Cáncer de mama con metástasis cutánea: caso clínico y cuestionamiento ético / Breast cancer with skin metastasis: clinical case and ethical questioning

El cáncer de mama es el tipo de cáncer más frecuente y la quinta causa de muerte por cáncer en mujeres a nivel mundial. Este tipo de cáncer constituye un importante problema de salud, tanto por su incidencia y mortalidad como por sus repercusiones físicas, psicológicas y económicas. Los programas de cribado y diagnóstico precoz, así como la mejora de los tratamientos, favorecen de manera significativa el pronóstico y la supervivencia a la enfermedad. Pero cuando se detecta de manera tardía, ya sea por fallo del sistema o por dejadez de la persona, surge el problema moral, la dicotomía entre tratar de curar a pesar de los efectos secundarios negativos de los tratamientos o aplicar medidas paliativas procurando mejorar la calidad de vida. A continuación, presentamos un caso clínico de una mujer de 78 años con cáncer de mama con diseminación cutánea y ulceración. Se revisa el tema: incidencia, evolución, mortalidad, linfedema, calidad de vida, decisiones anticipadas y atención paliativa.(AU)

Breast cancer is the most common type of cancer and the fifth leading cause of cancer death in women worldwide. This type of cancer constitutes a major health problem, both due to its high incidence and mortality and its physical, psychological and economic. Screening programs and early diagnosis, as well as improved treatments, significantly improve the prognosis and survival of disease. But when it is detected late, either due to system failure or neglect of the person, the moral problem arises, the dichotomy between trying to cure despite negative side effects of treatments or applying palliative measures trying to improve the quality of life, life despite anticipating that it will be short. Below we present a clinical case of a 78-year-old woman with skin dissemination and ulceration breast cancer. The subject is reviewed: incidence, evolution, mortality, lymphedema, quality of life, early decisions and palliative care.(AU)

Aporte espiritual/religioso pela enfermagem no tratamento do câncer de mama: revisão integrativa / Spiritual/religious support for nursing in the treatment of breast cancer: integrative review / Apoyo espiritual/religioso de la enfermería en el tratamiento del cáncer de mama: revisión integrativa

Objetivo: analisar na literatura científica a importância da abordagem espiritual/religiosa pela equipe de enfermagem no tratamento do câncer de mama. Método: revisão integrativa, realizada na BDENF, LILACS e SCOPUS. Resultados: foram selecionados seis estudos, evidenciou-se que a abordagem espiritual/religiosa pelos profissionais de enfermagem auxilia para o enfrentamento positivo do câncer de mama. Assim, emergiu a categoria.: Abordagem espiritual/religiosa na assistência de enfermagem e suas repercussões positivas para o enfrentamento do câncer de mama. Conclusão: a categoria da enfermagem integra a rede de apoio social para o alívio do sofrimento, por meio do aporte espiritual/religioso, auxiliando para a minimização de sentimentos negativos associados ao diagnóstico e aos eventos adversos dos tratamentos, sendo importante incluir discussões acerca desta temática na formação de nível técnico e graduação em enfermagem.

Objective: to analyze in the scientific literature the importance of the spiritual/religious approach by the nursing team in the treatment of breast cancer. Method: integrative review, carried out in BDENF, LILACS and SCOPUS. Results: six studies were selected, showing that the spiritual/religious approach by nursing professionals helps to cope positively with breast cancer. Thus, the following category emerged: Spiritual/religious approach in nursing care and its positive repercussions for coping with breast cancer. Conclusion: the nursing category is part of the social support network for relieving suffering, through spiritual/religious support, helping to minimize negative feelings associated with the diagnosis and adverse treatment events, and it is important to include discussions on this topic in technical and undergraduate nursing training.

