelines. Ongoing assessment and follow-up are critical to ensure optimum management of side effects to optimized quality of life. IMPLICATIONS FOR NURSING PRACTICE: Awareness of national antiemetic guidelines is important in caring for patients undergoing chemotherapy. CINV can have a significant impact on patients, causing physical effects, treatment delays, and diminished quality of life. Oncology nurses play a key role in assessment of patient-related risk factors, education of patients and caregivers regarding pain medications, side effects, and oral adherence and continued follow-up for early recognition and intervention for uncontrolled CINV.

A nurse-led intervention for fear of cancer progression in advanced cancer: A pilot feasibility study.

PURPOSE: To assess the feasibility, acceptability, and preliminary effects of a nurse-led intervention for managing fear of cancer progression in advanced cancer patients. METHODS: A single group mixed methods study was conducted in patients with stage III or IV gynecologic or lung cancer (n = 31) with dysfunctional levels of fear of progression or distress. The intervention consisted of seven videoconferencing sessions with skills practice. Feasibility measures included enrollment rate, attendance, attrition, and home practice adherence. Acceptability was based on exit interview responses. Content analysis was used to analyze the qualitative data. Participants completed quantitative questionnaires assessing fear of progression and secondary outcomes at baseline, eight, and 12 weeks. Linear mixed model analysis was used to assess changes in outcome measures. RESULTS: The average enrollment rate was seven participants/month over 4.5 months. Participants attended a mean of 5.3 of seven sessions. Attrition rate was 30%. The analysis showed improvements over time in fear of progression and exploratory outcomes. Participants reported feeling calmer and more focused. The skills practice helped to manage anxiety and fears. Themes included: Struggling with fears, Refocusing the fears, and Realizing/reaffirming what is important in life. The most beneficial components included the values clarification exercise, detached mindfulness and worry postponement practices. CONCLUSION: The intervention was acceptable; most feasibility criteria were met. Preliminary data suggest that the intervention reduced fear of progression and improved secondary outcomes. The intervention required a significant time commitment by participants, which may have contributed to increased attrition. To decrease burden, we will shorten the intervention.

Cancer Pain Management Considerations in Older Adults.

OBJECTIVE: To address the pharmacokinetics and pharmacodynamics of aging and its impact on the complexities of pain management in older adults with cancer. To describe assessment and nursing strategies for individualized care and side effect management DATA SOURCES: Peer-reviewed articles. CONCLUSION: Cancer pain is a complex problem in older adults because of the variations in aging and alterations in pharmacokinetics and pharmacodynamics. Pain management must be based on thorough assessment, incorporating the unique factors of each patient. Ongoing follow-up is critical to ensure adequate pain control with optimization of functional status. IMPLICATIONS FOR NURSING PRACTICE: Awareness of physiological changes of aging is important in caring for older adults. Oncology nurses can play a key role in the assessment of older adults with cancer and education of patients and caregivers regarding pain medications, side-effects, and oral adherence.

Quality of Life and Supportive Care Needs of Gynecologic Cancer Survivors.

Gynecologic cancer survivors experience significant distress that can impact quality of life (QOL). Optimal survivorship care requires an understanding of the survivor's QOL and supportive care needs. The purpose of this study was to describe the QOL and needs of gynecologic cancer survivors. Women with an initial diagnosis of gynecologic cancer within 7 months of completing primary treatment (N = 34) completed the QOL-Cancer Survivor tool and the Cancer Survivors' Unmet Needs Survey. Fear of cancer recurrence was a repetitive theme for both tools. The lowest ranking QOL items were distress from diagnosis and treatment, family distress, and uncertainty about the future. Commonly reported needs included help to reduce stress, manage side effects, cope with fears of cancer recurrence, and gain reassurance that providers were communicating, and providing the very best medical care. Appreciating QOL and needs can facilitate the development of support services specifically tailored to gynecologic survivors.

Older Adults With Lung Cancer: Assessment, Treatment Options, Survivorship Issues, and Palliative Care Strategies.

