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   Table of Contents - Current issue
Coverpage
January-February 2021
Volume 8 | Issue 1
Page Nos. 1-105

Online since Saturday, November 21, 2020

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EDITORIAL  

Cancer Care Delivery Challenges in India during the COVID-19 Era: Are We Prepared for the Postpandemic Shock? p. 1
Abhishek Shankar, Deepak Saini, Nalin Goyal, Shubham Roy, Harpreet Angural, Vikrant Kaushal, Sachidanand Jee Bharati, Rituraj Upadhyaya, Tarun Durga
DOI:10.4103/apjon.apjon_57_20  
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REVIEW ARTICLE Top

Unmet Supportive Care Needs of Patients with Hematological Malignancies: A Systematic Review Highly accessed article p. 5
Ioanna Tsatsou, Theocharis Konstantinidis, Ioannis Kalemikerakis, Theodoula Adamakidou, Eugenia Vlachou, Ourania Govina
DOI:10.4103/apjon.apjon_41_20  
Hematological malignancies require intensive and long-term treatment, which brings a significant burden on patients, leading to unmet supportive care needs. The purpose of this review was to investigate the unmet supportive care needs of patients with hematological malignancies during and after active treatment as well as the factors that affect them. A systematic bibliographic search was carried out in the PubMed database for English articles published between 2009 and 2020 according to the Preferred Reporting Items for Systematic Reviews guidelines and under the terms: “unmet needs”, “supportive care”, “hematological malignancy” and “hematological cancer.” Twenty studies were evaluated and reviewed. Hierarchical frequently reported unmet supportive care needs were informational, emotional, physical, daily living/practical (accessibility, transportation, and financial problems), and family life/relational needs. In particular, patients with multiple myeloma most frequently reported unmet needs at the informational, physical, emotional, and daily living/practical domain. Patients with myelodysplastic syndromes reported physical, emotional, practical, and relational needs. Patients with leukemia and lymphoma rated their needs as informational, physical, psychological, daily living, and sexual. Sexual and spiritual unmet needs were reported at a low level. Predictive indicators for increased unmet supportive care needs were the type of the hematological malignancy, younger age, marital status, female gender, monthly income, coexistence of anxiety and depression, and altered quality of life. To conclude with, the literature reports a significant number of unmet supportive care needs in patients with hematological malignancies, whose frequency and intensity were influenced by a variety of factors. However, the large heterogeneity of studies (design, sample, and needs assessment tools) makes the generalization of the results difficult.
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ORIGINAL ARTICLES Top

Immune-Related Adverse Events in the Older Adult with Cancer Receiving Immune Checkpoint Inhibitor Therapy Highly accessed article p. 18
Matthew D Biniakewitz, Mary Kate Kasler, Kristen L Fessele
DOI:10.4103/apjon.apjon_48_20  
Objective: Older adults with cancer (OAC) may be at elevated risk for immune-related adverse events (irAEs) during immune checkpoint inhibitor (ICI) therapy due to the normal organ function changes of aging, as well as related to a higher prevalence of comorbid conditions compared to younger patients. The importance of high-quality nursing care cannot be overstated for this population, including proactive symptom assessment, management, and coordination of care. The purpose of this paper is to describe the unique challenges faced by OAC receiving ICI drugs. Methods: We present both a case study and the results of a single-institution retrospective study from a large, urban US National Cancer Institute– designated comprehensive cancer center. The retrospective study examined the frequency and intensity of irAEs experienced by patients aged 75 years or older who received ICI therapy between January 2016 and December 2018 for melanoma. Results: We reviewed the records of 38 OAC (age range 75–92 years) with locally advanced or metastatic melanoma who received pembrolizumab, nivolumab and/or ipilimumab. Median length of therapy was 7.4 months, and median time to onset of irAEs was 81 days. Approximately half (47%) of the patients experienced Grade 1–3 irAEs, and discontinued therapy related to inability to tolerate the ICI more frequently than was reported in clinical trials (24%). Conclusions: OAC who receive ICI therapy frequently experience irAEs that may result in treatment interruption, discontinuation or long-lasting toxicity. Nurses are well positioned to provide support to this vulnerable population.