Objetivos:analizar la importancia del abordaje espiritual/religioso por el equipo de enfermería en el tratamiento del cáncer de mama en la literatura científica. Método: revisión integradora, realizada en BDENF, LILACS y SCOPUS. Resultados: fueron seleccionados seis estudios que demuestran que el abordaje espiritual/religioso por profesionales de enfermería ayuda a enfrentar positivamente el cáncer de mama. Surgió la siguiente categoría: Enfoque espiritual/religioso en los cuidados de enfermería y sus repercusiones positivas para el afrontamiento del cáncer de mama. Conclusión: la categoría de enfermería forma parte de la red de apoyo social para aliviar el sufrimiento, a través del apoyo espiritual/religioso, ayudando a minimizar los sentimientos negativos asociados al diagnóstico y a los eventos adversos de los tratamientos, siendo importante incluir discusiones sobre este tema en la formación técnica y de pregrado de enfermería.

Cuidados de salud en pacientes mastectomizadas: Revisión bibliográfica / Health care in mastectomized patients: Literature review

Introducción: El cáncer de mama es la neoplasia más frecuente en la mujer tanto en España como a nivel mundial, considerándose un gran problema para la salud pública. El cribado se realiza mediante la mamografía. Actualmente el enfoque terapéutico incluye tratamiento quirúrgico, existiendo la posibilidad de cirugía conservadora o no conservadora o mastectomía. Esta segunda opción fue introducida por Halsted y Meyer como intervención pautada, con bases científicas, en el año 1890. Hoy día sigue realizándose, desencadenando un gran impacto en todos los ámbitos de la vida de la mujer. Objetivo: Establecer los cuidados de salud apropiados para mujeres con cáncer de mama sometidas o en previsión de ser sometidas a una mastectomía, por parte de los profesionales de enfermería. Metodología: Esta revisión bibliográfica siguió el protocolo PRISMA. Los artículos seleccionados fueron únicamente ensayos clínicos aleatorizados (ECA). La búsqueda bibliográfica se realizó en las bases de datos Medline, Cinahl y Scopus mediante los términos MeSH “mastectomíy” , “nursing care” y “clincal trial” y el operador boleano “AND”. Se encontraron 20 artículos que cumplían los criterios de inclusión, y fueron transferidos al software Mendeley Desktop. Resultados: Tras una serie de cribados, fueron 9 los artículos incluidos en la revisión bibliográfica. Se midió su calidad metodológica mediante la escala PEDro. Conclusiones: A pesar de la gran incidencia del cáncer de mama, así como de la mastectomía, existen pocos ensayos clínicos aleatorizados publicados. Por tanto, sería interesante profundizar más respecto a este tema en futuras líneas de investigación.(AU)

Introduction: Breast cancer is the most frequent neoplasm in women both in Spain and worldwide, being considered a big problem for public health. Screening is done by a mammogram. Currently, therapy includes surgical treatment which could be breast-conserving surgery or mastectomy. The second option was introduced like a formal procedure by Hasteld and Meyer in 1890. It is still done nowadays, meaning a great impact for women in all fields of their lives. Purpose: Establish the appropriate health care for women with breast cancer who have been undergoing or will be undergoing a mastectomy, by nurses. Material and methods: This systematic review followed the protocol PRISMA. The selected articles were just randomized clinical trials (RCTs). The searching was made in Medline, Cinahl and Scopus databases by the Mesh terms “mastectomy”, “nursing care” and “clinical trial” and the boolean operator “AND”. Twenty articles that included inclusion criteria were found and transferred to Mendeley Desktop software. Outcomes: After articles were narrowed down, nine of them were included in the systematic review. Their methodological quality was measured by the PEDro scale. Conclusion: Despite the high incidence of breast cancer and mastectomy, there are a few published RCTs about that. Therefore, it would be interesting to go deeper into this topic in future lines of research.(AU)

La resiliencia de los padres de niños con cáncer y su importancia en el manejo del estrés y la satisfacción vital / Resilence, stress level and life satisfaction in parents of children with cancer

