Pregnancy after breast-conserving surgery and radiation therapy for breast cancer.

Since the incidence of breast cancer is increasing in young women and young women are more commonly delaying child-bearing, the issue of considering a pregnancy subsequent to the diagnosis and treatment of breast cancer is becoming more common. The impact of a subsequent pregnancy on disease progression and quality of life is, however, not well defined. We evaluated treatment outcome and quality of life among 23 breast cancer patients treated with conservative surgery and radiation among the 1624 patients treated at the Joint Center for Radiation Therapy between 1968 and 1985 who had subsequent pregnancies as compared with 23 patients without subsequent pregnancy matched by age and stage at diagnosis and time to pregnancy without recurrence. Quality of life was evaluated using two self-report measures, Ferrans and Powers Quality of Life Index and the Adaptation to Surviving Cancer Profile, and a measure of parenting stress (Parenting Stress Index). Results showed no differences in recurrence or distant metastasis between the matched groups. In addition, subjects with subsequent pregnancy perceived that family issues had the greatest impact on quality of life and were not at higher risk for parental stress due to breast cancer than the normal population. Both groups of young women perceived that they were able to adjust well after treatment. Study results are consistent with other clinical studies comparing patients with and without subsequent pregnancy who have failed to demonstrate a survival disadvantage.(ABSTRACT TRUNCATED AT 250 WORDS)

Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy.

Quality of life (QOL) is an important consideration as patients survive longer with cancer and is an area of increasing interest in patients with thyroid cancer who undergo long-term cancer surveillance. However, there are few disease-specific QOL tools available to evaluate QOL in patients with thyroid cancer. The purposes of this longitudinal, repeated-measures study were to: (1) test a new instrument, the QOL-Thyroid Scale, during thyroid hormone withdrawal; and (2) to evaluate the impact of thyroid hormone withdrawal on patients' perceived changes in quality of life. The sample included 34 subjects (mean age 40 years) undergoing thyroid hormone withdrawal in preparation for scanning procedures. Subjects completed three instruments (demographic data tool, the QOL-Thyroid, and the FACT-G) at four specific time points in relationship to scanning. The results demonstrated that the QOL-Thyroid tool is a reliable and valid measure of QOL. Cronbach's alpha coefficient of r = .78 between QOL-Thyroid and FACT-G indicated good concurrent validity. Second, the impact of thyroid hormone withdrawal on QOL showed significant changes in physical, psychological, and social well-being across the four testing points. The greatest changes occurred between peak hormone withdrawal and thyroxine (T4) therapy. While it is generally known that patients suffer troublesome physical symptoms relating to thyroid hormone withdrawal, the negative psychological, family, and work sequelae are less apparent. In conclusion, the QOL-Thyroid is a reliable and valid measure for use in evaluating patients undergoing scanning procedures and may be used to identify and target teaching and support for high-risk areas in patients lives that are negatively affected by hormone withdrawal.

Quality of life, survivorship, and psychosocial adjustment of young women with breast cancer after breast-conserving surgery and radiation therapy.

PURPOSE/OBJECTIVES: To examine changes in quality of life (QOL), psychosocial adjustment, and survivorship issues over time of women younger than 45 years who underwent breast-conserving surgery and radiation therapy (RT) for breast cancer. DESIGN: Repeated measures, longitudinal design. METHODS: Data were collected at four time points: start of RT, midpoint of RT, end of RT, and six months after RT. Three instruments were used to collect data: Quality-of-Life Index, Psychosocial Adjustment to Illness Scale, and the newly developed Adaptation to Survivorship Experience. Subjects also participated in an indepth interview at the start of RT. SETTING: A large radiation oncology department located in an urban teaching hospital in the Northeast United States. SAMPLE: 23 women with newly diagnosed stage I or II breast cancer who were starting RT following breast-conserving surgery, with a mean age of 37.8 years (range = 25-45 years). MAIN RESEARCH VARIABLES: QOL, psychosocial adjustment, and adaptation to survivorship experience. FINDINGS: Although subjects adjusted their lives to accommodate RT, QOL declined from the start of RT to midpoint, with gradual improvement reported six months later. Social and sexual adjustment declined from start of RT to six months later. Negative perceptions of the survivorship experience and worry about cancer increased from the start of RT to six months later. CONCLUSIONS: Young women with breast cancer experience changes in QOL, psychosocial adjustment, and adaptation to survivorship issues during RT. Changes may not reflect what is observed in clinical practice. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to be aware of changes in QOL, psychosocial adjustment, and survivorship to better understand and support young women during RT.

Decreasing documentation time using a patient self-assessment tool.

A 1986 audit of 150 randomly selected radiation therapy patient records revealed 147 records containing completed nursing assessment and weekly progress notes. Documentation of care provided was comprehensive, but concern was expressed over the length of time it required--an average of 40 minutes for the patient interview and an additional 20 minutes for documentation. Two strategies were proposed to reduce the amount of time spent in documentation without jeopardizing the detail of information contained in the initial nursing assessment: to pilot a patient self-assessment tool based on our original functional health pattern nursing assessment and to develop a standard flow sheet that contained both frequently used nursing diagnoses and potential interventions. Selected patients completed self-assessment records and discussed them with their primary nurses on the first day of treatment. Based on the pilot data, the forms were modified and revised. In 1987, 50 revised patient self-assessment records were reviewed revealing that both subjective and objective information had improved. Documentation time was reduced and information was more comprehensive.

