Ovarian cancer.

ABSTRACT: Ovarian cancer, a leading cause of cancer deaths, poses challenges due to insidious development and vague signs and symptoms. Risk factors include age, reproductive history, genetic mutations, and environmental factors. Treatment involves surgery, chemotherapy, and targeted therapy, with nursing interventions focusing on symptom management and supportive care.

Preserving Oneself in the Face of Uncertainty: A Grounded Theory Study of Women With Ovarian Cancer.

PURPOSE: To describe the cancer care process as it is perceived by women with ovarian cancer. PARTICIPANTS & SETTING: 18 English-speaking adult women with ovarian cancer were recruited from an advocacy organization for patients with ovarian cancer and the gynecologic oncology clinic at a community-based teaching hospital in Burlington, Massachusetts. METHODOLOGIC APPROACH: A grounded theory approach was used. Data were collected via individual interviews with participants. FINDINGS: An overarching theme of preserving oneself in the face of uncertainty was described by the participants. Trajectories from prediagnosis to treatment were influenced by the quality of patient-provider communication, support from significant others, and self-concept aspects. IMPLICATIONS FOR NURSING: Comprehensive care that validates patient concerns and supports information exchange is essential. Nurses can promote the physical and psychological well-being of women with ovarian cancer by identifying institutional and community-based resources for support and specialty care.

Hereditary Breast and Hereditary Ovarian Cancer: Implications for the Oncology Nurse.

OBJECTIVES: To review heredity cancer syndromes involving the breasts, ovaries, or breast and ovaries. To recommend useful professional and patient resources on cancer genetics. A case study of germline BRCA genetic testing after allogeneic bone marrow transplant is presented. DATA SOURCES: National guidelines, evidence-based summaries, peer-reviewed studies, editorials, and professional Web sites. CONCLUSION: Advancing genetic/genomic technology in oncology has led to a renaissance of information about hereditary cancer syndromes. IMPLICATIONS FOR NURSING PRACTICE: Nursing competence in genetics/genomics is necessary to provide evidence-based, personalized care for individuals with cancer. Resources are available to help nurses provide quality cancer genetic informed care.

Adding Silver to the Rainbow: Palliative and End-of-Life Care for the Geriatric LGBTQ Patient.

Lesbian, gay bisexual, transgender, and queer or questioning (LGBTQ) older adults have unique health care needs, especially in the palliative care and hospice setting. In this article, we present a male patient with metastatic ovarian cancer, admitted with worsening dyspnea, now at the end of life. Only his wife was aware of his identified gender, and nondisclosure was very important to him. As he continued to decline, the team navigated LGBTQ-sensitive care within the health care setting, insurance inequalities, and support and communication to his family. This case study summarizes clinical recommendations for the LGBTQ individual in the hospice and palliative care setting, suggesting how our patient's care may have been improved. With the changes in social acceptance and attitudes, the LGBTQ community has become more visible and their numbers appear to be growing. It is important, therefore, that hospice and palliative care providers be educated on their needs to provide competent and inclusive health care.

Prediction of Postoperative Length of Hospital Stay Based on Differences in Nursing Narratives in Elderly Patients with Epithelial Ovarian Cancer.

OBJECTIVES: The current study sought to evaluate whether nursing narratives can be used to predict postoperative length of hospital stay (LOS) following curative surgery for ovarian cancer. METHODS: A total of 33 patients, aged over 65 years, underwent curative surgery for newly diagnosed ovarian cancer between 2008 and 2012. Based on the median postoperative LOS, patients were divided into two groups: long-stay (>12 days; n = 13) and short-stay (≤12 days; n = 20). Patterns in nursing narratives were examined and compared through a quantitative analysis. Specifically, the total number (TN) of narratives pertaining to care and the standardized number (SN), which was calculated by dividing the TN by the LOS, were compared. Experts evaluated the relevance of the phrases extracted. LOS was then predicted using machine learning techniques. RESULTS: The median postoperative LOS was 18 days (interquartile range [IQR]: 16-24 days) in the long-stay group and 9.5 days (IQR: 8-11.25 days) in the short-stay group. In the long-stay group, surgery duration was longer. Overall, patients in the long-stay group showed a higher volume of nursing narratives compared with patients in the short-stay group (SN: 68 vs. 46, p = 0.021). Thirty-two of the most frequently used nursing narratives were selected from 998 uniquely defined nursing narratives. Multiple t-tests were used to compare the TN and real standardized number (RSN; minimum p < 0.1). Mean and standard deviation of classification results of long-short term memory recurrent neural networks for long and short stays were 0.7774 (0.105), 0.745 (0.098), 0.739 (0.107), and 0.765 (0.115) for F1-measure, precision, recall, and area under the receiver operating characteristic, respectively. Agreement between the differential narratives as assessed by statistical methods and the expert response was low (52.6% agreement; McNemar's test p = 0.012). CONCLUSIONS: Statistical tests showed that nursing narratives that utilized the words "urination," "food supply," "bowel mobility," or "pain" were related to hospital stay in elderly females with ovarian cancer. Additionally, machine learning effectively predicted LOS. SUMMARY: The current study sought to determine whether elements of nursing narratives could be used to predict postoperative LOS among elderly ovarian cancer patients. Results indicated that nursing narratives that used the words "urination," "food supply," "bowel mobility," and "pain" significantly predicted postoperative LOS in the study population. Additionally, it was found that machine learning could effectively predict LOS based on quantitative characteristics of nursing narratives.