Objetivo: El presente estudio se plantea como objetivo principal analizar cómo la resiliencia de los padres de niños diagnosticados con enfermedad oncológica influye en la percepción de estrés y en la satisfacción vital. Metodología: Participaron 112 padres de niños con patología oncológica que recibían tratamiento en Málaga. Los datos fueron recogidos a través de medidas de autoinforme. Resultados: Existe una relación significativa y negativa entre la resiliencia y el estrés percibido, y una relación significativa y positiva entre la resiliencia y la satisfacción vital. En el estudio por dimensiones de la resiliencia y el estrés, la competencia personal de los padres disminuye el estrés R2 = 0,24; F = 12,12; p<0,0001 y la dimensión de la resiliencia aceptación de uno mismo aumenta la satisfacción vital R2 = 0,42; F = 31,24; p<0,0001. Conclusiones: El análisis de la resiliencia a través de sus dimensiones ha permitido conocer el papel que tiene sobre el estrés y la satisfacción vital de los padres con niños con cáncer. Estos resultados pueden tener importantes implicaciones prácticas en el diseño de las intervenciones que mejoren su calidad de vida (AU)

Objective: The main objective of this study is to analyze how the resilience of the parents of children diagnosed with oncological disease influences the perception of stress and life satisfaction. Methodology: 112 parents of children with oncological pathology who received treatment in Malaga participated. Data were collected through self-report measures. Results: There is a significant and negative relationship between resilience and perceived stress, and a significant and positive relationship between resilience and life satisfaction. In the study by dimensions of resilience and stress, the personal competence of parents decreases stress R2 = 0.24; F = 12.12; p<0.0001 and the dimension of resilience acceptance of oneself increases life satisfaction R2 = 0.42; F = 31.24; p<0.0001. Conclusions: The analysis of resilience through its dimensions has allowed to know the role it has on stress and life satisfaction of parents with children with cancer. These results can have important practical implications in the design of interventions that improve their quality of life (AU)

Relato de experiência: grupo para mulheres com câncer de mama em radioterapia / An experience report: group for women with breast cancer in radiotherapy / Informe de experiencia: grupo de mujeres con cáncer de mama en radioterapia

Objetivo: relatar a experiência da criação de um espaço de acolhimento que promovesse o diálogo sobre os impactos que o diagnóstico do câncer traz para a vida das mulheres, o compartilhamento de sentimentos e o esclarecimento de dúvidas sobre o tratamento radioterápico. Método: estudo qualitativo, tipo relato de experiência, realizado por acadêmicas de enfermagem, durante a construção de um grupo de ajuda mútua para mulheres com câncer de mama. O encontro ocorreu semanalmente, com duração de cerca de uma hora e iniciava com a apresentação das participantes. Duas perguntas norteadoras: "Como foi a descoberta da doença?" e "Quais os sentimentos sobre o estado de saúde atual?" incentivavam o processo para o compartilhamento de vivências. Resultados: constatou-se que diversas pacientes não tinham recebido informações sobre os efeitos adversos e os cuidados durante a radioterapia. Além disso, compreendeu-se a dinâmica familiar e percebeu-se a reflexão que as mulheres faziam sobre si e suas vidas durante o tratamento. Conclusão: a realização desse grupo foi fundamental, para que os questionamentos manifestados fossem elucidados e as mulheres se tornassem mais fortalecidas, unidas e providas de conhecimento sobre o tratamento e o autocuidado.(AU)

Objective: To report the experience of creating a welcoming space that promotes dialogue about the impacts that the diagnosis of cancer brings to women's lives, sharing feelings and clarifying doubts about radiotherapy treatment. Method: this is a qualitative study, experience report type carried out by Nursing students during the construction of a mutual-help group for women with breast cancer. The meeting took place weekly, lasting about an hour, and began with the presentation of the participants. Then, two guiding questions emerged: "How was the discovery of the disease?" and "What are your feelings about your current health status?" encouraged the process of sharing experiences. Results: it was found that several patients had not received information about adverse effects and care during radiotherapy. In addition, it was possible to understand the family dynamics and realize the reflection that women made about themselves and their lives during treatment. Conclusion: the creation of this group was essential for the questions raised to be elucidated and for the women to become more empowered, united, and provided with knowledge about treatment and self-care.(AU)