BACKGROUND: Treatment advances offer options for cancer treatment in older adults that are less invasive and have fewer side effects. Geriatric assessment is a key component of treatment planning to identify functional and physiologic status and is the basis of decision making. OBJECTIVES: This article discusses the role of geriatric assessment, treatment options (e.g., surgical, chemotherapy, radiation therapy), survivorship issues, and palliative care strategies for older adults with cancer. METHODS: Literature was reviewed to identify geriatric assessment implications, current treatment strategies, and survivorship and palliative care interventions for older adults with cancer based on a case study approach. FINDINGS: Geriatric assessment is key to identifying deficits and disabilities in older adults with cancer and is a critical component in oncology treatment planning. Evidence-based, less invasive treatment options are available and offer older adults more tolerable oncologic therapies.

Frailty in Older Adults: Assessment, Support, and Treatment Implications in Patients With Cancer

BACKGROUND: Frailty is defined as a disability in those of advanced age, often with comorbidities, poor nutritional status, cognitive decline, and reduced functional status. OBJECTIVES: The purpose of this article is to discuss the concept of frailty, assess the use of a comprehensive geriatric assessment (CGA), and understand the implications for treatment to maintain or enhance physical, functional, and cognitive health of older adult patients with cancer. METHODS: Literature about frailty in older adult patients diagnosed with cancer was reviewed to determine evidence-based assessment and treatment options. FINDINGS: About half of all older adult patients with cancer experience some degree of frailty. CGA is a useful way to evaluate frailty and the extent of limitations. Many frailty-specific tools have been developed. Evidence-based strategies are available to address limitations associated with frailty in older adult patients with cancer.

Cultural Competency in Nursing Research.

According to data from the U.S. Census Bureau (2010), the demographics of the United States will change dramatically in the next 50 years. Non-Caucasians will more than double from 116.2 million in 2012 to 241.3 million by 2060, representing 57% of the U.S. population (U.S. Census Bureau, 2010). The Asian population also is expected to double in the next five years and comprise 8% of the U.S. population (U.S. Census Bureau, 2012). The United States also is becoming an aging population. By 2060, about one in five residents will be aged 65 years and older (U.S. Census Bureau, 2012). Individuals aged 85 years and older will more than triple to 18.2 million and represent 4% of the U.S. population (U.S. Census Bureau, 2012). 
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Case Study Research Methodology in Nursing Research.

Through data collection methods using a holistic approach that focuses on variables in a natural setting, qualitative research methods seek to understand participants' perceptions and interpretations. Common qualitative research methods include ethnography, phenomenology, grounded theory, and historic research. Another type of methodology that has a similar qualitative approach is case study research, which seeks to understand a phenomenon or case from multiple perspectives within a given real-world context.

Conducting pilot and feasibility studies.

Planning a well-designed research study can be tedious and laborious work. However, this process is critical and ultimately can produce valid, reliable study findings. Designing a large-scale randomized, controlled trial (RCT)-the gold standard in quantitative research-can be even more challenging. Even the most well-planned study potentially can result in issues with research procedures and design, such as recruitment, retention, or methodology. One strategy that may facilitate sound study design is the completion of a pilot or feasibility study prior to the initiation of a larger-scale trial. This article will discuss pilot and feasibility studies, their advantages and disadvantages, and implications for oncology nursing research. 
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Establishing an Advanced Practice Nursing Clinic in the Cancer Setting.

OBJECTIVES: To explore the roles of the Advanced Practice Nurse (APN), specifically the Nurse Practitioner (NP) in oncology and the issues, resources, and planning involved in establishing an NP clinic in the cancer setting. DATA SOURCES: Published peer reviewed literature, web-based resources, and cancer-related professional resources. CONCLUSION: The number of cancer patients is increasing and demands for oncology services are rising. With a shortage of oncologists projected over the next decade, the oncology NP can play a key role in providing oncology services across the cancer continuum. IMPLICATIONS FOR NURSING PRACTICE: Oncology APNs in the role of Nurse Practitioner (NP) can facilitate and enhance the delivery of oncology care. Traditional and innovative opportunities exist for the NP including the establishment of a NP clinic in the cancer setting; ultimately providing needed oncology services and quality care for patients with cancer.