The meaning of quality of life in cancer survivorship.

PURPOSE/OBJECTIVES: To describe the meaning of quality of life (QOL) in long-term cancer survivors, to validate inductively derived QOL themes, and to identify and cluster over-arching themes across long-term cancer survivors. DESIGN: Qualitative study that was part of a larger, cross-sectional survey. SETTING/SAMPLE: 687 (57% response) cancer survivors at an average of 6.7 years after diagnosis. In the sample, 81% were female (with a mean age of 49.6 years), 72% were college educated, 63% were married, and 49% worked full time. METHODS: Mailed survey of three open-ended questions and standard QOL tools. A QOL conceptual model was used to frame the research study, describe the QOL responses of the participants, and explore the meaning of cancer survivorship. Content analysis was used to answer the research questions. Data collection and analysis occurred sequentially. MAIN RESEARCH CONCEPTS: Meaning, QOL cancer survivorship. FINDINGS: 25 of 30 inductively derived QOL themes were validated in this study of long-term cancer survivors; 107 additional QOL themes were identified and clustered into 11 over-arching themes across the entire data set. Over-arching themes included struggle between independence-dependence, balance, wholeness, life purpose, reclaiming life, multiple losses, having control, altered meaning of health, and surviving cancer from a family perspective. IMPLICATIONS FOR NURSING PRACTICE: The meaning of QOL in long-term cancer survivors is multifaceted and complex. CONCLUSIONS: Nurses can use this broader conception of QOL in breast cancer survivors to help patients prepare for and cope with adjustments.

Quality of life in long-term cancer survivors.

PURPOSE/OBJECTIVES: To describe the quality of life (QOL) of long-term cancer survivors. DESIGN: Descriptive, mailed survey. SETTING: Membership of the National Coalition for Cancer Survivorship (NCCS), which is a nonprofit, peer-support network for people living with cancer. SAMPLE: 687 (57%) of the 1,200 members of NCCS completed the survey. The mean age of the sample was 49.6 years; 81% were female. The predominant cancer diagnoses were breast (43%), lymphoma (9%), ovarian (8%), and Hodgkin's disease (8%). METHODS: Mailed survey using three instruments: a demographic tool, the Quality of Life-Cancer Survivors (QOL-CS) tool, and the Functional Assessment of Cancer Therapy-General (FACT-G) tool. MAIN RESEARCH VARIABLES: Subscale and individual items of QOL including physical, psychological, social, and spiritual well-being. FINDINGS: Results include areas of positive effects for cancer survivors and continued demands of survivorship. Based on scoring of 0 (worst outcome) to 10 (best outcome), cancer survivors' mean QOL-CS subscores were 5.88 for psychological well-being, 6.59 for spiritual well-being, 6.62 for social well-being, and 7.78 for physical well-being. Several demographic factors (e.g., evidence of active disease; female gender; presence of spouse/partner or children; length of time since diagnosis; income) had significant influence on QOL. CONCLUSIONS: Cancer survivors experienced altered lives and had needs related to fear of recurrence and facing the spiritual aspects of having survived a life-threatening illness. IMPLICATIONS FOR NURSING PRACTICE: The growing population of cancer survivors has long-term needs for nursing care that address multidimensional aspects of QOL.

Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer.

PURPOSES/OBJECTIVES: To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidenced by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate. DESIGN: Experimental, two-group pretest, post-test. SETTING: Two university teaching hospital outpatient radiation therapy departments. SAMPLE: 46 women beginning a six-week program of radiation therapy for early stage breast cancer. METHODS: Following random assignment, subjects in the exercise group maintained an individualized, self-paced, home-based walking exercise program throughout treatment. The control group received usual care. Dependent variables were measured prior to and at the end of radiation therapy. In addition, symptoms were assessed at the end of three weeks of treatment. MAIN RESEARCH VARIABLES: Participation in the walking exercise program, physical functioning fatigue, emotional distress, and difficulty sleeping. FINDINGS: Hypothesis testing by multivariate analysis of covariance, with pretest scores as covariates, indicated significant differences between groups on outcome measures (p < 0.001). The exercise group scored significantly higher than the usual care group on physical functioning (p = 0.003) and symptom intensity, particularly fatigue, anxiety, and difficulty sleeping. Fatigue was the most frequent and intense subjective symptom reported. CONCLUSIONS: A self-paced, home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy. IMPLICATIONS FOR NURSING PRACTICE: Nurse-prescribed and -monitored exercise is an effective, convenient, and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment.

Quality of life and the cancer experience: the state-of-the-knowledge.

