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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 6 | Issue 3
Page Nos. 207-314

Online since Tuesday, April 30, 2019

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EDITORIAL  

Active Smoking at the Time of A Lung Cancer Diagnosis p. 207
Rebecca H Lehto
DOI:10.4103/apjon.apjon_12_19  
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Factors in Cancer-Related Fatigue Self-Management Behaviors of Outpatients Undergoing Chemotherapy p. 209
Ikuko Chiba, Tomoyo Sasahara, Michiyo Mizuno
DOI:10.4103/apjon.apjon_1_19  
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REVIEW ARTICLES Top

Adverse Events of Oncologic Immunotherapy and Their Management p. 212
Fedricker Diane Barber
DOI:10.4103/apjon.apjon_6_19  
Over the past two decades, immunotherapy has emerged as a promising treatment option for patients with cancer. However, newer versions of immunotherapy, such as checkpoint inhibitors, may be associated with unusual adverse effects (AEs) that can range in severity from mild to life-threatening. Unlike common AEs of conventional chemotherapy, which have a predictable nadir or cyclic pattern after administration, AEs of these newer immunotherapies are variable, depending on the type of immunotherapy, route of administration, and mechanism of action. The onset and resolution of these AEs may be present at any time, during administration of treatment, a few weeks after administration of treatment, or several months after completion of treatment. Therefore, improving outcomes in patients undergoing oncologic immunotherapy requires oncology nurses' knowledge and understanding of various immunotherapy agents, as well as early recognition and management of potential AEs, especially AEs associated with checkpoint inhibitors and other therapies that manipulate T-cell activation causing autoimmune toxicity. This article draws upon current evidence from systematic reviews, meta-analyses, and expert consensus guidelines to provide a brief overview of common immunotherapies used in cancer and management of their associated AEs.
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Evaluation of the True Endpoint of Clinical Trials for Cancer Cachexia Highly accessed article p. 227
Tateaki Naito
DOI:10.4103/apjon.apjon_68_18  
Cachexia is an old disease but a new research area that has recently been vigorously investigated. The diagnostic and staging criteria for cancer-associated cachexia have been established through an international consensus report (CR) published in 2011, which may greatly influence the designs and interventions of future clinical trials. However, no standard treatment has been established so far. This may be partially due to the lack of a widely accepted common endpoint for clinical trials. This review aimed to summarize designs and endpoints of 65 randomized controlled trials for cancer cachexia in the past 16 years and seek clinically relevant patient-centered outcomes for future clinical trials. Compared with trials before the CR, trials after the report revealed that the study populations tended to be at the earlier stage of cachexia and included patients with precachexia or those at risk for cachexia. Nonpharmacological interventions have been widely tested, and functional endpoints have increasingly been selected in combination with standard endpoints of body mass or lean body mass. Disability-free survival has recently been used as a functional endpoint in clinical trials in several research fields. It might be also a suitable patient-centered outcome responsive to multiple physical changes in cancer cachexia, and patients might find it more acceptable than other classical endpoints. More efforts would be needed to identify an optimal measurable endpoint and establish a better combination of pharmacological and nonpharmacological interventions to improve the functional prognosis for patients with cancer cachexia.
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Utilizing the Advances in Digital Health Solutions to Manage Care in Cancer Patients p. 234
Andreas Charalambous
DOI:10.4103/apjon.apjon_72_18  
In recent years, the clinical context for cancer has changed, and it is now characterized by extended survival rates and more diverse and complex cancer trajectories and symptomatology. The changes in the landscape of cancer care also include a shift towards the home setting or the outpatient setting with an increased amount of care being delivered at home or transferred to the patients themselves and their family caregivers. These changes have also impacted the type and amount of information required by the patients and their caregivers as well as the type of care needs that are to be addressed by health-care professionals. Finally, the transitions within the health-care setting might also create a caring gap that the patient is left to deal with independently or with minimal support. These changes have led to the emergence of innovative digital/technological solutions for supporting patients during their cancer care continuum.
