Assessment and management of nausea and vomiting in cancer survivors.

ABSTRACT: Nausea and vomiting may occur in cancer survivors during or independent of treatment. A complete assessment is necessary to determine the etiology and to plan specific and successful interventions. NPs have a key role in managing cancer survivors' symptoms and determining the best supportive care.

ONS Guidelines™ to Support Patient Adherence to Oral Anticancer Medications.

PURPOSE: This evidence-based guideline intends to support patients, clinicians, and others regarding interventions and processes to support patient adherence to oral anticancer medications (OAMs). METHODOLOGIC APPROACH: A panel of healthcare professionals and patient representatives developed a clinical practice guideline to support patients taking OAMs. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology and criteria for trustworthy guidelines were followed. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. A quantitative or narrative synthesis of the evidence was completed. Certainty of the evidence was assessed using GRADE. FINDINGS: The panel agreed on recommendations and suggested an adherence risk assessment, education addressing adherence, ongoing assessment, proactive follow-up, coaching, and motivational interviewing in addition to usual care. The panel suggested the implementation of a structured OAM program. IMPLICATIONS FOR NURSING: As cancer treatment shifts from clinic to home settings, interventions and programs to support patients on OAMs are needed.

Affective determinants of physical activity in cancer survivors.

Objective: Research with non-cancer survivor populations finds affective variables to be important determinants of physical activity. This study assessed the ability of explicit and implicit affective variables to predict the physical activity of cancer survivors, above that accounted for by cognitive variables. The study also tested whether the affective variables were connected to physical activity directly or indirectly through their association with behavioural intentions. Design: In a cross-sectional design, cancer survivors (n = 122) completed questionnaires and an implicit affect task. Main outcome measures: Self-report measures assessed three affective variables (e.g. positive affective associations), five cognitive variables (e.g. cognitive beliefs), physical activity estimates, behavioural intentions and participants also completed an implicit affect task regarding physical activity. Results: Two of the three explicit affect variables and the implicit affect variable accounted for significant variability in physical activity estimates beyond that accounted for by the cognitive variables. Positive affective associations were the strongest predictor in multivariate analyses. Behavioural intentions did not mediate the link between the affect variables and physical activity estimates. Conclusions: Explicit and implicit affective variables are direct and unique predictors of physical activity in cancer survivors. Physical activity interventions for cancer survivors should target both explicit affect and implicit affect.

Assessing the Relationship Between Implicit and Explicit Evaluations of Fruit and Vegetable Consumption by Cancer Survivors.

BACKGROUND: Currently, little is known about the implicit evaluations that cancer survivors have for health behaviors, such as eating fruits and vegetables. Understanding both the implicit and explicit evaluations of fruit and vegetable consumption among cancer survivors may aid future interventions for changing motivations and intentions in this higher risk population. METHODS: A cross-sectional study at a university cancer center assessed explicit and implicit evaluations of fruit and vegetable consumption among 122 cancer survivors. The explicit evaluations regarding fruit and vegetable consumption were self-report data. To obtain implicit evaluations, participants completed an implicit evaluation task, the Affect Misattribution Paradigm. Moderating variables of time since first cancer treatment and if participants had a prior cancer occurrence were also self-reported. RESULTS: Simple correlations found no significant association between the implicit and explicit evaluations of fruit and vegetable consumption. Moderation regression analyses showed that the implicit and explicit evaluations became negatively associated as time since first treatment increased and when participants had a prior cancer occurrence. CONCLUSION: The results support the view that implicit and explicit measures of fruit and vegetable consumption diverge for cancer survivors, consistent to implicit and explicit evaluations in other domains and samples. Further, the association between these evaluations differed depending on time since first treatment and if they have been treated for a prior cancer occurrence. By knowing more about implicit and explicit positive evaluations, and their moderators, it may be possible for interventionists to alter cancer survivors' motivation and intention to eat fruits and vegetables.

Overview of the challenges related to oral agents for cancer and their impact on adherence.

BACKGROUND: The increasing number and complexity of oral agents for cancer (OACs) have created a paradigm shift in the process and outcomes in oncology care. With 25%-30% of new oncology medications in development being oral agents, and a steady increase in approvals in the past 5-10 years, the issues are relevant in clinical practice. OBJECTIVES: The purpose of this article is to provide an overview of the challenges related to OACs, including adherence, and to describe the consequences of adherence and resources for oncology nurses. METHODS: The literature was searched to determine challenges related to OACs and their impact on adherence, and an overview of the issues was compiled. FINDINGS: Oncology nurses are key stakeholders in recognizing the challenges and issues associated with the change in treatment regarding OACs. Oncology nurses are an integral part of managing the oral agent process, from access to adherence. Oncology nurses need to understand the issues surrounding OACs so that adherence practices can be improved.

Perceived impact of cancer treatment on diabetes self-management.

PURPOSE: The purpose of this study was to identify the impact that cancer and its treatment had on diabetes self-management and to identify common issues that individuals with diabetes encounter while undergoing chemotherapy. METHODS: This exploratory study utilized a baseline self-administered written survey and an 8-week telephone follow-up survey that included 2 open-ended questions. Forty-three adults aged 50 or older with diabetes and a solid tumor cancer receiving chemotherapy were recruited from 8 community outpatient cancer centers in Michigan and Ohio. Descriptives, t tests, and correlations were utilized to analyze the data. Content analysis was used to analyze the data from the open-ended questions. RESULTS: After a minimum of 8 weeks of chemotherapy, patients performed significantly fewer diabetes self-management behaviors. The majority of individuals experienced a moderate to high impact on their ability to perform diabetes self-management activities while receiving chemotherapy. Exercise, ability to eat and drink, and monitoring blood sugars were most affected. Three themes identifying patient issues were noted: self-management issues, health issues, and prioritization. CONCLUSIONS: Cancer treatment and cancer-related symptoms can have a negative impact on diabetes self-management behaviors in adults with diabetes who are undergoing chemotherapy. Diabetes self-management education is targeted to improve health outcomes in patients with diabetes and cancer and addresses the "cause" not just the "source" of the problem needs to be developed. Further research needs to be done to address issues related to glycemic control and health-related outcomes in this population.

Putting evidence into practice: evidence-based interventions to prevent, manage, and treat chemotherapy-induced nausea and vomiting.

Chemotherapy-induced nausea and vomiting (CINV) continues to have a considerable effect on the physical and psychological well-being of patients with cancer, despite significant advances in antiemetic drugs since the 1990s. This article reviews and summarizes past and current empirical evidence related to interventions for CINV. A resource that summarizes evidence-based interventions for CINV is critical for effective management of this distressing symptom. Pharmacologic and nonpharmacologic interventions are appraised. Finally, gaps in the literature and opportunities for research, education, and practice changes are discussed.