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Aim: Cognitive concerns are one of the most frequently reported symptoms by breast cancer survivors. This study aimed to evaluate perceived cognitive functioning in Portuguese women with breast cancer treated with chemotherapy. Methods: A cross‐sectional study enrolling 146 women (73 with breast cancer and 73 healthy) was conducted from August to October 2017, invited to participate through online dissemination. Participants completed self‐reported questionnaires to collect sociodemographic and clinical data and assess perceived cognitive functioning and psychological adjustment variables (anxiety and depression). Results: Compared to healthy women, women with breast cancer showed significantly lower scores on the Functional Assessment of Cancer Therapy‐Cognitive Function (FACT‐Cog) subscales and higher levels of depression. Both groups showed significant negative correlations between perceived cognitive functioning and anxiety and depression. Health status and depression seem to better explain perceived cognitive functioning, with health status adding significantly more explained variance beyond sociodemographic and psychological adjustment variables. Conclusion: The current findings provide evidence for the existence of more cognitive complaints among Portuguese women with breast cancer, compared to healthy individuals. Anxiety, depression, age and education also explain perceived cognitive functioning. Considering that health status and psychological adjustment seem to significantly explain perceived cognitive functioning, special attention should be given by health‐care professionals, including nurses, to designing clinical interventions for breast cancer patients to help manage cognitive impairment. Summary statement: What is already known about this topic? Cancer and associated treatments have diverse short‐ and long‐term side effects. Deficits in cognitive functions are one of the most frequently reported for breast cancer specifically due to chemotherapy.Subjective assessment of cognitive function is often neglected, although it might be clinically very useful and an important indicator of the impact of cognitive impairment on daily functioning.There is currently no Portuguese data on perceived cognitive impairment in cancer. What this paper adds? This Portuguese study shows that, compared to a matched healthy sample, breast cancer patients have significantly more cognitive complaints, as assessed by the FACT‐Cog scale.Furthermore, our findings showed that higher levels of anxiety and depression are associated with worse perceived cognitive functioning.Cognitive complaints in breast cancer patients are predicted by a complexity of factors, such as psychological adjustment, age, and education. The implications of this paper: Health‐care professionals, including nurses, should recognize cognitive complaints as legitimate in breast cancer patients.Findings may deepen nurses' knowledge about cognitive concerns in breast cancer patients, in order to improve the quality of care provided to this population.The results of the study highlight the importance of tackling this problem with specifically designed clinical interventions that target both the cognitive deficits and the psychological adjustment of patients, especially depressive symptomatology. [ABSTRACT FROM AUTHOR]

Background: There are controversial results about the effects of cancer and chemotherapy on the perception of distress. Aims: The purpose to the study is to explore the meaning of the distress experienced by patients with cancer and verify whether the cancer diagnosis, stage and receiving chemotherapy influence this experience. Design This is a mixed‐methods study with cancer patients. Methods: Data were collected in 2018 using a phenomenological interview (n = 18) and one suffering inventory (n = 100). Qualitative analysis was performed using the empirical‐comprehensive model and quantitative using statistical tests. The results were triangulated. Results: Distress originated from difficulties faced in health services, diagnosis confirmation, beginning treatment and interruption of life projects. Patients mobilized resources in the spiritual dimension that allowed them to redefine their distress positively. Chemotherapy brought hope back and promoted healing expectations. Higher average scores for distress were found in patients with advanced stage and receiving palliative chemotherapy. Not having begun chemotherapy and having head and neck cancer were associated with higher average scores for distress. Conclusion: Distress was greater among patients who had not yet begun chemotherapy; nearness of death and difficulty talking about feelings caused distress; distress was redefined by mobilization of spiritual resources. Summary statement: What is already known about this topic? There are conflicting results about distress between patients with cancer.The distress of cancer patients has been little reported or treated in cancer care units.There are no mixed‐method studies on distress in chemotherapy patients that have combined a measuring instrument and a phenomenological approach. What this paper adds? Distress among patients with cancer derives from elements that relate to health services, as well as the individual's ability to deal with the situation.Distress is greater among patients who have not begun chemotherapy and those who have head and neck cancer diagnoses.Phenomenological method can complement the use of scales to assess the subjective experience of distress in the context of cancer and chemotherapy. Implications of this paper Distress evaluation must encompass listening and the use of measurement instruments to strengthen the implementation of patient‐centred nursing care.Nurses are in a unique position to identify and approach distress, because they are often at the side of patients throughout the course of treatment.Professional training for reporting of difficult news is required. [ABSTRACT FROM AUTHOR]