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Radiation Fibrosis Syndrome: The Evergreen Menace of Radiation Therapy p. 238
Abhishek Purkayastha, Neelam Sharma, Arti Sarin, Sharad Bhatnagar, Nilotpal Chakravarty, Hari Mukundan, Virender Suhag, Sankalp Singh
DOI:10.4103/apjon.apjon_71_18  
Fibrosis is a descriptive appellation referring to the obliteration of normal tissue components replaced by matrix and disorganized and varied collagen fibrils that result in the loss of organ function and frequent tissue contraction leading to death or significant deterioration in the quality of life. Radiation fibrosis syndrome (RFS) is a progressive fibrotic tissue sclerosis with various clinical symptoms in the irradiation field. It is usually a late complication of radiation therapy and may occur weeks or even years after treatment. It may affect the musculoskeletal, soft tissue, neural tissue, and cardiopulmonary systems. RFS is a serious and lifelong disorder that, nevertheless, may often be prevented when identified and rehabilitated early. Genetic factors likely play a significant role in the development of chronic fibrotic response to radiation injury that persists even after the initial insult is no longer present. Management of this syndrome is a complex process comprising medication, education, rehabilitation, and physical and occupational therapy. A bibliographical search was carried out in PubMed using the following keywords: “radiation fibrosis,” “radiation fibrosis syndrome,” and “radiation-induced fibrosis.” We also reviewed the most relevant and recent series on the current management of RFS, and the reviewed data are discussed in this article. This review discusses the pathophysiology, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders as late effects of radiation treatment.
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ORIGINAL ARTICLES Top

Medication Safety: A Need to Relook at Double-Checking Medicines? p. 246
Gek Phin Chua, Kim Hua Lee, Gemma Diente Peralta, John Heng Chi Lim
DOI:10.4103/apjon.apjon_2_19  
Objective: To present a structured evaluation process that provides evidence that the single-checking (SC) system is not only a viable option in reducing medication errors, but also has the added advantage of increasing staff satisfaction. Methods: The structured evaluation involved one work improvement process and conducting a survey establishing registered nurses' (RNs') attitude toward SC of medicines. The survey questionnaire included 12 questions with a 5-point Likert scale. Results: In spite of the increased number of patients, the number of medication errors actually reduced (P < 0.001; two-sample test of proportions) with the implementation of SC of medication for competent and experienced staff. A survey was conducted to establish RNs' attitudes toward SC of medicines 3 years post SC implementation. RNs viewed the single-nurse checking protocol positively. In particular, the nurses considered single-nurse checking as an encouragement to update their drug knowledge and as a time-saving measure, enhancing the quality of patient care. Nonetheless, they also expressed concerns on single-nurse checking. Conclusions: The findings provide evidence that SC system is a viable way to reducing medication errors and also confer the added advantage of staff satisfaction. Assuring quality and safety involves the need to challenge the status quo based on revealed evidence.
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Falls and Functional Impairments in Breast Cancer Patients with Chemotherapy-Induced Peripheral Neuropathy p. 253
Hiroko Komatsu, Kaori Yagasaki, Yasuhiro Komatsu, Hideko Yamauchi, Teruo Yamauchi, Toshio Shimokawa, Ardith Z Doorenbos
DOI:10.4103/apjon.apjon_7_19  
Objective: We investigated the incidence of falls and functional impairments in breast cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). Additionally, we examined whether taxane-induced peripheral neuropathy was associated with the patients' falls and functional impairments. Methods: We conducted a cross-sectional study including 88 patients with breast cancer who received taxane-based chemotherapy and were recognized as having peripheral neuropathy symptoms (Common Terminology Criteria for Adverse Events Grade ≥1). Patients completed the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity questionnaire for neuropathy and described falls from the onset of the taxane-based chemotherapy to the time of the survey. Functional impairments were defined using the Activities of Daily Living subsection of the Vulnerable Elder's Scale. Data were analyzed using descriptive statistics and logistic regression. Results: Of the participants, 40.9% experienced falls and 38.4% reported functional impairments. Most falls occurred on flat ground. Bone fracture due to falls was observed in 11.4% of the participants. Logistic regression revealed that CIPN was not significantly associated with the reported incidence of falls. However, it was significantly associated with functional impairments (odds ratio, 6.415; 95% confidence interval: 1.271–32.379; P = 0.024). Conclusions: CIPN was associated with functional impairments, but not with the incidence of falls. Patients should be informed prior to the onset of anticancer therapy that CIPN is a risk factor for functional impairments.
