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ABSTRACT Background Aims Design Data Sources Methods Results Conclusions Impact Reporting Methods Patient or Public Contribution Breast cancer patients experience various adverse symptoms during adjuvant chemotherapy. These adverse symptoms often form symptom clusters and have a negative impact on patients.To summarise common symptom clusters in different dimensions and their longitudinal changes among breast cancer patients receiving adjuvant chemotherapy.A systematic review.Ten electronic databases were searched from 2001 to January 2024, and the search was last updated on 16 August 2024.Two reviewers independently assessed the eligibility of each study and extracted data. The Standard Quality Assessment Criteria for Evaluating Primary Research Papers was used to evaluate the quality of included studies. The findings were synthesised narratively. This systematic review has been registered (CRD42022370210).Nine studies with a total of 1454 participants were included. The common symptom clusters in breast cancer patients receiving adjuvant chemotherapy were the gastrointestinal symptom cluster (nausea‐lack of appetite), the fatigue‐pain‐sleep disturbance symptom cluster and the psychological symptom cluster (worry‐sadness‐nervousness‐distress‐feeling irritable‐difficult concentrating). The severity dimension was the most frequently utilised in identifying symptom clusters, with the number and concurrence of symptom clusters showing variation over time.This study summarised common symptom clusters in breast cancer patients receiving adjuvant chemotherapy and revealed their changes from symptom dimensions and the chemotherapy process. These findings support further exploration of symptom cluster changes and underlying mechanisms, facilitating the design of targeted management strategies, including appropriate interventions and measurement dimensions in clinical nursing, to ultimately reduce patients' symptom burden.Common symptom clusters have been identified in breast cancer patients receiving adjuvant chemotherapy. Clinical nursing in oncology can prioritise these symptom clusters and provide patients with targeted management strategies.PRISMA guidelines and SWiM guidelines.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: This research aimed to explore the level of hope and symptom burden of breast cancer women undergoing chemotherapy, and predictive factors of hope were also investigated. Background: Chemotherapy brings physical and psychological stress to breast cancer patients. As an effective coping strategy, hope gives them the courage to overcome difficulties and improve prognosis and survival. Therefore, efforts are needed to raise hope. Design/Methods: A total of 450 women who were undergoing breast cancer chemotherapy participated in this cross‐sectional study. Sociodemographic data, disease characteristics, and measures of hope and symptom burden were collected using questionnaires. Hope was assessed using the validated Herth Hope Index, and the previously validated Memorial Symptom Assessment Scale was used to assess symptom burden. This paper adhered to the STROBE guidelines. Results: Chinese breast cancer chemotherapy women hope average scores of 30.15 ± 4.82 were in the medium range of the Hearth Hope Index as specified by Herth to be 24–35. Patients with age ≤45, religious beliefs and lighter symptom burden have a higher level of hope. These variables explained a total of 22.9% of the variation in hope. Conclusions: The level of hope for women undergoing breast cancer chemotherapy still needs to be further improved. Symptom burden can negatively predict hope. Relevance to clinical practice: If nurses can decrease breast cancer chemotherapy women symptom burden, there is an impact on increasing levels of hope. [ABSTRACT FROM AUTHOR]

Background: Post‐operative diarrhoea is a common adverse event after pancreatic surgery. While the risk factors for this condition have been identified, the increasing trend of administering chemotherapy before surgery might change these factors. This study aimed to identify the risk factors of post‐operative diarrhoea in patients with pancreatic ductal adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy. Design: A retrospective cohort study. Methods: Patients who underwent neoadjuvant chemotherapy and pancreatectomy because of PDAC between 2021 and 2023 were included. The preoperative characteristics of, operative details of and post‐operative outcomes in patients with and without post‐operative diarrhoea were collected and compared. The independent risk factors of post‐operative diarrhoea were identified using logistic regression analysis. STROBE checklist was used. Results: Post‐operative diarrhoea occurred in 65 out of 145 (44.8%) patients during hospitalization. Elevated white blood cell count, advanced tumour stage, and late abdominal drain removal were independent risk factors for post‐operative diarrhoea (p <.001, p =.006 and p =.009, respectively). Conclusions: Some perioperative factors influence post‐operative diarrhoea in patients who undergo neoadjuvant chemotherapy. More attention should be paid to patients at a higher risk of post‐operative diarrhoea, with an emphasis on high‐quality management for these patients. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To describe the main acupuncture techniques and parameters that have been used in the most varied symptoms of different types of cancer. Background: Clinical evidence about the potential effectiveness of acupuncture and related therapies to control signs and symptoms associated with cancer or its treatment has been in several studies. Currently, there is already evidence of the use of acupuncture for the treatment of nausea and vomiting, fatigue, dry mouth, anxiety, depression, insomnia and pain. However, many studies lack firm rights or reproducible guidelines for treatment. Design: This study performs a systematic review of clinical trials related to the topic, based on the PRISMA protocol. Thus, a search was carried out in the Scopus, Pubmed and Web of Science databases, covering studies since January 2007. Methods: Structured and organised according to PICO standards, using keywords ("cancer" OR "malignant tumour" OR "chemotherapy" OR "radiotherapy") AND ("acupuncture" OR "electroacupuncture") AND ("pain" OR "nausea" OR "vomit" OR "fatigue" OR "xerostomia" OR "insomnia" OR "depression" OR "neuropathy"). Results: After the selection and evaluation phase, 23 studies were included and analysed. Conclusion: Based on this analysis, it is concluded that acupuncture is safe and there is evidence of the reduction of gastrointestinal symptoms, chemotherapy‐induced peripheral neuropathy, pain, dry mouth, fatigue, insomnia, and improvement of cognitive capacity. Relevance to clinical practice: Acupuncture treatments could act by minimising the side effects of conventional treatments and reducing symptoms induced by tumours. No Patient or Public Contribution: The patients had no direct involvement with the study in question. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To identify symptom clusters and examine their association with health‐related quality of life. Background: Multiple myeloma patients undergoing chemotherapy suffer from disease symptoms and adverse effects during the course of the disease. However, single symptom management has little effect, and symptom management for these patients remains challenging. Symptom clusters open a new perspective and provide important clues for symptom management. Design: A cross‐sectional study. Method: Participants were invited to complete the Chinese version of the Memorial Symptom Assessment Scale and Quality of Life Questionnaire‐core 30. Appropriate indicators were used for descriptive statistics. Principal component analysis was used to identify symptom clusters. Associations between symptom clusters and quality of life were examined with Pearson correlation coefficients, Pearson correlation matrix and multiple linear regression. This study was reported following the STROBE checklist. Results: A total of 177 participants were recruited from seven hospitals in this study. We identified self‐image disorder, psychological, gastrointestinal, neurological, somatic and pain symptom clusters in multiple myeloma patients with chemotherapy. Approximately 97.65% of patients suffer from multiple symptom clusters. The pain, psychological and gastrointestinal symptom clusters have negatively influence on health‐related quality of life. The strongest association was found with the pain symptom cluster. Conclusion: Most of multiple myeloma patients suffer from multiple symptom clusters. When improving the multiple myeloma patients' health‐related quality of life, the clinical staff should prioritise relieving the pain symptom cluster. Relevance to Clinical Practice: When multiple myeloma patients undergoing chemotherapy suffer from multiple symptom clusters, nurses should prioritise relieving the pain symptom cluster to improve their health‐related quality of life. When drawing up and providing interventions, nurses should focus on the correlation among symptoms rather than single symptom. By relieving one symptom in a given cluster, other symptoms within the same symptom cluster may also be relieved. [ABSTRACT FROM AUTHOR]

Objective: To develop and test the model of association of social connectedness and health‐related quality of life (HRQoL) among patients with cancer undergoing chemotherapy and to describe their social connectedness through photo‐elicitation. Background: Social connectedness has been empirically associated with several well‐being outcomes. However, little is known on the association of social connectedness among patients with cancer undergoing chemotherapy. Methods: Employing a mixed‐methods design following the good reporting of a mixed methods study guideline, the quantitative approach involved 230 consecutively‐selected patients with cancer undergoing chemotherapy who answered a three‐part survey. From these patients, six informants participated in the photo‐elicitation and key informant interview sessions. Gathered data were quantitatively analyzed using structural equation modelling and qualitatively processed using polytextual thematic analysis. Results and Findings: Social connectedness had a positive influence on social well‐being (β =.22, p =.008) and emotional well‐being (β =.20, p =.023); however, it had a negative effect on functional well‐being (β = −.20, p =.007). The overall model revealed good model indices: χ2/df =.82, RMSEA =.01, GFI = 1.00. Qualitative analysis culled from photo‐elicitation uncovered five interconnected themes yielding the Honeycomb model of social connectedness which was composed of correspondence, cohesion, constitution, convergence and corroboration. Conclusion: HRQoL among patients with cancer undergoing chemotherapy is a multi‐factorial health construct affected by social connectedness. The presented model emphasises the importance of social connectedness and paves way for the development of appropriate strategies to promote social connectedness among patients with cancer undergoing chemotherapy. Relevance to Clinical Practice: The findings provide impetus in the modification and development of appropriate practices, policies and strategies in promoting social connectedness. These approaches are geared towards patient–family empowerment and health education techniques to ascertain that assistance from significant others is provided without limiting the patient's autonomy or independence. [ABSTRACT FROM AUTHOR]

Background: A range of psychological issues often accompany breast cancer chemotherapy. Due to their ubiquity, mobile phones have been used to deliver supportive interventions addressing these issues. However, we currently lack sufficient evidence to guide the design of such interventions. Aim: To analyse and synthesise available evidence on the effectiveness of mobile‐phone‐based (mHealth) interventions in alleviating the psychological issues experienced by women receiving chemotherapy for breast cancer. Methods: A systematic literature search was conducted from 14 relevant databases. Revman 5.4 was used to pool the quantitative results from comparable studies for statistical meta‐analysis. For clinically heterogeneous studies where statistical pooling of results was not possible, a narrative summary was used to present the findings. Results: The review included nine RCTs which covered 1457 patients. The meta‐analysis results indicated a significant improvement in the quality of life (standardised mean difference [SMD] = 0.32, 95% confidence interval [CI] [0.07, 0.58], p =.01, I2 = 17%). No significant effects were found for anxiety (SMD = −0.01, 95% CI [−0.26, 0.25], p =.96, I2 = 53%) and depression (SMD = 0.02, 95% CI [−0.17, 0.20], p =.87, I2 = 0%). Individual studies suggest reduced symptom prevalence (p =.033, d = 0.27), symptom distress (p =.004, d = 0.34), symptom interference (p =.02, d = 0.51), supportive care needs (p <.05, d = 2.43); improved self‐efficacy (p =.03, d = 0.53), self‐esteem (p <.001, d = 0.87) and emotional functioning (p =.008, d = 0.30). The methodological quality ranged from low to moderate. Conclusion: mHealth interventions might help address certain psychological issues experienced by this population, although the evidence is still being gathered and not yet conclusive. More rigorous trials are warranted to confirm the suitable duration while addressing the methodological flaws found in previous studies. PROSPERO registration number: CRD42021224307. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study set out to understand the experiences and expectations of scalp cooling among women with early‐stage breast cancer. The objective was to develop patient co‐produced information resources to better inform and prepare women considering scalp cooling during chemotherapy. Background: Treatment‐induced alopecia is a common concern among women preparing for chemotherapy. Evidence indicates that many women feel inadequately prepared for scalp cooling, resulting in potentially mitigable distress and disappointment. Design: A single‐site, sequential, explanatory mixed‐methods design was used. Participants included women with early‐stage breast cancer who had previously or were currently using, scalp cooling. Women completed an online survey exploring scalp cooling experiences and expectations and self‐selecting participants took part in one semi‐structured, audio‐recorded interview. Guidelines for Good Reporting of a Mixed Methods Study were followed. Results: Forty‐nine women (69%) consented to take part in the survey and 23 took part in an interview. Most women described losing more hair than they expected. Many described feeling inadequately prepared for the discomfort of scalp cooling; the additional time needed to accommodate scalp cooling during treatment and, that they lacked information about self‐ care to help minimise hair loss. Importantly, several participants described variability in nurses' knowledge and practical skills regarding scalp cooling. Conclusions: To optimise experience of scalp cooling, women need comprehensive preparatory information about variability in efficacy of scalp cooling; time needed to accommodate scalp cooling; hair care during treatment, and the potential discomfort associated with it. They also need nurses to be confident and well informed about scalp cooling processes. Relevance to clinical practice: Our study led to the development of online, patient co‐produced resources to help prepare and inform women considering using scalp cooling; and an online scalp cooling training module and checklist for nurses. Links to the resources are included in the manuscript. [ABSTRACT FROM AUTHOR]

The article focuses on cancer as a leading cause of global death, with a projected increase in cases by 47% by 2040. It authors conducted a systematic review on the efficacy of acupuncture in cancer patients undergoing chemotherapy or radiotherapy, highlighting its safety and potential benefits in reducing various symptoms associated with cancer treatments.

