Attitudes, challenges and needs about diet and physical activity in endometrial cancer survivors: a qualitative study.

With rates of endometrial cancer survival increasing, there is growing interest about lifestyle behaviours that could improve quality of life and reduce the risk for chronic diseases. This study aimed to explore the attitudes, challenges and needs of endometrial cancer survivors regarding diet and physical activity. Sixteen UK-based endometrial cancer survivors participated in two focus groups (n = 5, n = 3) or individual telephone interviews (n = 8), using a semi-structured interview guide. Data were collectively analysed by two researchers until consensus was reached on a coding structure. Data analysis proceeded until themes were identified. Participants were within 5 years post-cancer treatment with median age and BMI of 57 years and 25.8 kg m-2 respectively. Three themes were identified: (1) defining a healthy lifestyle, (2) factors influencing diet and physical activity and (3) needing to search for information. Results suggest interventions should incorporate recommendations on managing late-treatment effects, and behaviour change techniques for cognitive, practical and social barriers to healthy lifestyle changes. Healthcare professionals are in a vital position to provide or introduce endometrial cancer survivors to in-person behaviour change interventions at the early post-treatment period.

Breast cancer detection: knowledge, attitudes, and behaviors of women from Pennsylvania.

PURPOSE/OBJECTIVES: To assess relationships among breast cancer detection behaviors and selected variables in healthy women. DESIGN: Correlational study. SETTING/SAMPLE: A sample of 1,000 women was selected randomly from the 16,500 members of the General Federation of Women's Clubs of Pennsylvania. Respondents (N = 538; 54% response rate) were predominately white, well educated, lived in urban areas, and had an average age of 60 years. METHODS: Mailed packets with a professionally designed, scannable survey instrument that included questions related to detection behaviors, a risk index, health behaviors, attitudes, and knowledge. MAIN RESEARCH VARIABLES: Breast cancer detection behaviors: mammography, clinical breast examination (CBE), breast self-examination (BSE). Structural/demographic variables: age, education, residence, knowledge of breast cancer and detection methods, teaching history, encouragement, and risk index (family/medical history). Predisposing variables: susceptibility, benefits/barriers, confidence, social norms and influence, and general health motivation. FINDINGS: Women reported moderate/high adherence to recommendations for early detection of breast cancer. Mammography behavior was predicted by older age, being encouraged by a doctor or nurse, and greater risk. CBE predictors were greater knowledge and risk along with greater benefits, social norms, and health motivation. BSE behavior was predicted by having had BSE technique checked, greater knowledge, greater risk, decreased barriers to BSE, and higher health motivation. CONCLUSIONS: Common predictors of breast screening behaviors include risk (family/medical history), knowledge, and general health motivation. IMPLICATIONS FOR NURSING PRACTICE: Educational efforts can be designed specifically to influence variables related to compliance with early breast cancer detection behaviors.

The menopausal symptom experience in young mid-life women with breast cancer.

Menopausal symptoms are important concerns for breast cancer survivors, which may influence daily activities, physical comfort and sexual health. Incidence and severity ratings of menopausal symptoms contribute to our knowledge about menopause in women with cancer, but fail to fully describe the symptom experience. The purpose of this article is to broaden our understanding by describing variation in menopausal symptom distress and how women interpret and manage symptoms within the context of breast cancer. From a larger grounded theory study that explored women's responses to the experience of premature induced menopause within the context of breast cancer, the constant comparative method of analysis was used to generate a detailed contextually grounded description of the menopausal symptom experience in a sample of 27 women with breast cancer who received adjuvant therapy. Women identified a symptom profile of menstrual cycle changes, hot flashes, insomnia, vaginal dryness, dyspareunia, alterations in mood, cognition and libido, and weight gain. The majority of women reported menopausal symptoms but some women were distress free while others reported moderate to severe distress. The context of breast cancer influenced women's response to symptoms and their decision making about menopausal symptom management.

Weight gain and quality of life in women treated with adjuvant chemotherapy for early-stage breast cancer.

