Acceptability, Effectiveness, and Roles of mHealth Applications in Supporting Cancer Pain Self-Management: Integrative Review.

BACKGROUND:  Cancer pain remains highly prevalent and persistent throughout survivorship, and it is crucial to investigate the potential of leveraging the advanced features of mobile health (mHealth) apps to empower individuals to self-manage their pain. OBJECTIVE:  This review aims to comprehensively understand the acceptability, users' experiences, and effectiveness of mHealth apps in supporting cancer pain self-management. METHODS:  We conducted an integrative review following Souza and Whittemore and Knafl's 6 review processes. Literature was searched in PubMed, Scopus, CINAHL Plus with Full Text, PsycINFO, and Embase, from 2013 to 2023. Keywords including "cancer patients," "pain," "self-management," "mHealth applications," and relevant synonyms were used in the search. The Johns Hopkins research evidence appraisal tool was used to evaluate the quality of eligible studies. A narrative synthesis was conducted to analyze the extracted data. RESULTS:  A total of 20 studies were included, with the overall quality rated as high (n=15) to good (n=5). Using mHealth apps to monitor and manage pain was acceptable for most patients with cancer. The internal consistency of the mHealth in measuring pain was 0.96. The reported daily assessment or engagement rate ranged from 61.9% to 76.8%. All mHealth apps were designed for multimodal interventions. Participants generally had positive experiences using pain apps, rating them as enjoyable and user-friendly. In addition, 6 studies reported significant improvements in health outcomes, including enhancement in pain remission (severity and intensity), medication adherence, and a reduced frequency of breakthrough pain. The most frequently highlighted roles of mHealth apps included pain monitoring, tracking, reminders, education facilitation, and support coordination. CONCLUSIONS:  mHealth apps are effective and acceptable in supporting pain self-management. They offer a promising multi-model approach for patients to monitor, track, and manage their pain. These findings provide evidence-based insights for leveraging mHealth apps to support cancer pain self-management. More high-quality studies are needed to examine the effectiveness of digital technology-based interventions for cancer pain self-management and to identify the facilitators and barriers to their implementation in real-world practice.

Work-health balance of cancer survivors returning to work: A meta-ethnography.

PURPOSE: This meta-ethnography investigates the multifaceted health-related experiences of cancer survivors returning to work (RTW), recognizing the pivotal role of employment in overall well-being, particularly in the context of increasing cancer cases among working-age adults. METHOD: Following the methodology of Noblit and Hare, a comprehensive literature search was conducted from 2013 to 2023 in databases including PubMed, Scopus, CINAHL, PsycINFO, and Embase. Qualitative studies assessing cancer survivors' experiences, motivation, concern, resilience, and need in the process of RTW were identified. Eligible studies were assessed for quality using the Critical Appraisal Skills Program Checklist, and their findings were subsequently synthesized. RESULTS: Seventeen studies were included for analysis. The finding revealed five key themes: motivations (voluntary and involuntary), cancer-related concerns, resilience, needs for cancer healthcare support, and workplace accommodation. Voluntarily RTW was primarily linked to desires of normalcy, while involuntary RTW was often financially driven. Cancer survivors often face physical, psychological, and social challenges in the RTW process. Resilience played a crucial role in their readaptation to the workplace. Participants expressed the need for additional guidance from healthcare providers and tailored support from the workplace to facilitate a smoother RTW experience. CONCLUSION: Cancer survivors aspire to be actively engaged, have their specific needs addressed, and achieve success in their return-to-work endeavors. Occupational guidance and accommodation from healthcare providers and employers play a pivotal role in empowering survivors to balance cancer and work, facilitating the return-to-work process, and enhancing the quality of survivorship.

Symptom Patterning Across the Cancer Care Trajectory for Patients Receiving Chemoradiation for Head and Neck Cancer: A Retrospective Longitudinal Study Using Latent Transition Analysis.