Objetivo: relatar la experiencia de crear un espacio acogedor que promueva el diálogo sobre los impactos que el diagnóstico de cáncer trae en la vida de las mujeres, compartiendo sentimientos y aclarando dudas sobre el tratamiento con radioterapia. Método: se trata de un estudio cualitativo, tipo relato de experiencia realizado por estudiantes de enfermería durante la construcción de un grupo de ayuda mutua para mujeres con cáncer de mama. El encuentro se llevó a cabo semanalmente, con una duración aproximada de una hora y comenzó con la presentación de los participantes. Luego, se realizaron dos preguntas orientadoras: "¿Cómo fue el descubrimiento de la enfermedad?" y "¿Cuáles son sus sentimientos acerca de su estado de salud actual?" alentó el proceso de compartir experiencias. Resultados: se encontró que varios pacientes no habían recibido información sobre efectos adversos y cuidados durante la radioterapia. Además, fue posible comprender la dinámica familiar y darse cuenta de la reflexión que las mujeres hacen sobre sí mismas y sus vidas durante el tratamiento. Conclusión: la realización de este grupo fue fundamental para dilucidar las cuestiones planteadas y para que las mujeres se empoderaran, se unieran y se les dotara de conocimientos sobre el tratamiento y el autocuidado.(AU)

Abordaje integral de la persona con una lesión neoplásica cutánea. Plan estandarizado de cuidados de enfermería basado en la evidencia / Comprehensive approach to the person with a neoplastic skin lesion. Evidence-based standardized nursing care plan

Introducción: Las lesiones neoplásicas cutáneas generan un elevado impacto en salud por la complejidad de su abordaje sintomatológico y las complicaciones asociadas, entre las que destaca el impacto emocional que provocan tanto en el paciente como en la familia. Es muy importante detectar las necesidades del paciente y, en ausencia de un horizonte curativo, brindar bienestar y confortabilidad, mejorando así la calidad de vida. Desarrollo del plan de cuidados: Se desarrolla un plan de cuidados estandarizado basado en la mejor evidencia científica disponible para atender las necesidades de una mujer de 65 años que presenta una herida neoplásica de 6 meses de evolución en la zona pectoral. Se proponen diagnósticos enfermeros basados en la taxonomía NANDA I, criterios de resultados (NOC) y las intervenciones enfermeras (NIC), así como las actividades correspondientes basadas en la evidencia científica. Se formulan los problemas de colaboración y complicaciones potenciales. Discusión y conclusiones: La valoración holística del paciente con enfermedad neoplásica y el abordaje integral mediante un equipo multidisciplinar son factores clave para brindar al paciente y a su familia, en ausencia de objetivos curativos, la mejor calidad de vida posible (AU)

Introduction: Neoplastic skin lesions cause a huge impact on health related with the complexity of symptomatic management and the associated complications, standing out the emotional impact caused on the patient and his family. It is very important to detect the patient's needs and, in the absence of a healing horizon, provide well-being and comfort, thus improving the quality of life. It is very important to detect the patient's needs and, in the absence of a healing horizon, provide well-being and comfort, thus improving the quality of life. Development of the care plan: A standardized care plan is developed based on scientific evidence to attend the needs of a 65-year-old woman who has a 6-month evolution neoplastic wound in the chest area. Nursing diagnoses based on the NANDAI taxonomy, outcome criteria (NOC) and nursing interventions (NIC) are proposed, as well as the corresponding activities based on scientific evidence. Collaboration problems and potential complications are also formulated. Discussion and conclusions: The holistic assessment of the patient with neoplastic disease and the comprehensive approach through a multidisciplinary team are key factors to provide the patient and his or her family, in the absence of curative objectives, with the best possible quality of life (AU)

Breast cancer and gynecologic risks in lesbian and bisexual women.

ABSTRACT: Lesbian and bisexual women may be at an increased risk for gynecologic infections and breast cancer due to a higher prevalence of factors such as obesity, smoking, and lower pregnancy rates. This article discusses the role of healthcare professionals in preventive screening for breast and gynecologic cancers and promoting healthy living in these patients by avoiding smoking, maintaining an ideal body weight, and limiting alcohol consumption.

