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   2020| April-June  | Volume 7 | Issue 2  
    Online since March 30, 2020

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Understanding the Associations between Caregiver Characteristics and Cognitive Function of Adults with Cancer: A Scoping Review
Yesol Yang, Sharron Rushton, Hyeyoung K Park, Heeyeon Son, Amanda Woodward, Eleanor Mcconnell, Cristina C Hendrix
April-June 2020, 7(2):115-128
Cognitive impairment (CI) is one of symptoms that adults with cancer frequently report. Although there are known factors that contribute to a patient's CI, these factors did not sufficiently explain its variability. Several studies conducted in patients with neurocognitive disorders have reported relationships between patients' cognitive function and caregiver characteristics, which are poorly understood in the context of cancer. This scoping review aims to map the literature on caregiver characteristics associated with CI in adults with cancer. We used the framework proposed by Arksey and O'Malley and PRISMA-Sc. Studies published in English by 2019 were searched through seven electronic databases. All retrieved citations were independently screened and eligibility for inclusion was determined by two independent authors. Ten studies met inclusion for this review with all of them showing significant associations between a patient's cognitive function and caregiver characteristics. Caregiver's mental health was the most commonly associated with a patient's cognitive function followed by family functioning, adaptation to illness, attitude toward disclosure of the illness, burden, coping and resilience, and demographic characteristics. These review findings suggest that enhanced information about CI in relation to caregiver characteristics will eventually provide the foundation for multifocal interventions for patients with impaired cognitive function. This scoping review identified caregiver characteristics that are associated with patients CI. These characteristics should be also assessed when health providers assess and treat CI of adults with cancer.
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Symptom Clusters And Quality Of Life Over 1 Year In Breast Cancer Patients Receiving Adjuvant Chemotherapy
Ann M Berger, Gaurav Kumar, Tricia D LeVan, Jane L Meza
April-June 2020, 7(2):134-140
Objective: Evidence is scant regarding symptom clusters and quality of life (QOL) over 1 year in women who receive adjuvant breast cancer chemotherapy (CTX). Our purpose was to identify the prevalence and severity of individual symptoms, symptom clusters, and QOL in women receiving adjuvant breast cancer CTX from baseline over 1 year. Methods: Symptoms were identified in a sample (n = 219) at three times: baseline (prior to the first adjuvant CTX treatment), 1 month after the last CTX (approximately 6 months after baseline), and 1 year after baseline. The Hospital Anxiety and Depression Scale and Symptom Experience Scale measured symptoms. The Medical Outcomes Study, Short-Form Survey, measured QOL. Exploratory factor analysis identified symptom clusters at each time and core symptoms in clusters over time. Results: The prevalence and severity of 10 symptoms decreased over time (P < 0.05). Fatigue, sleep disturbance, and pain were most prevalent; all were of mild severity. Two symptom clusters were identified at baseline and one met internal consistency reliability criteria at the later times. Core symptoms were identified. Both the physical and mental component scores of QOL improved over time (P < 0.01), but physical was below the general population norms 1 year after baseline. Conclusions: The symptom experience was dynamic, and symptom clusters changed over 1 year. Despite mild severity, core symptoms and clusters persisted over 1 year, and physical health was below the general population norms. Breast cancer survivors with persistent single and co-occurring symptoms need to be taught to manage the patterns of symptoms over time because they may not resolve by 1 year.
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Oncology Nursing in Singapore: How It Evolved and What Does the Future Hold?
Gek Phin Chua
April-June 2020, 7(2):129-133
Cancer is the leading cause of death in Singapore since the early 1980s and has remained so since then, accounting for 29.7% of deaths in 2015. Rapid technological advancements in the treatment of cancer and the development of the specialty of radiation and medical oncology demanded nurses with the knowledge and skills to provide care and support to cancer patients and their families. The evolvement of oncology nursing as a specialty in Singapore mirrors many countries due to the increase in cancer incidences as well as the development of medical specialty in the treatment of cancer. This paper traces the development of oncology nursing as a clinical specialty in Singapore. The historical perspective maps up the factors that caused oncology nursing to develop as a specialty within nursing practice. As cancer continues to be the leading cause of mortality for many years to come in Singapore and cancer care continues to evolve, the roles of oncology nurses will continue to unfold and expand as part of an interdisciplinary team in the fight against cancer.