Background: The DigniCap System is an effective scalp cooling device for the prevention of chemotherapy‐induced alopecia in early breast cancer patients. Aim: This prospective study was designed to confirm the efficacy and tolerability of the device, to explore potential factors associated with its efficacy and to collect data on patient perceptions and satisfaction. Methods: Between January 2016 and June 2018, 163 early breast cancer patients eligible for adjuvant chemotherapy were enrolled. Hair loss was assessed using the Dean scale, where a score of 0–2 (hair loss ≤50%) was defined as successful. Results: Hair preservation was successful in 57% of patients in the overall series. The proportion was even higher (81%) in the patient subgroup treated with a paclitaxel and trastuzumab regimen. Side effects (feeling cold, headache, head heaviness, scalp and cervical pain) were mild to moderate and did not correlate with the rate of hair loss. Lifestyle, anthropometric factors and hair characteristics failed to be associated with device efficacy. Conclusions: The DigniCap System was well tolerated and found to be effective in preventing alopecia in early breast cancer patients. Our study failed to identify factors other than type of chemotherapy regimen associated with hair preservation. SUMMARY STATEMENT: What is already known about this topic? While the DigniCap System is known to be effective in preventing chemotherapy‐induced alopecia, nearly 50% of patients do not benefit from its use, and its side effects can be relevant.Identifying factors associated with the efficacy of scalp hypothermia is particularly important to avert the side effects of scalp cooling in patients unlikely to gain any advantage and to avoid unnecessarily prolonging chemotherapy chair occupation in patients at high risk of hair loss. What this paper adds? This single‐centre prospective study involving a relatively large series of breast cancer patients confirmed the efficacy and tolerability of the DigniCap.Our study failed to identify factors other than type of chemotherapy regimen significantly associated with hair preservation. The implications of this paper: Since a high success rate was observed in patients treated with paclitaxel and trastuzumab, use of the DigniCap may be recommended in breast cancer patients receiving this regimen.In other patients, the use of the device should be considered on an individual patient basis, balancing the efficacy rates and the longer duration of chemotherapy administration against the physical and psychological distress linked to hair loss.Oncology nurses can identify patients who are likely to develop early side effects and/or are unlikely to benefit from scalp hypothermia. [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: To examine the prevalence and associated factors of chemotherapy‐related cognitive impairment (CRCI) in older breast cancer survivors (BCS). Design: Systematic review. Data Sources: We searched EMBASE, PubMed, PsychInfo, CINAHL, Cochrance Library, Web of Science, CNKI and SinoMed, without language restrictions, for studies published from the establishment of the database to September 2022. Review Methods: Two researchers independently examined the full texts, data extraction and quality assessment, and any discrepancies were resolved through discussion with a third reviewer. Quality of evidence was assessed using the Newcastle‐Ottawa Scale and the Agency for Healthcare Research and Quality Scale. Results: The seven included studies showed that the estimated prevalence of CRCI in older BCS ranged from 18.6% to 27% on objective neuropsychological tests and from 7.6% to 49% on subjective cognitive assessments. The areas most affected were attention, memory, executive functioning and processing speed. CRCI was associated with 10 factors in six categories, including sociodemographic (e.g. age, education level), physiological (e.g. sleep disorders, fatigue and comorbidities), psychological (e.g. anxiety, depression), treatment modalities (e.g. chemotherapy cycles, chemotherapy regimens), genetic (e.g. APOE2, APOE4) and lifestyle factor (e.g. physical inactivity). Conclusion: CRCI is multifactorial and has a relatively high prevalence. However, the results of subjective and objective cognitive examinations were inconsistent, possibly due to variations in tools used to evaluate different definitions of CRCI. Nevertheless, as there are few published studies of older BCS, this conclusion still require verification by well‐designed studies in the future. Impact: We found that the prevalence of CRCI in older adults is relatively high and multifactorial, providing evidence for further health care for this population. No Patient or Public Contribution: There was no patient or public involvement. [ABSTRACT FROM AUTHOR]