Psychosocial factors related to BRCA1/2 disclosures.

ABSTRACT: Patients who learn they carry breast cancer genes 1 and 2 (BRCA1/2) must decide if, when, and how they want to disclose this information to family members who may be affected. This article discusses the psychosocial factors that may influence patient decisions to disclose positive BRCA1/2 results to family members, as well as the role of nurses in educating and advocating for patients and their families.

Factors affecting anxiety and depression in young breast cancer survivors undergoing radiotherapy.

PURPOSE: This study examined anxiety and depression, and their relationship with symptom assessment, uncertainty, social support, and stress in young breast cancer patients receiving radiotherapy. METHODS: This is a descriptive quantitative study. The participants were 126 patients under 50 years of age with breast cancer undergoing radiotherapy. RESULTS: The anxiety and depression levels were higher among those who were married (t = -2.318, p = .022), non-religious (t = 4.510, p = .005), and had a higher monthly income (F = 2.840, p = .041). The hierarchical regression analysis model included symptom assessment, uncertainty, social support, and stress, and accounted for about 49% of the variance in anxiety and depression (F = 7.688, p < .001). Additionally, uncertainty (ß = 0.304, p = .001) and stress (ß = 0.308, p = .001) were significant predictors of anxiety and depression. CONCLUSIONS: Based on the results of this study, nursing interventions are needed to reduce uncertainty and stress in order to reduce anxiety and depression in young breast cancer patients undergoing radiation treatment.

Examining Predictors of Fear of Cancer Recurrence Using Leventhal's Commonsense Model: Distinct Implications for Oncology Nurses.

BACKGROUND: Fear of cancer recurrence (FCR) is a common concern for survivors. Oncology nurses have a unique opportunity to identify survivors at increased risk of heightened FCR. Understanding predictors of FCR would be useful for this purpose; however, results about FCR predictors are inconsistent. OBJECTIVE: To examine empirically inconsistent predictors of FCR as guided by Leventhal's Commonsense Model. METHODS: A cross-sectional survey design was used to assess FCR, sociodemographic and clinical characteristics, and characteristics of the self (self-esteem and generalized expectancies) among cancer survivors. Structural equation modeling was used to examine predictors of FCR. RESULTS: Among 1001 participants, the mean time since diagnosis was 9.07 years, and most were diagnosed with breast cancer (65.93%). The strongest predictor of higher FCR was belief that knowing someone with a recurrence affects one's own level of FCR, although knowing someone with a recurrence actually predicted lower FCR. Other significant predictors of higher FCR were having 1 or more symptoms attributed to cancer, lower self-esteem, younger age, female gender, lower pessimism, longer time since diagnosis, and active follow-up at the survivorship clinic. CONCLUSION: Cancer survivors' perceptions are among an important series of variables that may predict higher levels of FCR. Oncology nurses are uniquely situated to identify the subset of cancer survivors with levels of FCR requiring professional intervention. IMPLICATIONS FOR PRACTICE: Oncology nurses can use the predictors indicated in this study to identify survivors with greatest need for coping with FCR to facilitate expedient intervention and/or referral to psychosocial providers.

The Effects of Logotherapy on Distress, Depression, and Demoralization in Breast Cancer and Gynecological Cancer Patients: A Preliminary Study.

