The association between the gut microbiome and fatigue in individuals living with cancer: a systematic review.

PURPOSE: Fatigue is the most distressing symptom for individuals with cancer. While numerous studies have investigated biological pathways that could underlie the mechanism of fatigue, the cause of fatigue remains unclear. This review aimed to investigate the association between gut microbial composition and fatigue in individuals with cancer. METHODS: Medline (PubMed), Embase (Elsevier), and CINAHL Complete (Ebscohost) were systemically searched on March 30, 2023, for articles investigating gut microbial composition (relative abundance, alpha diversity, and beta diversity) and fatigue in individuals with cancer; no limitations were placed on dates, participant age, nor cancer type/treatment. RESULTS: Microbial composition in the form of relative abundance was correlated with fatigue in six of the seven articles. A high relative abundance of g_Ruminoccocus was observed in individuals with low fatigue. An elevated relative abundance of g_Escherichia and f_Enterobacteriaceae was associated with high fatigue. However, other associations between fatigue and relative abundance composition, such as with g_Bifidobacterium and g_Faecalibacterium, had conflicting results. For alpha diversity and fatigue, the findings were contradictory; the association between beta diversity and fatigue was unclear due to conflicting results. CONCLUSIONS: Pro-inflammatory bacteria, such as f_Enterobacteriaceae, were more commonly associated with higher fatigue scores, while anti-inflammatory or short-chain fatty acid producing bacteria, such as g_Ruminoccocus, were linked with lower fatigue scores in individuals with cancer. The relationship between alpha and beta diversity and fatigue was inconclusive. Further investigation is needed to clarify whether gut microbial changes play a correlative or causal role in the development of fatigue in individuals with cancer.

"I don't have a choice but to keep getting up and doing the things that protect her": The informal caregiver's adaptation to the cancer diagnosis.

PURPOSE: Patients with hematologic malignancies (HM) typically rely on informal caregivers for support. Caregivers experience distress, poorer health, and lower quality of life. This study aimed to understand caregivers' experiences adapting to, and making meaning of, their family members' cancer diagnosis and treatment. APPROACH: Qualitative, constructivist approach. PARTICIPANTS: Caregivers (N = 28) of patients with HM within three months of diagnosis. METHODS: A descriptive content analysis was used to analyze semi-structured interview responses and generate themes. FINDINGS: Six themes emerged: power and control (powerlessness, empowerment, relinquishing control/accepting help), protection (gatekeeping, protective buffering), integrating the diagnosis, tolerating uncertainty, preparedness for the caregiver role, and maintaining positivity. CONCLUSIONS: Findings highlight challenges and resilience-promoting processes for caregivers adapting to HM diagnosis and treatment. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: Psychological and supportive care interventions can promote acceptance of the diagnosis, preparation for caregiving, navigation of power and control, and targeted coping strategies.

Impact of a Hematologic Malignancy Diagnosis and Treatment on Patients and Their Family Caregivers.

OBJECTIVES: Hematologic malignancies (HMs) are life-threatening cancers that frequently entail aggressive, long, inpatient treatment protocols. This can result in numerous concurrent symptoms and decreased quality of life for patients and can affect family caregivers (FCs). This study examined the impact of an HM diagnosis on patients and on their FCs. SAMPLE & SETTING: A descriptive design was used to explore the experiences of 28 newly diagnosed patients and their FCs. All patients were receiving treatment on an inpatient acute oncology unit at a National Cancer Institute-designated cancer center. METHODS & VARIABLES: Semistructured, separate interviews with patients and FCs were recorded and transcribed verbatim. Textual and content analyses were conducted to generate common themes. RESULTS: Patients and FCs reported how diagnosis and treatment affected them physically, emotionally, logistically, and financially. They described the effects of their experiences with the health system and providers in areas such as diagnostic process, trust in the medical team, support needs, and hospitalization. IMPLICATIONS FOR NURSING: Understanding the parallel experiences of patients with HMs and their designated FCs allows researchers to develop targeted interventions and enables clinicians to provide personalized patient- and family-centered care.

How Caregivers Cope and Adapt When a Family Member Is Diagnosed With a Hematologic Malignancy: Informing Supportive Care Needs.

