From bystander to enlisted carer - A qualitative study of the experiences of caregivers of patients attending follow-up after curative treatment for cancers in the pancreas, duodenum and bile duct.

PURPOSE: Caregivers of patients with cancer play an important role throughout the treatment trajectory. This can be challenging and might infer health and psychosocial problems. This may especially be the case in caregivers of patients with cancers that carry a high risk of recurrence such as cancers of the pancreas, duodenum and bile duct. This study therefore explored the experiences of caregivers of patients attending follow-up after completion of treatment with curative intent for cancers of the pancreas, duodenum and bile duct. METHODS: A qualitative study using semi-structured, individual interviews. Data were analysed using content analysis. RESULTS: Ten caregivers of patients attending follow-up after completed curative treatment for cancers of the pancreas, duodenum and bile duct in a specialized gastro-surgical center at a tertiary hospital in the Capital Region of Denmark participated. We identified three themes: "From bystander to enlisted carer", inferring that caregivers felt enlisted as carers during treatment and follow-up, however without sufficient instruction or assessment of their needs. "Lonesome worrying" meaning that caregivers hid their feelings of concern and foreboding, and finally, "Keeping a stiff upper lip" indicating that caregivers outwardly maintained a positive face when interacting with the patient. CONCLUSION: Caregivers described taking on a substantial burden of care without feeling competent. They experienced distress and emotional isolation which affected their relationship with the patient and their mutual coping. The results indicate a need for health care professionals to facilitate reflection on the needs and roles of both patients and caregivers throughout the treatment trajectory.

Hereditary Pancreatic Cancer Syndromes: Providing Care to At-Risk Families.

Hereditary pancreatic cancer continues to pose challenges to providers, as well as to patients and their families. Pancreatic cancer has a poor prognosis, and individuals with family histories of pancreatic cancer are often motivated to pursue genetic testing. This article reviews various hereditary pancreatic cancer syndromes, as well as pancreatic cancer screening recommendations, options, and limitations.

Impact of skilled nursing facility quality on postoperative outcomes after pancreatic surgery.

BACKGROUND: Data on skilled nursing facility utilization among patients undergoing pancreatic surgery remain scarce. We sought to define the incidence of utilization of skilled nursing facilities and determine the impact of skilled nursing facility quality markers on postoperative outcomes among patients who underwent pancreatic surgery. METHODS: Medicare Standard Analytic Files were used to identify patients who underwent pancreatic resection during 2013-2015. Nursing Home Compare datasets were used to examine the influence of skilled nursing facility quality as estimated by quality markers (Medicare star ratings) on postoperative outcomes. RESULTS: Among 13,018 patients who underwent pancreatectomy, 2,247 (17.3%) were discharged to a skilled nursing facility. Compared with patients discharged home, patients discharged to a skilled nursing facility were older (median age: 72 [interquartile range 68-76] vs 76 [interquartile range 71-80]), more likely female (44.4% vs 56.8%), and had greater Charlson comorbidity index scores (median score: 3 [interquartile range 2-8] vs 4 [interquartile range 2-8]) (all P < .001). Most patients were discharged to an above-average skilled nursing facility (N = 1,463, 65.1%), and a lesser subset was discharged to a skilled nursing facility with a below-average (N = 490, 21.8%) or average (N = 294, 13.1%) star rating. The 30-day hospital readmission was greatest among patients discharged to a below-average skilled nursing facility (below average N = 217, 44.3%; average N = 110, 37.4%; above average N = 517, 35.3%; P = .002). On multivariate analysis, patients discharged to below-average skilled nursing facilities remained 64% more likely to be readmitted within 30 days (OR 1.64, 1.29-2.02, P < .001). In contrast, 30-day mortality was comparable across the skilled nursing facility star rating categories (P = .08). CONCLUSION: Roughly 1 in 6 patients undergoing pancreatic surgery were discharged to a skilled nursing facility. Patients discharged to a below-average skilled nursing facility were more likely to be readmitted compared with patients discharged to an above-average skilled nursing facility.