BACKGROUND: Globally, cancer is the second leading cause of death. Breast cancer and gynecological cancer can damage patients' body image and lead to psychological distress, depression, and demoralization syndrome. No studies have explored the effect of logotherapy in gynecological cancer patients' psychological distress, depression, and demoralization. OBJECTIVE: To evaluate the effects of logotherapy on distress, depression, and demoralization in breast cancer and gynecological cancer patients. METHODS: A quasi-experimental design was used in this study, involving 61 breast cancer and gynecological cancer patients: 31 in the experimental group and 30 in the control group. Participants in the experimental group received logotherapy 4 to 6 times during the 12 weeks of intervention. Outcomes were measured by the (1) Distress Thermometer, (2) Patient Health Questionnaire, and (3) Demoralization Scale Mandarin Version (DS-MV). RESULTS: Distress Thermometer did not differ between groups, but significant differences in favor of the intervention group were noted in the Patient Health Questionnaire (U = 674.500, P = .002); the DS-MV subcategories of loss of meaning (U = 706.500, P = .000), dysphoria (U = 673.000, P = .002), disheartenment (U = 670.000, P = .003), helplessness (U = 621.000, P = .022), and sense of failure (U = 629.500, P = .016); and the total score of the DS-MV (U = 728.500, P = .000). CONCLUSION: Logotherapy was effective in the reduction of breast cancer and gynecological cancer patients' depression and demoralization. IMPLICATIONS FOR PRACTICE: Clinical professionals could add logotherapy to the treatment for breast cancer and gynecological cancer patients to reduce their depression and demoralization.

Feasibility and effect of a guided self-disclosure intervention designed to facilitate benefit finding in breast cancer patients: A pilot study.

PURPOSE: This pilot study aimed to evaluate the feasibility and effect of a guided self-disclosure intervention (GSDI) promoting benefit finding (BF) for breast cancer patients. METHODS: A total of 40 women with breast cancer were randomized either to a GSDI group, which included a 6-session face-to-face self-disclosure intervention, or to a control group. The Benefit Finding Scale (BFS) was used to measure BF, the Distress Disclosure Index (DDI) was used to measure self-disclosure, and the Impact of Event Scale-Revised (IES-R) was used to measure cognitive reappraisal. The outcomes were evaluated at baseline and the 3rd and 6th months. RESULTS: The GSDI group had more satisfaction (t = 2.35, P = .02) than the control group and had significant group effects of higher BF (t = 2.214, P = .03) and a lower avoidance of the IES-R (t = -2.353, P = .024) at the 3rd month. There was a significant difference of BF (t = 2.036, P = .049) between the two groups at the 6th month, and other outcomes were not significant (P > .05). Intention-to treat (ITT) analysis showed significant time effects for all outcomes (P < .05); there were slightly significant time × group effects for BF (F = 4.15, P = .052) and disclosure (F = 2.719, P = .090). There were no time × group effects for the other outcomes (all P > .05). CONCLUSION: This study suggests that the GSDI intervention may be feasible in the clinic and might improve BF for breast cancer patients. However, future research needs to further refine the intervention and expand the sample to carry out a full-scale randomized controlled trial.

Itinerários terapêuticos das mulheres com câncer de mama: percepções dos enfermeiros da atenção primária em saúde / Therapeutic routines of women with breast cancer: perceptions of nurses of primary health care / Itinerarios terapéuticos de mujeres con cáncer de mama: percepciones de enfermeras de atención primaria de salud

Objective:To reveal primary care nurses' perceptions regarding health care provided to women with breast cancer. Method: an exploratory, descriptive study using a qualitative approach, conducted with eight nurses who worked in the Family Health Strategy of a city in Santa Catarina. Data were collected through semi-structured interviews in the second half of 2018. For data analysis, content analysis was used. Results: The offer of free treatment by SUS and the fact that municipality is a reference in cancer treatment emerged as opportunities. The lack of protocols to expand the autonomy of nurses and a flow of reference and counter reference were highlighted as challenges. Conclusion: Continuous training for professionals, establishment of flows and prevention and health promotion strategies are necessary In order to reduce the incidence of this disease

Objetivo: Desvelar as percepções dos enfermeiros da atenção primária quanto a assistência em saúde fornecida as mulheres com câncer de mama. Método: estudo exploratório, descritivo, com abordagem qualitativa, realizado com oito enfermeiras que atuam na Estratégia Saúde da Família de um município catarinense. A coleta de dados deu-se através da entrevista semiestruturada, no segundo semestre de 2018. Para análise dos dados utilizou-se a análise de conteúdo. Resultados: a oferta do tratamento gratuito pelo SUS e o munícipio ser referência para o tratamento oncológico despontaram como potencialidades. A falta de protocolos para ampliação da autonomia do enfermeiro e de um fluxo de referência e contra referência foram destacados como fragilidades. Conclusão: são necessárias ações de educação permanente para profissionais e estabelecimento de fluxos visando a qualificação da assistência em tempo oportuno, bem como adoção de estratégias de promoção e prevenção para a diminuição dessa enfermidade

