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   Table of Contents - Current issue
Coverpage
January-March 2019
Volume 6 | Issue 1
Page Nos. 1-100

Online since Thursday, November 29, 2018

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EDITORIALS  

Physical Activity and Exercise after Hematopoietic Cell Transplantation: Just Keep on Moving p. 1
Eileen Danaher Hacker
DOI:10.4103/apjon.apjon_64_18  
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Cancer- and Chemotherapy-Related Symptoms and the Use of Complementary and Alternative Medicine p. 4
Ping Lei Chui
DOI:10.4103/apjon.apjon_51_18  
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Cancer-Related Fatigue: Some Clinical Aspects p. 7
Svetlana Savina, Boris Zaydiner
DOI:10.4103/apjon.apjon_45_18  
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REVIEW ARTICLES Top

Oncology Nursing in Hong Kong: Milestones over the Past 20 Years p. 10
Suzanne So-Shan Mak
DOI:10.4103/apjon.apjon_46_18  
The article reviews the development of oncology nurses' role, training, education, practice, and service provision in Hong Kong, highlighting milestones over the past two decades and providing directions for future training, practice, and research. There was an expansion of the diversity of roles and practice from the 2000s onward, reflecting the importance of contribution by nurses to clinical practice and service for cancer patients. These areas include advanced roles and competence development, advanced training, service delivery model, cross-cluster collaboration, quality improvement initiatives, and new nurse clinic model. Recognizing the challenges and the opportunities, it helps to identify the future work with newer and more advanced practice foci as well as training initiatives in advanced practice being developed to meet the increased needs of increasing service load and populations in need of ongoing access to oncology care. The role and the continuous efforts of the clinical, academic, and professional bodies to meet this goal will be crucial and strategic in the future.
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The Changing Face of Lung Cancer: Survivor Perspectives on Patient Engagement p. 17
Margaret I Fitch
DOI:10.4103/apjon.apjon_43_18  
Objective: Advances in the diagnosis and treatment of lung cancer have resulted in an increasing number of individuals living longer following their diagnosis. No longer is lung cancer the “death sentence” it once was. This initiative was designed to document the current experiences of lung cancer patients and explore the potential for patient engagement. Methods: Three avenues of investigation were undertaken: a literature review regarding lung cancer and patient engagement, an environmental scan of lung organizations and cancer societies regarding their approaches to lung cancer patient and family engagement, and in-depth interviews with lung cancer survivors and family members about their experiences and perspectives about patient engagement. Information was collated and major themes identified. Results: Evidence about the experience of lung cancer patients illustrates their needs are complex and dynamic. It also presents a clear picture of unmet physical, psychosocial, and spiritual needs. In particular, stigma is a significant issue for those diagnosed with lung cancer. Information, support, and communication play important roles in helping patients cope but access to resources remains challenging. Patients and family members expressed interest in becoming engaged in advocacy to improve care. Conclusions: The changing face of lung cancer creates the potential for lung cancer survivors to become engaged not only in participating in their own care but also become more involved in peer support and advocacy than lung cancer patients have been able to do in the past.
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Social Media and Health Policy p. 24
Andreas Charalambous
DOI:10.4103/apjon.apjon_60_18  
The current era is characterized by the vibrant and rapidly evolving communication technologies. Communication in any form has evolved and now includes media such as Facebook, Twitter, and Instagram to report a few. Communicating and consuming information has shifted from the more traditional ways to new ones as part of this communication evolution. Cancer is an area of healthcare where such social media have been championed either to promote public awareness and drive campaigns or influence political decision-making. Although health-care lags behind many other industries in adopting social media as a part of a business or policy strategy, the increasing engagement of patients, the public, and the policymakers in social media raised the need for integrating these tools as a part of an overall program to support the strategic imperatives of the health care. As these and other new ways to communicate are introduced to the world and injected into our cultural and political systems, the question that raises here is: “How successful are social media in influencing health policy?”
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ORIGINAL ARTICLES Top