Liposomal Irinotecan: Nursing Considerations in an Outpatient Cancer Center

Recent approaches in treating pancreatic adenocarcinoma, an aggressive disease with limited survival, include the use of liposomal irinotecan as an option when first-line therapy has failed. Liposomal irinotecan has been approved in combination with 5-fluorouracil and leucovorin for patients with metastatic pancreatic cancer. Liposomal irinotecan is a newer therapy requiring oncology nurses to obtain knowledge and skills for proper administrating, monitoring of hypersensitivity reactions during infusion, managing side effects, and providing patient education. Nursing considerations when administering this drug include infusion time, premedication, risk for hypersensitivity reactions and adverse events, and side effects.

[Care Plan for Resuming the Physical Activity of Patients With Pancreatic Cancer and Diabetes After Surgery].

Many barriers influence the ability of postoperative cancer patients to reengage in normal physical activities. Training programs have been shown to be effective in helping restore physical activity in patients and in reducing the care burdens of family members. Nurses cannot use physical activity guidelines in their care plan to assess individual needs. The clinical practice guidelines for physical activity in survivorship were published by the National Comprehensive Cancer Network (NCCN) in 2016. These guidelines are used to assess patients' physical status, curable factors, physical barriers, and risk of postoperative pancreatic cancer and diabetes. In line with this assessment tool, the physical activity guidelines, and the recommendations for cancer patients, the authors planned a physical activity training program that addressed the actual needs of patients under their care. Further, the authors provided special notes for a diabetic diet that helped reduce the barriers to resuming physical activity and enhanced independent care efficacy. Meanwhile, the authors encouraged family members to participate in patient-care activities and family mental-health support and to promote patient participation in the training program in order to increase quality of life. The present project demonstrates that this care plan may provide an effective guide for nurses to help other cancer patients resume physical activity.

[Psychiatry and palliative care, collaboration for the benefit of the patient]. / Psychiatrie et soins palliatifs, une collaboration au service du patient.

As palliative care units continue to develop, the provision of end-of-life care for patients with a chronic mental illness needs to be addressed. Aside from the somatic comorbidities to which these patients are particularly exposed and in view of the specificity of psychiatric treatment, the forms of end-of-life support for a patient with schizophrenia are described here, based on the experience of a psychiatric unit in the Var region.

Helen's Family.

A nurse learns it's not inappropriate to celebrate life as death approaches.

Neuroendocrine Tumors and Lanreotide Depot: Clinical Considerations and Nurse and Patient Preferences.

BACKGROUND: Somatostatin analogs (SSAs) are a mainstay therapy for the treatment of carcinoid syndrome associated with neuroendocrine tumors (NETs). They are effective for a range of gastroenteropancreatic NETs (GEP-NETs). Lanreotide depot (Somatuline®) is an SSA that is approved for the treatment of GEP-NETs to improve progression-free survival (PFS). OBJECTIVES: The article reviews the efficacy, safety, and administration of lanreotide depot and relates those attributes to considerations and preferences of oncology nurses and their patients. METHODS: A review of the literature on the use of lanreotide for the treatment of NETs and carcinoid syndrome was conducted. In addition, the literature on drug delivery and routes of administration was surveyed to provide context for comparative studies related to clinical and patient preferences. FINDINGS: Lanreotide depot prolongs PFS and is well tolerated by patients who expressed satisfaction in the ability to control symptoms related to carcinoid syndrome. Nurses cited several benefits to using lanreotide depot in the clinical setting, including more time saved to address other patient care issues. Attributes of lanreotide depot-including its efficacy, safety and tolerability, dosing and administration, and cost-may contribute to healthcare decisions regarding the treatment and management of NETs.

Gastroenteropancreatic neuroendocrine tumours: an overview.

Gastroenteropancreatic neuroendocrine tumours (GEP-NET) represent a heterogeneous family of diseases of often challenging clinical management. Although many GEP-NET are slow progressing and frequently less aggressive than neoplasms of other origin, they can metastasise and reduce the life span of the patient. GEP-NET can be functioning (secreting hormones that may cause symptoms and organ damage), but some 60% are non-functioning. Thorough clinical assessment including family history, biochemical tests, radiology and nuclear medicine scans, and histological confirmation are important to tailor the optimal treatment of GEP-NET, which should be managed with a multidisciplinary approach and mainly guided by tumour grading and staging, functioning status, and location of the primary lesion.