Objetivo: Revelar las percepciones de las enfermeras sobre la atención primaria con respecto a la atención médica brindada a las mujeres con cáncer de seno. Método: estudio exploratorio descriptivo con enfoque cualitativo, realizado con ocho enfermeras que trabajaron en la Estrategia de Salud Familiar de una ciudad de Santa Catarina. Los datos se recopilaron a través de entrevistas semiestructuradas en la segunda mitad de 2018. Para el análisis de datos, se utilizó el análisis de contenido. Resultados: la oferta de tratamiento gratuito por parte del SUS y el municipio como referencia para el tratamiento del cáncer surgió como potencialidades. La falta de protocolos para ampliar la autonomía de las enfermeras y un flujo de referencia y contrarreferencia se destacaron como debilidades. Conclusión: se necesitan acciones de educación continua para los profesionales y el establecimiento de flujos destinados a la calificación de asistencia oportuna, así como la adopción de estrategias de promoción y prevención para reducir esta enfermedad

Nurses' Role in Providing Comprehensive Communication, Prognostication, and Palliative Care During the COVID-19 Pandemic.

This article presents the case of a mother of young children who has terminal stage IV cancer with whom providers had not discussed goals of care and prognostication. Communications about prognostication and goals of care are commonly initiated by physicians. Adolescents and young and middle-age adults with complex chronic or terminal illness often are not provided with timely, clear, complete information or palliative care support. Early palliative care for chronically ill patients facilitates discussions of prognostication and goals of care, in addition to providing symptom management. Such discussions do not diminish hope but rather allow patients to adjust hope to attain an optimal quality of life. Nurses can become active, confident advocates for patients with terminal illness of any age, and they are well positioned to assess patients and engage in goals of care and end-of-life conversations. It is especially important that palliative care nurses promote and maintain these early and comprehensive discussions during the COVID-19 pandemic because this population is at a high risk of complications from the coronavirus.

A Web-Streamed Yoga Intervention for Breast Cancer Survivors.

BACKGROUND: Current research indicates that structured yoga practice may improve physical and emotional symptoms related to cancer treatment. Yoga is recommended for patients with cancer, yet there are barriers to participation in community- and hospital-based classes. Wellness interventions such as yoga are easy to access via the internet, but information can be overwhelming and not tailored to people with cancer. PURPOSE: The purpose of this study was to develop a nurse-led, breast cancer-specific, web-based gentle yoga video for home use, and to understand the feasibility, utilization, and safety of the video in a sample of breast cancer survivors. METHOD: Data was collected via open-ended telephone interviews three times over a 4-week period. RESULTS: The 14 women participating in the study reported that the web-based video was safe in that it resulted in no injury, and was easy to use, and convenient to access. However, most did not continue to practice the video for the full 4 weeks of the study. A knowledge deficit about gentle yoga as a structured mindful movement-based practice rather than a vigorous exercise was identified. IMPLICATIONS: Nurses can provide tailored wellness interventions for cancer survivors via video stream. Future work should include instruction that yoga is a mindfulness-based self-care activity requiring regular practice.

Effects of a nurse-led medication self-management programme in women with oral treatments for metastatic breast cancer: A mixed-method randomised controlled trial.