Aim: The purposes of this study were to describe the degree of knowledge and explore the factors associated with knowledge of infertility among women of childbearing age with breast cancer. Methods: In this cross‐sectional study, we recruited women of childbearing age with a diagnosis of breast cancer who had completed chemotherapy at a hospital in Taipei from 2015 through 2016. Face‐to‐face interviews were completed with 201 (62%) of 324 eligible women, asking about sociodemographic variables, disease and treatment characteristics, fertility intention, and infertility‐related knowledge. Results: The result showed one in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy. The mean score of infertility knowledge among participants was low, especially for general knowledge. Women with higher levels of education had better knowledge scores. Fertility intention score, especially for the domain of the pregnant risk, was negatively associated with infertility knowledge score. Conclusion: Women with breast cancer lacked knowledge about infertility and underestimated the possibility of infertility. We suggest future patient education on infertility after cancer treatment and about reproductive technology in oncologic practice before treatment begins. SUMMARY STATEMENT: What is known about this topic? Women with cancer diagnosed during the reproductive age are interested in a subsequent pregnancy.Less than half of childbearing‐age women with cancer have a comprehensive discussion about the potential impact of cancer therapy on fertility with the oncology physician.Reproductive‐age women with breast cancer have gaps in their knowledge of fertility planning as breast cancer survivors. What this paper adds? One in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy.Most women with breast cancer lack sufficient general and cancer‐specific knowledge about infertility.Factors associated with knowledge of infertility are fertility intention and education level. The implications of this paper: Results offer oncological nurses an understanding of fertility needs and infertility‐related knowledge in childbearing‐age women with breast cancer.Clinical nurses should continue to assess fertility willingness and knowledge of infertility in women with cancer both before and after cancer treatments.Comprehensive education about fertility and infertility in Taiwan is suggested. [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]

Aim: The aims of the study are to determine the incidence of oral mucositis, the stage of the condition, risk factors, and other oral complications in patients receiving outpatient chemotherapy and to evaluate the factors that have an impact on these. Methods: The study included 147 patients undergoing outpatient cancer chemotherapy at the Chemotherapy Unit of a University Hospital between February and April 2015. We used a questionnaire and the World Health Organization "Mucositis Grading Scale". Chi‐squared tests were used to determine the relationships between factors, and multiple logistic regression analysis was employed to explore predictive factors. Results: The frequency of oral mucositis was 51.7%. The most common oral problems were mouth dryness (55.1%), a reduced/changed sense of taste (52.4%), and a lack of appetite (47.6%). Logistic regression analysis showed that the risk factors for oral mucositis were advanced age, a lack of appetite, and the duration of chemotherapy. Conclusions: As a result, half of all patients undergoing outpatient cancer chemotherapy developed oral mucositis. Patients are unable to adequately prevent oral mucositis and carry out oral care. It is recommended that more studies be conducted in outpatient units to evaluate predictive factors for oral mucositis. SUMMARY STATEMENT: What is already known about this topic? Oral mucositis is an important complication that develops in patients receiving chemotherapy.Mucositis is a painful lesion and afflicts feeding, quality of life, and treatment process of the patient.The applications of basic oral care to patients receiving chemotherapy have an impact on the incidence and severity of oral mucositis and contribute to prevent bacterial colonization in the context of mucositis. What this paper adds? Oral mucositis affects outpatients receiving chemotherapy as much as it does inpatients.Advanced age, lack of appetite, duration of chemotherapy, and the presence of oral complications are effective factors in the development of oral mucositis.Patients are unable to adequately prevent oral mucositis and carry out oral care. The implications of this paper: Patients who will be receiving outpatient chemotherapy should undergo an oral examination before, during, and after their therapy and should under all circumstances receive education.The relationship between oral mucositis and the form, dose, and duration of the drugs used in chemotherapy should be taken into consideration in the case of individuals undergoing outpatient chemotherapy.Mucositis prevention and treatment should not be underestimated in patients treated in the outpatient setting. [ABSTRACT FROM AUTHOR]

