Self-Reported Distress: Adult Acute Leukemia Survivors During and After Induction Therapy.

BACKGROUND: Data suggest that acute leukemia survivors experience moderate to severe distress that does not significantly decline from diagnosis through survivorship.
. OBJECTIVES: The purpose of this study is to assess acute leukemia survivors' level and source of self-reported distress from active cancer treatment through six months post-treatment.
. METHODS: A cross-sectional group-comparison design was used. Male (n = 60) and female (n = 40) survivors aged 19-84 years were accrued from a National Cancer Institute-designated cancer center. Patients were sampled at four time points. FINDINGS: Self-reported distress was elevated for all groups. Highest distress scores were found during induction therapy.

Incorporation of eicosapentaenioic and docosahexaenoic acids into breast adipose tissue of women at high risk of breast cancer: a randomized clinical trial of dietary fish and n-3 fatty acid capsules.

SCOPE: The fatty acid profile of dietary lipids is reflected in mammary adipose tissue and may influence mammary gland biology and cancer risk. To determine the effects of fish consumption on breast adipose tissue fatty acids, we conducted a study of fish versus n-3 PUFA supplements in women at increased risk of breast cancer. METHODS AND RESULTS: High risk women were randomized to comparable doses of marine n-3 PUFAs as canned salmon + albacore or capsules for 3 months. Pre- and posttreatment fatty acid profiles were obtained by GC. Dietary fish (n = 12) and n-3 PUFA capsules (n = 13) yielded increased eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in plasma (p < 0.0001), erythrocyte membranes (p < 0.0001), and breast fat (p < 0.01) at 3 months. Women taking capsules had higher plasma and erythrocyte membrane EPA changes (∼four versus twofold, p = 0.002), without significant differences in DHA. Increases in breast adipose EPA, DHA were similar for both groups. Higher BMI correlated with smaller changes in plasma, erythrocyte membrane EPA, and breast adipose EPA, DHA. Adherence was excellent at 93.9% overall and higher in the fish arm (p = 0.01). CONCLUSION: Fish provides an excellent source of n-3 PUFAs that increases breast adipose EPA, DHA similar to supplements and represents a well-tolerated intervention for future studies of the impact of n-3 PUFAs and dietary patterns on breast cancer.

Reconstruction of the breast following mastectomy.

OBJECTIVES: To review immediate and delayed breast reconstructive options following surgery for high-risk or cancer-related unilateral or bilateral mastectomy and examine restorative interventions to promote a positive body image and long-term survivorship. DATA SOURCES: Review of PubMed, Scopus, and Cochran Review. CONCLUSION: For women facing mastectomy, a consultation with a plastic/reconstructive surgeon is a first step toward recovery with restoration of a missing body part. Nursing interventions are integral to physical and psychosocial healing. IMPLICATIONS FOR NURSING PRACTICE: An understanding of the reconstructive process can be beneficial in the care of women facing and recovering from a mastectomy. Psychological and physical issues occur whether the woman is undergoing bilateral prophylactic mastectomies for a high-risk condition or mastectomy as treatment for a malignant tumor.

Accelerated partial breast irradiation.

Local therapies to treat newly diagnosed breast cancer include a lumpectomy with radiation therapy or a mastectomy. The 20-year data from studies about the safety and efficacy of lumpectomy with full-breast radiation therapy support the safety of this regimen and its role to decrease the risk of ipsilateral recurrence and increase long-term survivorship of women with breast cancer. Accelerated partial breast irradiation (APBI) provides radiation therapy to the tumor bed but spares the remaining breast tissue. APBI accelerates the time required to complete the therapy regimen, with a range of one intraoperative session to five consecutive days compared to five to seven weeks. Several techniques exist to administer APBI, including the insertion of a balloon into the lumpectomy space. Of interest is the widespread use of APBI in community and academic settings that has preceded outcomes of large, randomized clinical trials. Because of selection bias in a number of small, single-institution, nonrandomized studies, published data are of limited value to ensure APBI as a standard of care.

Oncology nurses' knowledge of survivorship care planning: the need for education.

PURPOSE/OBJECTIVES: To survey nurses about their knowledge of cancer survivorship care. DESIGN: Descriptive, cross-sectional. SETTING: Midwestern comprehensive cancer center. SAMPLE: 223 registered and advanced practice nurses. METHODS: Online survey of survivorship knowledge using a 50-item questionnaire derived from the Institute of Medicine report and related publications. MAIN RESEARCH VARIABLES: Concepts of survivorship care and common long-term symptoms. FINDINGS: Most nurses reported having knowledge about healthy lifestyle habits; more than 50% of nurses reported having knowledge about chemotherapy, surgery, and radiation therapy, as well as side effects of fatigue, depression, limitations of daily activities, and weight gain; less than 50% of nurses reported having knowledge of impact on family, biologic agents, lymphedema, immunizations or vaccinations, and osteoporosis screening; less than 40% of nurses reported having knowledge about marital and partner relationships, osteoporosis prevention and care, sexuality, side effects of bone marrow transplantation, employment issues, and angiogenesis agents; and less than 25% of nurses reported having knowledge on genetic risks, as well as fertility, financial, and insurance issues. CONCLUSIONS: Oncology nurses at an academic comprehensive cancer center reported gaps in knowledge consistent with previous studies about knowledge of survivorship care. IMPLICATIONS FOR NURSING: The Institute of Medicine has challenged oncology providers to address cancer survivorship care planning. Gaps in cancer survivorship knowledge are evident and will require focused education for this initiative to be successful.