Top 10 Tips Palliative Care Clinicians Should Know When Caring for Patients with Ovarian Cancer.

The vast majority of women diagnosed with ovarian cancer present with advanced-stage disease with a five-year survival rate less than 50%. Studies have shown that in the past, gynecologic oncologists were not routinely collaborating with palliative care physicians resulting in goals of care planning often not occurring until the last 30 days before death. In recent years, professional societies have been increasingly more vocal about the importance of incorporating palliative care early in a patient's disease course. As these calls increase, palliative care clinicians will be likely to comanage patients with ovarian cancer and may benefit from additional targeted education on this unique population. We brought together a team of gynecologic oncology and palliative care experts to collate practical pearls for the care of women with epithelial ovarian cancer. In this article, we use a "Top 10" format to highlight issues that may help palliative care physicians understand a patient's prognosis, address common misconceptions about ovarian cancer, and improve the quality of shared decision making and goals-of-care discussions.

Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: A randomized controlled trial.

BACKGROUND: High levels of fatigue have been documented in ovarian cancer patients. However, increased levels of fatigue are positively associated with a high risk of sleep disturbance and depression. OBJECTIVE: To investigate the feasibility of a nurse-led home-based exercise and cognitive behavioral therapy (E&CBT) for ovarian cancer adults with cancer-related fatigue on outcomes of fatigue, plus other secondary outcomes (sleep disturbance and depression), either during or after completion of primary cancer treatment. DESIGN: Randomized, single-blind control trial. SETTINGS: Gynaecologic oncology department of the First Hospital of Jilin University in China. PARTICIPANTS: 72 eligible women who recently had surgery and completed their first cycle of adjuvant chemotherapy were randomly assigned to two groups. INTERVENTION: The experimental group received exercise and cognitive behavioral therapy. Five nurses with nursing master degree were trained to deliver this intervention. Patients received online interventions each week in the patient's place of residence or in the nurse-led clinic, as requested. Home visits, coupled with telephone-based motivational interviews twice a week were available with the permission of the participants. comparison group participants received services as usual. MEASUREMENTS: The primary outcome was measured by the Chinese version of the Piper Fatigue Scale that has 4 subscales (Behavior, Affect, Sensory, and Cognition). Secondary outcomes were measured using the Self-Rating Depression Scale and the Pittsburgh Sleep Quality Index questionnaire. Repeated-measure ANOVA was used to examine the effectiveness of this intervention in reducing fatigue, depression, and improving sleep quality. RESULTS: For baseline comparisons, no significant differences were found between the two groups. After the interventions, total fatigue scores were significantly reduced from T1 to T2, to T3 in the experimental group (4.37, 4.24, 3.90), respectively. The comparison group showed almost no change in total fatigue score over time. In the repeated measures ANOVA, the differences of behavioral fatigue score (F=11.647, p=0.001) and cognitive fatigue score (F=5.741, p=0.019) were statistically significant for the group by time interaction. After the interventions, the experimental group participants demonstrated significantly lower symptoms of depression compared with the comparison group (T2: p=0.001 and T3: p<0.001). Sleep duration, sleep dysfunction, daytime dysfunction as well as total sleep quality significantly improved. CONCLUSION: Nurse-delivered home-based E&CBT have measurable benefits in helping women with ovarian cancer to decrease cancer-related fatigue, depressive symptoms, and improving their quality of sleep.

Art in cancer care: Exploring the role of visual art-making programs within an Energy Restoration Framework.

