A systematic review and meta-analysis of e-cigarette use among cancer survivors.

PURPOSE: We conducted a systematic review and meta-analysis to determine the use of e-cigarettes among cancer survivors, factors associated with their use, and prevalence of e-cigarette use as a quit attempt. METHODS: We searched five electronic databases until June 2022. Two authors independently selected studies, appraised their quality, and collected data. RESULTS: Twenty-three publications from eight data sources (national surveys) met our eligibility criteria. The pooled rate of lifetime e-cigarette use among cancer survivors was 15% (95% CI 6-27%); current use was 3% (95% CI 0-8%). Among survivors who currently used traditional cigarettes, 63% (95% CI 57-69%) also used e-cigarettes. The reported rates of weighted lifetime e-cigarette use differed between age groups (18-44 years, up to 46.7%; 45-64, up to 27.2%; ≥65, up to 24.8%). Nine publications reported factors associated with lifetime e-cigarette use (i.e., active use of traditional cigarettes; heavy drinking; poor mental health; younger age; being male, non-Hispanic White, or single; having less than high school education or income ≤$25,000 USD; and living in the South regions of the US or urban areas). E-cigarettes were used as a quit resource by 75% of survivors reporting dual use of electronic and traditional cigarettes (95% CI 63%, 85%). CONCLUSION: More than two-thirds of survivors currently using traditional cigarettes also use e-cigarettes. Higher use rates of e-cigarettes were reported among young cancer survivors compared to older survivors. Future studies are needed to assess the impact of e-cigarettes on long-term health and improve screening of smoking behaviors. IMPLICATIONS FOR CANCER SURVIVORS: Our study provides an overview of the prevalence of e-cigarette use and sociodemographic risk factors associated with e-cigarette use among cancer survivors. The findings can assist providers in supporting attempts to quit among cancer survivors.

Launching an Electronic Patient-Reported Outcomes Initiative in Real-Time Clinical Practice.

Patient-reported outcomes play an essential role in improving care across the cancer continuum. This paper reports on the experience of a tertiary care center to standardize the use, collection, and reporting of patient-reported outcomes (PROs) in 10 disease-specific survivorship clinics. To minimize the burden of patients to complete surveys, an institutional committee with oversight on all patient surveys required an application be reviewed and approved before their distribution in a clinic. To begin collecting PROs, each clinic submitted an application tailored to its clinical operations, staffing, and scheduling characteristics. The dates for the submission of each application were staggered over a 2-year period, which contributed to a lack of uniformity in the project (ie, approval dates, start dates, collection and reporting of results). The delays were primarily due to the time and resources required to build the electronic version of the PRO survey into the institutional electronic medical record. To date, 6 of 10 survivorship clinics submitted applications, 5 were approved, and 4 launched the electronic MD Anderson Symptom Inventory (eMDASI) through the patient portal. Metrics collected between January 2019 and December 2020 for the thyroid, bone marrow transplant, genitourinary, and head and neck clinics indicated the numbers of eMDASIs sent to patients varied by clinic, with the lowest from the bone marrow transplant survivorship clinic (6) and the highest (746) in the thyroid Clinic. The total number of eMDASIs returned by the patients ranged from 2 (bone marrow transplant) to 429 (thyroid). Overall, patients' return rates of the eMDASI ranged from 33.3% to 57.7%. Several strategies were implemented to increase the delivery, submission, and completion of eMDASIs. Our findings indicate the integration and implementation of PROs in survivorship clinics are achievable. Further work is needed to enhance the ePROs web-based process to adequately compare PROs across diverse cohorts of cancer survivors .

Innovating the Personalization of Stratified Survivorship Care Pathways: Using a Cancer Data Ecosystem to Improve Care Access, Outcomes, Efficiency, and Costs.

New models of survivorship care are needed that improve outcomes for the growing number of cancer survivors, address the increasing complexity of their health needs, and deal with the shortage of clinicians and rising costs of this care. Technology can aid the delivery of personalized, stratified survivorship care pathways where the intensity of care, the care setting, and the providers required for that care vary with survivors' needs. Building a cancer data ecosystem of connected data streams that supports and learns from each patient can be used to streamline care, enhance efficiency, reduce costs, and facilitate research. This manuscript describes the input, analytics, and output components of the cancer data ecosystem that must be built and connected and also provides a real-world use case of how such a system could transform care in a large US comprehensive cancer center.