The Impact of Breast Care Nurses: An Evaluation of the McGrath Foundation's Breast Care Nurse Initiative p. 28
Jane Mahony, Holly Masters, James Townsend, Fionnuala Hagerty, Lisa Fodero, Joe Scuteri, Darren Doromal
DOI:10.4103/apjon.apjon_61_18  
Objective: Over the four years to 30 June, 2017 the McGrath Foundation's Second Federal Government Breast Care Nurse (BCN) Initiative funded 57 McGrath BCNs (MBCNs) to deliver better continuity of care and provide specialized support to those diagnosed with and undergoing treatment for breast cancer. This article summarizes the findings generated through a mixed-method evaluation of the program's appropriateness, effectiveness, and efficiency. Methods: The evaluation comprised surveys and semi-structured interviews with patients, multidisciplinary clinicians and MBCNs. The research also drew on secondary materials, including MBCN activity and patient caseload data, a review of existing programs and costing information. Results: The evaluation generated evidence that access to an MBCN results in an improved experience for patients and clinicians, and that these impacts are more profound when MBCNs come into contact with their patients at the time of diagnosis. The economic modeling component of the evaluation revealed that there are cost savings to the health system when breast cancer patients have early access to an MBCN (through reduced health service utilization). The net saving produced by the program was estimated to be worth $6,323,257 per year, or $1,527 per new breast cancer patient seen. Stakeholders indicated that the MBCN model of care could be evolved to respond to emerging trends in breast cancer care pathways, such as a greater role in survivorship. Conclusion: This research advances the current understanding of the impact of BCNs on different levels of the health system and holds relevance for health-care funders, providers, and policy-makers. The evaluation demonstrates that access to an MBCN results in an improved experience for patients and clinicians, along with savings to the health system (through reduced health service utilization). The evaluation also shows that these impacts are more profound when MBCNs come into contact with their patients at the time of diagnosis.
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Exploring the Use of Neurofeedback by Cancer Survivors: Results of Interviews with Neurofeedback Providers and Clients p. 35
Marian F Luctkar-Flude, Jane Tyerman, Dianne Groll
DOI:10.4103/apjon.apjon_34_18  
Objective: Cancer survivors may experience persistent physical and psychological symptoms following completion of cancer treatment. Neurofeedback is a noninvasive form of brain training reported to help with symptoms including pain, fatigue, depression, anxiety, insomnia, and cognitive decline; however, there is a lack of research exploring its use with cancer survivors. The objective of this study was to describe the experiences of neurofeedback and its impact on the lives of posttreatment cancer survivors as perceived by neurofeedback providers and cancer survivor clients. Methods: This qualitative descriptive study employed semi-structured interviews and thematic analysis of interview transcripts. A convenience sample of twelve neurofeedback providers and five cancer survivor clients participated in this study. Results: Thematic analysis revealed seven overarching themes as follows: (1) paying it forward; (2) transforming lives; (3) regaining control; (4) brain healing itself; (5) comforting experience, (6) accessibility, and (7) failure to respond. The first five themes related to benefits of neurofeedback, and the final two related to challenges of using neurofeedback with cancer survivors. Conclusions: Results support the use of neurofeedback to improve quality of life for cancer survivors; however, more research is needed to determine which neurofeedback systems and protocols are most effective for this population with persistent symptoms.
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Frailty Prevalence and Characteristics in Older Adults with Hematologic Cancer: a Descriptive Study p. 43
Esra Atakul, İmatullah Akyar
DOI:10.4103/apjon.apjon_35_18  
Objective: This study investigated the prevalence of frailty in older patients with hematologic cancer and assessed the association between older patients' characteristics and frailty. Methods: This descriptive study enrolled 90 older patients undergoing treatment for hematological malignancies at an oncology hospital. Frailty was assessed with the Edmonton Frailty Scale as not frail (0–4), apparently vulnerable (5–6), mildly frail (7–8), moderately frail (9–10), and severely frail (11–17). The association of frailty and older patient characteristics and diagnosis was assessed by logistic regression. Results: The prevalence of frailty (mild, moderately, and severely) was 42.2%, and “apparently vulnerable” frailty was 60%. The mean scale score was 5.59 ± 3.13. Frailty was more prevalent in patients who were ≥75 years of age, had ≥4 children, were diagnosed with leukemia, and were diagnosed for ≥2 years. Gender, diagnosis, and employment were factors associated with the presence of frailty. Female gender and lack of employment were factors associated with a high risk of frailty. A diagnosis of multiple myeloma was associated with a low risk of frailty. Conclusions: The prevalence of frailty was high in older patients. Female and unemployed patients were at high risk for frailty. Frailty characteristics of older patients with hematologic cancer highlighted the need for comprehensive geriatric assessment and frailty screening, provided prevalence and characteristics of frailty in this group of patients during treatment, and highlighted the need for holistic care approach.
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Skin-related Quality of Life among Midwestern US Community-based Women with Breast Cancer Experiencing Radiodermatitis p. 50
Laura Curr Beamer, Marcia Grant
DOI:10.4103/apjon.apjon_40_18  
Objective: Little is known about the skin-related quality of life (QOL) among women receiving external radiotherapy (EBT) and who experience breast radiodermatitis. This pilot study aimed to describe the thoughts and experiences of women experiencing breast radiodermatitis of the breast at a comprehensive community cancer program. Methods: A printed survey was used to solicit feedback on the Dermatology Life Quality Index (DLQI) during the 5th week of EBT. An open-ended question inquired which DLQI-related issue was most important and why. A directed qualitative content analysis was conducted on the narrative responses. Results: Twenty-eight women provided a response to the “most important” question. Sixty narratives led to the identification of 35 codes and six themes during content analysis. Themes included perspectives on having radiodermatitis, sensations caused by radiodermatitis, knowledge, and preparation for radiotherapy, prevention of radiodermatitis, emotions induced by skin changes, and physical appearance of the breast skin. Conclusions: The study results provide a glimpse into the perceptions of skin-related QOL among community-dwelling women who experienced breast radiodermatitis. Some women expressed that radiodermatitis had a profound impact on their QOL while other were surprised that EBT was easy compared to chemotherapy. Our findings parallel those found in a previous study conducted in an urban setting. Results provide insight into the thoughts and needs of women undergoing breast EBT. Assessing individual differences in skin-related QOL can provide needed information for tailoring care to the unique needs of each woman. Additional studies focusing specifically on skin-related QOL are needed.
