Demographic and disease characteristics associated with non-hodgkin lymphoma survivors' quality of life: does age matter?

PURPOSE/OBJECTIVES: To examine demographic and disease characteristics by age and the moderating effect of age on quality of life (QOL) among non-Hodgkin lymphoma (NHL) survivors. DESIGN: A cross-sectional, secondary analysis study of NHL survivors. SETTING: Two North Carolina cancer registries. SAMPLE: 741 NHL survivors with a mean age of 62 years and a mean time since diagnosis of 10 years. METHODS: Mailed surveys were sent to individuals treated for NHL. All analyses were conducted using SPSS®, version 18.0. Multiple regression was used to analyze relationships among demographic and disease characteristics, age, and QOL. MAIN RESEARCH VARIABLES: Demographic, disease, and clinical characteristics on QOL. FINDINGS: In relation to QOL, income and gender were moderated by age; for example, younger survivors who earned less than $30,000 annually had a poorer QOL. Women reported a higher QOL than men. CONCLUSIONS: Age was a moderator for income and an indicator for how income could affect care of younger survivors. Men reported a lower QOL than women and gender-specific resources may be helpful to them. IMPLICATIONS FOR NURSING: Nursing research should focus on age-sensitive resources targeted for younger NHL survivors. KNOWLEDGE TRANSLATION: Age is an important characteristic that impacts overall health-related QOL. Oncology nurses are instrumental in identifying patients at all ages who could benefit from age-specific resources.

Why do cancer patients die in the emergency department?: an analysis of 283 deaths in NC EDs.

Emergency department (ED) visits are made by cancer patients for symptom management, treatment effects, oncologic emergencies, or end of life care. While most patients prefer to die at home, many die in health care institutions. The purpose of this study is to describe visit characteristics of cancer patients who died in the ED and their most common chief complaints using 2008 ED visit data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). Of the 37,760 cancer-related ED visits, 283 resulted in death. For lung cancer patients, 104 died in the ED with 70.9% dying on their first ED visit. Research on factors precipitating ED visits by cancer patients is needed to address end of life care needs.

The role of oncology nurses in the care of adults with sickle cell disease.

Oncology nurses are experts in pain management, and pain is the hallmark of sickle cell disease (SCD). Because individuals with cancer and individuals with SCD often receive care from hematologists or oncologists and are admitted to the same nursing units, oncology nurses need to have an understanding of SCD and the challenges that these individuals face.

Patient and provider preferences for survivorship care plans.

PURPOSE: Survivorship care plans (SCPs) are tools used to assist in the transition from treatment to surveillance cancer care. However, few studies have investigated survivor and provider preferences regarding SCPs. Our purpose was to explore survivor and primary care provider preferences regarding content, format, and delivery of SCPs. METHODS: Focus groups and provider interviews were performed in 2010. Five different templates were presented to study participants for their feedback. Each SCP included a treatment summary, surveillance schedule, and care plan for the same fictitious patient. Sessions were transcribed, and field notes taken. RESULTS: Four focus groups (n = 29 survivors) and five primary care providers participated. No cancer survivors had ever received a written SCP. We found clear preferences for the Journey Forward format (with some modifications) and face-to-face delivery (print or electronic) to the survivor by his or her oncologist just before or soon after completion of treatment. Primary care providers preferred an abbreviated version. CONCLUSION: Written SCPs were endorsed by all patients and primary care providers as helpful communication tools. However, if used alone, the SCP would be insufficient to ease the transition to follow-up care. Improved communication and care coordination were identified as important for survivorship care that went beyond what this document might provide.

Adjuvant therapy of breast cancer in women 70 years of age and older: tough decisions, high stakes.

In most Western nations, the incidence and mortality rates for breast cancer rise dramatically with increasing age, and in the coming decades oncologists will be faced with managing an increasing number of older patients with breast cancer. Having the knowledge and tools to optimally treat this group will be essential. The challenge of caring for an older cancer patient is to provide treatment options that maximize long-term survival and account for life expectancy, comorbidities, and the effects of treatment on function. For example, a mild treatment-induced peripheral neuropathy can transform a functioning elder into one who is dependent on institutional care. Complicating matters, there is a paucity of data from randomized trials on the risks and benefits of our newer and increasingly effective treatments in older breast cancer patients. In this review we will discuss how to evaluate older breast cancer patients, including estimating survival, defining functional limitations, and providing guidelines for optimal adjuvant therapies.