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An Assessment of Health Information Resource Center and Supportive Program Needs p. 25
Gek Phin Chua, Quan Sing Ng
DOI:10.4103/apjon.apjon_27_20  
Objective: No practical method or assessment tool for identifying patients' and their families' health information resource needs in a resource center exists. We sought to assess the health information and resource preferences of patients and their families to guide the planning of a health information resource center (HIRC). Methods: A needs assessment was conducted using convenience sample of patients and families drawn from the National Cancer Centre in Singapore. A survey was conducted to gather data from April 23, 2018, to May 11, 2018, at the Specialist Oncology Clinics (SOCs) and the Ambulatory Treatment Unit. Results: A total of 778 surveys were analyzed, and the majority of the respondents were Chinese (79.8%). There were 449 (57.7%) patients and 317 (40.7%) family members. Among the 778 respondents, the overall top item chosen for facilities, resources, and equipment were a quiet and comfortable area for reading and reflection (77.2%), information about education and support services offered by the center (71.6%), and computers with internet access (63.6%), respectively. The overall top three services needed in the resource center were advice on useful resources (70.6%); announcements on newly received materials, programs, and support services (64.8%); and resource personnel to assist with identifying materials/navigating through resources (53.2%). Written education pamphlets/brochures were rated as the most useful material (74.6%), followed by consumer health books (74.2%) and newsletter (59.6%). The top overall three supportive programs required were nutrition talks and cooking demonstrations (76.7%), counseling (individual, couples, family, and bereavement) (74.3%), and exercise (e.g., Tai Chi, yoga) (68.5%). Conclusions: The findings obtained from this assessment provide guidance to the development of a user-friendly, patient- and family-centric HIRC.
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Evaluation of Appropriateness of A Nursing Intervention Program to Promote Pain Self-Management for Adult Outpatients with Cancer Pain p. 33
Masako Yamanaka, Kumi Suzuki
DOI:10.4103/apjon.apjon_37_20  
Objective: This study aimed to develop a nursing intervention program structured to promote pain self-management for adult outpatients with cancer pain to enable coping with cancer pain-related problems and evaluate the appropriateness and clinical applicability of the program. Methods: A questionnaire survey was conducted with two pharmacists and ten oncology nursing specialists using a questionnaire created by the authors. The questionnaire comprised of 23 items asking about the appropriateness of the program, clinical applicability, and feasibility of instruction materials, rated by 5-point scales. Results: We collected 11 responses. The mean score of all the 23 items was 4.3 (standard deviation [SD] 0.6), the mean scores of the items were 4.4 (SD 0.6) for the appropriateness of the program, 4.2 (SD 0.5) for the clinical applicability of the program, and 4.3 (SD 0.7) for the feasibility of the instruction materials. The participants provided comments that the program made it easier to select patients for intervention and tasks that patients and nurses can share. Some comments pointed out that the program should be improved to allow patients who need the same intervention several times. Based on these comments, we modified the program partially and completed the first edition of the cancer pain self-management (CPSM) program. Conclusions: The findings suggest that the CPSM program may be considered appropriate and clinically applicable from the point of view of pharmacists and oncology nurses. Further studies are needed to verify the effects and usefulness of the program in clinical settings.
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Coping Strategies among Malaysian Women with Recurrent Ovarian Cancer: A Qualitative Study p. 40
Yew Kong Lee, K Asokan Praveena, Yin Ling Woo, Chirk Jenn Ng
DOI:10.4103/apjon.apjon_38_20  
Objective: Ovarian cancer is one of the most common cancers among Malaysian women with high recurrence. Patients with recurrence are prone to emotional distress and are forced to cope with poor prognosis. This study aimed to explore the coping strategies employed by women with recurrent ovarian cancer in Malaysia, a developing multicultural country in Asia. Methods: This was a qualitative study with patients diagnosed with recurrent ovarian cancer and receiving chemotherapy at a hospital gynecologic day-care unit. In-depth individual interviews were conducted with patients to explore how they coped with recurrence of ovarian cancer. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Results: The participants' (n = 10) age range was 52–84 years, the three most common ethnic backgrounds were represented (Malay, Chinese, and Indian), and most of the patients were well educated. All patients were on chemotherapy. Six coping strategies were identified: (1) maintaining a mindset of hopefulness, (2) avoidance of information, (3) accepting their condition, (4) seeking spiritual help, (5) relying on family for support, and (6) coping with financial costs. Conclusions: Coping strategies employed during ovarian cancer recurrence in this setting were rarely based on the accurate information appraisal, but rather on the individual emotion and personal beliefs.
