Resilience in Older Adults Diagnosed With Cancer and Receiving Chemotherapy.

BACKGROUND: Resilience is the capacity for physical and emotional recovery from stressful events like cancer diagnosis and treatment. OBJECTIVES: The objectives of this study were to review existing literature to understand and illustrate ways to assess and manage resilience when providing holistic care to older adults with cancer. METHODS: A review of the literature was conducted with a focus on assessment, management, and preservation of resilience in older adults with cancer. FINDINGS: Interventions to support resilience include managing problems that occur in the areas of nutrition, exercise, social support, cognition, functional status, and emotion. Cell cycle arrest using pharmacologic agents may provide a novel proactive approach to protect resilience from deteriorating during chemotherapy to treat cancer. The oncology nurse can assess and manage resilience. which can lead to better treatment outcomes.

Incorporating a Microlearning Wellness Intervention Into Nursing Student Curricula.

BACKGROUND: Cultivating healthy lifestyle beliefs (HLBs) can result in positive health outcomes for students during their nursing program. PURPOSE: The purpose of the study was to determine the effectiveness of short wellness interventions (microlearning) in nursing courses on reducing stress and anxiety and enhancing HLB. METHODS: Microlearning wellness interventions were offered to graduate and undergraduate nursing students in this cluster randomized intervention study. The Perceived Stress Scale 4, Generalized Anxiety Disorder 7, and Healthy Lifestyle Beliefs Scales were administered. Student perceptions were evaluated using a short answer narrative. RESULTS: The intervention group reported higher HLB (P = .15), lower anxiety (P = .06), and lower stress (P = .06) compared with the control group after adjusting for baseline differences. Student comments were favorable and included enjoying the activities, weight loss success, and mindfulness strategies. CONCLUSIONS: Incorporating wellness interventions into nursing curricula demonstrates a positive trend toward reducing anxiety and stress and improving HLB.

Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer.

BACKGROUND: The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES: This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS: NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS: Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.

Factors Associated With Poor Sleep in Older Women Diagnosed With Breast Cancer

OBJECTIVES: To determine the relationship among gait, grip strength, cognition, depression, pain, and fatigue, and to identify which variables are most predictive of poor sleep. SAMPLE & SETTING: 60 women with breast cancer aged 69 years or older who were receiving treatment in the Senior Adult Oncology Program at the James Cancer Hospital at the Ohio State University. METHODS & VARIABLES: The variables were gait and grip strength (functional domains), cognition, depression, pain, and fatigue. Patients were tested using the Timed Up and Go Test (TUG), Jamar Hydraulic Hand Dynamometer, Mini-Cog, Numeric Pain Rating Scale, Brief Fatigue Inventory, Geriatric Depression Scale, and Pittsburgh Sleep Quality Index. Pearson correlation coefficients and logistic regression models were used. RESULTS: The mean age of the sample was 78 years. Pain and fatigue, depression and pain, and depression and fatigue each were positively related, and grip strength and TUG scores were negatively related. Fatigue was the strongest predictor of poor sleep. IMPLICATIONS FOR NURSING: These findings are important to the comprehensive care of older women diagnosed with breast cancer. Understanding symptoms associated with poor sleep helps nurses develop comprehensive care plans for older adults with breast cancer.

Feasibility of Mind-Body Movement Programs for Cancer Survivors

PURPOSE/OBJECTIVES: To evaluate mind-body movement exercise (MBME) classes (yoga, tai chi, and Qigong) for cancer survivors. 
. DESIGN: A single-group, repeated-measures design.
. SETTING: The Ohio State University Wexner Medical Center-Arthur G. James Cancer Hospital in Columbus.
. SAMPLE: 33 adult cancer survivors, with any cancer diagnosis, participating in MBME classes.
. METHODS: The researchers sought to examine feasibility of multiple data collection time points and data collection measures; acceptability; and changes to physical, emotional, and biometric measures over time, as a result of participation in MBME classes.
. MAIN RESEARCH VARIABLES: Quality of life, sleep, depressive symptomatology, fatigue, stress, upper body strength, gait and balance, body mass index, heart rate, and blood pressure.
. FINDINGS: The current study was feasible because survivors were willing to participate and completed most of the questionnaires. Participants found these classes to be beneficial not only for exercise, but also for social support and social connectedness. Poor sleep quality was consistently reported by participants. MBME classes should be recommended to survivors and are beneficial for oncology practices to offer.
. CONCLUSIONS: Conducting MBME research with cancer survivors is feasible, and participants find the MBME acceptable and a way of addressing health and managing cancer-related symptoms.
. IMPLICATIONS FOR NURSING: Nurses should help patients and caregivers identify locations and times when MBME class participation is possible, assess MBME class participation during each clinic visit to promote continued involvement and to understand if positive effects are occurring, and continue to provide support for MBME classes throughout the survivorship experience.