  2,036 214 -
Psychosocial Experiences, Challenges, And Coping Strategies Of Chinese–Australian Women With Breast Cancer
Janelle V Levesque, Martha Gerges, Afaf Girgis
April-June 2020, 7(2):141-150
Objective: Chinese migrant women with breast cancer are at risk of poorer psychosocial outcomes. However, little is known about the cancer-related challenges experienced by these women, or how they self-manage their concerns. This qualitative study aims to explore the experience of breast cancer for Chinese–Australian women and gain insight into their coping behaviors. Methods: Twenty-four Chinese–Australian women, previously diagnosed with breast cancer, participated in a semi-structured interview or focus group session, conducted in the participant's preferred language. Qualitative data were subjected to thematic analysis. Results: Three main themes emerged, reflecting the psychological impact of the diagnosis, the challenges experienced, and the use of social support and other coping behaviors. The theme of psychological impact highlighted the emotional toll of diagnosis and the ongoing anxiety surrounding the fear of cancer recurrence. The theme of challenges identified stressors relating to treatment side effects and the need for psychological support. The social support and coping theme identified the various levels of social support participants received and how Chinese–Australian women may limit their use of social support to protect others. Participants used several behavioral (e.g., diet and exercise) and cognitive (e.g., reframing) strategies to cope with their cancer experience. Conclusions: Chinese–Australian women with breast cancer face significant challenges that impact on their psychological well-being. Varying levels of social support, and the desire to protect others through self-sacrifice, may reflect the cultural expectations of women. The results highlight the need for cultural understanding when developing strategies that optimally support Chinese migrant women with breast cancer.
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A Pilot Intervention Study to Improve Sexuality Outcomes in Breast Cancer Survivors
Natalia Gondim de Almeida, Tish M Knobf, Marcos Renato de Oliveira, Marina de Góes Salvetti, Mônica Oliveira Batista Oriá, Ana Virginia de Melo Fialho
April-June 2020, 7(2):161-166
Objective: The main objective of the study is to assess the efficacy of the Permission, Limited information, Specific Suggestion, and sexual therapy (PLISSIT) model directly with breast cancer survivor (BCS) on sexual function and quality of life (QOL) domains. Methods: A pilot control trial was conducted comparing the PLISSIT model intervention to usual care. The intervention was delivered by two health professionals (nurse and professional sexual therapist) consisted of five sessions on counseling, genitalia anatomy, human sexual response, and sexual function. Data were collected before and 3 months after the intervention using the Female Sexual Function Index and the World Health Organization QOL-BREF questionnaire. Results: The sample consisted of 19 BCS (11 intervention, 8 controls) with a mean age of 54.5 8 years (standard deviation = 7.14) and the majority were married, Black or mixed Brazilian, received chemotherapy, radiation and/or hormonal therapy, and education varied from high school to college. There was significant improvement in physical health (P = 0.031), social relationships (P = 0.046), orgasm (P = 0.055), and pain (P = 0.049) over time and the intervention resulted in improved arousal (P = 0.038). Conclusions: The results suggest that the PLISSIT model may be an effective intervention for BCS in coping with and managing changes in sexuality and sexual function after treatment. It is important that nurses are aware of sexual intimacy concerns for BCS and integrate assessment into their nursing care.
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Assessment of Fall-Related Self-Efficacy: Characteristics that Influence the Perception of Patients with Chemotherapy-Induced Peripheral Neuropathy
Sena Yamamoto, Naomi Fujikawa, Kota Asano, Masayo Toki, Ayumi Takao, Harue Arao
April-June 2020, 7(2):190-195
Objective: The present study aims to describe fall-related self-efficacy as perceived by patients with chemotherapy-induced peripheral neuropathy (CIPN). The characteristics of patients associated with low perceived self-efficacy of preventing falls were investigated. Methods: A cross-sectional study of four hospitals in Japan. In this study, 100 outpatients who were receiving chemotherapy for cancer and experiencing CIPN were recruited. Participants completed an anonymous, self-administered questionnaire. Self-efficacy was measured with the falling self-efficacy (FSE) scale, and the severity and impact of CIPN was assessed with the Comprehensive Assessment Scale for CIPN in Survivors of Cancer (CAS-CIPN). Data about the demographic information of the patients, cancer diagnosis and treatment, pain and fatigue symptoms, and history of previous falls were collected. Logistic regression analysis was used to assess relationships between variables. Results: A total of 81 (81.0%) participants with CIPN completed the questionnaire. They reported experiencing fear of falling during their daily activities, which include the act of standing up, walking, and using the stairs. Small events, such as unstable postures and uncomfortable situations, affected their confidence of preventing falls. Logistic regression revealed that low FSE scores were significantly associated with female sex (P = 0.022), low body mass index (BMI;P= 0.026), and the CAS-CIPN score (P < 0.001). Conclusions: Female patients with CIPN and low BMI might have an increased need for enhanced fall-related self-efficacy. A comprehensive assessment of CIPN in patients at risk of low FSE scores is likely to be beneficial.