The impact of education on caregiver burden on two inpatient oncology units.

Providing standardized education can alleviate the burden felt by the caregiver and improve health outcomes for both the patient and caregiver. Four disease groups were included in this study that represent a significantly longer hospital stay than other cancers: acute myelogenous leukemia, acute lymphoblastic leukemia, lymphoma, or those undergoing blood marrow transplant. The complexity of care is significantly higher, necessitating greater caregiver burden following hospitalization. Eligible patients and their caregivers received post-hospitalization care education through an Oncology CarePartner Program addressing the patient's physical and emotional needs. The impact of the CarePartners program on caregiver burden was evaluated by the Oberst Caregiving Burden Scale (OCBS) and Bakas Caregiving Outcomes Scale (BCOS) on two oncology units (medical/oncology (n = 17) and blood marrow transplant (n = 21)) at three times: within 5 days of admission (T1), patient discharge from the hospital (T2), and 30 days post-discharge (T3). There were significant increases seen from T1-T2 (median = 4, p = 0.0007) and T1-T3 (median = 5.5, p = 0.003) in the BCOS. No significant changes in OCBS (time or difficulty) were seen. Standardized patient education helped improve caregivers' overall well-being but lacked in impacting the time spent and difficulty with caregiving tasks. Educational changes to address these specific areas or evaluation by different scales are both worth further investigation.

Self-care recommendations of middle-aged and older adults with sickle cell disease.

Self-care management is an important part of living with a chronic illness. Sickle cell disease (SCD) is a chronic disease with acute, painful exacerbations that often results in a shortened life expectancy. Some middle-aged and older adults with SCD lived with the disease prior to having a diagnosis and without modern advances. The purpose of this study is to share the self-care recommendations of middle-aged and older adults with SCD. Using descriptive qualitative methods, data were gathered through semistructured interviews from 11 individuals living with SCD, including 6 women and 5 men. Self-care recommendations themes included physiological, psychological, and provider-related. The self-care recommendations may be seen as an additional resource or "words of wisdom" for younger adults with SCD who can use the recommendations to better manage their own disease. Additionally, providers may be able to use these recommendations to inform their practice.

Life stories of older adults with sickle cell disease.

Sickle cell disease (SCD) is a chronic disease with acute, painful exacerbations that often results in a shortened life expectancy. We explored the life stories of middle-age and older adults with SCD to ascertain how they explain their longevity and how they see the place of SCD in their lives. Data were gathered using semi-structured interviews with 12 individuals living with SCD--seven women and five men. Respondents offered four main reasons for their longevity: self-care, supportive family/friends, a higher power, and medical care. Respondents reported life satisfactions of family, employment/education, and religious activities. The life stories reflect challenges of often living with a disease prior to diagnosis and without modern advances and the unpredictable nature of the disease. Their stories provide healthcare providers with insight into the supports SCD patients need to improve their health outcomes as they move through the life course.

Why do patients with cancer visit emergency departments? Results of a 2008 population study in North Carolina.

PURPOSE: Emergency departments (EDs) in the United States are used by patients with cancer for disease or treatment-related problems and unrelated issues. The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) collects information about ED visits through a statewide database. PATIENTS AND METHODS: After approval by the institutional review board, 2008 NC DETECT ED visit data were acquired and cancer-related visits were identified. Descriptive statistics and logistic regressions were performed. Of 4,190,911 ED visits in 2008, there were 37,760 ED visits by 27,644 patients with cancer. RESULTS: Among patients, 77.2% had only one ED visit in 2008, the mean age was 64 years, and there were slightly more men than women. Among visits, the payor was Medicare for 52.4% and Medicaid for 12.1%. More than half the visits by patients with cancer occurred on weekends or evenings, and 44.9% occurred during normal hours. The top three chief complaints were related to pain, respiratory distress, and GI issues. Lung, breast, prostate, and colorectal cancers were identified in 26.9%, 6.3%, 6%, and 7.7% of visits, respectively, with diagnosis. A total of 63.2% of visits resulted in hospital admittance. When controlling for sex, age, time of day, day of week, insurance, and diagnosis position, patients with lung cancer were more likely to be admitted than patients with other types of cancer. CONCLUSION: To the best of our knowledge, this is the first study to provide a population-based snapshot of ED visits by patients with cancer in North Carolina. Efforts that target clinical problems and specific populations may improve delivery of quality cancer care and avoid ED visits.