The benefits of medical qigong in patients with cancer: a descriptive pilot study

Medical Qigong (MQ) is a mind-body exercise that includes movement and meditation and is beneficial in reducing high blood pressure, high cholesterol, anxiety, stress, pain, and incidence of falls. The purpose of the current study was to determine whether patients with cancer and survivors who participated in an MQ class experienced a change in fatigue, depression, and sleep from a preintervention evaluation to a postintervention evaluation. Participants were patients diagnosed with cancer who participated in MQ classes. Some were actively undergoing cancer treatment (e.g., surgery, hormone therapy, radiation therapy, chemotherapy) and some were receiving no treatment. Patients diagnosed with cancer and enrolled in an MQ class were invited to participate. A packet of surveys was completed before the first class and before the final class. Scores showed a reduced depression score after completing the five-week MQ course. Those findings indicate that MQ is helpful in reducing some of the problems associated with cancer and cancer treatment.

Quality of life (QOL), supportive care, and spirituality in hematopoietic stem cell transplant (HSCT) patients.

For many patients, a hematopoietic stem cell transplant (HSCT) can be challenging to physical and emotional health. Supportive care needs can be overwhelming for many patients and families. The purpose of this study was to evaluate the effect of quality of life (QOL), spiritual well-being, and supportive care resources post-HSCT. This descriptive, repeated-measures study included people over the age of 18 years undergoing HSCT for any cancer diagnosis. The Functional Assessment in Cancer Therapy--Bone Marrow Transplant scale, the Functional Assessment of Chronic Illness Therapy--Spiritual--12 scale, and a resource questionnaire were administered prior to HSCT and following HSCT at 30, 60, 90, and 180 days. Three groups of HSCT patients were examined: allogeneic, autologous, and overall. Data analysis included descriptive statistics and correlations. In the sample (n = 159), the autologous HSCT group reported the highest QOL scores. Spirituality scores increased for the autologous HSCT group at 90 days, but decreased for the overall and allogeneic groups. The type of supportive care resources most used were information from the physician and nurse, the Leukemia and Lymphoma Society Support as the most used form of support group, and Faith, Prayer and Spiritual Healing. QOL and spiritual well-being scores correlated best at 180 days (6 months) for autologous and allogeneic patients.

Retrospective study of multidisciplinary rounding on a thoracic surgical oncology unit

Multidisciplinary rounding (MDR) reduces medical errors and improves the quality of care for hospitalized patients. The purpose of this study was to evaluate hospital length of stay, patient satisfaction, admission to a skilled care facility, and the use of home health care or hospice in patients who received MDR compared to those who did not. This retrospective study included the records of 3,077 thoracic surgical patients with cancer who were admitted to a midwestern National Cancer Institute-designated comprehensive cancer center from January 1, 2006, through July 1, 2011. Overall mean length of stay was 5.3 days in the MDR group compared to 6.5 days in the no MDR group. The MDR group also had significantly shorter mean length of stay compared to the no MDR group among patients who were discharged home from the hospital, admitted to hospice following a hospital discharge, discharged to a skilled care facility, or admitted to home healthcare services. No significant differences in satisfaction scores were reported in patients who received MDR compared to those who did not. MDR is an important aspect of inpatient oncology care, and staff should be identified to participate who have expertise relevant to patients' needs.

The geriatric cancer experience at the end of life: testing an adapted model

PURPOSE/OBJECTIVES: To test an adapted end-of-life conceptual model of the geriatric cancer experience and provide evidence for the validity and reliability of the model for use in practice and research. DESIGN: Nonexperimental and cross-sectional using baseline data collected within 24-72 hours of admission to hospice. SETTING: Two hospices in the southeastern United States. SAMPLE: 403 hospice homecare patients; 56% were men and 97% were Caucasian with a mean age of 77.7 years. METHODS: Confirmatory factor analyses using structural equation modeling with AMOS statistical software. MAIN RESEARCH VARIABLES: Clinical status; physiologic, psychological, and spiritual variables; and quality of life (QOL). FINDINGS: A three-factor model with QOL as an outcome variable showed that 67% of the variability in QOL is explained by the patient's symptom and spiritual experiences. CONCLUSIONS: As symptoms and associated severity and distress increase, the patient's QOL decreases. As the spiritual experience increases (the expressed need for inspiration, spiritual activities, and religion), QOL also increases. IMPLICATIONS FOR NURSING: The model supports caring for the physical and metaphysical dimensions of the patient's life. It also highlights a need for holistic care inclusive of physical, emotional, and spiritual domains.

Vitamin D in older patients with cancer

Vitamin D insufficiency has been found to be as high as 75% among community-dwelling adults aged 65 and older. The purpose of this article is to provide a review of published literature focused on the benefits of vitamin D and calcium supplementation in older patients with cancer. Insufficient vitamin D levels may have considerable effects on cancer-related diagnosis and treatment. Patient education should include information concerning vitamin D and calcium administration to reduce falls and injury from falls and enhance functional status. This article will consider the issue of vitamin D levels related to cancer prevention, diagnosis, treatment, functional status, and falls in older patients with cancer. Dosing and serum measurement information will be discussed.