Using electronic surveys in nursing research.

Computer and Internet use in businesses and homes in the United States has dramatically increased since the early 1980s. In 2011, 76% of households reported having a computer, compared with only 8% in 1984 (File, 2013). A similar increase in Internet use has also been seen, with 72% of households reporting access of the Internet in 2011 compared with 18% in 1997 (File, 2013). This emerging trend in technology has prompted use of electronic surveys in the research community as an alternative to previous telephone and postal surveys. Electronic surveys can offer an efficient, cost-effective method for data collection; however, challenges exist. An awareness of the issues and strategies to optimize data collection using web-based surveys is critical when designing research studies. This column will discuss the different types and advantages and disadvantages of using electronic surveys in nursing research, as well as methods to optimize the quality and quantity of survey responses.

Computer-assisted qualitative data analysis software.

Advances in technology have provided new approaches for data collection methods and analysis for researchers. Data collection is no longer limited to paper-and-pencil format, and numerous methods are now available through Internet and electronic resources. With these techniques, researchers are not burdened with entering data manually and data analysis is facilitated by software programs. Quantitative research is supported by the use of computer software and provides ease in the management of large data sets and rapid analysis of numeric statistical methods. New technologies are emerging to support qualitative research with the availability of computer-assisted qualitative data analysis software (CAQDAS).CAQDAS will be presented with a discussion of advantages, limitations, controversial issues, and recommendations for this type of software use.

Breast cancer: reviewing the past to give direction for the future.

Since the 1970s, significant advances have been made in the diagnosis and treatment of breast cancer. Incidence rates increased during the 1980s and 1990s but began to decrease about 2% each year for women aged 50 years and older beginning in the year 2000, with a 7% decrease in the year 2002 (Siegel, Naishadham, & Jemal, 2013). Mortality rates in the United States also have decreased since 1990, particularly in women younger than 50 years. The declining incidence of breast cancer and improved mortality rates have been attributed to early detection, improved treatment, and research investigating factors associated with an increased risk of breast cancer. However, challenges such as limited effective treatment for symptoms resulting from estrogen deprivation still exist.

Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline.

PURPOSE: To develop an evidence-based guideline on central venous catheter (CVC) care for patients with cancer that addresses catheter type, insertion site, and placement as well as prophylaxis and management of both catheter-related infection and thrombosis. METHODS: A systematic search of MEDLINE and the Cochrane Library (1980 to July 2012) identified relevant articles published in English. RESULTS: The overall quality of the randomized controlled trial evidence was rated as good. There is consistency among meta-analyses and guidelines compiled by other groups as well. RECOMMENDATIONS: There is insufficient evidence to recommend one CVC type or insertion site; femoral catheterization should be avoided. CVC should be placed by well-trained providers, and the use of a CVC clinical care bundle is recommended. The use of antimicrobial/antiseptic-impregnated and/or heparin-impregnated CVCs is recommended to decrease the risk of catheter-related infections for short-term CVCs, particularly in high-risk groups; more research is needed. The prophylactic use of systemic antibiotics is not recommended before insertion. Data are not sufficient to recommend for or against routine use of antibiotic flush/lock therapy; more research is needed. Before starting antibiotic therapy, cultures should be obtained. Some life-threatening infections require immediate catheter removal, but most can be treated with antimicrobial therapy while the CVC remains in place. Routine flushing with saline is recommended. Prophylactic use of warfarin or low-molecular weight heparin is not recommended, although a tissue plasminogen activator (t-PA) is recommended to restore patency to occluded catheters. CVC removal is recommended when the catheter is no longer needed or if there is a radiologically confirmed thrombosis that worsens despite anticoagulation therapy.