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For over a decade, symptom distress has been a key concept in several studies of cancer. However, the definition of symptom distress is still unclear, and there are few measures targeting symptom distress, in general, and specific cancers, in particular. Prostate cancer is the sixth most common cancer worldwide and the second leading cause of death in American men. Many men with clinically localized prostate cancer may experience unique and multidimensional symptoms that occur from diagnosis through treatment, and thereafter. These symptoms associated with the disease and its treatments are in the form of physical and psychological sequelae such as urinary and bowel problems and sexual dysfunction. The purposes of this article are to (1) systematically review literature on symptoms and symptom distress in localized prostate cancer and (2) synthesize evidence of symptom distress applications and measurement in this group. A comprehensive, systematic review was conducted to identify original, data-based studies of symptoms and symptom distress in localized prostate cancer. Clarification of symptom distress and more comprehensive information about symptoms and symptom distress will provide nurses with a better foundation for developing self-management interventions aimed at ameliorating symptom distress and, ultimately, enhancing the quality of life of patients with localized prostate cancer.

Background Acute lymphoblastic leukemia is the most common pediatric cancer, and survival approaches 90%. Acute lymphoblastic leukemia survivors are more likely than healthy peers or siblings to experience academic underachievement, yet little is known about neurocognitive predictors of academic outcomes. Objectives Objectives were to compare neurocognitive abilities to age-adjusted standardized norms, examine change over time in neurocognitive abilities, and establish neurocognitive predictors of academic outcomes. Methods Seventy-one children were followed over the course of therapy. Cognitive abilities were assessed during induction when the child was in remission (baseline) and annually for 3 years (years 1, 2, and 3). Reading and mathematics abilities were assessed at year 3. Results Fine motor dexterity was significantly below age-adjusted norms at all data points but showed improvement over time. Baseline visual-motor integration was within the reference range but significantly declined by year 3, and mean scores at years 2 and 3 were significantly below age-adjusted norms. Verbal short-term memory was significantly below age-adjusted norms at all assessments. Visual-motor integration predicted reading and mathematics abilities. Verbal short-term memory predicted reading abilities, and visual short-term memory predicted mathematics abilities. Conclusions Central nervous system-directed therapy is associated with specific neurocognitive problems. Visual-spatial skills and verbal and visual short-term memory predict academic outcomes. Implications for practice Early assessment of visual-spatial perception and short-term memory can identify children at risk of academic problems. Children who are at risk of academic problems could benefit from a school-based individual educational program and/or educational intervention.

BACKGROUND Patients treated with radical prostatectomy (RP) or radiation therapy (RT) for prostate cancer can experience stress and symptoms that impact quality of life. OBJECTIVE The objectives of this study were to describe cortisol levels, perceived stress, symptoms, and symptom distress; compare differences in variables measured between RP and RT; and identify associations among cortisol levels, perceived stress, symptoms, and symptom distress in patients treated for localized prostate cancer. METHODS A descriptive, cross-sectional study was conducted with 53 patients (RP n = 24, RT n = 29). Data from saliva, questionnaires, and interviews were collected within 3 months of treatment. Saliva samples were collected at 4 times over 2 consecutive days. Data were analyzed using descriptive statistics, correlations, and regressions. RESULTS A robust diurnal rhythm of cortisol secretion with heightened levels in the early morning and lowered levels late in the day was found. On average, the entire sample had moderate symptoms and symptom distress for urinary, bowel, and sexual dysfunction. The RP group reported significantly more urinary and sexual dysfunction symptoms and fewer bowel symptoms than did the RT group. Perceived stress was positively correlated with higher afternoon cortisol levels and greater symptom distress. CONCLUSION Moderate symptoms and symptom distress found in our sample indicate the need for interventions to address these outcomes in men treated for prostate cancer. Self-reported perceived stress can be used to assess the stress level and symptom distress in clinic setting. IMPLICATIONS FOR PRACTICE Patients treated for prostate cancer with RP or RT should be assessed for symptoms and symptom distress and targeted for early symptom management interventions.

One part of a study on the effects of childhood cancer on families focused on the emotional reactions of school-age siblings. The authors identify themes in the siblings' feelings taken from transcripts of interviews with them. Responses were categorized as experience of diagnosis and hospitalization; awareness of prognosis and mortality; need for information; continuing effect of disease or death on the well child; correct understanding of cancer; and hopes and desires for the future. The responses were grouped either in a sibling with a living child category or sibling with a deceased child category. From their analysis, the authors present implications for nurses' interactions with these children: children's need for information; their feelings of being displaced and unimportant; need for encouraging involvement in the life of the ill child. The authors also identify additional questions that could direct future nursing research.

This study was conducted to identify the process and outcomes of empowerment as experienced by Hong Kong Chinese patients with cancer through participation in cancer self-help groups. The study involved in-depth individual interviews of self-help group members (n = 12) and participant observation of the group meetings over a period of 6 months. The empowered outcomes at a personal level included interconnectedness, confidence and hope, support and affirmation, and a feeling of usefulness. At a social level, expanded social network and opportunities to participate in more activities were reported. Collective efficacy also was demonstrated, although this happened only occasionally through participation in the group. One main theme that runs through the process of participation is empowerment among the members. On the basis of the efficacy demonstrated by self-help groups in this study, nurses should strongly consider referral of patients to such groups. Self-help groups serve as an important resource for patients with cancer in the Hong Kong Chinese community.

This study focused on the physiopsychological reactions to the stress of parents of children with cancer in China. Eighty-nine families who had a child with cancer were recruited into four groups: group A, the child was newly diagnosed with cancer; group B, the child was under treatment for cancer; group C, the child had relapsed and was not expected to live; and group D, the child with cancer had already died. Interviews were conducted in Cantonese. The semistructured interviews were conducted in the hospital or in the home. Specific questions were asked regarding colds, headaches, dizziness, loss of appetite, and weight loss. The Parent Stress Rating Scale (PSRS) and the Parent's Support Scale (PSS) were administered. Results indicated that parents most often reported symptoms of loss of appetite, weight loss, and sleeping difficulty, followed by headache, dizziness, and, least of all, colds. Mothers experience more symptoms than fathers. Only in the newly diagnosed group and the under treatment group did the fathers report having had more colds than the mothers. Parents rated the child's death as having caused the highest stress, followed by the terminal stage and the diagnosis. Spouses received the highest rating for being supportive, across all groups.

Twenty-two families who had a child dying from cancer in hospitals in China were interviewed regarding their situation. The interviews were all conducted in Chinese, and the results were analyzed descriptively. Cancer was identified by all families as the most frightening aspect of their situations. Not having enough money for medicines and hospitalization were identified as being the most difficult problem. Sixteen of 22 families paid for the total cost of medical treatment and hospitalization by themselves. The families gave suggestions for other families who may have a child with cancer.

This paper presents findings from a research project on home care for children dying of cancer. Nurses coordinated the care while the parents were the principal care givers and physicians served as consultants. In one year, 27 children died at home while five reentered and died in the hospit