A mentored cooperative group pilot study: atrophic vaginitis.

OBJECTIVES: To review nursing research initiatives from two cooperative groups and outline a pilot study performed by a junior nurse researcher mentored by cooperative group nurse researchers and institutional physicians. DATA SOURCES: PubMed, Cochrane Library, Scopus, World Wide Web. CONCLUSION: Nursing research can be initiated and led by nurses in the cooperative group setting. The team approach model of research includes several disciplines to examine multiple facets of the same problem, or of multiple problems that a cancer patient may face. This new model will enable a greater number of nurse researchers to investigate symptom management, survivorship, and quality-of-life issues. IMPLICATIONS FOR NURSING PRACTICE: Nurse researchers should be included in every cooperative group study to investigate nurse-sensitive outcomes and issues related to symptom management, survivorship, and quality of life.

Omega-3 fatty acid supplements in women at high risk of breast cancer have dose-dependent effects on breast adipose tissue fatty acid composition.

BACKGROUND: Preclinical evidence of the preventive benefits of omega-3 (n-3) polyunsaturated fatty acids (PUFAs) in breast cancer continues to fuel interest in the potential role of dietary fat content in reducing breast cancer risk. The dose of fish-oil/omega-3 PUFAs needed to achieve maximal target tissue effects for breast cancer prevention remains undefined. OBJECTIVE: To determine the dose effects of omega-3 fatty acids on breast adipose tissue fatty acid profiles, we conducted a study of 4 doses of omega-3 PUFAs in women at high risk of breast cancer. DESIGN: In this 6-mo randomized open-label study, 48 women with increased breast cancer risk received 1, 3, 6, or 9 capsules/d of an omega-3 PUFA supplement that provided 0.84, 2.52, 5.04, and 7.56 g docosahexaenoic acid (DHA) + eicosapentaenoic acid (EPA) daily, respectively. Subjects made monthly visits, at which time pill counts were made and fasting blood samples were collected to determine fatty acid profiles; anthropometric measurements were made, breast adipose tissue samples were collected, and laboratory tests of toxicity (alanine aminotransferase, LDL cholesterol, and platelet function) were made at baseline and at 3 and 6 mo. RESULTS: All doses led to increased serum and breast adipose tissue EPA and DHA concentrations, but the response to 0.84 g DHA+EPA/d was less than the maximum possible response with > or = 2.52 g/d. Body mass index attenuated the dose response for serum tissue DHA and EPA (P = 0.015 and 0.027, respectively) and breast adipose tissue DHA (P = 0.0022) in all of the treatment groups. The incremental increase in DHA and EPA correlated inversely with baseline fat and serum values. Compliance over 6 mo was 92.9 +/- 9.2% and was unaffected by treatment arm. No severe or serious toxicities were reported. CONCLUSIONS: Daily doses up to 7.56 g DHA+EPA were well tolerated with excellent compliance in this cohort at high risk of breast cancer. Body mass index and baseline fatty acid concentrations modulated the dose-response effects of omega-3 PUFA supplements on serum EPA and DHA and breast adipose tissue DHA.

Supportive patient care in the guise of a quilt.

Attention to the physical environment of an oncology center and the therapeutic potential of the environment are concepts to consider in nursing care. Art can enhance the human elements of caring and touch. Colorful quilts, whether hanging on the walls or given to patients, can provide emotional and physical warmth as well as represent a caring environment.

Urogenital atrophy in breast cancer survivors.

PURPOSE/OBJECTIVES: To review the symptoms of urogenital atrophy in breast cancer survivors, influencing factors, and their effects on performance. DATA SOURCES: Review of qualitative and quantitative research data that describe pain, function, satisfaction, and quality of life related to urologic, genital, and sexual function. DATA SYNTHESIS: Breast cancer treatment can induce or exacerbate symptoms related to urogenital atrophy. The lower urinary and genital tracts are affected by physiologic alterations, the potential abrupt onset of menopause, and treatment side effects. Symptoms of urogenital atrophy often are more prevalent and severe in women treated for breast cancer than in age-matched women without breast cancer. CONCLUSIONS: Symptoms related to urogenital atrophy are common in breast cancer survivors and can be affected by physiologic, situational, and psychological influences with negative effects on performance. Research is essential to the understanding of how transient or permanent hormonal alterations affect the urogenital system and the role of these symptoms on quality of life. IMPLICATIONS FOR NURSING: Nurses must listen with sensitivity to breast cancer survivors and their descriptions of these significant and life-altering symptoms. Personalized discussion enables the nurse to explore issues, assess symptoms, recommend interventions, and evaluate at follow-up visits. Nurses are integral to the provision of survivorship care planning that can address the short- and long-term effects of a cancer diagnosis and related treatments.