Cancer Prevention in the Survivorship Setting.

OBJECTIVES: To describe how nurses can use risk reduction and health promotion activities to facilitate surveillance of late effects and secondary cancers in long-term cancer survivors. DATA SOURCES: Literature review on survivorship, nursing practice, cancer prevention, and survivorship; articles published in peer-reviewed scientific journals; and Web-based or professional organization resources. CONCLUSION: Appropriate participation in screening activities, early detection of cancer, and further advances in treatment have contributed to the rise in cancer survivors. A demand for nurses with clinical experience and competence in survivorship care will follow. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses have an essential role in providing safe and high-quality care throughout the survivorship experience, which can contribute to better long-term outcomes.

Changing Nursing Practice in Survivorship Care With Clinical Decision Tools.

The paradigm shift to include survivorship care as part of the cancer care continuum underscores the critical need for a change in nursing practice. One way to ensure that change in practice is delivered in a safe and efficient manner is through the use of clinical decision tools (CDTs). Such tools can be used to increase relevant knowledge and skills of nurses and patients. Despite the widespread recognition of their value, CDTs to educate providers on cancer survivors' care are limited and, when available, often are not used. Clinical practice algorithms were developed for disease-specific survivorship clinics in a cancer academic center. This article reviews the conceptual framework of the survivorship algorithms, describes the application of the algorithms in multidisciplinary disease-specific survivorship clinics, and discusses the implementation strategies used to promote clinicians' adoption and implementation of the algorithms. At a Glance • The authors found that algorithms can be successfully used as clinical decision tools(CDTs) to deliver survivorship care. • Algorithms and other CDTs are powerful tools to enhance professional practice. • Additional studies are needed to assess their effect on clinical practice and survivor outcomes.

Celebrating ONS's 40th anniversary and its commitment to cultural competency, diversity, and inclusiveness.

Today, we all have been taught that cultural competence is a valuable tool in providing patient-centered care. However, this concept was not considered a standard of oncology nursing practice when the Oncology Nursing Society (ONS) began. It was not regarded as a critical component of patient safety, satisfaction, or quality care. In fact, in the 1970s, the importance of providing culturally competent care was virtually nonexistent in our nation's government policies, regulatory standards, academic curriculum, or professional practice. 
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Automated pain intervention for underserved minority women with breast cancer.

BACKGROUND: Minority patients with breast cancer are at risk for undertreatment of cancer-related pain. The authors evaluated the feasibility and efficacy of an automated pain intervention for improving pain and symptom management of underserved African American and Latina women with breast cancer. METHODS: Sixty low-income African American and Latina women with breast cancer and cancer-related pain were enrolled in a pilot study of an automated, telephone-based, interactive voice response (IVR) intervention. Women in the intervention group were called twice weekly by the IVR system and asked to rate the intensity of their pain and other symptoms. The patients' oncologists received e-mail alerts if the reported symptoms were moderate to severe. The patients also reported barriers to pain management and received education regarding any reported obstacles. RESULTS: The proportion of women in both groups reporting moderate to severe pain decreased during the study, but the decrease was significantly greater for the intervention group. The IVR intervention also was associated with improvements in other cancer-related symptoms, including sleep disturbance and drowsiness. Although patient adherence to the IVR call schedule was good, the oncologists who were treating the patients rated the intervention as only somewhat useful for improving symptom management. CONCLUSIONS: The IVR intervention reduced pain and symptom severity for underserved minority women with breast cancer. Additional research on technological approaches to symptom management is needed.

Transforming cancer survivorship care through quality improvement initiatives.

Oncology nurses must become better prepared to conduct quality improvement projects that will optimize quality of care and patient safety for long-term cancer survivors. The growing interest in survivorship care has led to the availability of multiple versions of cancer survivorship care plans (SCPs). Despite the availability of SCPs, research is lacking evidence-based processes to evaluate whether providers comply with planning and issuing SCPs. In the current article, the authors describe exploratory efforts to monitor the providers' compliance rate in issuing SCPs in diverse disease-specific clinics.

Oncology nurses and indoor tanning: stylish or risky behavior?