PURPOSE: Adherence to medication is the most important challenge facing patients receiving oral anticancer treatment. This study aimed to evaluate the effects of a patient-centred medication self-management support programme in patients with metastatic breast cancer undergoing oral anticancer treatment. METHODS: This trial was a two-phased mixed-method randomised controlled study. Eligible participants were 155 patients with metastatic breast cancer newly prescribed an oral chemotherapy or targeted therapy agent. The intervention group received the patient-centred medication self-management support programme conducted by trained nurses. Primary outcome was adherence to medication at three months after the commencement of treatment, calculated by medication possession ratio (MPR). Secondary outcomes included self-efficacy, functional assessment, psychological distress, symptom severity and symptom interference, and patient satisfaction. After the completion of the intervention study, focus group interviews were conducted among intervention nurses. RESULTS: Both intervention and control groups maintained more than 90% of MPR and no significant difference was observed in the primary outcome. Regarding secondary outcomes, only general self-efficacy was significantly different in the two groups. In the qualitative study, the intervention nurses perceived improvement in the patients' self-efficacy, ability to anticipate the impact of treatment and adjust to life, and avoidance of loneliness. CONCLUSIONS: A significant effect of the programme was not found in the program because the adherence rate was high in both groups. Improvement in the patients' self-efficacy was observed both quantitatively and qualitatively. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR), Japan, UMIN000016597. (27 February 2015).

Breast cancer nursing interventions and clinical effectiveness: a systematic review.

OBJECTIVES: To examine the effects of nurse-led interventions on the health-related quality of life, symptom burden and self-management/behavioural outcomes in women with breast cancer. METHODS: Cochrane Controlled Register of Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Embase databases were searched (January 1999 to May 2019) to identify randomised controlled trials (RCTs) and controlled before-and-after studies of interventions delivered by nurses with oncology experience for women with breast cancer. Risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomised trials. Intervention effects were synthesised by cancer trajectory using The Omaha System Intervention Classification Scheme. RESULTS: Thirty-one RCTs (4651 participants) were included. All studies were at risk of bias mainly due to inherent limitations such as lack of blinding and self-report data. Most studies (71%; n=22) reported at least one superior intervention effect. There were no differences in all outcomes between those who receive nurse-led surveillance care versus those who received physical led or usual discharge care. Compared with control interventions, there were superior teaching, guidance and counselling (63%) and case management (100%) intervention effects on symptom burden during treatment and survivorship. Effects of these interventions on health-related quality of life and symptom self-management/behavioural outcomes were inconsistent. DISCUSSION: There is consistent evidence from RCTs that nurse-led surveillance interventions are as safe and effective as physician-led care and strong evidence that nurse-led teaching, guidance and counselling and case management interventions are effective for symptom management. Future studies should ensure the incorporation of health-related quality of life and self-management/behavioural outcomes and consider well-designed attentional placebo controls to blind participants for self-report outcomes. PROTOCOL REGISTRATION: The International Prospective Register of Systematic Reviews (PROSPERO): CRD42020134914).

Breast Cancer Surgery During the COVID-19 Pandemic: An Observational Clinical Study of the Breast Surgery Clinic at Ospedale Policlinico San Martino - Genoa, Italy.

BACKGROUND: COVID-19 pandemic required a marked re-allocation of healthcare resources, including at Breast Units. A patient-tailored program was developed to assess its efficacy regarding prevention of COVID-19 infection among patients with breast cancer undergoing surgery and healthcare workers (HCWs). PATIENTS AND METHODS: From March 9th to April 9th 2020, 91 patients were selected for elective surgery by means of: i) Pre-hospital screening aimed at avoiding hospitalization of symptomatic or suspicious COVID-19 patients, and ii) prioritisation of surgical procedure according to specific disease features. RESULTS: Eighty-five patients (93.4%) were fit for surgery, while five patients (5.5%) were temporarily excluded through 'telephone triage'; another two patients were excluded at in-hospital triage. A total of 71 out of 85 patients (83.5%) were diagnosed with invasive cancer, most of whom were undergoing breast-conserving surgery (61 out of 85 patients, 71.8%). The mean in-hospital stay was 2.2 days (SD=0.7 days). After hospital discharge, no patient needed re-admission due to post-operative complications; moreover, no COVID-19 infection among patients or HCWs was detected. CONCLUSION: Safe breast cancer surgery was accomplished for both patients and HCWs by means of a careful preoperative selection of patients and in-hospital preventative measures. This screening program can be transferred to high-volume Breast Units and it may be useful in implementing European Community recommendations for prevention of COVID-19 infection.