Aims and objectives: This study examined the effect of virtual reality (VR)‐based documents (VRdocs) on knowledge and attitude towards chemotherapy administration in nursing students. Background: Chemotherapeutic drugs in cancer patients are a complicated and dangerous process. However, despite the high toxicity of the chemotherapeutic drugs, the compulsory or internship courses in nursing schools do not include training in operational chemotherapeutics and its associated safety measures. Design: A randomised controlled trial based on the CONSORT 2010 guidelines (registry number: NCT03707210). Method: A total of 77 students were randomised to an experimental (VRdocs, n = 38) or a control group (n = 39). Pre‐ and posttest data were collected. After the pretest, the control group received the education documents, whereas, the experimental group used VR software consisting of an application about chemotherapy administration. Finally, the effectiveness of the intervention was self‐evaluated using questionnaires after 7 days. Results: The posttest scores for knowledge (F = 6.412, p =.013) and attitude in the experimental group were significantly different from those in the control group (F = 8.469, p =.005). Compared with the control group, a significant number of students in the experimental group indicated their higher recommendation score for the VRdocs (p =.0001). Conclusion: Schools must provide a variety of handouts and teaching methods to educate nursing students about high‐risk nursing techniques. Methods using VR can address the shortcomings of the traditional documents, and the use of both methods simultaneously can produce better learning results. Relevance to clinical practice: Virtual reality based documents were provided to the participants to understand the preparation, implementation, and safety of chemotherapy. VRdocs allow students to re‐learn high‐risk care techniques without the influence of time and space and may prove useful for other nursing courses. [ABSTRACT FROM AUTHOR]

Aims and Objective: To identify clinical indicators of septic shock in critical care patients. Background: The identification of clinical indicators of septic shock is relevant to avoid clinical deterioration of patients with sepsis. However, the recognition of these factors, especially by the nursing team, is still deficient and reinforces the need for studies that investigate the subject in different realities such as that of Brazil. Design: The study had a cross‐sectional design based on STROBE guidelines (see Appendix S1). Methods: A sample of 392 patients with sepsis or septic shock was admitted to the Intensive Care Unit of a Brazilian university hospital. Data were collected from medical records of the Intrahospital Sepsis Combat Program referring to patients admitted between January 2018–January 2019. Sociodemographic and clinical data were collected, as well as information on the time from diagnosis of sepsis or septic shock to initiation of antibiotic therapy, length of stay, and discharge or death outcomes. Data were statically analysed. Results: Out of the total sample, 190 (49%) patients were admitted with septic shock. Clinical indicators of septic shock were hypotension, mechanical ventilation, lactate levels between 2.0–3.9 or >4, hypothermia <36°C, radiotherapy‐associated chemotherapy, Sequential Organ Failure Assessment score >3 and admittance through the emergency unit. Among patients with septic shock, 85 (44.7%) were discharged and 105 (55.2%) died in the intensive care unit. Conclusions: Patients with septic shock presented hyperlactataemia and greater organic dysfunction as clinical indicators when compared to patients with sepsis. Mechanical ventilation, chemotherapy and radiotherapy increased the risk of developing septic shock. Relevance to clinical practice: Our results can support the nursing team by providing the main clinical indicators of septic shock and contributing to the interprofessional team in the prevention of septic shock. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine and compare the differences in symptoms and symptom clusters between postmenopausal women with early‐stage breast cancer who did and did not receive chemotherapy prior to aromatase inhibitor (AI) therapy. Background: Women with breast cancer often experience multiple concurrent symptoms during AI therapy. The burden of symptoms prior to AI is associated with nonadherence to cancer treatment. To date, few studies have comprehensively explored the symptoms and symptom clusters occurring prior to AI therapy. Design: Secondary analysis of a prospective repeated‐measures study. Methods: The sample comprised postmenopausal women (N = 339) with breast cancer who would receive AI therapy with or without chemotherapy. We collected information on 48 symptoms after surgery or chemotherapy but before AI therapy using different symptom assessment tools. Mann–Whitney U tests were used to compare the differences in the severity of symptoms between groups. Exploratory factor analysis (EFA) was conducted to determine symptom clusters. This study followed STROBE guidelines. Results: The most severe symptoms among women with breast cancer prior to AI therapy were breast sensitivity, unhappy with the appearance of my body, general aches and pain, joint pain and muscle stiffness. Women who received chemotherapy prior to AI therapy experienced significantly higher severity of 22 symptoms than women who did not receive chemotherapy. Through EFA seven distinct symptom clusters were revealed in both groups: cognitive, musculoskeletal, psychological, vasomotor, weight, sexual and urinary, with additional gastrointestinal symptom cluster been identified in women who received chemotherapy. Conclusions: This study indicates the presence of symptoms among women with breast cancer prior to AI therapy, with higher severity of symptoms and greater number of symptom clusters for women who received chemotherapy. Relevance to clinical practice: Nurses should assess and be aware of symptoms and symptom clusters existed prior to AI therapy and manage them in advance. [ABSTRACT FROM AUTHOR]

Aims and objectives: To measure cancer‐related fatigue (CRF), self‐care agency (SCA) and fatigue self‐care strategies, and to explore the relationship between CRF and SCA. Background: Cancer‐related fatigue has been consistently rated as the most elusive, common and severe of symptoms that patients with cancer undergoing chemotherapy experience. Despite its frequency and severity, CRF is poorly managed. A renewed focus on supporting self‐care among patients with cancer has been found to reduce symptom burden, empower patients and improve patient satisfaction. Understanding the link between self‐care agency (i.e. capability and willingness to self‐care) and CRF levels will help practitioners to better support individuals on the cancer journey. Design: A descriptive, correlational survey design was employed. Methods: Patients (n = 362) undergoing chemotherapy with a primary diagnosis of breast, colorectal, Hodgkin's and non‐Hodgkin's lymphoma cancers were recruited from four oncology centres in one city in the South of Ireland. Participants completed the Piper Fatigue Scale‐Revised, Appraisal of Self‐care Agency Scale and a researcher‐developed Fatigue Self‐Care Survey. Multivariate logistic regression was used to examine the relationship between CRF and self‐care agency using a dichotomous dependent variable score of four as the cut‐off between those deemed to be fatigued (≥4) and those not fatigued (<4). As recommended by the EQUATOR Network, the STROBE checklist of items for cross‐sectional studies is used to report the study. Results: The incidence of CRF was high with 75% of participants scoring clinically relevant CRF. Higher SCA (OR = 0.96, 95% CI = 0.93–0.99, p = .011) was associated with decreased odds of developing CRF. Having non‐Hodgkin's lymphoma (OR = 3.02, 95% CI = 1.29–7.07, p = .011) was associated with increased odds of developing CRF. Conclusions: Patient's undergoing chemotherapy experience significant fatigue. Higher capability for self‐care is associated with lower fatigue. The promotion of SCA and self‐care strategies can impact on CRF. Relevance to clinical practice: Understanding the link between self‐care abilities and fatigue can lead to more individualised and tailored approaches to CRF. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine changes in patients' bowel function and to compare patients' outcome among different operation and treatment after rectal resection. Background: Anal‐preserving surgery is the trend of treatment of colorectal cancer and bowel function after surgery needs to be concerned. Design: Prospective cohort study. Methods: A total of 38 patients with convenience sampling were recruited from a teaching hospital. The low anterior resection syndrome (LARS) score was used to assess bowel function disturbances before discharge and at 1 week, 1 month and 3 months after discharge. We followed the STROBE checklist to ensure rigour in our study. Results: Approximately half of the patients experienced major LARS, including daily stool frequency of more than seven times and stool clustering at least once a week. The LARS scores observed at 1 month after discharge were significantly higher than those observed before discharge. Patients who received intersphincteric resection had higher LARS scores compared with those who received other surgeries. Furthermore, patients who underwent concurrent chemoradiotherapy, operation (OP) and chemotherapy had the highest LARS scores compared with those who underwent only an OP. Conclusion: The patients experienced varied intestinal dysfunction after surgery based on their treatment plan and surgical method. Nurses should provide individualised health education for these patients. Relevance to clinical practice: A health education booklet is recommended to educate patients about LARS symptoms and the techniques to adapt in their daily lives after surgery. [ABSTRACT FROM AUTHOR]

Aims and objectives: To summarise the current state of knowledge of symptom clusters research from studies that included, as part of their sample, patients who were receiving primary or adjuvant chemotherapy. Background: Since the concept of a symptom cluster was first introduced into the oncology literature in 2001, only four comprehensive reviews of symptom clusters research in oncology patients were identified that provide insights into this important concept in symptom management research. Design: A comprehensive review of the literature. Methods: A comprehensive literature search was conducted for the years 2000 to 2016. Only 19 studies met the inclusion criteria for this literature review. These studies were evaluated in terms of the symptom assessment instruments used; the statistical analysis methods used; the symptom dimension(s) used to create the symptom cluster(s); the number and types of symptom clusters identified; and whether the specific symptom clusters changed over time. Results: The number of symptom clusters identified ranged from one–seven. The majority of the studies used some type of factor analysis to create the symptom clusters. The most common symptom dimension used to create the clusters was symptom severity. A “gastrointestinal symptom cluster” was the most common symptom cluster identified. Across the eight longitudinal studies, for half of these studies the symptom clusters remained relatively stable over time. Conclusions: Additional research is needed in oncology patients to address the assessment of symptom clusters, the specific nature of symptom clusters and whether symptom clusters change over time. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop a nurse-led psychological intervention programme and to evaluate its effects on psychological distress and quality of life in patients with breast cancer undergoing chemotherapy and at a high risk of depression. Background: Depression is common among patients with breast cancer undergoing chemotherapy. Psychological intervention programmes that improve psychological distress and quality of life have previously been lacking in South Korea. Design: This was a pre- and post-test randomised controlled trial. Methods: The nurse-led psychological intervention programme comprised seven weekly counselling sessions delivered face to face and telephonically. These aimed to provide emotional support to patients and to enable them to express their feelings. Patients at a high risk of depression were recruited from an oncology outpatient clinic in a university hospital. Sixty participants were evenly and randomly allocated to either the intervention group or the control group. The effects of the intervention on psychological distress (mood disturbance, anxiety and depression) and quality of life were examined using linear mixed models. Results: Compared with the control group, the intervention group reported significantly lower mood disturbance, anxiety and depression and showed an improved global health status and physical, role and emotional functions. They also reported fewer symptoms such as fatigue, nausea/vomiting, pain and insomnia. Conclusions: Our nurse-led psychological intervention programme might reduce patients’ uncertainty and encourage them to be proactive and self-controllable. Relevance to clinical practice: Nurse-led psychological intervention programmes should be implemented to reduce psychological distress and improve quality of life in patients with breast cancer, particularly those at a high risk of depression. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the pain assessment and management practices documented by health professionals within a tertiary-level Children's Cancer Centre and to evaluate how these practices were compared with international recommendations. Background Children with cancer are vulnerable to pain due to the intensity of antineoplastic therapy. Therefore, it is imperative to ensure that current pain management practices provided to paediatric oncology inpatients are of a high quality. Design A single-site cross-sectional audit. Methods A 24-hour period of documented pain-related care in randomly selected inpatients of an Australian tertiary-level Children's Cancer Centre was examined. The current pain management practices were audited over a two-month period resulting in 258 episodes of pain-related care being reviewed. Results Pain related to medical treatment for cancer was common ( n = 146/258, 57%) and persistent. The presence of pain was not consistently recorded by health professionals ( n = 75/146, 51%). Pain was mild ( n = 26/75, 35%) and opioids were the mainstay of pain management interventions ( n = 63/112, 56%). Adjuvants were an important component of pain management ( n = 47/112, 42%), and nonpharmacological methods of managing pain were under-represented in this audit ( n = 38/146, 26%). According to the Pain Management Index, pain was appropriately managed for the majority of children ( n = 65/76, 87%). Conclusions Pain management practices did not fully reflect the recommendations of contemporary paediatric pain management. Due to limitations in the documentation of children's pain, it was difficult to determine the effectiveness of pain management interventions. Relevance to clinical practice This study highlights the ongoing problem of pain for children receiving antineoplastic therapy. It is recommended that health professionals routinely screen for the presence of pain during hospitalisation and assess the efficacy of pain-related care. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the effect of sociodemographic and clinical factors on body image, sexual function and sexual satisfaction in women following breast cancer treatment. Background Women with breast cancer may experience a wide range of symptoms associated with body image and sexuality that can severely affect their quality of life. Therefore, the health care professional's ability to understand the patient's complaints and her sexual history is highly relevant in specialised multidisciplinary care. Design A cross-sectional survey. Methods Seventy-seven participants were included. Body image, sexual function and sexual satisfaction were evaluated using the EORTC QLQ-BR23 questionnaire. Results were shown as means, standard deviations, frequencies and percentages. Cronbach's alpha was calculated. Spearman's correlation test, the chi-square test and multivariate logistic regression were used in the statistical analysis, conducted using the spss statistical software package, version 17.0. Results Low scores were found in the desire (34·63), frequency (32·03) and sexual satisfaction (45·91) domains, while body image scores were higher (63·57). No strong correlation was found between body image and any of the other domains. Patients without a steady partner experienced more sexual desire ( p < 0·04) and more frequent sexual activity ( p < 0·01). Sexual activity was also more frequent ( p < 0·03) in women with a higher education level and in those using aromatase inhibitors. Conclusions Sexual function and satisfaction were affected to a greater extent than body image. No association was found between body image and sexual performance. The effect of marital status and education level on sexual function merits particular attention. Relevance to clinical practice A well-trained multidisciplinary team should be available to evaluate women's need for support and to provide information on the disease, its treatment and its impact on their lives and on their sexuality. [ABSTRACT FROM AUTHOR]

Aims and objectives To characterise the effects of local heat application on the ease of subsequent intravenous catheter insertion. Background Intravenous catheter insertion is a challenging procedure for both nurses and chemotherapy patients. The local application of heat to the area before intravenous catheter insertion may decrease these difficulties by increasing venous distension and visibility. Design This study was an open label experimental study involving intervention and control groups. Methods Patients receiving chemotherapy were divided into intervention ( n = 40) and control ( n = 40) groups. For patients in the intervention group, a digital moist heating pad was applied to the arm prepared for catheter insertion for 10 minutes in addition to routine care. No additional preparation procedure beyond routine care was performed for control patients. Data were collected using a data collection form and evaluated using chi square, Fisher's exact chi square, Student's t, Mann-Whitney U, Wilcoxon and Pearson correlation tests. Results Local application of heat decreased patients' pain ( p = 0·011), increased the rate of successful catheter placement at first attempt ( p = 0·004), decreased the catheterisation procedure time ( p = 0·001) and decreased nurse-perceived difficulty during catheter placement ( p = 0·001). Conclusions Local application of heat before the catheterisation procedure is suggested for patients receiving chemotherapy, particularly in cases where visibility of the veins is poor and intravenous catheter insertion is difficult. Relevance to clinical practice Local application of heat results in vasodilation, and thus intravenous catheter insertion becomes easier. Our findings have important implications for nurses who care for chemotherapy patients. The inclusion of local heat application before catheterisation as a preparation step is suitable to be implemented by nurses in other hospitals and clinics where chemotherapy is provided. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the changes in symptoms experienced by rectal cancer patients during preoperative chemoradiotherapy, with a specific focus on fatigue and to explore how symptoms impact the quality of life. Background Rectal cancer continues to be a healthcare issue internationally, despite advances in management strategies, which includes the administration of preoperative chemoradiotherapy to improve locoregional control. It is known that this treatment may cause adverse effects; however, there is a paucity of literature that specifically examines fatigue, symptoms and quality of life in this patient cohort. Design A prospective, quantitative correlational design using purposive sampling was adopted. Methods Symptoms and quality of life were measured with validated questionnaires in 35 patients at four time points. Results Symptoms that changed significantly over time as examined using rm-anova include fatigue, bowel function issues, nutritional issues, pain, dermatological issues and urinary function issues. Findings indicate that fatigue leads to poorer quality of life, with constipation, bloating, stool frequency, appetite loss, weight worry, nausea and vomiting, dry mouth and pain also identified as influencing factors on quality of life. Conclusion Findings have highlighted the importance of thorough symptom assessment and management of patients receiving preoperative chemoradiotherapy, particularly midway through treatment, in order to optimise quality of life and minimise interruptions to treatment. Relevance to Clinical Practice Close monitoring of symptoms during preoperative chemoradiotherapy, particularly at week 4, will enable the implementation of timely interventions so that interruptions to treatment are prevented and the quality of life is optimised, which may hasten postoperative recovery times. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore factors influencing exercise adherence among women with breast cancer while following an exercise programme. Background Earlier research shows that women with breast cancer decrease physical activity following the cancer diagnosis and that adhering to exercise interventions can be a challenge. Research is needed to identify motivational factors and barriers for exercise adherence among women during treatment for breast cancer. Design This was a qualitative study to explore patient's perceptions of the challenges to exercise adherence during a randomised, controlled trial. Methods Twenty-seven women with early-stage breast cancer were purposively sampled for focus group interviews during 2011-2012 from their participation in the exercise intervention group during 2010-2012. Five focus groups were performed, and data analysis was completed using the systematic text condensation method. Results During the focus group study, five main themes were identified, which described factors participants perceived to influence their adherence to exercise during chemotherapy: 'side effects of breast cancer treatment as a barrier to exercise', 'restoring and maintaining normality in daily life motivates exercise', 'other valued activities compete with exercise', 'constructive support enhances exercise' and 'positive beliefs about efficacy and outcomes motivate exercise'. Conclusion Adherence to exercise in women with breast cancer is challenged by internal and external conditions and may be improved by attention to the impact of treatment side effects and by supporting patient self-efficacy towards changing health behaviour. Relevance to clinical practice Nurses should be aware that exercise adherence could be a challenge among women with breast cancer. They should help identify obstacles to exercise for women and ways to overcome them, as well as support them in their beliefs that they are capable of changing their health behaviour. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore health professionals' perceptions of the needs of patients undergoing chemotherapy treatment for cancer. Background Patients with vulnerabilities face additional challenges. People with learning difficulties are often protected from even basic cancer information; patients with severe mental illness are open to structural discrimination with limited access to diagnostic and treatment services. There is also a much poorer survival rate after a cancer diagnosis for patients living with dementia. Design A qualitative design was used. Methods A focus group design was undertaken for this project using a narrative analytical approach revealing how narrative tales are presented and performed. Eighteen healthcare workers were recruited from a regional oncology centre in North West England. Two focus groups were conducted with nine participants in each. The data were collected from late 2011-2012. Results Participants were primarily focused on getting patients through treatment. The identification of vulnerability was an 'extra' complication and one that in practice was difficult to define/categorise. The participants appreciated the wider inclusion of family and friends to support vulnerable patients although they felt formalised health care was not particularly facilitative of this process. There were difficulties in achieving support for complex patient needs in the presence of a target driven culture. Conclusions Healthcare professionals need wider managerial and cultural support in meeting the needs of vulnerable patients. There appeared to be a tendency by healthcare professionals to minimise the inherent coping abilities of vulnerable patients. Relevance to clinical practice There is a clear need to support health professionals in providing appropriate resources in order to address the complex needs of vulnerable patients. This requires a cultural shift away from targets and an investment into greater resources for effective multidisciplinary working. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the trajectory of weight change in Taiwanese women with breast cancer after starting chemotherapy and the impact of chemotherapy regimens on weight change while controlling for age, menopausal status, body mass index, lymph node involvement and changes in habits of dietary fat intake and exercise. Background Weight gain after adjuvant chemotherapy in women with breast cancer has negative impact on health outcomes. Design Longitudinal, clinical observational study. Methods Weights were repeatedly measured in 147 women with breast cancer stages I- III. Hierarchical linear modelling was used to analyse these longitudinal data. Results The overall pattern of weight change was a cubic form beginning with a mean of 56·9 kg before chemotherapy. It gradually increased to 59·4 kg at 8·5 months after the first chemotherapy followed by a decrease to 58·5 kg at 21·5 months. During the last 2·5 months, weight increased slightly and never returned to the initial level. After controlling for confounders, steeper weight change was observed among women receiving cyclophosphamide, methotrexate and fluorouracil. The highest weight gain in the cyclophosphamide, methotrexate and fluorouracil group was 2·9 kg (5%) vs. 0·9 kg (1%) in the anthracycline-based group. Conclusion The trajectory of body weight change within two years after chemotherapy shows a trend of gradual ascent, followed by a small decline and a slight increase in the last 2·5 months. The chemotherapy regimen can predict the trend after controlling for other confounders; women on cyclophosphamide, methotrexate and fluorouracil have a steeper weight change. Relevance to clinical practice Nurses can inform women with breast cancer about the expected changes in body weight after chemotherapy to reduce their uncertainty. Future studies on effective interventions to minimise chemotherapy-induced weight gain are needed. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the incidence and risk factors for peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer. Background With the widespread use of peripherally inserted central venous catheters, peripherally inserted central venous catheters-related upper extremity venous thrombosis in patients with cancer leads to increasing morbidity and mortality. It is very important to further explore the incidence and risk factors for peripherally inserted central venous catheters-related venous thrombosis. Design and methods Consecutive patients with cancer who were scheduled to receive peripherally inserted central venous catheters, between September 2009 and May 2012, were prospectively studied in our centre. They were investigated for venous thrombosis by Doppler sonography three times a day within 30 days after catheter insertion. Univariable and multivariable logistic regressions' analyses were performed to identify the risk factors for peripherally inserted central venous catheters-related thrombosis. Results A total of 89 patients with cancer were studied in our research. Of these, 81 patients were followed up within one month. The mean interval between catheter insertion and the onset of thrombosis was 12·45 ± 6·17 days. The multivariable analyses showed that chemotherapy history, less activities and diabetes were the key risk factors for thrombosis. Conclusions Peripherally inserted central venous catheters-related upper extremity venous thrombosis had high incidence rate, and most cases had no significant symptoms. The history of chemotherapy, less activities and diabetes were found to be the key risk factors. It should be routinely scanned in high-risk patients every 3-5 days after catheter insertion, which would then find blood clots in time and reduce the incidence of pulmonary embolism. Relevance to clinical practice Risk factors associated with peripherally inserted central venous catheters-related upper extremity venous thrombosis are of critical importance in improving the quality of patients' life. It is very important to grasp the indications to reduce the incidence rate of peripherally inserted central venous catheters-related upper extremity venous thrombosis. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe how patients with malignant blood diseases conceive the influence of chemo- or chemoimmunotherapy on sexuality, and their need of support related to this issue. Background Sexuality is often negatively affected in cancer patients with sex-specific diagnoses. For patients with malignant blood diseases, the research is limited with regard to the effect on sexuality. Knowledge about their need for support related to sexuality is also needed as nurses are found to often avoid this area of their responsibility. Design Qualitative design. Methods Twelve patients treated for malignant blood diseases were interviewed twice. Phenomenography was used for the analysis. Results The analyses revealed an outcome space consisting of two main categories: 'Sexuality is overshadowed by the cancer experience' and 'No need of support but timely information might be helpful', both comprehensively related to three interrelated description categories 'Affected strength', 'Affected sexual desire' and 'Affected body image', which describe conceptions of how sexuality was affected. Conclusion Patients experienced negative effects on sexual function and sexual relationship during and after treatment period due to affected strength, sexual desire and negatively body image. However, when disease and side effects were experienced as severe, thoughts and interest of sexuality were overshadowed, and the need or wish for support related to this issue was very low. It is important to note that some patients expressed that pre- or post-treatment information might have been helpful. Relevance to clinical practice It is acknowledged in the cancer care of today that cancer follow-up should address psychosocial support in which sexuality is an important area. Therefore, it is imperative that cancer care is organised in a patient centred way, with adequate time for nurses to provide continuity in the nurse-patient relation and supportive care also during cancer rehabilitation. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the essence of the illness experiences of middle-aged men with oral cancer. Background Having oral cancer creates great challenges in the lives of middle-aged men and their families. Understanding patients' experiences provides a sound basis for patient-centred and individualised care. Research is limited regarding the illness experience of middle-aged men with oral cancer with regard to facing both the invasion of disease and the responsibilities of middle age. Design A phenomenology approach was used. Methods Nine men diagnosed with oral cancer within one year were recruited during 2009 and 2010. Data were collected through individual in-depth interviews and analysed using Colaizzi's phenomenological analysis procedures. Results The following five themes emerged from the patterns of categorised interview data: the psychological journey in facing oral cancer, the question of how patients can control their disease as well as the sequelae of cancer treatment, the continuous disturbance and turmoil resulting from the disease, the appreciation of the support from family and friends, and the ability to learn to actively face the future. Conclusions Patients with oral cancer experienced tremendous physical, psychosocial and financial challenges. Although burdened with multiple stressors, these middle-aged men were able to learn from their experiences and exhibit positive growth in life. Relevance to clinical practice Patients with oral cancer have to constantly adjust to the impact of their disease. The study results may serve as a reference for improving clinical practice and the quality of care among patients with oral cancer. Cancer care is multidimensional and holistic. Healthcare professionals should develop a set of plans by which patients receive complete medical care and support, as well as assistance from professionals and family members, as their treatment progresses to help patients face the challenges of cancer. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess the perceived fertility status and to determine the association between perceived fertility status and sexual function, as reported by young female Hodgkin lymphoma survivors. Background Young female Hodgkin lymphoma survivors are at risk of infertility and impaired sexual function. However, little is known about their awareness of infertility and its association with sexual functioning. Design A descriptive questionnaire survey. Methods In this cross-sectional study, a survey was completed by female Hodgkin lymphoma survivors (< 40 years). Outcome measures included self-reported fertility status and sexual problems and the internationally validated Female Sexual Function Index. Results In total, 36 survivors were included (mean age 32 years, SD 4). Eighteen women (50%) thought themselves fertile. Eight survivors (22%) who perceived themselves as being infertile were more often treated with alkylator-based chemotherapy, and 63% reported sexual dysfunction. Ten survivors (28%) were not aware as to whether they were fertile or not; seven of these would like to have children. The reported fertility status was related to age and chemotherapy regimen. Regarding sexuality, 14 (39%) of the female Hodgkin lymphoma survivors reported one or more sexual problem and none reported recovery. Female sexual dysfunction according to the Female Sexual Function Index was reported by 11 (31%) survivors. Conclusion Almost 30% of Hodgkin lymphoma survivors do not know whether they are fertile or not. Overall sexual dysfunction is common in Hodgkin lymphoma survivors and comparable to the general population. However, a lack of desire was significantly more often reported in female Hodgkin lymphoma survivors. Relevance to clinical practice To prevent assumed infertility and unintended childlessness by postponing parenthood in young female survivors, awareness of fertility status is needed. There is also a need to routinely assess sexual function and provide adequate interventions to improve arousal and lubrication problems. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the effect of the Breast Cancer Patient Pathway program on breast cancer patient's empowerment process. Background The results of earlier studies indicate that the use of tailored Internet-based patient education programs increased patient's knowledge level; however, other outcome measures differed. Design This randomised control trial studied the effect of the Internet-based patient educational program on breast cancer patients' empowerment. In this study, we measured the quality of life, anxiety and managing with treatment-related side effects as the outcomes of breast cancer patients' empowering process. Methods Breast cancer patients who were Internet users in one Finnish university hospital during 2008-2010 were randomised to the control group ( n = 43) and the intervention group ( n = 47). Baseline data were collected first in the hospital and the following data seven times during the treatment process, the last time one year after breast cancer diagnosis. Results There were no statistically significant differences in the quality of life, anxiety or side effects of treatment between the groups. The amount of treatment-related side effects was connected to both physical and psychological well-being. Conclusions In this study, the Breast Cancer Patient Pathway program did not decrease anxiety level or treatment-related side effects among breast cancer patients or improve subscales of quality of life when compared with controls. Relevance to clinical practice There is a need to relieve the side effects caused by patients' care with the help of patient education. Internet-based patient education programs need more focus when developing new patient education methods. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine Chinese cancer patients' fatigue self-management, including the types of self-management behaviours used, their confidence in using these behaviours, the degree of relief obtained and the factors associated with patients' use of fatigue self-management behaviours. Background Fatigue places significant burden on patients with cancer undergoing chemotherapy. While some studies have explored fatigue self-management in Western settings, very few studies have explored self-management behaviours in China. Design Cross-sectional self- and/or interviewer-administered survey. Methods A total of 271 participants with self-reported fatigue in the past week were recruited from a specialist cancer hospital in south-east China. Participants completed measures assessing the use of fatigue self-management behaviours, corresponding self-efficacy, perceived relief levels plus items assessing demographic characteristics, fatigue experiences, distress and social support. Results A mean of 4·94 (±2·07; range 1-10) fatigue self-management behaviours was reported. Most behaviours were rated as providing moderate relief and were implemented with moderate self-efficacy. Regression analyses identified that having more support from one's neighbourhood and better functional status predicted the use of a greater number of self-management behaviours. Separate regression analyses identified that greater neighbourhood support predicted greater relief from 'activity enhancement behaviours' and that better functional status predicted greater relief from 'rest and sleep behaviours'. Higher self-efficacy scores predicted greater relief from corresponding behaviours. Conclusions A range of fatigue self-management behaviours were initiated by Chinese patients with cancer. Individual, condition and environmental factors were found to influence engagement in and relief from fatigue self-management behaviours. Relevance to clinical practice Findings highlight the need for nurses to explore patients' use of fatigue self-management behaviours and the effectiveness of these behaviours in reducing fatigue. Interventions that improve patients' self-efficacy and neighbourhood supports have the potential to improve outcomes from fatigue self-management behaviours. [ABSTRACT FROM AUTHOR]

Aims and objectives To reveal the effects of music therapy and visual imagery on chemotherapy-induced anxiety and nausea-vomiting. Background Behavioural techniques such as music therapy and visual imagery are becoming increasingly important in dealing with chemotherapy-induced anxiety, nausea and vomiting. Design The study is an experimental and cross-sectional one and performed on a single sample group with the pre-post-test design consisting of 40 individuals. The individuals in the sample group comprised both the control and the case group of the study. Methods To obtain the study data, the following forms were used: the Personal Information Form, Spielberger State- Trait Anxiety Inventory, The Visual Analogue Scale and Individual Evaluation Form for Nausea and Vomiting adapted from The Morrow Assessment of Nausea and Vomiting. Results In the study, the participants' state and trait anxiety levels decreased significantly ( p < 0·05). Music therapy and visual imagery reduced the severity and duration of chemotherapy-induced nausea and vomiting significantly ( p < 0·05). In our research, 40% of the patients did not have anticipatory nausea and 55% of the patients did not have anticipatory vomiting during the third chemotherapy cycle during which music therapy and guided visual imagery were implemented. Conclusions It was determined that complementary approaches comprising music therapy and visual imagery had positive effects on chemotherapy-induced anxiety, nausea and vomiting, which are suffered too often and affect the patients' whole lives adversely. Relevance to clinical practice This study is worthy of interest as it has revealed that music therapy and visual imagery which have been proven to be effective in many health problems in different areas are also important, and practical complementary approaches that are effective in getting chemotherapy-induced anxiety, nausea and vomiting under control. [ABSTRACT FROM AUTHOR]

To determine the effect of music therapy and verbal relaxation on state anxiety and anxiety-induced physiological manifestations among patients with cancer before and after chemotherapy. Cancer and its treatment provoke a series of changes in the emotional sphere of the patient's anxiety. Music therapy and verbal relaxation had reported the anxiety reduction effect on patients with cancer receiving chemotherapy. Few studies have been undertaken comparing music therapy and verbal relaxation in differentiating high-normal state anxiety subsample. A randomised controlled trial and permuted block design were used. Outpatient chemotherapy clinic operated by a University medical centre in southern Taiwan. Ninety-eight patients were randomised into three groups: the music therapy group received one-hour single music session; the verbal relaxation group received 30 minutes of guided relaxation; the control group received usual care. Spielberger State-Trait Anxiety Instrument, Emotional Visual Analog Scale, three biobehavioural indicators: skin temperature, heart rate and consciousness level were measured during and after chemotherapy. Music therapy had a greater positive effect on postchemotherapy anxiety than verbal relaxation and control groups and a significantly increase in skin temperature. Patients with high state anxiety receiving music therapy had a greater drop in postchemotherapy anxiety than did the normal state anxiety subsample. Both music and verbal relaxation therapy are effective in reducing chemotherapy-induced anxiety. Thirty minutes of intervention initiates anxiety reduction. Patients with high state anxiety receiving chemotherapy obtain the most benefit from music or verbal relaxation. Prior to chemotherapy, patients with high state anxiety must be sorted from all patients as they are more responsive to interventions. Oncology nurses can offer music and verbal relaxation as adjuvant interventions to reduce chemotherapy-induced anxiety and enhance the quality of care. [ABSTRACT FROM AUTHOR]

The aim of this study was to test the effectiveness of polyurethane foam in contact with the heel inside a plaster cast to decrease the rate of pressure sores in the population at most risk. The rate of pressure sores caused by the plaster cast is reported to be 14-15% in the paediatric population, 33·3% in patients having undergone chemotherapy for bone tumours and 43% in orthopaedic patients who already have sore skin when the cast is applied (grade 1 lesion) to the heel. Controlled clinical trial. From November 2007-January 2009, all consecutive subjects requiring lower limb casts having undergone chemotherapy and/or presenting heel soreness received polyurethane foam in contact with the skin of the heel before applying the cast. The results were compared with those of patients with the same risk factors but were not administered the foam and were enrolled from May 2005-August 2006. In total, 156 patients were enrolled, 85 in the control group and 71 in the experimental group. In the experimental group, 2 of the 56 patients (3·6%) with sore skin developed a pressure sore compared with 21 of 49 (42·9%) in the control group without polyurethane foam ( p < 0·0005). In the experimental group, one of the 24 patients (4·2%) patients undergoing chemotherapy developed a pressure sore compared with 18 of 54 (33·3%) in the control group ( p = 0·005). Placing polyurethane foam in contact with the skin of the heel inside a plaster cast prevents the formation of pressure sores. This study provides evidence that using polyurethane foam to prevent sores even inside plaster casts in populations at most risk is a simple and cost-effective strategy and decreases the discomfort, pain and risks in these patients. [ABSTRACT FROM AUTHOR]