Being tan has become a social norm, and some nurses engage in that widely accepted lifestyle. Mounting evidence of the increased risk to melanoma and nonmelanoma skin cancers associated with indoor tanning supports the need for nurses to integrate skin cancer education, counseling, and referrals into routine practice. The current article presents an overview of the risks associated with indoor tanning, discusses its acceptance as a social norm, and offers strategies to support oncology nurses in changing the widespread trend.

Care, compassion, and communication in professional nursing: art, science, or both.

Debate continues as to whether nursing is a science, art, or a combination of the two. Given the recent growing emphasis in the current healthcare environment to deliver patient-centered care, the art of nursing and its impact on patient outcomes is being re-examined. The current article discusses a case narrative to provide a venue for self-reflection in nursing practice.

A multidisciplinary team approach to improving psychosocial care in patients with cancer.

The demand for patient-centered care has reinforced the need for a systematic approach to planning appropriate psychosocial services. A proposed strategy to address this need is to use a multidisciplinary team comprised of oncology nurses, physicians, mental health professionals, social workers, ethicists, and other healthcare professionals to provide comprehensive psychosocial care to patients and their families. This article describes key aspects of a broad-based team approach used to develop evidence-based, multidisciplinary practice change that could improve psychosocial care and outcomes.

Call for action: caring for the United States' aging cancer survivors.

The United States is undergoing significant societal shifts that will have profound implications for the professional practice of oncology nurses, including the aging of the nation's baby boomers and an anticipated increase in cancer survivors. Understanding of the confluence of those factors and their impact on survivors' physical and psychological outcomes remains limited. Nurses may be aware of advances in general survivorship care but may not have the specific knowledge and skills to meet the distinctive needs of older adult cancer survivors. The authors call for a paradigm change in nursing practice, which will increase awareness across professional specialties that survivorship care for older adults is a professional obligation of all nurses.

Bereaved parents' perspectives on pediatric palliative care.

This study's goal was to describe and begin to understand the experience of bereaved parents whose deceased child had received pediatric oncology services at a tertiary comprehensive cancer center. Focus groups were conducted with parents whose children were age 10 years and older at the time of death. Potential participants were contacted by mail and telephone. Sessions were audiotaped and transcribed verbatim. The ATLAS.ti qualitative software program was used to identify and analyze dominant themes. Fourteen parents identified four major themes: standards of care, emotional care, communication, and social support. Bereaved parents discussed the challenges associated with institutional procedures and interpersonal aspects of care in anticipation of and following their child's death. The results of these personal narratives may be used to guide care plans and deliver pediatric palliative and end-of-life interventions.

Patients, family caregivers, and patient navigators: a partnership approach.

BACKGROUND: Navigation services may be strengthened by establishing a partnership between the patient, family/caregiver, and the navigator. Involvement of a patient's familial or social network in the navigation process would allow patient navigators to spend more time and resources with the subset of patients who do not have support from family and friends. The Partnership Approach evolves from combining the strength of a patient's existing social support and network with the delivery of navigation services. METHODS: To develop this novel approach, the Family and Caregiver Workgroup was convened at the American Cancer Society's National Leadership Summit. Individuals were asked to serve in this group due to their interest, research, or experience in family and caregiver issues. RESULTS: By the end of the Summit, the workgroup had achieved 3 major outcomes: 1) enhancement of current patient navigation services by building a partnership between the patient, family or primary caregivers, and navigators; 2) identification of a set of core functions that a family/caregiver could perform in a partnership; and 3) consensus on a set of metrics to use with caregivers and patients. Five major domains were selected to measure patient and/or caregiver outcomes: quality of life, satisfaction with care, social support, distress, and caregiver burden. Metrics appropriate for each domain were recommended. CONCLUSIONS: Integration of these domains and scales in current navigation services is needed to develop future research. Evidence from such research would help determine whether the Partnership Approach contributes to improved patient and caregiver outcomes.

Levels of symptom burden during chemotherapy for advanced lung cancer: differences between public hospitals and a tertiary cancer center.