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Knowledge about Human Papillomavirus and Cervical Cancer Prevention among Intern Nurses p. 46
Jing Pu, Mei He, Yaling Pu, Zhongli Liu, Li Le, Haiyan Wang, Xiaobo Du
DOI:10.4103/apjon.apjon_45_20  
Objective: Intern nurses will play an important role in the use of vaccination to prevent cervical cancer. This study assesses the knowledge about human papillomavirus (HPV) infection and cervical cancer prevention among intern nurses. Methods: We developed a questionnaire to investigate intern nurses' knowledge about HPV infection and cervical cancer prevention. Participants included 323 intern nurses from eight schools. Results: The effective response rate was 79.8%. Some (7.0%) knew that early-stage cervical cancer is commonly asymptomatic. Only 9.7% knew that infection is generally asymptomatic and 20.5% knew that vaccination has no major side effects. There were differences in gender, age, school type, and place of residence for several questions. Conclusions: This study indicates a low level of knowledge about HPV infection and cervical cancer prevention among intern nurses. Our findings highlight the need for more education in this topic to increase the knowledge of intern nurses.
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Evaluation of Sexual Dysfunction in Patients with Hematological Malignancies p. 51
Yasemin Karacan, Hicran Yildiz, Burcin Demircioglu, Ridvan Ali
DOI:10.4103/apjon.apjon_40_20  
Objective: Physiological and/or psychological problems that affect the quality of life of the patients occur depending on the diagnosis and treatment of hematological malignancies. Cancer treatment causes sexual problems such as infertility, vaginal dryness, and erectile dysfunction in the patients. Erectile dysfunction and loss of sexual desire are the most common sexual problems of men, while dyspareunia and loss of sexual desire are the most common sexual problems of women. This descriptive study was carried out to evaluate sexual problems and affecting factors in the patients with hematological cancer. Methods: Between July 1, 2011, and July 31, 2011, 45 sexually active patients who volunteered to participate in the study and whose written consents were obtained were included in the study. The data of the study were collected using the descriptive characteristics form prepared by the researchers based on the relevant literature and the Arizona Sexual Experiences Scale (ASEX). The scale scores range from 5 to 30 and a score of >11 above indicates sexual dysfunction. Results: Sexual dysfunction was observed in 62.2% of the patients. About 80.0% of women and 57.1% of men had sexual dysfunction. Sexual dysfunction was observed to be highest between the ages of 52–71 (81.2%) years. The mean total ASEX score was 15.90 ± 4.25 in women and 13.34 ± 5.37 in men. The ability to reach orgasm subscale score was found to differ by gender in the ASEX scale (P < 0.05). Conclusions: The prevalence of sexual dysfunction is high in the patients with hematological malignancies. It is recommended to evaluate these patients in terms of the presence of sexual dysfunction, as in the patients with other chronic diseases.
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Thai Buddhism-Based Mindfulness for Pain Management in Thai Outpatients with Cancer: A Pilot Study p. 58
Srisuda Ngamkham, James J Yang, Ellen Lavoie Smith
DOI:10.4103/apjon.apjon_43_20  
Objective: This study aimed to evaluate Thai Buddhism-based Mindfulness (TBbM) feasibility based on recruitment and retention rates and to obtain preliminary data regarding changes (effect sizes) in pain severity and other outcomes when comparing control to intervention participants following TBbM use. Methods: A randomized controlled trial was conducted in the Outpatient Department at Sawanpracharak Hospital, Thailand, from April 2018 to February 2019. Seventeen participants completed the pretest and posttest. Both groups (control group [n = 10] and intervention group [n = 7]) received usual care and watched a 25-min educational video about cancer pain. The intervention group participated in a 3-day mindfulness training program at a Buddhist temple and continued practicing at home for 8 weeks. Data were collected at baseline and at 1 and 2 months postintervention. Results: One-hundred and thirty-five participants met the eligibility criteria; 112 (82%) declined to participate and 6 of 23 (26%) were lost to follow-up/dropped out. Control and intervention participants had an average age of 44 (± 8.77) and 56 years (± 7.41), respectively. When compared to the control group, the TBbM participants reported no statistically significant improvements in pain or other outcomes. While not statistically significant, the effect size indicated that pain did improve in the TBbM group (Cohen's d = 0.41). Conclusions: Given the suboptimal recruitment and retention rates, modification of the intervention is warranted. Further, our findings suggest that the intervention had a moderate effect on pain. To evaluate efficacy, future adequately powered studies are needed to test a more feasible TBbM intervention.