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Cancer Illness Perception and Self-Management of Chinese Patients p. 57
Fang-Yu Chou
DOI:10.4103/apjon.apjon_56_18  
Objective: The purpose of this article is to examine the relationships of illness perception, self-care, self-efficacy, and self-care strategies and their effects on Chinese cancer patients' quality of life (QOL). Methods: Questionnaires include data on demographic characteristics, illness perception, symptom self-care activity, and QOL. A secondary analysis was conducted on a sample of ethnic Chinese breast-and-colon cancer patients (n = 159) to examine multivariate associations. Descriptive statistics, bivariate correlational analysis, and hierarchical regression analysis were used to analyze quantitative data. Results: The hierarchical regression model explained 43% of variance in QOL. Perceived illness consequence, personal control, and performance functioning status were found to be significant predictors in the model. Comparisons between breast-and-colon cancer patients showed that colon cancer patients significantly perceived higher levels of chronicity and negativity toward cancer than breast cancer patients. Conversely, breast cancer patients had significantly higher level of QOL and efficacy in making decision. Stress and overwork were the common perceived causes of cancer reported by these patients. Conclusions: These findings suggest that improving self-care efficacy and positive personal control can improve Chinese cancer patients' QOL. Variation in illness perceptions of cancer by different types of cancer should be considered in cancer survivorship planning and patient education.
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Ensuring Cultural and Cognitive Integrity in Instrument Translation: Quality of Life Index for Japanese Cancer Patients p. 64
Michiyo Mizuno, Keiko Sugimoto, Thomas Mayers, Carol Estwing Ferrans
DOI:10.4103/apjon.apjon_57_18  
Objective: The objective of this paper is to provide a practical illustration of methods useful for translating and testing questionnaire instruments for nursing and healthcare to ensure reliability, validity, and appropriateness for the target culture. Methods: We present the process used to create the Japanese version of a well-established quality of life (QOL) instrument, originally developed in American English. The Ferrans and Powers Quality of Life Index (QLI)-Cancer Version III was translated into Japanese by a team of bilingual translators and tested using an iterative process involving cognitive interviewing with monolingual Japanese cancer patients. Results: Discussions among the translation team made it possible to find and resolve linguistic, cultural, and practical issues regarding the translation. Problems stemming from question interpretation and information retrieval were resolved through the cognitive interviewing process. One problem related to response editing could not be remedied with altered phrasing, namely a question referring to the respondents' sex lives. This item was retained in the Japanese version of the QLI as an indispensable component of QOL, particularly in a healthcare context. Conclusions: The final Japanese version captured the intended meaning of the original, and also was culturally appropriate and clearly understood by Japanese cancer patients.
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What Patients, Families, Health Professionals and Hospital Volunteers Told Us about Advance Directives p. 72
Carmen WH Chan, Martin MH Wong, Kai Chow Choi, Helen YL Chan, Amy YM Chow, Raymond SK Lo, Michael MK Sham
DOI:10.4103/apjon.apjon_38_18  
Objective: An advance directive (AD) is a document that allows mentally competent individuals to make healthcare decisions about their condition that they might no longer be able to make in the future. This study aimed to explore the perceptions of AD decision-making of various stakeholders in the Chinese palliative care setting. Methods: Patients with life-limiting diseases, family members, health professionals, and hospital volunteers were recruited in the palliative care unit of two hospitals in Hong Kong by purposive sampling on age and sex. Qualitative semi-structured individual interviews were conducted. Results: A total of 96 participants, including 24 participants from each group, completed the study. Most participants were willing to discuss AD but had not heard about it before the interview. Patients regarded the decisions made in the AD as a way to reduce their future sufferings, while they also considered the welfare of their family. Family members were concerned about the psychological burden when discussing about the AD. Health professionals emphasized the logistic and process of the AD. Hospital volunteers pointed out the impact of Chinese culture on AD acceptance and the lack of AD promotion in the community. Conclusions: The findings of the study indicated the need for more promotion of AD in the society. It is important to consider the opinion of a patient's family during AD discussions in a Chinese culture. Health professionals may need to identify the best timing for the discussion of AD with patients and their families.
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Exploring Lived Experiences of Married Pakistani Women Post-Mastectomy p. 78
Laila Hussain, Zeenatkhanu Kanji, Sharifa Lalani, Shabnam Moledina, Abida K Sattar
DOI:10.4103/apjon.apjon_30_18  
Objective: This qualitative descriptive exploratory study aimed to explore the lived experiences of married Pakistani women, 2 years post-mastectomy. Methods: Twelve participants were recruited through purposive sampling from outpatient oncology clinic from a tertiary care hospital in Pakistan. Interviews were audio-taped and transcribed, and then themes and sub-themes were identified. Results: Women verbalized a range of their experiences throughout the span from diagnosis to mastectomy. One over arching theme, quality of life and four main themes and their subthemes emerged from the data. Following are the themes; from history to diagnosis, worries, coping strategies, and recommendations. Conclusions: The study findings revealed that effective coping strategies were beneficial for these women, as these women coped well after being diagnosed with breast cancer. Strong recommendations were made by the participants for the formulation of support groups, which could help them reduce their anxiety through information exchange.
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RAPID COMMUNICATION Top

