Unplanned emergency department visits and hospital admissions of older adults under treatment for cancer in the ambulatory/community setting.

PURPOSE: This study aims to identify the incidence and risk/protective factors for (1) unplanned emergency department (ED) visits and hospital admissions (HA) and (2) nausea/vomiting/dehydration (NVD) at time of treatment in older adults under treatment for cancer. MATERIALS AND METHODS: This is a exploratory retrospective cohort study of adults (60 and older) with cancer. Adults were included if they had a new cancer diagnosis and were being treated with chemotherapy. Study outcomes included the number of ED visits and HA (cycles 1-4) and NVD at the time of receiving chemotherapy (cycles 2-4). Repeated measures, Poisson regression was used to obtain risk ratios with 95% confidence intervals for independent predictors of outcomes. RESULTS: Of 402 study participants, 20% experienced an ED visit, and 18% experienced a HA. Common reasons for ED visits were pain (23.5%) and NVD (20.4%). Common reasons for HA were infection (34.4%) and NVD (22.2%). Multivariate analysis showed risk factors for ED visits included chemotherapy cycle 1, having esophageal cancer, being treated with ≥ 3 chemotherapy agents, and increasing levels of functional impairment. Risk factors for HA included chemotherapy cycle 1, increasing levels of functional impairment, intravenous fluids between treatment, and being prescribed antiemetics for home use. Predictors of NVD at time of chemotherapy treatment included Hispanic ethnicity, insurance status, cancer type, chemotherapy emetic potent, treatment frequency, intravenous fluids between cycles, and number of home antiemetics. CONCLUSION: Unplanned ED visits and HA occur in older adults under treatment for cancer due to numerous treatment-related side effects. Helping older adults identify and manage side effects early may reduce the number of unplanned admissions.

Advances and Challenges: Student Reflections From an Online Death and Dying Course.

This study describes nursing students' reflections on taking an online course on death and dying. In a semistructured paper, students described fears of caring for clients at end of life (EOL), important content learned, and remaining discomforts. Data were analyzed using directed content analysis. Consistent themes were noted among the papers. Student reflections on the knowledge they gained closely followed initial fears. Several students appreciated the ability to reflect on their experiences in a nonjudgmental setting. Overall, the data showed that nursing students can become more confident in EOL care through online education. Knowledge gains and continued fears about the same topics suggest EOL confidence lies along a continuum and may require ongoing education. Future research should focus on offering online continuing education on EOL to practicing nurses.

A Pap test does not screen for everything: nurse practitioner knowledge of ovarian cancer.

PURPOSE: Nurse practitioners (NPs) are in a prime position to educate women about initial signs and symptoms of ovarian cancer (OC) and perform appropriate screening tests. However, little is known about NPs knowledge regarding OC. This article's purpose is to present the outcomes of a focused OC awareness program for NP students. DATA SOURCES: NP students (N = 104) participated in this longitudinal one group pre-post study. Knowledge was calculated based on the number of correct answers for a total knowledge score and subscales related to OC incidence, risk, screening, symptoms, and treatment. An item related to the effectiveness of the Pap test to screen for OC was evaluated separately. CONCLUSION: Knowledge deficits continue to exist related to OC, emphasizing the need for NPs to be aware of risk factors, symptoms, and early detection options for women with average risk. Many NP students erroneously believed a Pap test was an effective screening tool for OC. IMPLICATIONS FOR PRACTICE: Many NPs are inadequately prepared to assess risk, detect early symptoms, and perform screening tests for OC. Continuing education and reinforcement about OC is essential if NPs are to provide appropriate education to clients and detect this deadly disease as early as possible.

Developing the Tracheostomy Care Anxiety Relief Through Education and Support (T-CARES) Program.

Home care of a patient with a tracheostomy after surgery for head and neck cancer requires caregivers to be comfortable with handling medical equipment and to be competent and proficient with completing many new and complex tasks. However, the responsibility of managing an artificial airway may increase caregiver anxiety, which may subsequently lead to improper care of the patient with head and neck cancer and increase the risk for complications and rate of readmission to oncology units. This article describes the development and outcomes of the Tracheostomy Care Anxiety Relief Through Education and Support (T-CARES) program, developed in response to high readmission rates for patients with head and neck cancer discharged with a tracheostomy. T-CARES consists of an 18-minute video demonstration, group discussion, return demonstration, and skills assessment. The course also incorporates hands-on practice on a low-cost anatomical task trainer created by the authors. A significant reduction in caregiver anxiety was noted after participation in the T-CARES program. T-CARES and similar programs can be developed to teach self-care for a variety of conditions that patients and caregivers are expected to manage at home.