Aim: To assess the validity of the translated Spanish Cancer Symptom Scale. Background: Instruments to facilitate comprehensive and objective assessments of the cancer symptom experience in underrepresented populations are essential. Methods: The Cancer Symptom Scale was translated into Spanish, and a back translation was conducted. During June 2016, a sample of 121 Hispanic Puerto Rican patients with any cancer diagnosis, all undergoing cancer treatments, completed four paper surveys. A subgroup of 15 patients agreed to complete the Spanish Cancer Symptom Scale a second time after a short delay of 1 to 2 hours. Construct validity and reliability (internal consistency via Cronbach alpha and test‐retest reliability) was evaluated. Results: All the Intensity Items of the Spanish Cancer Symptom Scale correlated significantly with the matched items on the MD Anderson Symptom Inventory. In a subgroup of 77 participants, each Cancer Symptom Scale subscale total of scores correlated significantly with the total scores from the Functional Assessment of Cancer Therapy‐General. Discriminant validity was demonstrated between those receiving chemotherapy and those from post treatment. The Spanish Cancer Symptom Scale internal consistency reliability was 0.98. Conclusion: The Spanish Cancer Symptom Scale has excellent evidence of validity and reliability for assessing cancer‐therapy‐related symptoms. SUMMARY STATEMENT: What is already known about this topic? The Cancer Symptom Scale English version has proven to be useful for symptom management research and is currently being used as a method to evaluate the effectiveness of interventions or palliative treatments in ameliorating cancer‐therapy related symptoms. What this paper adds? The Spanish Cancer Symptom Scale is a valid and reliable instrument for determining the symptom profile of Hispanic Puerto Rican patients undergoing cancer treatments. The implications of this paper: The Spanish Cancer Symptom Scale is an easy to answer numeric rating instrument that has the potential to be included in clinical practice settings to achieve a more comprehensive and objective assessment of the symptom experience. [ABSTRACT FROM AUTHOR]