PURPOSE: In contrast to art-therapy, little is known about the role of art-making for people who have been diagnosed with cancer, and even less is known about program-based art-making. This study explored the experience of participation in a visual art-making program for people during and after cancer treatment in the Northern Territory of Australia. METHOD: A longitudinal, qualitative, single cohort study was undertaken. Eight women diagnosed with breast and/or ovarian cancer participated in weekly art-making sessions over eight weeks, facilitated by two professional artists. Data were collected before, during and after the sessions by interviews and group discussions. The Energy Restoration Framework was used to document and analyse the benefits of participation in terms of the a priori themes of: Expansive, Belonging, Nurturing and Purposeful. RESULTS: The four a priori themes were retained and an additional attribute of an energy restoration activity called Stimulating was added, along with sub-themes, which broadened and deepened understanding of the art-making experience within cancer care. CONCLUSIONS: Involvement in an activity that was expansive, new, beautiful and fascinating was highly valued in addition to the appreciation for being with and belonging to a supportive and accepting group facilitated by dynamic artists. There is much scope for continued research and promotion of art-making programs as an adjunct to cancer treatment.

Pelvic pain in transgender men taking testosterone: Assessing the risk of ovarian cancer.

Some guidelines on care for transgender men taking testosterone recommend oophorectomy to prevent ovarian cancer, while others recommend following guidelines for females. A review of the literature finds no strong evidence that transgender men are at increased risk for ovarian cancer. In transgender men taking testosterone without other risk factors, oophorectomy to prevent cancer is unnecessary.

Ovarian Cancer Follow-up: A Preliminary Comparison of 2 Approaches.

OBJECTIVE: The aim of the study was to perform a preliminary comparison of quality of life (QoL) and patient satisfaction in individualized nurse-led follow-up versus conventional medical follow-up in ovarian cancer. METHODS: One hundred twelve women who received a diagnosis of ovarian, fallopian tube, or peritoneal cancer, completed primary treatment by surgery alone or with chemotherapy, irrespective of outcome with regard to remission, and expected survival of more than 3 months. Fifty-seven participants were randomized to individualized follow-up and 55 patients to conventional follow-up. Well-being was measured at baseline and at 3, 6, 12, and 24 months after randomization for QoL (QLQ-C30 [European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire], QLQ-Ov28), the Hospital Anxiety and Depression Scale (HADS), and a Patient Satisfaction Questionnaire (PSQ-III). The primary endpoints were the effects of follow-up on each of the scores (via hierarchical mixed-effects model) and on relapse-free time (via Cox model). The total cost of follow-up was compared between each group. RESULTS: There was evidence for a QoL and patient satisfaction benefit for individualized versus standard follow-up (QLQ-C30, P = 0.013; 95% confidence interval, -0.03 to -0.001; PSQ-III P = 0.002; 95% confidence interval, -0.003 to -0.015; QLQ-Ov28, P = 0.14). Hospital Anxiety and Depression Scale data provided no evidence in favor of either treatment (P = 0.42). Delivered to protocol individualized follow-up resulted in a delay in the presentation of symptomatic relapse (P = 0.04), although the effect on survival in this study is unknown. Cost was £700 lower on average for the individualized follow-up group, but the difference was not statistically significant at the 5% level (P = 0.07). CONCLUSIONS: Individualized follow-up was superior to conventional follow-up in 3 of the 4 QoL and patient satisfaction surveys in this preliminary study. Further prospective studies are needed in a larger population.Trial registration number is ISRCTN59149551.

Caregiver Burden in End-Stage Ovarian Cancer.

BACKGROUND: Caregiver burden associated with caring for women with ovarian cancer has received limited focus. However, these patients often have complex needs, requiring a high level of care at home and imposing substantial burdens on caregivers. OBJECTIVES: This pilot study assessed the level of caregiver burden experienced by the primary caregivers of patients with end-stage ovarian cancer and identified variables associated with caregiver burden. METHODS: Caregiver burden was assessed using the Caregiver Reaction Assessment. Fifty caregivers completed an anonymous and voluntary survey. Pearson correlations and independent samples t tests were used to analyze data. FINDINGS: Most participants were Caucasian, married or living with a partner, and college graduates, with an annual household income of less than $90,000. Caregiver ages ranged from 29-81 years. Participants agreed most with the self-esteem scale, indicating they had pride in caring for their loved ones. Disrupted schedules and financial problems were the most burdensome factors in providing care. Because financial issues affected caregiver burden, nurses should facilitate interdisciplinary support. Future research is needed to determine the impact of nurse-led interventions to reduce caregiver burden.

Symptom Clusters in Ovarian Cancer Patients With Chemotherapy After Surgery: A Longitudinal Survey.