  987 158 -
The Palliative Care Outcome Scale: Turkish validity and Reliability Study
Vildan Kocatepe, Emel Emine Kayıkçı, Ülkü Saygılı, Dilek Yıldırım, Gülbeyaz Can, Güngör Örnek
April-June 2020, 7(2):196-202
Objective: To examine the validity and reliability of the Turkish version of the Palliative Care Outcome Scale (POS). Methods: This methodological study consisted of 69 patients hospitalized in the palliative care (PC) service of three hospitals between June 2016 and August 2016, 69 carers who undertook continuously primary care of these patients, and 28 staff members working in the PC service and providing care to these patients. The data of the study were collected using the Personal Diagnosis Form, the POS. The scope, structure and criterion validity and internal consistency reliability of the scale were tested. Item analysis, Cronbach's alpha analysis, content validity ratio, confirmatory factor analysis for construct validity, criterion validity, patient validity, and intraclass correlation coefficient for the adaptation of outcomes of patient, carer, and staff groups were conducted. Results: The content validity ratio of the scale was found to be higher than 0.80 for patient, carer, and staff questionnaires. Item-total score correlation coefficients were determined between 0.27 and 0.72 for the items in the patient questionnaire, 0.33–0.67 for the carer questionnaire, and 0.34–0.72 for the staff questionnaire. The Cronbach's alpha reliability coefficients were determined as 0.64 for the patient questionnaire, 0.73 for the carer questionnaire, and 0.68 for the staff questionnaire. Conclusions: The Turkish version of the POS was determined to be a valid and reliable tool to be used for assessing the needs of PC patients in three dimensions in terms of the perspectives of patient, carer, and staff.
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Fatigue in Children with Cancer: Reliability and Validity of the Persian Version of Child, Parent, and Staff Fatigue Scale
Fatemeh Mahdizadeh, Afsoon Hassani Mehraban, Mohammad Faranoush, Malek Amini, Maryam Mehdizadeh
April-June 2020, 7(2):174-179
Context: The fatigue is reported as the most common and annoying symptom in patients with cancer, timely diagnosis, and treatment can significantly influence the treatment and rehabilitation. It is crucial to have an appropriate tool to accurately assess fatigue status. Objectives: Our purpose was to assess psychometric properties of the Persian versions of fatigue scale by Original Scales from the viewpoint of children with cancer (Child Fatigue Scale [CFS]-24 h), their parents (Parent Fatigue Scale [PFS]-24 h), and staff (Staff Fatigue Scale FSF-24 h). Methods: Convenience sampling of the participants was conducted 100, including children with cancer within the age range of 7–12 years, their parents, and caregivers in medical staff. Test–retest reliability and internal consistency were evaluated using intraclass correlation (ICC) and Cronbach's alpha coefficient. Dimensionality was determined by factor analysis. The patients' fatigue was also assessed through visual analog scale-fatigue (VAS-F). Results: Test–retest (ICCCFS= 0.71, ICCPSF= 0.82, and ICCSFS= 0.78) was acceptable with a high level of internal consistency (αCFS= 0.80, αPFS= 0.83, and αSFS= 0.84). Factor analysis identified three, five, and two components for the CFS, PFS, and Staff Fatigue Scale (SFS), respectively. There was moderate correlation between CFS and VAS-F. Conclusions: Results of the current study indicated that CFS in children with cancer, PFS in their parents, and SFS in medical staff were valid and reliable instruments to assess fatigue from the viewpoint of children with cancer along with their parents and medical staff.
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Evaluation of the Japanese Version of the Cancer Survivors' Unmet Needs Scale
Hiroko Komatsu, Kaori Yagasaki, Yasunori Sato, Harue Arao, Sena Yamamoto, Tetsu Hayashida
April-June 2020, 7(2):167-173
Objective: This study aimed to evaluate the psychometric properties of the Japanese version of the Cancer Survivors' Unmet Needs (CaSUN-J) scale among cancer survivors in Japan. Methods: The CaSUN-J was developed using standardized translation methodology. Content validity was evaluated by a group of experts, and a pilot test was conducted with a convenience sample of 10 cancer patients. A total of 183 Japanese cancer survivors completed the CaSUN-J. The internal consistency of the scale was examined with Cronbach's α. Construct validity was analyzed using correlations with the physical effects, quality of life (QoL), and age. To assess the factorial validity of the CaSUN-J, confirmatory factor analysis (CFA) was performed. Results: The CaSUN-J indicated good readability and high content validity for use as an assessment tool among Japanese cancer survivors. All Cronbach's α coefficients were above the minimum acceptable criterion of ≥0.70. For construct validity, higher physical effect scores, as well as poorer QoL scores and younger patients, were significantly positively associated with higher levels of needs. CFA indicated that the five-factor structure of the CaSUN-J was a good fit to the data. Conclusions: The CaSUN-J can serve as a valid and reliable tool to evaluate unmet needs among Japanese cancer survivors.