BACKGROUND: Informal family caregivers (FCs) of adults with various diseases including hematologic malignancy (HM) experience low quality of life and psychological well-being. Although HMs are life-threatening cancers associated with high mortality, numerous symptoms, and lengthy hospitalizations and are therefore likely to be challenging for FCs to cope with, there is scant research exploring FC experiences. OBJECTIVE: The aim of this study was to describe the coping and adaptation of FCs of patients during diagnosis and treatment of HM. METHODS: This study used a qualitative descriptive design to analyze semi-structured interview responses from FCs (N = 28) within 3 months of the patients' HM diagnosis. A content analysis was conducted to generate common themes. RESULTS: Family caregivers endorsed adaptive and maladaptive coping. Adaptive strategies included taking one day at a time, spirituality, engaging in pastimes, and utilizing emotional and instrumental family and community support. Maladaptive coping included wishful thinking, harmful habits, avoidance, and lacking or being unable to accept family and community support. CONCLUSIONS: Findings highlight the complexities of caregiver burden as they support their loved ones with HM. IMPLICATIONS FOR PRACTICE: Family caregivers would benefit from receiving an interdisciplinary family-centered approach as their HM person is initiating treatment. Nurses should consider assessing the FCs' psychosocial needs to help facilitate appropriate services, such as palliative care consultations, social work referrals, support groups, and/or counseling.

The relationship between emotional well-being and understanding of prognosis in patients with acute myeloid leukemia (AML).

PURPOSE: Adults with acute myeloid leukemia (AML) face considerable distress and often have a poor prognosis. However, little is known about these patients' perceptions of prognosis and how this relates to emotional well-being (EWB). METHODS: We conducted a prospective, observational study of 50 adult patients with AML initiating chemotherapy, and surveyed them longitudinally for 6 months about their prognosis, treatment goals, quality of life, and EWB (by FACT-G). We derived a prognostic estimate for each patient based on data from published trials summarized in National Comprehensive Care Network Guidelines. We used descriptive statistics and longitudinal modeling to test the hypothesis that more accurate prognostic awareness is associated with worse EWB. RESULTS: Most patients (n = 43; 86%) had an objectively poor prognosis attributable to relapsed disease, complex karyotype, or FLT3 mutation. Yet, 74% of patients reported expecting a 50% or greater chance of cure. Patients with a poor prognosis more often had discordant prognostic estimates, compared to those with favorable risk AML (OR = 7.25, 95% CI 1.21, 43.37). Patient-reported prognostic estimates did not vary significantly over time. At baseline, patients who better understood their prognosis had worse EWB and overall quality-of-life scores (EWB 12 vs. 19.5; p = 0.01; FACT-G 65 vs. 75.5; p = 0.01). CONCLUSION: Patients with AML overestimate their prognosis, and awareness of a poor prognosis is associated with worse emotional well-being. Efforts are needed to improve patients' understanding of their prognosis, and to provide more psychosocial support and attention to well-being as part of high-quality leukemia care.

Psychological and Financial Distress Management in Adults With Acute Leukemia.

OBJECTIVES: To review and summarize psychological and financial distress in adults with acute leukemia and provide evidence-based methods that nurses can apply to alleviate distress experienced by patients. DATA SOURCES: Oncology and palliative care literature published over the past decade. CONCLUSION: Current evidence supports the efficacy of psychosocial interventions to improve psychological well-being and reduce distress for adults undergoing treatment for leukemia. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a critical role, not only in identifying patients who are experiencing impaired psychological well-being and high levels of distress, but also in providing prompt support to these patients.

Psychosocial Experiences of Young Adults Diagnosed With Acute Leukemia During Hospitalization for Induction Chemotherapy Treatment.

The diagnosis of cancer for anyone is a time of fear and uncertainty. For young adults (YAs) diagnosed with acute leukemia (AL), there are the additional challenges related to lengthy aggressive in-hospital treatment, multiple concurrent symptoms, and decreased well-being. The purpose of this study was to explore the experiences of YAs with AL undergoing induction chemotherapy. This study used a nested qualitative longitudinal design with a convenience sample. Qualitative data were collected using semistructured interviews, and participants were invited to maintain journals. The semistructured interviews were audiotaped, transcribed, and loaded into Atlas.ti for analysis. Common themes and categories were verified and used to disseminate the findings. Seven YAs, mean age 32 (SD, 4) years, participated in this study. Three thematic classifications emerged: getting through, supported yet isolated, and information exchange preferences, which detail how these YAs processed and coped during treatment. The findings from this study provide important insights for nurses regarding coping mechanisms that YAs apply, which included relying on technology and social media platforms. Additionally, the YAs in this study discussed their need for information. The findings from this study may provide insights for clinicians currently caring for YAs with AL, while also directing future palliative care research endeavors.

Emerging Models of Providing Oncology Palliative Care.