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Chemotherapy-Induced Peripheral Neurotoxicity as A Risk Factor for Poor Sleep Quality in Breast Cancer Survivors Treated with Docetaxel p. 68
Ya-Ning Chan, You-Wun Jheng, Ya-Jung Wang
DOI:10.4103/apjon.apjon_51_20  
Objective: The purpose of this study was to explore sleep quality and to determine whether chemotherapy-induced peripheral neurotoxicity is a risk factor for poor sleep quality in breast cancer survivors who receive docetaxel treatment. Methods: Secondary data analysis from a cross-sectional study. Sample characteristics were collected using an information sheet. Independent variables included the Hospital Anxiety and Depression Scale (HADS), the Patient Neurotoxicity Questionnaire (PNQ), and the Identification Pain Questionnaire (ID pain). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). We performed descriptive analyses and simple logistic regression. Results: A total of 98 participants were included. More than 60% of them reported poor sleep quality, with their average PSQI score being 7.54 ± 4.45. Poor subjective sleep quality (1.37 ± 0.88) and short sleep duration (1.37 ± 1.08) were their main problems. In addition, significant risk factors for poor sleep quality were chronic illness (odds ratio [OR] = 2.753, P = 0.041), anxiety (OR = 7.714, P = 0.009), neuropathic pain (OR = 11.261, P = 0.022), sensory neuropathy (OR = 2.529, P = 0.032), motor neuropathy (OR = 3.781, P = 0.002), and undergoing chemotherapy (OR = 2.593, P = 0.027). Targeted therapy that some survivors received served as a protective factor (OR = 0.351, P = 0.015). Conclusions: We found a high prevalence of poor sleep quality in breast cancer survivors treated with docetaxel. The results indicated that, in addition to clinical characteristics and psychological discomfort, chemotherapy-induced peripheral neurotoxicity is a significant risk factor for poor sleep quality.
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Translation and Validation of the Arabic Version of the Cancer Needs Questionnaire-Short Form p. 74
Loai Abu Sharour
DOI:10.4103/apjon.apjon_33_20  
Objective: Care needs among Arabic cancer patients have not been assessed previously due to the lack of translated instrument that can determine the care needs among the cancer patients in Arab countries. The aim of this study was to translate and validate an Arabic version of the Cancer Needs Questionnaire-Short Form (CNQ-SF). Methods: A cross-cultural adaptation and psychometric testing was used. Brislin's model of translation was used to translate the CNQ-SF from English to Arabic. A cross-cultural adaptation and psychometric testing was used. A sample of 113 participants with different types of cancer completed the study surveys including the CNQ-SF (Arabic version) and Functional Assessment of Cancer Therapy-General (FACT-G). Descriptive, bivariate statistics and exploratory factor analysis (EFA) were performed. Results: Content validity was evaluated by a panel of experts and 20 participants and showed that translated scale was clear, understandable, and logical in order. Reliability analysis of CNQ-SF domains ranged from 0.85 to 0.93 and 0.94 for the total Arabic version of CNQ-SF. Convergent analysis showed a significant relationship between CNQ-SF (Arabic version) and FACT-G. Results of EFA indicated that the CNQ-SF scale has 32-items. It consists of five domains, the results indicated that Kaiser–Meyer–Olkin was 0.851, and Bartlett's Test of Sphericity was significant (significant (P < 0.001). Conclusions: The current study indicates that the Arabic version of CNQ-SF is valid, reliable, and applicable. It can be used by researchers, clinical practitioners, and health educators in Arab countries.