Nursing Implications of Chemotherapy Agents and Their Associated Side Effects in Patients With Pancreatic Cancer.

BACKGROUND: Survival for patients with advanced (locally advanced unresectable and metastatic disease) pancreatic cancer is very poor; however, several advances in treatment have been made during the past several years. Gemcitabine (Gemzar®)-based regimens, FOLFIRINOX, and nab-paclitaxel (Abraxane®)-based regimens have demonstrated efficacy in patients with advanced pancreatic cancer. Understanding the unique safety profile of each of these regimens is crucial in helping nurses identify symptoms, develop patient education strategies, and ultimately improve outcomes. OBJECTIVES: This article aims to provide background information on and nursing implications of the treatment of patients with advanced pancreatic cancer by exploring the mechanism of action and efficacy and safety profiles of standard treatment regimens. METHODS: Key trials of standard treatment regimens used in the treatment of advanced pancreatic cancer were examined with respect to efficacy outcomes and the most commonly observed adverse events. Symptom identification and management strategies are discussed from the nursing perspective. FINDINGS: The current standard treatment options for patients with advanced pancreatic cancer have differences in efficacy and safety profiles. Nurses should educate themselves on these differences, particularly on associated adverse events and their management.

Total Pancreatectomy With Islet Cell Transplantationfor the Treatment of Pancreatic Cancer.

Resection or removal of the pancreas causes loss of parenchyma, which can result in extreme disruption of glucose homeostasis and malabsorption of dietary nutrients. However, islet autotransplantation (IAT) may reduce or prevent the severity of pancreatogenic diabetes. This article explores total pancreatectomy with IAT within the context of pancreatic cancer treatment. At a Glance • The liver is the preferred site for implantation because of easy vascular access. • Following islet autotransplantation, the liver becomes an insulin-producing organ as the transplanted beta cells begin making insulin. • The most significant complication of implantation in the liver is portal vein occlusion because of thrombosis; consequently, a heparin drip is infused for the first seven days postoperatively to prevent portal vein thrombus formation.

Papel de la enfermera coordinadora en el área de tumores hepatobiliopancreáticos / The role of the Nurse Navigator in the area of hepato-biliopancreatic tumours

INTRODUCCIÓN: los pacientes con cáncer de páncreas se enfrentan a procesos complejos y variados en los que actúan múltiples profesionales. La figura de una/o enfermera/o que coordine este proceso tiene un papel clave para facilitar la gestión y la asistencia del paciente a lo largo de toda la enfermedad. OBJETIVO: profundizar en el conocimiento de la figura de la enfermera coordinadora, en sus competencias, impacto en el cuidado de la salud y en su desarrollo en España. METODOLOGÍA: se realizó una revisión narrativa de la literatura en las bases de datos PubMed, CINAHL y en Google Académico de artículos publicados entre 1995 y 2013. Se utilizaron como palabras clave en inglés: patient navigation; nurse navigator; patient care; pancreatic cancer y en español: enfermera coordinadora; enfermera gestora; enfermera de enlace. RESULTADOS: se encontraron 25 artículos que abordan el tema. La enfermera coordinadora o patient navigator es una figura novedosa en el ámbito nacional, que surge según han ido apareciendo diferentes necesidades de salud. Se caracteriza por tener diversidad de competencias de gestión, asistencia e investigación. Tiene un impacto positivo en la satisfacción de los pacientes, pero todavía no se conoce el mismo sobre aspectos de supervivencia. CONCLUSIONES: esta figura está en creciente desarrollo y se destaca el beneficio de su intervención para abordar la complejidad del proceso de estos pacientes, coordinando y favoreciendo la atención multidisciplinar que requieren