PURPOSE: We compared risk factors for high disease- and treatment-related symptom burden over 15 weeks of therapy in medically underserved patients with advanced non-small-cell lung cancer and in patients treated at a tertiary cancer center. PATIENTS AND METHODS: We monitored symptom severity weekly during chemotherapy. Patients were recruited from a tertiary cancer center (n=101) and three public hospitals treating the medically underserved (n=80). We used a composite symptom-severity score and group-based trajectory analysis to form two groups: one with consistently more severe symptoms and another with less severe symptoms. We examined predictors of group membership. RESULTS: Seventy percent of the sample (n=126) reported low symptom-severity levels that decreased during therapy; 30% (n=55) had consistently severe symptoms throughout the study. In multivariate analysis, patients with good performance status being treated in public hospitals were significantly more likely than patients treated at the tertiary cancer center to be in the high-symptom group (odds ratio, 5.6; 95% CI, 2.1 to 14.6; P = .001) and to report significantly higher symptom interference (P = .001). Other univariate predictors of high-symptom group membership included variables associated with being medically underserved (eg, having less education, being single, and being nonwhite). No group differences by ethnicity were observed in the public hospitals. Medically underserved patients were less likely to receive adequate pain management. CONCLUSION: Patients with advanced lung cancer and good performance status treated at public hospitals were more likely than those treated at a tertiary cancer center to experience substantial symptoms during chemotherapy.

Measuring the symptom burden of lung cancer: the validity and utility of the lung cancer module of the M. D. Anderson Symptom Inventory.

We conducted a study to establish the psychometric properties of a module of the M. D. Anderson Symptom Inventory (MDASI) developed specifically for patients with lung cancer (MDASI-LC). The MDASI measures 13 common "core" symptoms of cancer and its treatment. The MDASI-LC includes the 13 core MDASI symptom items and three lung cancer-specific items: coughing, constipation, and sore throat. MDASI-LC items were administered to three cohorts of patients with lung cancer undergoing either chemotherapy or chemoradiotherapy. Known-group validity and criterion (concurrent) validity of the MDASI-LC were evaluated using the Eastern Cooperative Oncology Group performance status and the 12-item Short-Form Health Survey. The internal consistency and test-retest reliability of the module were adequate, with Cronbach coefficient α-values of 0.83 or higher for all module items and subscales. The sensitivity of the MDASI-LC to changes in patient performance status (disease progression) and to continuing cancer treatment (effects of treatment) was established. Cognitive debriefing of a subset of participants provided evidence for content validity and indicated that the MDASI core items and three additional lung cancer-specific items were clear, relevant to patients, and easy to understand; only two patients suggested additional symptom items. As expected, the item "sore throat" was sensitive only for patients receiving chemoradiotherapy. The MDASI-LC is a valid, reliable, and sensitive symptom-assessment instrument whose use can enhance clinical studies of symptom status in patients with lung cancer and epidemiological and prevalence studies of symptom severity across various cancer types.

Caregiver symptom burden: the risk of caring for an underserved patient with advanced cancer.

BACKGROUND: The growing diversity of the population of the United States and the high burden of cancer-related symptoms reflect the need for caregiver research within underserved groups. In this longitudinal study, the authors assessed changes in symptom severity in caregivers and underserved minority patients diagnosed with advanced solid tumors who were being treated at public hospitals. METHODS: A total of 85 matched patient-caregiver dyads completed the M. D. Anderson Symptom Inventory 3 times during 20 weeks of chemotherapy. At each time point, symptom severity and interference with daily activities were assessed. Group-based trajectory modeling was used to classify caregivers into high-symptom or low-symptom burden groups. RESULTS: Sadness and distress were more prevalent among caregivers (P = .005). Symptom burden remained stable among caregivers in the high-symptom group (40%), whereas the low-symptom group (60%) demonstrated a statistically significant decrease over time. Multivariate analysis found being a family-member caregiver (adjusted odds ratio [ADJ-OR], 4.1; 95% confidence interval [95% CI], 1.4-11.6) and caring for a highly symptomatic patient (ADJ-OR, 8.0; 95% CI, 1.5-41.4), rather than race, ethnicity, or sociodemographic characteristics, were significant predictors of the caregiver's membership in the high-symptom burden group. CONCLUSIONS: Approximately 40% of the caregivers in the current study were found to be at an increased risk for moderate to severe sadness and distress, which remained severe throughout the patient's treatment course at public hospitals. To the authors' knowledge, this study marks the first time that the concept of symptom burden has been used to measure caregiver burden, and the first time that symptom burden has been measured and documented in dyads of caregivers and underserved minority patients. Cancer 2011. © 2010 American Cancer Society.