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Nursing Students' Awareness about the Warning Signs of Cancer p. 81
Hatice Karabuga Yakar, Sıdıka Oguz, Nuriye Öktem, Serbülent Yürük
DOI:10.4103/apjon.apjon_34_20  
Objective: Nursing students who take care of the patient in clinical area practices as a part of their internships in primary health care and clinical areas, should be aware of the warning signs of cancer so that they may inform the community about them. Methods: This study was conducted to determine the awareness of nursing students about the warning signs of cancer. The research was planned as a descriptive and cross-sectional study. The research was completed with 460 nursing students between February 2019 and May 2019. Results: The average age of the students participating in the study was 20.05 ± 2.04 years. Female nursing students were more familiar with the warning signs of cancer, than male nursing students. Second, third- and fourth-grade nursing students knew the warning sign of better than the first graders. More nursing students who had taken the internal diseases nursing course knew the warning sign of better compared to the students who did not take the course. Nursing students with a family member with a history of cancer knew the warning better than those who did not have a family history of cancer. Thickening or lump in the breast or elsewhere” was the most known warning sign of cancer (92.6%), whereas the least known sign was “indigestion or difficulty in swallowing” (47.0%). Conclusions: Female nursing students those who had taken the internal diseases nursing course and those who had a family member with a history of cancer were more aware of the warning signs of cancer.
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Mediating Role of Social Support in Resilience and Quality of Life in Patients with Breast Cancer: Structural Equation Model Analysis p. 86
Gulden Kucukakca Celik1, Hatice Çakır, Engin Kut
DOI:10.4103/apjon.apjon_44_20  
Objective: This study aimed to investigate the mediating role of social support in the relationship between resilience and quality of life (QoL) among Turkish patients with early-stage breast cancer. Methods: The study used a descriptive and cross-sectional design and was carried out in the oncology ward of a hospital in the Central Anatolia region of Turkey. A demographic-disease survey, the Turkish version of the Connor–Davidson Resilience Scale 25, the Multidimensional Perceived Social Support Scale, the European Organization for Research and Treatment of Cancer QoL Questionnaire Core, and the QoL Questionnaire Breast Cancer 23 were used to interview 113 patients with breast cancer. Results: Social support played a partial mediator role in the relationship between resilience and functional QoL. There was a negative correlation between functional QoL Questionnaire Breast Cancer 23 and psychological resilience and social support (P < 0.005). The mediation effect ratio was 10.2% (R2 = 0.102). Social support was found to not have a mediating role in the relationship between psychological resilience and general QoL (P < 0.05). Conclusions: Patients do not want social support to end, and their weakness in the eyes of others may have a negative impact on their QoL and resilience.
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Psychological Distress in Parents of Children with Cancer: A Descriptive Correlational Study p. 94
Xin Wei Isabel Tan, Siti Zubaidah Mordiffi, Violeta Lopez, Katherine Leong
DOI:10.4103/apjon.apjon_46_20  
Objective: This study aimed to ascertain levels of distress and contributing factors among parent caregivers of pediatric cancer patients in Singapore. Methods: In this descriptive correlational study, parental caregivers were recruited via convenience sampling during their child's inpatient admission or outpatient appointment. They were asked to complete a self-administered demographic survey and the Distress Thermometer for Parents (DT-P) tool. Descriptive statistics, Chi-square tests, and correlation analyses were performed. Results: The mean DT-P score was 5.07 (standard deviation = 2.78), out of a maximum of 10. Distress was reported among 67.9% (n = 55) of caregivers. The cognitive domain of caregiving problems on the DT-P was found to correlate with distress. Parents most frequently reported cognitive problems (n = 21, 25.9%) and, least often, social problems (n = 6, 7.4%). Practical (P = 0.040), emotional (P = 0.001), physical (P = 0.026), and cognitive problems (P = 0.001) of caregiving were statistically significantly associated with distress. Conclusions: Notable levels of distress and proportions of distressed parents highlighted the heavy burden of caregiving. This may also be attributed to the differences in caregiving challenges. The psychological effects of parental caregiving highlight the need for supportive measures for pediatric cancer caregivers.
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CASE REPORT Top

Identification and Management of Posterior Reversible Encephalopathy Syndrome in a Patient Enrolled in an Immunotherapy Combination Phase I Clinical Trial: A Case Study p. 103
Fedricker D Barber
DOI:10.4103/apjon.apjon_49_20  
Posterior reversible encephalopathy syndrome (PRES) is a rare potential immune-related adverse event (irAE) of checkpoint inhibitors. PRES is a disorder that has a variety of clinical and radiological features, which makes it a challenge for advanced practice registered nurses to diagnose. IrAEs such as PRES require prompt recognition and intervention to optimize clinical outcomes. Author Queries??? AQ1: Please ensure that the patient consent form has been obtained.
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