BACKGROUND: Patients with head and neck cancer (HNC) experience a multitude of symptoms because of the tumor and its treatment. OBJECTIVE: To identify the symptom patterns present in cancer treatment and survivorship periods for patients with HNC using latent class analysis. METHODS: A retrospective longitudinal chart review was conducted to examine symptoms reported by patients who received concurrent chemoradiation for HNC in a regional Northeastern United States cancer institute. Latent class analysis was performed to identify the latent classes present across multiple timepoints during treatment and survivorship for the most commonly reported symptoms. RESULTS: In 275 patients with HNC, the latent transition analysis revealed 3 latent classes for both treatment and survivorship periods: (1) mild, (2) moderate, and (3) severe symptoms. Patients were more likely to report a greater number of symptoms in a more severe latent class. During treatment, moderate and severe classes had representation of all most common symptoms: pain, mucositis, taste alterations, xerostomia, dysphagia, and fatigue. Different symptom patterns emerged for survivorship, with prominence of taste alterations and xerostomia across all classes, and all symptoms present in the severe class. The probability of symptom expression varied more in the survivorship period compared with the treatment period. CONCLUSIONS: Patients reported numerous symptoms during active treatment persisting into survivorship. Patients tended to transition to more severe symptomatology as treatment progressed and to more moderate symptomatology as survivorship evolved. IMPLICATIONS FOR PRACTICE: Examining the trend of persistent moderate symptomatology into survivorship is useful to optimize symptom management.

A Descriptive Survey Study of Patient Needs and Preferences for Cancer Pain Self-Management Support.

OBJECTIVES: To characterize the needs and preferences for pain self-management support (SMS) among patients with cancer during the transition of cancer care from the hospital to the home setting. SAMPLE & SETTING: 38 participants with cancer pain at a research-intensive cancer center in New England. METHODS & VARIABLES: A descriptive, cross-sectional survey study was conducted to investigate relationships among preferred and received support, extent and management of transitional change, and pain outcomes. Pain intensity and interference were measured using the Brief Pain Inventory-Short Form, transitional change was measured using the Measurement of Transitions in Cancer Scale, and SMS was measured using dichotomous questions. RESULTS: About half of participants reported concordance between preferred and received cancer pain SMS in the hospital and at home. The extent of transitional change in cancer care was found to be a significant predictor of average pain intensity in the hospital and pain interference at home. Satisfaction with cancer pain SMS was a significant predictor of pain intensity at home. IMPLICATIONS FOR NURSING: The extent of change during care transitions should be considered when fulfilling patient needs and preferences for cancer pain SMS to optimize outcomes.

An Integrative Review of the Role of the Oral and Gut Microbiome in Oral Health Symptomatology During Cancer Therapy.

PROBLEM IDENTIFICATION: Both chemotherapy and radiation therapy cause considerable symptom burden on patients' oral health, influencing nutritional status and quality of life. The role of the oral and gut microbiome in oral health alterations during cancer therapy is an emerging area of science in symptom management. LITERATURE SEARCH: PubMed®, CINAHL®, and Scopus® were searched for articles published from January 2000 through July 2020. DATA EVALUATION: Articles published in English that were focused on chemotherapy and/or radiation therapy were included in the review. SYNTHESIS: Of the 22 identified studies, 12 described oral health symptoms during chemotherapy and radiation therapy for head and neck cancer. Ten studies assessed symptoms during treatment for a variety of solid tumors and blood cancers, with four of these describing microbial interventions for the management of oral mucositis. Interventions varied, but the results supported the benefits of probiotics and synbiotics in reducing mucositis severity. Overall, less diverse oral and gut microbiome environments were associated with increased severity of oral health symptomatology. IMPLICATIONS FOR PRACTICE: Additional research is needed to determine how the oral and gut microbiome and microbial interventions may be used to improve oral health management during cancer treatment.

Needs Assessment to Inform and Improve Educational Practices Surrounding Omega-3 Consumption during Pregnancy.