OBJECTIVE: To describe palliative care integration into oncology, including several models that facilitate this integration, important considerations when initiating a program, special oncologic populations that would benefit from palliative care, and challenges to consider. DATA SOURCES: Palliative care and oncology literature over the past decade. CONCLUSION: Multiple models exist to facilitate the integration of palliative care based on the needs of the providers or payers. There are several special populations that would benefit from early integration of palliative care. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a critical role in identifying patients, providing early primary palliative care, and facilitating collaborative relationships with and referring to specialist palliative care.

Social Media: Support for Survivors and Young Adults With Cancer

Social media use is ubiquitous among young adults. Young adults with cancer must make important decisions about where, what, and how to share information on social media. Oncology nurses are in a unique position to start conversations about the risks and benefits of social media use. This column aims to review a variety of social media platforms that may be used by young adults with cancer and provide guidance to nurses on initiating open dialogue with young adults about social media usage. 
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Symptom Management and Psychosocial Needs of Adults With Acute Myeloid Leukemia During Induction Treatment: A Pilot Study.

BACKGROUND: Patients with a new diagnosis of acute myeloid leukemia (AML) are at risk of experiencing a high symptom burden due to the disease and its treatment, which includes a long period of hospitalization. OBJECTIVE: The aim of this pilot work was to describe the multidimensional symptoms and health-related quality of life experienced by patients with a new diagnosis of AML across induction chemotherapy. METHODS: A prospective, longitudinal descriptive study design was implemented to evaluate symptoms and health-related quality of life at the time of enrollment through 6 weeks postdiagnosis and identify who might be most at risk of experiencing high symptom burden. RESULTS: A total of 19 participants were included in this analysis. Moderate to severe levels of distress were present in 25% to 50% of participants, depending on timing in treatment. Females and those with a previous history of a psychological disorder reported higher symptom burden during treatment. CONCLUSIONS: Our findings indicate that adults with AML experience multiple distressing symptoms during the induction treatment. IMPLICATIONS FOR PRACTICE: Timely routine multidimensional assessment of symptoms in individuals undergoing induction chemotherapy treatment for AML is critical as they may be experiencing multiple concurrent symptoms. Additional research to advance symptom assessment and amelioration of distressing symptoms to improve health-related quality of life is needed in this unique population.

The unique supportive care needs of a mother with acute myeloid leukemia during treatment.

Acute myeloid leukemia (AML) is an aggressive cancer of the blood that is linked with poor survival. The disease requires immediate intensive chemotherapy treatment that leaves patients hospitalized for at least one month and often longer, depending on their supportive care needs. Mothers undergoing treatment for AML may benefit from having attention paid to their supportive care needs during that time.

Physiologic and psychological symptoms experienced by adults with acute leukemia: an integrative literature review.

PURPOSE/OBJECTIVES: To evaluate the current knowledge of symptoms experienced by adults with acute leukemia (AL) and provide evidence to inform practice and research. DATA SOURCES: Literature review using an electronic search supplemented by a hand search of current literature reporting the physiologic and/or psychological symptoms of patients with AL was conducted. DATA SYNTHESIS: Because of the variability found in the methods and specific aims of the articles, a rating system was applied to score how strongly the findings contributed to meeting the aims of the research. This rating system was applied to assist the authors in analyzing the findings. Therefore, the articles that scored lower ultimately contributed less during the analysis phase. CONCLUSIONS: Knowledge regarding the symptoms experienced by adults undergoing treatment is being slowly evaluated. However, to better understand and subsequently manage these symptoms, longitudinal research examining the symptom trajectories in this population is needed. IMPLICATIONS FOR NURSING: Additional investigation into symptom characteristics will facilitate the development of tailored interventions to manage the temporal characteristics of symptoms for this population.

Distress in patients with acute leukemia: a concept analysis.

BACKGROUND: Patients with acute leukemia (AL) require immediate and aggressive inpatient treatment that results in many weeks to months of hospitalization. Thus, it is not surprising that distress has been found in as many as 45.5% of patients. Although distress is a regularly reported outcome measure in clinical research, currently, there is a lack of a clear, consistent, and universal definition of this concept. OBJECTIVE: The purposes of this article were to examine the current state of the science surrounding the concept of distress and to propose a model of distress for patients with AL. INTERVENTIONS/METHODS: The Walker and Avant framework was used to guide the analysis of the concept of distress in patients with AL. The findings from this analysis were then used to generate a model guided by the current science. RESULTS: Distress in AL is generally accepted as multidimensional, quantifiable, subjective, and temporal. Antecedents to distress include demographics, intrinsic factors, social support, disease progression, treatment, and communication. Consequences to distress include decreased quality of life, patient outcomes, as well as the severity of physical and psychological symptoms. CONCLUSIONS: Distress is an outcome measure that is frequently assessed and reported within the literature. The operationalization of distress varies by investigator, limiting its generalizability. IMPLICATIONS FOR PRACTICE: The proposed conceptual model may be used to guide further research on distress in patients with AL at high risk for negative outcomes. Improved understanding of patient distress may guide interventions aimed at managing the psychosocial needs for patients receiving treatment for AL.