"A bump in the road": older women's views on surviving breast cancer.

Due to the aging of the Baby Boomer generation, surviving with breast cancer will become more common, but also more complicated, as older women are often dealing with additional chronic illnesses and problems of aging. The purpose of this qualitative study was to explore how older women view surviving breast cancer in context with aging. Findings suggest that most women are able to put their cancer experience in the background and come to view breast cancer as a bump in the road through expecting illness with aging, putting cancer in perspective, and sensing a partnership.

Posttreatment concerns of older women with early-stage breast cancer.

BACKGROUND: The majority of older (aged ≥65 years) women diagnosed with breast cancer are in the early stage. However, little is known about older women's posttreatment concerns in the early stages of survivorship. OBJECTIVES: The purpose of this study was to describe posttreatment-related concerns of older, early-stage breast cancer survivors. METHODS: Fifty older women who completed treatment for early-stage breast cancer participated. Participants were interviewed within the first year since diagnosis. Content analysis was used to analyze transcripts about concerns after treatment. RESULTS: Older women experienced treatment-related adverse effects, but often discussed non-cancer-related concerns as being more pressing than concerns from breast cancer. Older women accepted treatment-related adverse effects as part of life and often attributed adverse effects to causes other than breast cancer. Older women also engaged in "compartmentalization," in which they separated past cancer experiences from everyday life. CONCLUSION: Non-cancer-related concerns often overshadowed concerns from having had breast cancer. Compartmentalization was used to cope with cancer as a past, not current event. IMPLICATIONS FOR PRACTICE: New insights on how older women view their disease after treatment can guide nurses in educating older breast cancer survivors about treatment-related adverse effects.

Preliminary evaluation of psychoeducational support interventions on quality of life in rural breast cancer survivors after primary treatment.

Although most cancer survivors are at risk for being lost in the transition from treatment to survivorship, rural breast cancer survivors face special challenges that might place them at particular risk. This small-scale preliminary study had 2 specific aims: (aim 1) establish the feasibility of rural breast cancer survivors participation in a longitudinal quality of life (QOL) intervention trial and (aim 2) determine the effects of the Breast Cancer Education Intervention (BCEI) on overall QOL. Fifty-three rural breast cancer survivors were randomized to either an experimental (n = 27) or a wait-control arm (n = 26). Participants in the experimental arm received the BCEI consisting of 3 face-to-face education and support sessions and 2 face-to-face and 3 telephone follow-up sessions, along with supplemental written and audiotape materials over a 6-month period. Breast Cancer Education Intervention modules and interventions are organized within a QOL framework. To address the possible effects of attention, wait-control participants received 3 face-to-face sessions and 3 telephone sessions during the first 6 months of participation in the study, but not the BCEI intervention. Research questions addressing aim 1 were as follows: (a) can rural breast cancer survivors be recruited into a longitudinal intervention trial, and (b) can their participation be retained. Research questions for aim 2 were as follows: (a) do participants who received the BCEI show improvement in overall QOL, and (b) is the QOL improvement sustained over time. Data were analyzed using repeated-measures general linear mixed models. Results demonstrated the ability to recruit and retain 53 rural breast cancer survivors, that the experimental arm showed improvement in overall QOL (P = .013), and that there were significant differences in overall QOL between the experimental and wait-control groups at both months 3 and 6. Thus, it appears that at least some rural breast cancer survivors can and will participate in a larger trial and will maintain their participation and that those that do participate experience significant QOL benefit.

Quality of life in older women with early-stage breast cancer in the first year of survivorship.