OBJECTIVES: Adequate dietary consumption of long chain omega-3 fatty acids (n-3 LCPUFA) during pregnancy has been associated with better maternal and infant health outcomes. Given that the primary source of n-3 LCPUFA is fish and fish oils, concerns surrounding contamination and uncertainty of safe fish intake guidelines have negatively affected consumption of fish during pregnancy. Although obstetric healthcare providers are in a unique position to influence dietary intake patterns, a gap exists in their understanding the knowledge and practices surrounding n-3 LCPUFA. This needs assessment investigation evaluated knowledge, attitudes and prescribing/recommending practices of obstetric practitioners surrounding n-3 LCPUFA consumption and/or supplementation to generate evidence supporting the development of targeted educational initiatives. METHODS: A cross-sectional, needs assessment was conducted using anonymous online-survey of affiliate members of the American College of Nurse Midwives (N = 105). A 24-item, previously validated (α = 0.86) needs assessment survey (Obstetric Clinicians Omega-3 Survey, OCOS) was used to assess attitudes, knowledge, and prescribing practices surrounding n-3 LCPUFA. RESULTS: The total OCOS score representing attitudes, knowledge and prescribing patterns collectively was 69.48% (Mean = 79.90(± 12.44), score range = 24-115). Scores for the sub-domains included attitude 68.33% (Mean = 20.50(± 3.64), score range = 6-30); knowledge 71.40% (Mean = 30.70(± 5.43), score range = 9-43); and prescribing patterns 68.31% (Mean = 28.69(± 5.39), score range = 9-42). CONCLUSIONS FOR PRACTICE: Although the majority of respondents had fair-moderate n-3 LCPUFA knowledge, attitudes and prescribing/recommending, our results highlight an opportunity for additional research and educational outreach targeting improved n-3 LCPUFA knowledge and practices. Specific areas of educational interest included associated health outcomes, dosing and safe consumption guidelines.

Omega-3 Consumption During Pregnancy to Support Optimal Outcomes.

Long-chain omega-3 polyunsaturated fatty acids (n-3 LCPUFA), including docosahexaenoic acid, are components of cellular membranes that affect biological functioning. Most pregnant women consume inadequate amounts of n-3 LCPUFA and inadequately convert linolenic acid into docosahexaenoic acid. The purpose of this article is to educate nursing professionals on the importance of n-3 LCPUFA consumption during pregnancy and highlight the critical role of nursing professionals in supporting optimal consumption for improved metabolic, antioxidant, and anti-inflammatory potential.

Systematic Review of the Effect of Enteral Feeding on Gut Microbiota in Preterm Infants.

OBJECTIVE: To examine the effect of feeding type on microbial patterns among preterm infants and to identify feeding factors that promote the colonization of beneficial bacteria. DATA SOURCES: PubMed, Cochrane Database of Systematic Reviews, Scopus, and the Cummulative Index of Nursing and Allied Health Literature were thoroughly searched for articles published between January 2000 and January 2017, using the keywords gut microbiome, gut microbiota, enteral microbiome, enteral microbiota, premature infant, preterm infant, extremely low birth weight infant, ELBW infant, very low birth weight infant, feeding, breast milk, breastfeeding, formula, prebiotic, probiotic, and long chain polyunsaturated fatty acid. STUDY SELECTION: Primary studies written in English and focused on the association between enteral feeding and gut microbiome patterns of preterm infants were included in the review. DATA EXTRACTION: We independently reviewed the selected articles and extracted information using predefined data extraction criteria including study design, study participants, type of feeding, type and frequency of biospecimen (e.g., feces, gastric aspirate) collection, microbiological analysis method, and major results. DATA SYNTHESIS: In 4 of the 18 studies included in the review, researchers described the effects of milk products (mothers' own milk, donor human milk, and formula). In 5 studies, the effects of prebiotics were assessed, and in 9 studies, the effects of probiotics on the gut microbiome were described. Mothers' own breast milk feeding influenced the compositional structure of preterm infants' gut microbial community and increased diversity of gut microbiota compared with donor human milk and formula feeding. The results of the use of prebiotics and probiotics varied among studies; however, the majority of the researchers reported positive bifidogenic effects on the development of beneficial bacteria. CONCLUSION: Mothers' own milk is considered the best form of nutrition for preterm infants and the gut microbial community. Variation in fatty acid composition across infant feeding types can affect microbial composition. The evidence for supplementation of prebiotics and probiotics to promote the gut microbial community structure is compelling; however, additional research is needed in this area.

Reduced DHA transfer in diabetic pregnancies: mechanistic basis and long-term neurodevelopmental implications.

Infants born to diabetic mothers have a higher frequency of impaired neurodevelopment. The omega-3 or n-3 fatty acid docosahexaenoic acid (DHA) is an important structural component of neural tissue and is critical for fetal brain development. Maternal DHA supplementation during pregnancy is linked to better infant neurodevelopment; however, maternal-fetal transfer of DHA is reduced in women with diabetes. Evidence of mechanisms explaining altered maternal-fetal DHA transfer in this population is limited. This review explores existing evidence underpinning reduced maternal-fetal DHA transfer in maternal fuel metabolism in this population. Further research is necessary to evaluate the role of peroxisome proliferator-activated receptors in modulating placental fatty acid binding and maternal-fetal DHA transfer. Considerations for clinical practice include a diet high in DHA and/or provision of supplemental DHA to obstetric diabetic patients within minimum guidelines.