Young women's experiences with complementary therapies during cancer described through illness blogs.

Many young women with cancer have a high symptom burden and negative psychosocial consequences as a result of their disease. To offset some of these experiences, a growing number of young women with cancer are writing about their experience with complementary therapies through online illness blogs. The purpose of this qualitative study was to examine descriptions of complementary therapy use among young women (diagnosed between 20 and 39 years of age) who maintained an online cancer blog. Women's narratives describe several themes of the experience of using complementary therapies including awakening, new identities (that incorporate loss), the good stuff, and release. Online illness blogs allow researchers to understand the complete experience of the patient through personal accounts and substantially contributes to the body of knowledge surrounding cancer in young adulthood and complementary therapy use.

No stone left unturned: challenges encountered during recruitment of women with advanced ovarian cancer for a phase I study.

The recruitment and accrual of participants for cancer clinical trial research is often challenging. Chronic low accrual rates negatively influence the findings and generalizability that can be drawn from the available pool of research. There is a need for further evidence regarding both unsuccessful and successful approaches and useful strategies that investigators have used to counter common recruitment challenges. During recruitment for an intervention study examining the safety, efficacy, and feasibility of a potentially novel supportive therapy, a variety of steps were taken to avoid and subsequently overcome potential and real recruitment challenges the investigators faced. In this article the authors provide an overview of common recruitment challenges as well as the actual challenges encountered, procedures and strategies implemented to counter these challenges, while investigating the combined intervention of flaxseed oil, fasting, caffeine, and exercise in women with recurrent or multi-drug resistant stage III or IV ovarian cancer.

A complementary care study combining flaxseed oil, caffeine, fasting, and exercise in women diagnosed with advanced ovarian cancer: findings from a case study.

This article presents the experiences of 1 participant with advanced ovarian cancer enrolled in a proof of concept complementary therapy study evaluating the effects of a combined intervention of flaxseed oil, fasting, caffeine, and exercise. Improvements were observed in physical and psychological symptoms. The participant adopted positive lifestyle modifications.

Management of Cancer Related Distress in Patients with a Hematological Malignancy.

Patients with hematologic malignancies often require urgent, aggressive, and lengthy chemotherapy treatment. These treatment regimens, divided into cycles, result in extended, often isolating periods of hospitalization where any direct clinical benefit for the patient, such as remission or "no evidence of disease" is not immediately declared. Consequently, this population is at a high risk of experiencing severe levels of cancer related distress. Cancer related distress is a complex psychosocial phenomenon that has consequences for patients, their families as well as the healthcare staff. Thus the importance of prevention, early recognition, treatment and management is unquestionable. Nurses have an important role to help identify and manage the presence of cancer related distress in these patients, as well as their family's. Nurses should work proactively in close partnership with an interdisciplinary team to effectively provide the necessary support for patients experiencing or who are at risk for high levels of cancer related distress. This case study and subsequent discussion illustrates the symptom management needs and challenges related to cancer related distress in the patient with a hematologic malignancy. Current evidence-based practice guidelines for the assessment and management of cancer related distress will be presented.

Physical activity in patients with advanced-stage cancer: a systematic review of the literature.

The importance of physical activity for chronic disease prevention and management has become generally well accepted. The number of research interventions and publications examining the benefits of physical activity for patients with cancer has been rising steadily. However, much of that research has focused on the impact of physical activity either prior to or early in the cancer diagnosis, treatment, and survivorship process. Research focusing on the effects of physical activity, specifically for patients with advanced-stage cancer and poorer prognostic outcomes, has been addressed only recently. The purpose of this article is to examine the state of the science for physical activity in the advanced-stage disease subset of the cancer population. Exercise in a variety of intensities and forms, including yoga, walking, biking, and swimming, has many health benefits for people, including those diagnosed with cancer. Research has shown that, for people with cancer (including advanced-stage cancer), exercise can decrease anxiety, stress, and depression while improving levels of pain, fatigue, shortness of breath, constipation, and insomnia. People diagnosed with cancer should discuss with their oncologist safe, easy ways they can incorporate exercise into their daily lives.