  815 131 -
Functional Status, Supportive Care Needs, and Health-Related Quality of Life in Advanced Lung Cancer Patients Aged 50 and Older
Zhe-Peng Huang, Hui-Lin Cheng, Soon Yue Loh, Karis Kin Fong Cheng
April-June 2020, 7(2):151-160
Objective: This study aimed to examine the levels of functional status, supportive care needs, and health-related quality of life (HRQOL), and their relationships reported by advanced lung cancer patients aged 50 and older. Methods: A cross-sectional descriptive correlational study was conducted with 103 participants recruited from a cancer center in Singapore. Functional status, supportive care needs, and HRQOL were measured using validated instruments. Descriptive statistics were used to describe the sample profiles. Univariate and multivariate regression analyses were adopted to determine factors that were associated with HRQOL. Results: About 70.9% of participants were dependent in at least one instrumental activities of daily living (IADL). The mean number of unmet needs rated by participants was 9 (range = 0–28). The top three ranked items with moderate-to-severe unmet needs were “not being able to do things you used to do” (28.2%), “fear about cancer spreading” (25.3%), and “lack of energy/tiredness” (25.2%). Higher IADL scores were significantly associated with better HRQOL, whereas higher levels of supportive care needs, particularly in psychological domain significantly predicted poorer HRQOL in most domains. Conclusions: This study found that poor functional status and unmet supportive care needs are common in advanced lung cancer patients. Psychological needs and functional status are associated with patients' HRQOL. Future interventions incorporating functional assistance and psychological support may increase HRQOL in this population.
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Giving A Face to Chemotherapy-Induced Alopecia: A Feasibility Study on Drawings by Patients
Kirsten van Alphen, Anne Versluis, Wouter Dercksen, Henk de Haas, Rieneke Lugtenberg, Jitske Tiemensma, Judith Kroep, Elizabeth Broadbent, Ad A Kaptein, Corina van den Hurk
April-June 2020, 7(2):218-224
Objective: Individuals with cancer experience the impact of chemotherapy on hair loss in different ways. The aim of this pilot study was to explore patients' experiences of alopecia through patients' drawings. Methods: Fifteen female patients diagnosed with cancer and treated with chemotherapy were recruited at the oncological day-care unit of a teaching hospital in the Netherlands. Participants completed a semi-structured interview about alopecia. They drew their head and hair before and during chemotherapy and completed the Brief Illness Perception Questionnaire (B-IPQ).Results: The drawings revealed predominantly physical effects, rather than emotions. Emotions were evident in the text that patients wrote under the drawings and in the B-IPQ open question about the perceived consequences of alopecia. The overall impact of alopecia that emerged from the drawings and the B-IPQ corresponded to the information retrieved from the interviews, namely disappointment, insecurity, sadness, and confrontation.Conclusions: Drawings expose cognitive and emotional responses to alopecia that may be relatively unexplored when using traditional assessment methods such as questionnaires or interviews. In future research, the drawing instructions need to be more specifically focused on feelings in order to better capture emotional reactions to hair loss.
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Evaluation of Fatigue in Cancer Patients in An Area Affected by the Great East Japan Earthquake
Daisuke Sato
April-June 2020, 7(2):203-208
Objective: The objective of this study is to evaluate fatigue in cancer outpatients receiving chemotherapy using an objective system and to clarify the type of nursing support needed after a disaster. Methods: Based on the diagnostic criteria for chronic fatigue syndrome, the degree of subjective fatigue, autonomic function, and amount of physical activity were measured in cancer outpatients undergoing chemotherapy from an area affected by the Great East Japan Earthquake. Results: The study participants were ten adults (8 men [80.0%] and 2 women [20.0%]). Significant differences were seen in subjective physical fatigue (P = 0.347), mental fatigue (P = 0.128), comprehensive fatigue (P = 0.621), and comprehensive evaluations (P = 0.293); however, no significant differences were seen in the results for changes over time for any survey item. The balance between sympathetic and parasympathetic nerve function changed statistically significant with time (log low frequency [LF] [P = 0.039] and log LF/high frequency [HF] [P = 0.021]). In all participants, autonomic nervous function was enhanced in the sympathetic nervous system, and the sympathetic nervous system was dominant. Significant differences were observed between the three measurements for mean diurnal activity (P = 0.027), total sleep time (P = 0.011), sleep efficiency (P = 0.019), awakening (P = 0.032), and naps (P = 0.037). Conclusions: In the event of a disaster, in addition to self-care support for side effects caused by anticancer drugs, patients' physical and mental conditions are assessed in terms of fatigue using objective indicators, and then, appropriate nursing support is provided. The nurse grasps objective facts behind the patient's subjective data and systematically recommends adjustments to the patient's daily life. In addition, by providing appropriate information to patients, patient education specific to each patient is provided.