Cancer Screening and Diagnostic Tests in Global Contexts: Case Study and Concept Analysis p. 86
Haeok Lee, Shin-Young Lee, Jasintha T Mtengezo, MarySue Makin, Jeong-Hwan Park, Linda Thompson
DOI:10.4103/apjon.apjon_59_18  
Objective: Although the purposes and outcomes of screening and diagnostic tests are different, they are often confused. Therefore, it is important to delineate the clinical concept of cancer screening tests to be clear in our communication not only among healthcare professionals but also with client populations. The aim of this study is to both describe and analyze the concept of cancer screening and explain their practical meaning in global contexts. Methods: Comparative case studies of cervical and liver cancer screening tests were used as the basis for developing an understanding of a specific concept (phenomenon) of cancer screening and for delineating the relationships between factors that cause screening to occur. Results: A cancer screening is defined as an action taken by both the patient and health-care provider to detect a possible pre-cancerous condition among healthy and asymptomatic individuals who are at sufficient risk of a specific disorder to warrant further investigation or treatment. The case study-based concept analysis has been shown to be useful for improving our understanding of the multi-dimensional nature of the concept in global contexts. Conclusions: New paradigms maximizing participation in cancer screening to detect diseases before symptoms are manifested rather than focusing on diagnosis and treatment of symptomatic infectious diseases need to be developed and implemented.
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LETTERS TO THE EDITOR Top

Letter to the Editor: Perspectives of Oncology Unit Nurse Managers on Missed Nursing Care: a Qualitative Study p. 94
Janneice Caldwell-Wright
DOI:10.4103/apjon.apjon_54_18  
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AONS NEWS Top

MASCC at a Glance: Congress and Events in Wien p. 95
Paz Fernández Ortega
DOI:10.4103/apjon.apjon_55_18  
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Report on International Conference on Cancer Care Nursing 2018: A Very Successful Conference in New Zealand p. 98
Qi Wang, Winnie So, Patsy Yates
DOI:10.4103/apjon.apjon_66_18  
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