Aim: This study aimed at identifying the factors associated with health literacy, self‐care behaviours, and quality of life among older persons with lung cancer receiving chemotherapy. Methods: This was a descriptive study. A total of 80 older persons with lung cancer receiving chemotherapy participated in this study. Data were collected from July 21 to November 3, 2016 in Korea. The Short Form of the Korean Functional Health Literacy Test, the Self‐Care Behaviours Scale, and the Functional Assessment of Cancer Therapy Scale‐Lung were used to measure functional health literacy, self‐care behaviours, and quality of life, respectively. Stepwise multiple regression analyses were conducted to analyse the data. Results: In the each regression model for the general and disease‐related quality of life, performance status, self‐care behaviours, and prior lines of treatment were identified as a predictor. However, functional health literacy was found to be a predictor only of disease‐related quality of life. Among these predictors, self‐care behaviours had the greatest impact. Conclusion: Health care providers should be aware of the effects of health literacy and self‐care behaviours on health‐related quality of life and consider the factors associated with quality of life when they take care of older persons with lung cancer receiving chemotherapy. SUMMARY STATEMENT: What is already known about this topic? Older persons with lung cancer undergoing chemotherapy may more severely experience diverse adverse effects than younger adults.Lack of health literacy and self‐care behaviours would be expected to have a negative impact on quality of life in older persons with lung cancer receiving chemotherapy.It is difficult to find studies that address the effects of health literacy and self‐care behaviours on quality of life in older persons with lung cancer receiving chemotherapy What this paper adds? The results showed that general and disease‐related quality of life was higher when the performance status was better, the level of self‐care behaviours was higher, and the prior lines of treatment were lower.Older persons with high health literacy had better disease‐related quality of life than those with low health literacy. The implications of this paper: Nurses should consider the associations between health literacy, self‐care behaviours, and quality of life when they care for older persons with lung cancer receiving chemotherapy.Customized intervention studies that can enhance self‐care behaviours and health literacy in older persons with lung cancer undergoing chemotherapy are needed. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study analysing the effect of a home-based walking exercise program on symptoms and mood distress among breast cancer women receiving chemotherapy postoperatively. Background. Treatment-related symptoms, mood distress and decline in physical activity have been identified as major complaints among cancer patients. Studies on the efficacy of home-based walking exercise for symptoms and mood did not fully describe the exercise prescriptions that could be safe and beneficial for women with breast cancer, especially these receiving adjuvant chemotherapy. Method. This is a prospective, randomized clinical trial. In 2008-2009, participants were recruited from the oncology outpatient clinic of a medical center in Taiwan, and were assigned to either the exercise group (n = 19) or the control group (n = 21). Women in the exercise group participated in a moderate-intensity home-based walking program for 12 weeks during their chemotherapy treatments. Symptoms, mood status and physical activity level were measured at baseline, 6- and 12-week follow-up. Data were analysed by two-way repeated-measures analysis of variance. Results. Women in the exercise group reported significantly lower symptom severity scores and mood disturbance compared with those in the control group throughout the study period. Conclusion. Regular moderate-intensity exercise can play an important role in improving treatment-related symptoms and mood in women with breast cancer. A home-based walking exercise program can be easily incorporated into care for women with breast cancer undergoing chemotherapy. [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]

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 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]

Aim: To develop and test the psychometric properties of the Taiwanese safety climate instrument suitable for nurses handling chemotherapy drugs. Design: This is an instrument development study. Method: All four stages, including questionnaire design, expert consultation, cognitive testing and psychometric validation, were used in this study. The data were collected between August and December 2018. Nurses with experience in handling chemotherapy drugs (N = 484) at one medical centre and two regional hospitals in Taiwan completed this instrument. Data were randomly split into two groups: one group (N = 237) for exploratory factor analysis and the other (N = 247) for confirmatory factor analysis. Results: The instruments' items were based on qualitative research, and the content validity index levels exceeded the acceptable value. An exploratory factor analysis revealed 43 items remaining in six factors, which accounted for 74.4% of variance. The result of the confirmatory factor analysis verified the acceptability of a 43‐item model. The composite reliability values, Cronbach's alpha values, convergent validity and discriminant validity for each factor exceeded the acceptable value. Conclusion: Most climate safety instruments used in the health care sector focus mainly on patient safety outcomes. Furthermore, there is no safety climate instrument for handling chemotherapy drugs, and there is a cultural difference. Through the development and validation process, we have developed a new instrument suitable for nurses handling chemotherapy drugs, which has good psychometric properties. Impact This instrument is valuable as its development was based on the concept of a safety climate for health care perceptions and qualitative survey findings. Hospital managers can use this instrument regularly to evaluate nurses' perceptions of the safety climate to determine the strengths and weaknesses of their workplace, thereby assisting organizational managers in proposing concrete actions. [ABSTRACT FROM AUTHOR]