Validation and application of a module of the M. D. Anderson Symptom Inventory for measuring multiple symptoms in patients with gastrointestinal cancer (the MDASI-GI).

BACKGROUND: The M. D. Anderson Symptom Inventory (MDASI) was developed as a brief yet comprehensive tool to assess patient-reported symptom severity and interference in patients with cancer. The authors report the development of an MDASI module for use in patients with gastrointestinal (GI) cancer (the MDASI-GI). METHODS: Patients with GI cancer (N = 184) participated in module development and validation. The process included: 1) generating GI-specific candidate items with input from GI oncologists and from qualitative interviews with patients and adding those items to the core MDASI for testing; 2) dropping candidate GI items that lacked sensitivity; 3) validating the psychometric properties (validity, reliability, sensitivity) of the resulting MDASI-GI; and 4) conducting cognitive debriefing interviews with patients to confirm the questionnaire's ease of comprehension, relevance, and acceptability. RESULTS: Five GI-specific symptom items (constipation, diarrhea, difficulty swallowing, change in taste, and feeling bloated) were added to the original 19 MDASI symptom and interference items to form the MDASI-GI. Sixty-one percent of the sample had 1 or more moderate-to-severe symptom(s) (>or=5 on a severity scale from 0 to 10). Cronbach alpha values were .80 and .87 for symptom severity items and interference items, respectively. Known-group validity (sensitivity) was supported by the ability of the MDASI-GI to detect significant differences in symptom and interference levels according to performance status (P < .001). Cognitive debriefing demonstrated that, for patients, the MDASI-GI was an easy-to-use and understandable tool. CONCLUSIONS: The current results indicated that the MDASI-GI is a valid, reliable, and concise tool for measuring symptom severity and interference with function in patients with GI cancer.

Opioids and cancer survivors: issues in side-effect management.

PURPOSE/OBJECTIVES: To describe the most common side effects associated with the use of opioid treatment in patients with moderate to severe cancer pain; to discuss research findings specific to the use of opioids for cancer pain in long-term cancer survivors. DATA SOURCES: Published research, articles from a literature review, and U. S. statistics. DATA SYNTHESIS: Side effects associated with opioid use are a major contributor to patient reluctance to follow treatment plans for cancer pain. Clinicians must follow the critical steps necessary to build comprehensive treatment plans that include a preventive approach to side effects and opioid rotation when side effects do not resolve. CONCLUSIONS: Side effects associated with long-term use of opioids by cancer survivors are a major contributor to patient reluctance to follow a cancer pain treatment plan. Patient education efforts must promote open and clear communication between survivors and their providers about side effects and other important issues related to long-term use of opioids in managing pain related to cancer and its treatment. IMPLICATIONS FOR NURSING: Oncology nurses recognize that patients often require the long-term use of opioids when they experience chronic pain as a result of their disease or its treatment. The long-term physical and cognitive effects of such opioid use are not well known, despite the advances that have been made in cancer pain control and research. Survivors should communicate their concerns about side effects to the treatment team. In addition, patients and family members must be encouraged to inform their providers about personal attitudes, beliefs, and practices that may affect decisions about taking their analgesics as prescribed. Most importantly, oncology nurses must teach patients and their families to self-advocate for optimal pain relief with minimal side effects.

An urban community's preferences for hypothetical outcomes of analgesic pain treatment.

We assessed preferences of urban residents regarding hypothetical treatment outcomes related to analgesic use to determine how well subjects understood the severity of the outcomes, describe community preferences for these outcomes, and identify predictors of preferences. In a cross-sectional telephone survey, we obtained mean ratings for hypothetical outcomes that included two dimensions of clinical pain (pain severity and potential side effects): A=moderate pain, three side effects; B=mild pain, three side effects; C=moderate pain, one side effect. We focused on 111 respondents who rated Outcome A, moderate pain with three side effects, as the worst condition (the logical choice). Being Spanish speaking predicted preferences across treatment Outcomes A and B. Spanish-speaking subjects and those in fair to poor health tended to view all three outcomes more negatively than other respondents. Knowledge of public preferences can help clinicians better understand factors that influence treatment choices and may help them motivate their patients to adhere to analgesic regimens.