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Recognizing One's Own Care Pattern in Cancer Nursing and Transforming toward A Unitary Nursing Practice Based on Margaret Newman's Theory
Mari Mitsugi, Emiko Endo, Maki Ikeda
April-June 2020, 7(2):225-228
  715 160 -
Translation, Adaptation, and Validation of Revised Colorectal Cancer Perception and Screening Instrument among First-Degree Relatives of People with Colorectal Cancer in China
Yang Bai, Winnie K W. So, Cho Lee Wong
April-June 2020, 7(2):180-189
Objective: The purpose of the study was to translate and validate the psychometric properties of the Revised Colorectal Cancer Perception and Screening (RCRCPS) instrument for the first-degree relatives (FDRs) of people with colorectal cancer (CRC) in China. Methods: The translation, adaptation, and validation guideline developed by Sousa and Rojjanasrirat was used to guide this study. All items from the Colorectal Cancer Perception and Screening (CRCPS) instrument and three items from the Perceived Barriers Questionnaire were combined and further adapted for a colonoscopy test, resulting in RCRCPS. The resultant RCRCPS was translated from English to Chinese through forward- and backward-translation methods, and a panel review was conducted to examine its content validity. The RCRCPS (simplified Chinese version) was then tested with a convenience sample of 197 Chinese FDRs of patients with CRC. Validity was tested through confirmatory factor analysis (CFA) and discriminative validity, and reliability was assessed using Cronbach's α and test–retest reliability. Results: The content validity index (CVI) of the RCRCPS (simplified Chinese version) was satisfactory (item CVI = 0.80–1 and scale CVI = 0.92). The results demonstrated acceptable internal consistency (Cronbach's α = 0.74–0.87) and test–retest reliability in a 4-week interval (intraclass coefficient = 0.53–0.84). CFA revealed that the RCRCPS (simplified Chinese version) conformed to the four-factor model suggested by the original version (Chi-square/degree of freedom = 1.326, root-mean-square error of approximation = 0.041, comparative fit index = 0.904, Tucker–Lewis index = 0.896, and standardized root mean square residual = 0.684). Conclusions: The 38-item simplified Chinese version of RCRCPS demonstrated acceptable reliability and validity. Healthcare professionals may use this instrument in the development and evaluation of interventions to promote colonoscopy screening among people at an increased risk of developing CRC.
  627 129 1
Perceived Well-Being, Social Support, and Self-Management Behavior among Women Experiencing Chemotherapy-Related Nausea and Vomiting in A Tertiary Hospital in Lahore, Pakistan
Rita Ramos, Rehana Elahi, Muhammad Yousaf, Farhana Badar, Muahammad Abu Baka
April-June 2020, 7(2):209-217
Objective: The basic objective is to determine the level of the self-management behaviors (SMB), perceived well-being, and social support of patients in the outpatient settings at tertiary care hospital at Lahore Pakistan. It also explores if there is any significant relationship among all three variables.Methods: A descriptive-correlational study design has been used. The data have been collected at single setting of 32-bedded chemotherapy unit of a tertiary care hospital of Pakistan. The purposive sampling method has been employed. The IBM SPSS version 20 (IBM Corp., Armonk, NY, USA) has been utilized for statistical analyses. Results: A total of 317 patients' data were analyzed. The average age of patients was 42 years, and they received chemotherapy for different cancers. It was revealed that the SMB, for example, taking anti-emetics on time, and applying physical and cognitive distractions, have strong association with psychological, social, physical, and emotional dimensions of the perceived well-being. Similar self-managing strategies have associations with the provision of social support from the health-care team, personal, and family side. Conclusions: To conclude, the most common self-care methods of women receiving chemo are pharmacological management, applying physical and cognitive distraction, executing relaxation measures to control chemo-induced nausea.
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