PURPOSE/OBJECTIVES: To address the state-of-the-knowledge concerning quality of life (QOL) issues and the cancer experience from theoretical, research, clinical, and educational perspectives. DATA SOURCES: Published books and articles and a panel of experienced QOL experts who convened at the Oncology Nursing Society's State-of-the-knowledge Conference on Quality of Life in February 1995. DATA SYNTHESIS: Despite the evolution and support of QOL in oncology nursing practice, education, and research, there remains gaps in theory, research, and practice related to QOL. This article explores these gaps in knowledge and recommends future directions for QOL theory, research, education, and practice. CONCLUSIONS: Further conceptual work and resolution of QOL methodologic issues to guide clinical practice and education are warranted. The impact of cultural variables and precancer life experiences on patients' perceptions of QOL also must be addressed. NURSING IMPLICATIONS: Oncology nurse clinicians, educators, and researchers must continue to work collaboratively to enhance the knowledge base regarding QOL and to improve the nursing care provided to individuals with cancer.

Pregnancy and breast cancer.

Pregnancy-associated breast cancer (PABC) and pregnancy subsequent to breast cancer are two areas of concern facing women of childbearing age. The current approach to the management of PABC is to treat the cancer with some modification because of the pregnancy. The clinical management of both PABC and pregnancy occurring after breast cancer in young survivors, with emphasis on issues in clinical decision making, clinical management, and client education and support, are addressed.

Quality of life in women with ovarian cancer.

Despite growing interest in quality of life (QOL) as an important variable in nursing and health care, little research focuses on QOL in women with ovarian cancer (OVCA). The purpose of this study was to examine QOL in OVCA survivors. The convenience sample consisted of 152 women in all disease stages. Quantitative data were collected using the QOL-Cancer Survivors tool and a demographic sheet. Qualitative data were collected by asking participants to write their definitions and experiences of QOL since their diagnosis. Reliability and validity of all data and findings were established. Findings reveal that QOL is moderately high for this group of cancer survivors, despite some specific negative facets of the illness and treatment experience. Qualitative analysis elaborates the four domains of Ferrell's QOL model: physical, psychological, social, and spiritual well-being. Qualitative data also reflect the complexity of the cancer experience.

Newer developments in the diagnosis and staging of breast cancer.

Tremendous changes have occurred in the diagnosis and staging of breast cancer. There are more sophisticated diagnostic techniques available and new developments in prognostic indicators that have altered decisions regarding adjuvant treatment. In the near future, progress in quantity and quality of survival may be linked to early diagnosis and precise staging of the disease.

A review of late effects of cancer in women.

The phenomenal changes in women's advocacy, activism, and consumerism, coupled with advances in screening and early detection, and improved supportive therapies have led to long-term survival for many women's cancers (with the exception of lung cancer). These results have, in turn, had an effect on the experience of surviving cancer in women. Late physical effects, and changes in psychologic, social, and spiritual well-being have become an important aspect of follow-up care. Health promoting activities, supportive care, and future research are integral to the continuing care and rehabilitation of women surviving cancer.

The growing phenomenon of cancer survivorship.

With the advent of successful treatment modalities for many types of cancer, the care of survivors and their families has become an important, new component of oncology nursing practice. Nurses in many different practice settings must be aware of the specialized needs of this growing population of survivors, and must continue to develop interventions to meet these needs. This article provides an overview of the late physical and psychosocial effects these survivors face. Comments on health care policy, research, and nursing practice with regard to cancer survivors are also presented.

Designing and facilitating class discussion in an Internet class.

Designing a replacement for face-to-face classroom discussion is a major consideration in the development of an Internet course, whether the course is completely new or a redesign of an existing course. The experiences of four faculty members who were involved in developing courses for a baccalaureate completion program for RNs taught entirely on the Internet will be used to illustrate key issues in designing andfacilitating on-line discussion.

Having children after breast cancer.

Having children after breast cancer is an important clinical issue. Evidence from clinical studies on pregnancy subsequent to breast cancer has not shown a survival disadvantage. Clinical experience suggests that desire for children, support from family, and quality of life issues are also important factors in decisions about pregnancy. This qualitative study was done (1) to identify reasons why young women decide to become pregnant after breast cancer; (2) to describe concerns about subsequent pregnancy; (3) to describe helpful behaviors in decision making; and (4) to explore the meaning of having children after breast cancer. Twenty-three women were identified who had early-stage breast cancer and became pregnant after breast-conserving surgery and radiation therapy. Sixteen women participated in a semi-structured interview. Qualitative data were analyzed for content. Results indicate that pregnancy subsequent to breast cancer is a powerful stimulus for young women to "get well" again. Reasons for subsequent pregnancy were related to the women's developmental age. Young women expressed concerns about the potential for future disease recurrence, about breast self-examination and mammography during pregnancy, and about surviving to see their children grow up. Perceived helpful behaviors included developing a realistic perspective, living with uncertainty, love and support of spouse, and delineating differences between personal and medical decision making.

Breast cancer and fertility.

Maintaining fertility and having children after treatment for breast cancer are a growing concern for women of childbearing age. There are many factors to be considered before a decision can be made. This article reviews the changes in breast cancer survival and treatment, epidemiology of pregnancy after breast cancer, and concerns during and after the pregnancy period. Specific nursing interventions aimed at improving quality of life and surviving illness are described.