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Emotional Intelligence as A Predictor of Health-Related Quality of Life in Breast Cancer Survivors p. 261
Sahar Mirzaei, Ahmad Izadi Tame, Robab Anbiaie, Fateme Moradipour, Malihe Nasiri, Camelia Rohani
DOI:10.4103/apjon.apjon_76_18  
Objective: The objective of this study is to explore the predictive role of emotional intelligence (EI) and its elements for health-related quality of life (HRQoL) dimensions in a sample of breast cancer survivors. Methods: This cross-sectional study was conducted in a single oncology clinic at a university hospital. A sample of breast cancer survivors (n = 180) completed three questionnaires: Short-Form Health Survey SF-36 (the RAND 36-item) with 8 dimensions; Cyberia Shrink EI Test (with five elements); and demographic Characteristics. The data were analyzed using SPSS version 20 (IBM Corporation, Armonk, NY, USA). A series of multiple linear regression models were used to analyze the data. Results: EI was a predictor for two dimensions of HRQoL components in survivors: mental (β = 0.45, P < 0.001); and physical (β = 0.27, P < 0.001). However, it was a better predictor for the mental HRQoL than for physical. More specifically, several elements of EI, including self-motivation, self-awareness, and self-control, demonstrated significant variance with a medium effect for prediction of dimensions of HRQoL. “Self-motivation” (β = 0.27, P < 0.001) and “self-awareness” (β = 0.29, P < 0.01) together were the best predictors of the variances of survivors' “general health” (R2 = 28%). “Self-motivation” (β = 0.39, P < 0.001), and “self-control” (β = 0.19, P < 0.05), also together, were the best predictors of the variances of survivors' “emotional well-being” (R2 = 28%). Conclusions: Educational intervention programs should be planned by concentrating on special elements of EI, including self-motivation, self-awareness and self-control, to improve HRQoL dimensions in breast cancer survivors.
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Toward A Germinal Theory of Knowing-Revealing-Humanizing as Expressions of Caring in Cancer Palliative Care p. 269
Chinomso Ugochukwu Nwozichi
DOI:10.4103/apjon.apjon_9_19  
Objective: Survival chances of people with cancer in Nigeria are far worse than those in developed countries. While the chance of finding a lasting solution to cancer in Nigeria is remote, patients living with cancer still need treatment regardless of the terminal outcome, and hence cancer palliative care is necessitated. Caring patterns and expressions differ in diverse contexts. Therefore, this article aimed to present the meanings and expectations of caring and the resulting transformative theory of practice. Methods: A descriptive, qualitative inquiry was conducted with a purposive sample of 12 cancer palliative patients, 9 nurses, 3 physicians, and 5 relatives who were approached for an in-depth interview about their conceived meanings and expectations of caring for or being cared for in the cancer palliative unit. Results: Cancer palliative care in Nigeria is best exemplified through the processes/themes of “knowing,” “revealing,” and “humanizing.” The meaning of care and the expectations of the patients and caregivers were grouped into these three overarching processes which then informed the conceptualization of a germinal theory of knowing-revealing-humanizing (TKRH) as expressions of caring in cancer palliative care. Conclusions: The application of the KRH practice processes is illustrated as a transformative germinal theory of practice. This TKRH as expressions of caring is transformative and can restore positive meanings in the life-world of persons in the cancer palliative care setting.