INTRODUCTION: patients with pancreatic cancer must face complex and varied processes, where multiple professionals are involved. The figure of a nurse to coordinate this process plays a key role in order to facilitate patient management and care throughout their disease. OBJECTIVE: to probe into the awareness of the Nurse Navigator role, their responsibilities, impact on healthcare, and development in Spain. METHODOLOGY: a narrative review of literature was conducted in the PubMed and CINAHL databases, and in Academic Google, including articles published between 1995 and 2013. The following were used as key words in English: patient navigation; nurse navigator; patient care; pancreatic cancer, and in Spanish: enfermera coordinadora; enfermera gestora; enfermera de enlace.RESULTS: twenty-five (25) articles addressing this subject were found. The "enfermera coordinadora" or Patient Navigator is a novel role in our national setting, which has appeared at the same time as different health needs. Their main characteristic is to have diverse competencies in terms of management, patient care and research. This has a positive impact on patient satisfaction, but its impact on survival aspects is still unknown. CONCLUSIONS: this role is in increasing development, and the benefits of their intervention in order to address the complexity of these patients' process must be highlighted, by coordinating and assisting in the multidisciplinary care they require

A pilot study of the experience of family caregivers of patients with advanced pancreatic cancer using a mixed methods approach.

CONTEXT: Pancreatic cancer presents a wide spectrum of significant symptomatology. The high symptom burden, coupled with a rapidly fatal diagnosis, limits preparation or time for adjustment for both patients and their family caregivers. From the initial diagnosis and throughout the illness experience, the physical and emotional demands of caregiving can predispose caregivers themselves to illness and a greater risk of mortality. Understanding the negative and positive aspects of caregiving for patients with advanced pancreatic cancer will inform interventions that promote positive caregiver outcomes and support caregivers in their role. OBJECTIVES: To provide feasibility data for a larger, mixed methods, longitudinal study focused on the experience of family caregivers of patients with advanced pancreatic cancer and preliminary qualitative data to substantiate the significance of studying this caregiver population. METHODS: This was a mixed methods study guided by the Stress Process Model. Eight family caregivers of patients with advanced pancreatic cancer from oncology practices of a university-affiliated medical center were surveyed. RESULTS: The pilot results supported the ability to recruit and retain participants and informed recruitment and data collection procedures. The qualitative results provided preliminary insights into caregiver experiences during the diagnosis and treatment phases. Key findings that substantiated the significance of studying these caregivers included the caregiving context of the history of sentinel symptoms, the crisis of diagnosis, the violation of assumptions about life and health, recognition of the circle of association, and contextual factors, as well as primary and secondary stressors, coping strategies, resources, discoveries, gains and growth, associated changes/transitions, and unmet caregiver needs. CONCLUSION: Findings indicated caregivers' willingness to participate in research, highlighted the negative and positive aspects of the caregiver experience, and reinforced the significance of the future study and the need to develop interventions to support family caregivers in their roles.

Incidence of preventable postoperative readmissions following pancreaticoduodenectomy: implications for patient education.

PURPOSE/OBJECTIVES: To determine readmission rates post-pancreaticoduodenectomy (PD), readmission reasons following PD, and patients' postoperative education prior to discharge. DESIGN: Retrospective, descriptive study of established medical records of patients who have undergone PD from 2006-2008. SETTING: PD cohort from a pancreatic cancer program. SAMPLE: 62 patients aged 18 years or older, diagnosed with pancreatic cancer, who had PD. METHODS: Data abstracted from inpatient and outpatient electronic records as per study protocol and entered into Excel® spreadsheet for analysis. MAIN RESEARCH VARIABLES: Incidences of and reasons for readmissions post the PD procedure. Discharge education given to patients prior to discharge. FINDINGS: Patients were discharged at mean postoperative day 11.3. Readmission rate was 28%. Reasons for readmission were dehydration or malnutrition (n = 10, 16%) and surgical site infection (n = 7, 11%); 10% of patients (n = 6) had documented difficulties with dehydration, malnutrition, and failure to thrive noted at follow-up. PD discharge teaching was documented in a mandatory discharge form. No standard curriculum was used. CONCLUSIONS: Patients undergoing PD experience an increase in self-care demand postdischarge. Poor discharge education can lead to high rates of readmission, specifically for dehydration and malnutrition, mandating an assessment of patient education prior to discharge. IMPLICATIONS FOR NURSING: Close attention must be given to the needs of patients with pancreatic cancer postdischarge. Trying to identify the areas of educational deficit at patient readmission could help nurses identify what they can do to minimize preventable complications. Educational focus for patients undergoing PD should be on prevention of dehydration, malnutrition, and surgical site infections.