Evidence of developmental continuity from birth to 1 year: sleep, temperament, problem solving, and recognition memory.

BACKGROUND: Research evidence is limited regarding developmentally appropriate care. Variations exits with respect to test procedure type, infant age at testing, and test relatedness. PURPOSE: To assess developmental continuity using multiple developmental measures from birth to 12 months in a single cohort of term infants. METHODS: A secondary analysis, longitudinal, correlational design was used to assess developmental continuity in a single cohort of infants (n 27). Measures included: sleep, using the Motility Monitoring System (first 48 hours of life); temperament, using the Infant Characteristics Questionnaire (ICQ, 6 months) and the Revised Infant Temperament Questionnaire (RITQ, 12 months); problem-solving, using the Willatts Infant Planning Test (PS, 9 and 12 months); and the Fagan Test of Infant Intelligence (FTII, 6 and 9 months). RESULTS: Using Spearmen correlation, significant correlations included: (1) Sleep and ICQ: transitional sleep and "unpredictable" (r 0.455, P .017), "unadaptable" (r 0.420, P .026), and "dull" (r 0.416, P .028); (2) ICQ and FTII 6 months (r -0.512, P .008); (3) RITQ "approachability" and quiet sleep (r 0.662, P .005); (4) arousals in active sleep and PS at 9 months (r -0.528, P .016). IMPLICATIONS FOR PRACTICE: Given our reported continuity between early sleep and later developmental measures, sleep-wake state should be considered in caregiving and environmental control to support sleep. Parental education on facilitating sleep-wake regulation in the home environment is essential. IMPLICATIONS FOR RESEARCH: These data support the existence of continuity between early sleep and later developmental milestones warranting a larger-scale investigation. Specific focus on development of care strategies for facilitating sleep immediately following birth is warranted.

Maternal consumption of a DHA-containing functional food benefits infant sleep patterning: an early neurodevelopmental measure.

BACKGROUND: Docosahexaenoic acid (DHA; 22:6n-3) is highly important during pregnancy for optimal development and functioning of fetal neural tissue. Infant ability to organize sleep and wake states following parturition is highly associated with later developmental outcomes. The impact of maternal DHA intake on sleep organization has not been previously investigated. AIMS: To examine the effect of a DHA-containing functional food consumed during pregnancy on early neurobehavioral development as assessed by infant sleep patterning in the first 48 postnatal hours. STUDY DESIGN: A longitudinal, randomized, double-blinded, placebo-controlled design was used. SUBJECTS: Women (18-35 y) with no pregnancy complications consumed a cereal-based functional food (92 kcal) containing 300 mg DHA an average of 5 d/week or placebo bars (n=27 DHA, n=21 Placebo). The intervention began at 24 weeks gestation and continued until delivery (38-40 weeks). OUTCOME MEASURES: Infant sleep/wake states were measured on postnatal days 1 (D1) and 2 (D2) using a pressure sensitive mattress recording respiration and body movements. RESULTS: Using ANCOVA and controlling for ethnic variation, there were significant group differences in arousals in quiet sleep on D1 (P=0.006) and D2 (P=0.011) with fewer arousals in the DHA intervention group compared to the placebo group. Similarly, arousals in active sleep on D1 were significantly lower in the DHA-intervention group (P=0.012) compared to the placebo group. CONCLUSIONS: We conclude that increased prenatal supply of dietary DHA has a beneficial impact on infant sleep organization.

Plasma or red blood cell phospholipids can be used to assess docosahexaenoic acid status in women during pregnancy.