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Scalp Cooling in Daily Clinical Practice for Breast Cancer Patients Undergoing Curative Chemotherapy: A Multicenter Interventional Study p. 277
Emilia Gianotti, Giorgia Razzini, Manuela Bini, Caterina Crivellaro, Angela Righi, Simona Darecchio, Stefania Lui, Maria Laura Basiricò, Silvia Cocconi, Katia Cagossi, Alessia Ferrari, Fabrizio Artioli
DOI:10.4103/apjon.apjon_4_19  
Objective: Chemotherapy-induced alopecia is a common and distressful side effect, especially among breast cancer patients. Scalp cooling (SC) can reduce hair loss during anthracycline- and taxane-based chemotherapy. This study assessed the effectiveness of SC in daily clinical practice in three Italian oncology units. Methods: From 2014 to 2016, we prospectively included 220 female early-stage breast cancer patients undergoing curative chemotherapy in combination with SC using the Paxman device. Effectiveness was defined as the severity of hair loss according to the Common Terminology Criteria for Adverse Events Version 4.0 as follows: Grade 0, no hair loss; Grade 1, <50% hair loss not requiring a wig; and Grade 2, ≥50% hair loss at each cycle and at completion of chemotherapy. The tolerability and safety were also evaluated. Results: The overall success rate of SC (hair loss Grade 0–1) was 68%. Severe hair loss was avoided in 89% of women receiving taxane-based chemotherapy and in 78% of women receiving both anthracyclines and taxanes. Among women undergoing anthracycline-based chemotherapy, 47% experienced hair preservation. SC was well tolerated, as only 20 patients discontinued SC for reasons other than hair loss. Conclusions: Our study confirmed that SC provides a reliable chance for breast cancer patients to keep their hair during taxane- and/or anthracycline-based chemotherapy.
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Factors Associated with Anxiety and Depression among Family Caregivers of Patients Undergoing Palliative Radiotherapy p. 283
Ourania Govina, Eugenia Vlachou, Ioannis Kalemikerakis, Demetrios Papageorgiou, Anna Kavga, Theocharis Konstantinidis
DOI:10.4103/apjon.apjon_74_18  
Objective: The family caregivers of patients receiving palliative care experience high levels of anxiety and depression. The aim of the present study was to investigate the factors associated with family caregivers' anxiety and depression when caring for patients with advanced cancer in Greece. Methods: The sample consisted of 100 patients undergoing palliative radiotherapy and their respective caregivers. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the MD Anderson Symptom Inventory. Their respective caregivers completed the Oberst Caregiving Burden Scale, the Bakas Caregiving Outcomes Scale, and the HADS. Correlational and multiple regression analyses were conducted to identify potential predictors of anxiety and depression. Results: The majority of patients were male (63.0%), whereas the majority of their caregivers were female (76.0%). The mean ages of patients and caregivers were 63.9 ± 10.8 and 53.3 ± 12.6 years, respectively. Caregiving anxiety and depression were associated with patients' variables, such as gender (P < 0.0005), primary cancer (P = 0.008), and past surgery (P = 0.002), and caregiver's variables, such as gender (P = 0.001), co-residence (P = 0.05), previous care experience (P = 0.04), and means of transport (P = 0.038). In multiple regression analyses, caregiving anxiety and depression were significantly predicted by caregivers' and patients' characteristics, in a model that accounted for 48% of the anxiety variance (P < 0.0005) and 39% of the depression variance (P < 0.0005). Conclusion: The caregivers who experienced more anxiety and depression shared the following traits: they were women, cared for men with lung cancer, cared for patients not undergoing surgery, lived together, were younger, went to the hospital by private means of transport, had previous care experience, and perceived an increased degree of general burden. Further investigation of the factors that may affect caregivers' psychological state is required to better identify parameters that may predict it.