PURPOSE/OBJECTIVES: To document weight gain in women treated with adjuvant chemotherapy for early-stage breast cancer and to examine the relationship of weight gain and perceived quality of life (QOL). DESIGN: Descriptive, correlational study. SETTING: Data collected in three settings: an ambulatory oncology service of a university teaching hospital, a private oncology office, and a university-affiliated health clinic, all located in southern New England. SAMPLE: Women with stage I or II breast cancer with primary treatment of simple or modified mastectomy or breast-conserving surgery with radiotherapy scheduled to receive adjuvant chemotherapy. METHODS: Weight data collected through retrospective chart review. QOL data collected prospectively using the Linear Analog Self Assessment Symptom Distress Scale for Breast Cancer and the Functional Assessment of Cancer Therapy for Breast Cancer Scale. MAIN RESEARCH VARIABLES: QOL and weight gain of five pounds or more. FINDINGS: One year after treatment began, 62.5% of the study participants experienced weight gain (X = 10.44 lb), with a range of 5-27 pounds. After two and three years, 68% and 40%, respectively, maintained a clinically significant weight gain. A greater weight gain occurred over time in premenopausal women. No correlation between overall QOL and weight gain existed, but selected items were significantly positively correlated with weight gain. CONCLUSIONS: This study documented a significant weight gain in women treated with adjuvant chemotherapy for early-stage breast cancer. A large percentage of those women maintained this weight gain. Women premenopausal at diagnosis had a greater tendency to gain weight. Although weight gain was not correlated with overall QOL it was distressing for these women. IMPLICATIONS FOR NURSING PRACTICE: Nurses can incorporate the possibility of weight gain into the plan of care for women with breast cancer. Nurses should include this information in education about side effects of treatment and in the ongoing nursing assessment of patients with breast cancer.

Natural menopause and ovarian toxicity associated with breast cancer therapy.

PURPOSE/OBJECTIVES: To provide essential knowledge of the physiologic changes and symptoms associated with declining ovarian function as a basis for assessment and intervention of premenopausal women treated for breast cancer. DATA SOURCES: Published articles selected from computerized databases; reference texts and lay publications on women's health and menopause. DATA SYNTHESIS: In healthy mid-life women, the years preceding and immediately following menopause are characterized by hormonal changes that result in altered menstrual bleeding patterns that progress to cessation of menses. These physiologic changes may be associated with hot flashes; changes in the vaginal epithelium; and mood, cognitive, and sleep alterations that are described as early menopausal symptoms. Adjuvant therapy for breast cancer suppresses ovarian function resulting in a wide variability of menstrual patterns, hormonal changes, and symptom experiences among treated premenopausal women. The natural perimenopausal transition informs our understanding of women who experience chemotherapy-induced premature menopause. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of the underlying physiology and symptom experience of natural and drug-induced menopause provides a foundation for oncology nurses. This foundation is essential to assessment and clinical decision making in the care of women with breast cancer.

Improving the cancer chemotherapy use process.

PURPOSE: Reports of the tragic consequences of erroneous cancer chemotherapy overdoses at a prominent cancer center and a university hospital prompted a review of our institution's practices and those of 123 other hospitals to ascertain for each the current in-house process to prevent chemotherapy errors. METHODS: A multidisciplinary committee of oncologists, nurses, and pharmacists reviewed the chemotherapy use process and identified opportunities for improvement. A 1-page facsimile survey was answered by 150 of 215 members of the American Society of Clinical Oncology (ASCO) who received it. RESULTS: We further restricted the writing of cytotoxic chemotherapy orders to physicians who were board-certified or -eligible in hematology or medical, pediatric, and gynecologic oncology and their approved fellows. Dispensation of drugs is limited to oncology-certified pharmacists, and administration to chemotherapy-certified nurses. Standard orders are used either on special oncology forms or designated order sets in the computer. Procedures to regulate the ordering of antineoplastic drugs for nonmalignant indications by nononcology specialists are outlined. A process to prevent chemotherapy errors is in place in 95% of hospitals. Dedicated medical oncology units are ubiquitous, and most cancer centers and university hospitals have dedicated gynecologic and pediatric oncology units. Chemotherapy orders are generally written by oncology fellows and countersigned by an attending oncologist in cancer centers and university hospitals, whereas private oncology attending physicians write them in most community hospitals. Drugs are administered by oncology-certified nurses in most institutions. CONCLUSIONS: These recommendations should improve the safety and effective use of chemotherapy and reduce the error rate to as close to zero as human fallibility will allow.