The suitability of using plasma phopholipids (PLs) to assess docosahexaenoic acid (DHA) status during pregnancy is well accepted. Recent discussions have centered around whether red blood cells (RBCs) can be used to indicate DHA status. We tested the hypothesis that in pregnant women participating in an intervention study when fed a functional food containing DHA, maternal plasma PL DHA would be positively associated with maternal RBC PL and umbilical cord blood RBC PL DHA. Maternal and umbilical cord blood samples were obtained at delivery from women whose mean dietary intake was 187 mg/d (including the amount consumed from the DHA-functional food). Maternal plasma and RBCs and cord blood RBC lipids were extracted and PLs separated by thin-layer chromatography. Phopholipid lipids were methylated, and fatty acids were identified using gas chromatography. Fifty-nine maternal samples and 30 cord blood samples were analyzed. There were moderate to strong correlations between DHA in all compartments (maternal plasma vs maternal RBC PL DHA weight percent [wt%], r = 0.633, P < or = .001; maternal plasma vs cord blood RBC PL DHA wt%, r = 0.458, P < or = .01; maternal RBCs vs cord blood RBC PL DHA wt%, r = 0.376, P < or = .01). These results support the practice of using either plasma PLs or RBC PLs to assess maternal and infant DHA status.

Maternal consumption of a docosahexaenoic acid-containing functional food during pregnancy: benefit for infant performance on problem-solving but not on recognition memory tasks at age 9 mo.

BACKGROUND: There are few studies reporting on docosahexaenoic acid (DHA, 22:6n-3) supplementation during pregnancy and infant cognitive function. DHA supplementation in pregnancy and infant problem solving in the first year have not been investigated. OBJECTIVE: We tested the hypothesis that infants born to women who consumed a DHA-containing functional food during pregnancy would demonstrate better problem-solving abilities and recognition memory than would infants born to women who consumed the placebo during pregnancy. DESIGN: In a double-blind, placebo-controlled, randomized trial, pregnant women consumed a DHA-containing functional food or a placebo from gestation week 24 until delivery. Study groups received DHA-containing cereal-based bars (300 mg DHA/92-kcal bar; average consumption: 5 bars/wk; n = 14) or cereal-based placebo bars (n = 15). The Infant Planning Test and Fagan Test of Infant Intelligence were administered to infants at age 9 mo. The problem-solving trial included a support step and a search step. The procedure was scored on the basis of the infant's performance on each step and on the entire problem (intention score and total intentional solutions). Scores were generated on the basis of the cumulative performance of the infant on 5 trials. RESULTS: Treatment had significant effects on the performance of problem-solving tasks: total intention score (P = 0.017), total intentional solutions (P = 0.011), and number of intentional solutions on both cloth (P = 0.008) and cover (P = 0.004) steps. There were no significant differences between groups in any measure of Fagan Test of Infant Intelligence. CONCLUSION: These data point to a benefit for problem solving but not for recognition memory at age 9 mo in infants of mothers who consumed a DHA-containing functional food during pregnancy.

A docosahexaenoic acid-functional food during pregnancy benefits infant visual acuity at four but not six months of age.

Within the visual system, docosahexaenoic acid (DHA, 22:6n-3) is an important structural component for retinal photoreceptors and cortical gray matter. There is a marked decrease in neural DHA accumulation in the face of DHA deficiency. DHA is accumulated at an accelerated rate during pregnancy, especially in the third trimester. However, pregnant women in the US and Canada have dietary DHA intakes that are significantly below the optimal level. The main objective of this study was to determine whether a DHA-functional food during pregnancy would benefit infant visual acuity at four and six months of age measured behaviorally using the acuity card procedure (ACP). In a randomized, longitudinal, double-blinded, and placebo-controlled trial, 30 pregnant women received either the DHA-functional food (n = 16) or the placebo (n = 14). There were significant main effects for visual acuity at four months of age (P = 0.018). The mean acuity scores were 3.8 +/- 1.1 cycles/degree in the DHA group versus 3.2 +/- 0.7 cycles/degree in the placebo group. At six months there were no group differences. Based on our results, we conclude that DHA supplemented during pregnancy plays a role in the maturation of the visual system.

Dietary intake of essential and long-chain polyunsaturated fatty acids in pregnancy.

The dietary intake of EFA and long-chain PUFA (LCPUFA) by women with (n = 14) and without (n = 31) gestational diabetes mellitus (GDM) was determined by repeated 24-h recalls. Women with GDM consumed significantly more energy as fat compared with women who had uncomplicated pregnancies; absolute dietary fat did not differ. Dietary n-3 LCPUFA was substantially lower than the current recommendation for pregnancy, whereas intake of saturated FA (SFA) exceeded it. We conclude that replacing dietary sources of SFA with those of EFA and LCPUFA, especially n-3 LCPUFA, would benefit the dietary fat profiles of all pregnant women.