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Effect of An Evidence-Based Nursing Intervention on the Diagnosis of Oral Mucositis in the Pediatric Stem Cell Transplant Unit p. 292
Seyda Avci, Hatice Yildirim Sari
DOI:10.4103/apjon.apjon_5_19  
Objective: This quasi-experimental, single-group study with a pre- and post-repeated measures design was carried out at the Pediatric Stem Cell Transplant Unit of a University Hospital. The study was aimed at investigating the effect of an evidence-based nursing intervention program, held for nurses providing care for pediatric stem cell transplant patients, on their skills in diagnosing oral mucositis (OM). Methods: Before training, data were collected from all the nurses using a sociodemographic characteristics questionnaire. Six patients who were admitted to the clinic and started chemotherapy (CT) were followed up for a maximum of 1 month during their hospitalization to find whether the diagnosis of OM was performed. During the intervention stage, the researcher provided nurses with training on the importance of the use of evidence-based research results in the clinic, including evidence regarding OM. After the training, the records of six patients who were admitted to the clinic and started CT were tracked for up to 1 month during their hospitalization to find whether the diagnosis of OM was performed. Results: At the end of the study, the rate of OM diagnosis was performed by nurses, which was 2.8% before the program and increased to 8.7% after the program. The difference between the percentages of performing OM diagnosis by the nurses before and after the program was 5.9%, which was considered statistically significant (χ2 = 11.004, P < 0.01). The postprogram rate of diagnosis of OM was 3.12 times higher (212% increase) than the preprogram rate (P < 0.01). Conclusions: One of the most important recommendations of the present study is to provide regular and continuous training sessions for nurses to improve and update their knowledge on oral care. It is also concluded that the establishment of oral diagnosis as a follow-up parameter, similar to vital signs in the clinic, will enable nurses to improve their skills in performing daily diagnosis and keeping proper records of the patients' outcomes.
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Knowledge and Behavior of University Students toward Human Papillomavirus and Vaccination p. 300
İlgun Ozen Cinar, Sevgi Ozkan, Gulbahar Korkmaz Aslan, Erkan Alatas
DOI:10.4103/apjon.apjon_10_19  
Objectives: Human papillomavirus (HPV) causes cervical cancer. This study aimed to determine the knowledge and attitude of university students toward HPV infection and vaccine prevention in Turkey. Methods: A total of 1563 female and male university students participated in the study. The study design was descriptive and cross-sectional. The study included students enrolled in the departments of faculties and vocational schools. Results: In total, 16.8% of students stated that they had heard of HPV. There was a statistically significant relationship between the mean awareness of HPV and different variables, such as age, gender, marital status, family history of cancer, and conversation about sexual matters (P < 0.01). As the age of the students increased, the chance of hearing about HPV also increased. Of all the students, 1.5% took HPV vaccination. Furthermore, 87.7% of the female students stated that they had heard of cervical cancer. Conclusions: The depth of knowledge among Turkish university students toward cervical cancer, HPV infection, and vaccination was inadequate. It is important to provide educational and counseling services by nurses to make university students aware of HPV infection and vaccination.
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Risk Factors of Cervical Cancer: A Case-Control Study p. 308
Nainakshi Kashyap, Nadiya Krishnan, Sukhpal Kaur, Sandhya Ghai
DOI:10.4103/apjon.apjon_73_18  
Objective: Cervical cancer is one of the most common malignancies among women. The present study aims to assess the risk factors for cervical cancer in women aged 25-80 years. Methods: The current study was a case-control study. In total, 75 age matched cases and 75 controls were enrolled. In case group sampling technique was total enumeration. Sampling for control group is done by purposive sampling. Women who satisfied the inclusion criteria were included in the study. A questionnaire was developed to assess the risk factors of cervical cancer among the participants. Face to Face interview were conducted with the participants. Results: There was a significant association (P < 0.05) of cervical cancer with education, place of residence, using an old cloth sanitary napkins, young age at marriage, number of husband's partners, washing the genitalia after sexual intercourse, and availability of health services. Bathing daily and during menstruations was found to be preventive factors for cervical cancer. In logistic regression, the utilization of health services and the presence of sexually transmitted infections showed a significant association with the development of cervical cancer. Conclusions: The present study aimed to assess the risk factors of cervical cancer. With prior knowledge of risk factors, cervical cancer can be identified. Identification of high-risk populations and starting early screening is found to be effective in early recognition of cervical cancer.
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