Treatment options for early stage breast cancer.

The second of this two-part series addresses the numerous decisions patients face regarding treatment options for early stage breast cancer. Nurses must develop strategies to help patients clarify, interpret, and process information for decision-making, anticipating treatment outcomes, managing side effects and effects of role function.

Decision-making for primary breast cancer treatment.

Decision-making for breast cancer treatment is exceedingly complex. It depends on multiple variables: the woman's decision-making style, age, coping mechanisms, stage of disease, risk of recurrence, consideration for adjuvant therapy, state-of-the-art treatment recommendations, and personal preferences. This review, the first of a two-part series, addresses the informational needs of women with breast cancer. In "Treatment Options for Early Stage Breast Cancer" to be published in the August 1994 issue of MEDSURG Nursing, intervention strategies nurses can use to help meet these needs will be discussed.

Women and cancer.

Cancer will be diagnosed in more than a half a million women this year. Prognosis and curability are associated with the stage of the cancer at diagnosis. If cancer is detected at an early stage, more than 75% of women can expect long-term survival or cure for the most common cancers, excluding lung. Promoting health behaviors that reduce risk and recommending screening tests are critical activities for the practitioner that may affect survival rates and quality of life of women with cancer diagnoses. Risk factors, incidence, presenting symptoms, staging, treatment and 5-year survival rates associated with 12 major cancer sites in women are presented. Diagnosis and survival for minority populations are reviewed, highlighting the need to improve cancer screening and detection for this group of women.

Reconstructive surgery in primary breast cancer treatment.

The goal of breast reconstruction is achievement of symmetry and preservation or restoration of a positive body image. The two methods of reconstructive breast surgery are implantation of a prosthesis or a flap procedure using skin, with or without autologous tissue from a donor site. Factors that determine which method is most appropriate are based on predicted outcome, patient expectations, and patient risk factors associated with complications of surgery.

Symptoms and rehabilitation needs of patients with early stage breast cancer during primary therapy.

The treatment for women diagnosed with early breast cancer is complex, dynamic, and controversial. More choices are available for local control and indications for systemic adjuvant therapy have changed dramatically. Knowledge of predictable physical and psychological responses through the various phases of primary treatment is the first critical element for the rehabilitation of these oncology patients. The health care provider can then anticipate problems, prepare the patient with accurate information, and institute interventions early to minimize symptoms. Information and psychological needs dominate the diagnostic phase, during which communication and emotional support are of paramount importance for decision making. Psychological distress persists through the treatment phase regardless of the choice of mastectomy or breast conservation surgery with radiation. The physical symptoms of these choices are similar, primarily related to the axillary lymph node dissection. Fatigue, breast soreness, sensation, and skin changes are common symptoms with breast irradiation that resolve over time. Nausea, vomiting, fatigue, hair loss, menopausal symptoms, and weight gain are predictable chemotherapy-related side effects and are reported as mild to moderately distressful by the majority of patients. Consistency of information, support, collaboration, coordination of care, and communication among patients and health care providers are essential to meet the challenge of successful treatment and rehabilitation.

Physical and psychologic distress associated with adjuvant chemotherapy in women with breast cancer.

The incidence of physical toxicity and psychosocial effects associated with adjuvant chemotherapy for stage II breast cancer have been reported in previous studies. The purpose of this exploratory study was to quantify the degree of physical and psychologic distress experienced by patients and identify life-style changes. A semistructured interview was conducted with 78 subjects to elicit demographic data, distress, and life-style changes using the Symptoms Distress Scale (SDS), the Psychiatric Status Schedule (PSS), and questions and scales developed by the investigator. All subjects received adjuvant chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil with or without vincristine and prednisone) following primary treatment for breast carcinoma. Fifty subjects were currently on therapy and 28 had completed treatment. Fatigue was the most distressful physical symptom. Although physical distress was rated higher by subjects receiving treatment, generally all rating scores indicated only mild symptom distress. Subjects perceived more distress for the psychologic and emotional response to disease and treatment, and this persisted for women who completed therapy. Changes in role performance and daily activity were minimal.