BACKGROUND: Ovarian cancer is 1 of the most common malignancies in the female reproductive system. Identification of symptom clusters in ovarian cancer patients may improve management of symptoms. OBJECTIVE: The objective of this article is to explore the changes in symptom clusters in ovarian cancer patients with adjuvant chemotherapy after surgery at different time points. METHODS: Basic details of the patients were documented and a longitudinal investigation was carried out. We used the Memorial Symptom Assessment Scale to examine 115 Chinese ovarian cancer patients' symptom experience at 4 time points: days before chemotherapy (T1), chemotherapy cycle 1 (T2), chemotherapy cycle 3 (T3), and chemotherapy cycle 6 (T4). The exploratory factor analysis was performed to determine the numbers and components of symptom clusters. RESULTS: Symptom clusters varied at different time points, which were classified as pain-related symptom cluster, psychological symptom cluster, menopausal symptom cluster, gastrointestinal symptom cluster, body image symptom cluster, and peripheral neurologic symptom cluster. The gastrointestinal symptom cluster and body image symptom cluster appeared at T1 and remained consistent at T3 and T4, whereas the peripheral neurologic symptom cluster was noted at T3 and T4. CONCLUSIONS: Clinicians should prioritize symptom management interventions with ovarian cancer patients to focus on the most severe symptom cluster: psychological symptom cluster at T1, gastrointestinal symptom cluster at T2, and body image symptom cluster at T3 and T4. IMPLICATIONS FOR PRACTICE: The ability to predict symptom clusters in ovarian cancer patients receiving chemotherapy may help to make optimized clinical decision in advance to alleviate patients' symptoms and improve their life quality.

Ovarian cancer: Ensuring early diagnosis.

Ovarian cancer is the most fatal of all gynecologic malignancies. Despite the lack of a recommended screening test for ovarian cancer, NPs can identify risk factors, ensure patients are aware of subtle symptoms, and provide adequate testing and analysis of results.

Economic Impact Among Family Caregivers of Patients With Advanced Ovarian Cancer.

OBJECTIVES: The life of a family caregiver changes in many ways when cancer is diagnosed. Changes regard also financial costs. To the authors' knowledge, little work has been done to estimate the costs associated with caregiving for cancer patients. The aim of the present study is to evaluate for the first time in literature the economic changes among family caregivers of advanced ovarian cancer during the first-line treatment in an Italian survey. METHODS: Between January 2009 and June 2014, the primary family caregivers of patients with advanced ovarian cancer (N = 172) were recruited from to the Division of Gynecologic Oncology of the University Campus Bio-Medico of Rome within 4 weeks of the patient's new diagnosis. Caregivers reported demographic, medical information, and economic cost, such as traveling to and from medical appointments, waiting with patients for appointments, missing work, and attending to patients who are hospitalized. RESULTS: Between January 2009 and June 2014, 172 primary family caregivers of patients with advanced ovarian cancer were enrolled in the study. The mean age of the study cohort was 54.01 years. They reported 3% of missing workdays. The mean cost for all caregivers was &OV0556;1,888,732 per year. Therefore, the mean cost for each caregiver was &OV0556;10,981 annually. CONCLUSIONS: This economic analysis of caregiving in patients with advanced ovarian cancer reports the significant burden that cancer treatment places on both families and society. These findings underscore the importance, when appropriate, of including valid estimates of the cost of informal caregiving when evaluating the cost-effectiveness of cancer treatments.

Aiding a reassertion of self: a qualitative study of the views and experiences of women with ovarian cancer receiving long-term nurse-led telephone follow-up.

PURPOSE: This study explored the views and experiences of women following treatment for ovarian cancer who had received long-term (at least 3 years) nurse-led telephone follow-up. Exploring the long-term experiences of follow-up for women with ovarian cancer provides important information regarding the coping processes of cancer survivors that can inform the development of innovative and patient-centred approaches of cancer follow-up. METHODS: This is a qualitative study approach using interpretative phenomenological analysis (IPA). Eleven women were identified by a clinical nurse specialist as having received nurse-led telephone follow-up for a period of at least 3 years. These women were interviewed in person or over the telephone using a semi-structured interview schedule; interviews were audio-recorded and transcriptions were analysed using IPA. RESULTS: Nurse-led telephone follow-up was felt to support a reassertion of self and a rejection of patient identity. Three core themes emerged regarding the positive impact of nurse-led telephone follow-up: 'Somebody was looking out for me' highlights the perception of increased psychosocial support; 'It's just reassurance' includes both the deep trust in the expertise of the nurse and the reassurance of the continued blood tests; and 'Time was never an issue' presents the perception of relaxed follow-up appointments with time to talk and the perceived practical benefits of this approach. CONCLUSIONS: Nurse-led telephone follow-up was broadly recommended for women following treatment for ovarian cancer, particularly for those later on in the survivorship trajectory when focus may move from biomedical aspects of cure to holistic approaches to well-being. Remote interventions which provide a perception of a consistent and constant source of medical and psychosocial support may support adaption to cancer survivorship by enabling a reassertion of self and a rejection of patient identity.