PURPOSE/OBJECTIVES: To describe quality-of-life (QOL) changes in older women with early-stage breast cancer in the first year of survivorship and report on the effectiveness of a psychoeducational intervention on survivors' QOL. DESIGN: Secondary analysis, descriptive, repeated measure. SETTING: An academic setting in the southeastern United States. SAMPLE: 50 early-stage breast cancer survivors, aged 65 years and older. METHODS: Data were drawn from the Breast Cancer Education Intervention (BCEI) research study. Data for a six-month time period within the survivors' first year were available for an experimental group participating in a psychoeducational intervention and a control group. MAIN RESEARCH VARIABLES: Overall QOL and physical, psychological, social, and spiritual well-being subscales. FINDINGS: Older women reported positive overall QOL within the first year of survivorship, but overall QOL declined slightly over time. Physical and psychological well-being declined over time. Social well-being initially improved over time, but then declined. Spiritual well-being initially declined over time, then improved. Survivors had a downward trend in overall QOL during the study time period; however, experimental group participants had a smaller decline in QOL compared to control group participants. CONCLUSIONS: QOL in older breast cancer survivors within the first year is positive. However, overall QOL declines over time. The BCEI attenuated decline of QOL in the experimental group compared to the control group. IMPLICATIONS FOR NURSING: Few studies focus on older breast cancer survivors. This descriptive study is one of the first to describe changes in QOL and report the effect of interventions for older breast cancer survivors. Oncology nurses are in a position to recognize QOL issues and help older women maintain QOL in the first year of survivorship after treatment.

Application of the CuSum technique to evaluate changes in recruitment strategies.

BACKGROUND: While lagging subject enrollment in longitudinal clinical trials is a complex problem, the best recruitment strategy has not been established. Cumulative summation (CuSum) is a statistical process control procedure often applied in quality improvement efforts to detect trend shifts in highly variable serial data. OBJECTIVES: To describe changes in efforts to increase referrals and enrollment in a longitudinal quality-of-life breast cancer study, determine effects of changes in referral strategies on enrollment using a novel application of CuSum, and discuss implications of CuSum as a tool for prospectively managing the subject recruitment process. METHOD: Ten referrals and eight enrollments per month for a total of 31 months were estimated to meet study subject accrual requirements in the clinical trial. The estimates were used as standards in performing CuSum calculations. CuSum was applied to monthly referral and enrollment data and trend graphs were generated. Alterations in recruitment tactics and strategies were evaluated as to whether changes in trend occasioned such alterations. Unplanned changes in trend were noted. RESULTS: While monthly data were highly variable, an average of 8.42 referrals and 5.92 enrollments were realized during Months 1-12. Based on these figures, projected accrual for 31 months would have enrolled only 184 subjects, 66 subjects short of target. CuSum illustrated this trend. Subsequent shifts in enrollment trends were shown with improvements in referral. DISCUSSION: Indications for use of CuSum include (a) earlier detection of enrollment trend shifts, and (b) earlier discrimination between effective and ineffective recruitment. Thus, CuSum has implications for both evaluating the effects of planned and unplanned process changes and for managing the recruitment process.

Interventions that address cancer health disparities in women.

Health disparities exist in cancer incidence and mortality rates among certain populations. Women of low socioeconomic status and minority women are at particular risk for not adhering to recommended cancer screening guidelines. Such behaviors may contribute to disparities when cancers are discovered at later stages, contributing to higher mortality rates in these women. Barriers to screening tests exist and are factors in preventing women from accessing available screening tests for breast and cervical cancer. Once barriers are identified, interventions can be developed to reduce certain health disparities. This article is a review of the literature that focuses on interventions that have been successful in addressing barriers that interfere with cancer screening in women.

Cardiac toxicity related to cancer treatment.

Cardiac toxicity is a dose-limiting toxicity that may occur during cancer treatment or several years after therapy ends. Cardiac toxicity may be caused by chemotherapy, biotherapy, and radiation therapy and may result in cardiomyopathy, congestive heart failure, dysrhythmias, and myocardial ischemia. The risk for developing cardiac toxicity varies based on type of treatment, patient age, presence of preexisting or concurrent heart disease, and concomitant treatment. Patients at high risk require careful evaluation and monitoring during and in the years following therapy to detect cardiac changes. Fortunately, cardioprotective agents and newer radiation therapy techniques decrease the risk for treatment-related cardiac toxicity. Oncology nurses can become more informed in the assessment of cardiac toxicity and can arm themselves with knowledge about early identification of symptoms as well as specific agents and treatments that increase risk for cardiac toxicity.