Quality of life domains among non-Hodgkin lymphoma survivors: an integrative literature review.

Survival rates of individuals with non-Hodgkin lymphoma (NHL) have increased in the past several years, as has the prevalence of older adults who are managing late and long-term effects of the disease and its treatment. In this integrative review, the state of the science for determining the quality of life (QOL) among NHL survivors is outlined. An online search of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and the Cochrane Library databases was conducted using the following Keywords: non-Hodgkin lymphoma, health-related quality of life, quality of life, and impact of cancer. Eighteen studies published between 2000 and 2010 are reviewed. Of these, 17 were descriptive, cross-sectional designs, and one was a systematic review. The studies included participants of varying ages and years post-diagnosis as reported in several countries. Importantly, many used one or more QOL measures as outcome variables. Future research is needed on older and minority cancer populations and should include longitudinal and interventional studies.

"Leaving the comfort of the familiar": fostering workplace cultural awareness through short-term global experiences.

PROBLEM: Facilitating the development of student nurses' cultural competence and translating these experiences into the clinical setting. METHODS: Qualitative methods. FINDINGS: A short-term global immersion experience informs student nurses' cultural awareness, education, and future clinical practice. CONCLUSIONS: Participation in a short-term global health experience contributes to students' personal growth and broadens their insight into multicultural care.

Immigrant women's cancer screening behaviors.

OBJECTIVES: Investigate the relationship between the dependent variable health outcome (perceived health status) and the independent variables population characteristics, (predisposing, which includes age, acculturation, months in the United States; enabling, which includes availability of medical insurance) and health behavior (personal health practices, which includes engaging in cancer screening of mammography, Pap smear, and breast self-exam) among immigrant women from the former Soviet Union. DESIGN: Descriptive correlational design was used with Andersen's Behavioral Model as the conceptual framework. SAMPLE: Convenience sample of 99 women, 18 years of age and older, was obtained from a community center. MEASURES: Demographic Information for Immigrants from the Former Soviet Union Survey (DIFSU) and Language, Identity, and Behavior Acculturation Survey (LIB) were used to collect data. RESULTS: Younger women were more likely to have a Pap smear and consider their health status as good or excellent; those with better English language skills were more likely to conduct breast self-exam but considered their health status as poor or fair; having insurance was positively correlated with having a Pap smear; the longer women were in the United States, the more likely they were to receive a mammogram. The model indicated that age and language acculturation significantly predicted health status. CONCLUSION: Given the incidence of breast cancer in the United States, the results highlight women in need of interventions to help them understand the value of cancer screening behaviors.

Diabetes management and self-care education for hospitalized patients with cancer.

Managing diabetes can be a daunting task for patients with cancer. Empowerment-based diabetes education and motivational interviewing are complementary approaches. Oncology nurses may feel unprepared to teach patients and their families about self-care for diabetes, but they provide individualized information on symptom management of cancer throughout hospitalization and at discharge. The essential self-care issues include food, exercise, medication, blood glucose monitoring, prevention, recognition and treatment of hypoglycemia and hyperglycemia, and when and how to get additional medical and educational support. This patient-centered model of diabetes education differs from the older "compliance" model that covers many universal rules for all patients, which are predetermined by the nurse. Informing nurses about their role in care of patients with cancer and diabetes is critical.

Symptom distress, spirituality, and quality of life in African American breast cancer survivors.

This study examined the relationships among the demographic characteristics, symptom distress, spirituality, and quality of life (QOL) of African American breast cancer survivors. A convenience sample of 30 survivors with a mean age of 56 years and a mean survival of 6 years was recruited from African American breast cancer support groups and churches in the Southeastern United States. Data were collected through face-to-face interviews using a demographic questionnaire, the Quality of Life Index-Cancer Version, the Symptom Distress Scale, and the Spiritual Perspective Scale. Statistically significant relationships were found between symptoms and QOL (r = -0.62, P < .05) and between spirituality and QOL (r = 0.70, P < .05). No statistically significant relationships were found between age at diagnosis, income, or education and QOL. This research suggests that symptoms and spirituality are associated with QOL. Culturally appropriate care should be provided to these women to reduce health disparities and to improve their QOL.

Priapism in the oncology setting.

CASE STUDY: N.L. is a 20-year-old Caucasian man with no significant medical history. He presented to the hospital with a two-day history of feeling ill with intermittent nausea, vomiting, blurred vision, and headache. He also noted slurred speech and left-upper-quadrant fullness for almost a month.