Aims: To examine patient-caregiver concordances about psychological distress among Chinese patients with breast cancer undergoing chemotherapy and identify factors related to concordance among patients and family caregivers. Design: Cross-sectional study. Methods: From October 2019 to June 2020, 137 patient-caregiver dyads were enrolled. Sociodemographic information, the distress thermometer (including the problem list), the Distress Disclosure Index and the Family Adaptability and Cohesion Evaluation Scale were used to collect data. Data were analysed using intraclass correlation coefficients (ICC), kappa statistics, two related samples test, chi-square tests and/or Fisher's exact tests and binary logistic regression. Results: Overall, fair agreement was identified between patients' and caregivers' reports (intraclass correlation coefficients [ICC] = .528). Patients reported significantly higher psychological distress scores than paired caregiver reports. Lower psychological distress concordance was found among patients with comorbidities (odds ratio [OR], 0.352; 95% confidence interval [CI], 0.155-0.798) and lower levels of self-disclosure (OR, 0.402; 95% CI, 0.186-0.868). Conclusion: There was relatively low concordance between patients' reports and caregivers' perceptions of psychological distress. Family caregivers tended to underestimate patients' psychological distress. A comorbid condition and lower levels of self-disclosure contributed to this bias. Impact: Having an awareness of the incongruence between patient and caregiver may help healthcare providers better interpret caregiver assessments. Healthcare providers should reinforce patient-caregiver dyadic psychosocial education to improve concordance. More psychological care and substantial emotional support should be provided for Chinese breast cancer patients undergoing chemotherapy by family caregivers and healthcare providers. [ABSTRACT FROM AUTHOR]

li x.-m., zhou k.-n., yan h., wang d.-l. & zhang y.-p. (2011) Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy: a randomized clinical trial. Journal of Advanced Nursing 68(5), 1145-1155. Abstract Aim. This paper is a report of a clinical trial of the effects of music therapy on anxiety of female breast cancer patients following radical mastectomy. Background. There is insufficient evidence on the effects of music therapy on state anxiety of breast cancer patients following radical mastectomy. Methods. A Hall's Core, Care, and Cure Model-based clinical trial was conducted in 120 female breast cancer patients from March to November 2009. A randomized controlled design was utilized. The patients were randomly allocated to the experimental group ( n = 60) received music therapy in addition to routine nursing care, and the control group ( n = 60) only received routine nursing care. A standardized questionnaire and the State Anxiety Inventory were applied. The primary endpoint was the state anxiety score measured at pretest (on the day before radical mastectomy) and at three post-tests (on the day before patients were discharged from hospital, the second and third time of admission to hospital for chemotherapy respectively). Results. The pretest score revealed that the majority of the patients had a moderate level (77·5%) and 15% had severe level of state anxiety. The repeated-measure ancova model analysis indicated that the mean state anxiety score was significantly lower in the experimental group than those in the control group at each of the three post-test measurements. The mean difference between the experimental and control group together with 95% confidence intervals were −4·57 (−6·33, −2·82), −8·91 (−10·75, −7·08) and −9·69 (−11·52, −7·85) at the 1st post-test, 2nd post-test and 3rd post-test respectively. Conclusion. Music therapy is found to have positive effects on decreasing state anxiety score. [ABSTRACT FROM AUTHOR]

Aims. The present study examines the efficacy of a scalp cooling system to prevent chemotherapy-induced alopecia in people with cancer. Background. Alopecia has been established as the most distressing aspect of chemotherapy to such an extent that some patients even refrain from cytotoxic treatment. Methods. Using a quasi-experimental approach in 2007, a total number of 63 patients aged 16-59 years (mean 35 ± 5·5 years) participated in the study and were treated with an intravenous regimen of chemotherapy drug. Thirty-one patients accepting the scalp-cooling system were compared for alopecia with 32 participants who refused it. Hair loss in the participants was evaluated by nurses using World Health Organization criteria at each cycle of chemotherapy. Results. Using chi-square test differences between the two groups were statistically significant at cycles 2-6 ( P < 0·05). Twenty-four participants (77·4%) of the study group were assessed as first and second grade of alopecia in the second cycle, whereas seven participants (22·6%) of this group exhibited third and fourth grade of alopecia. However, in the control group at the same cycle, 19 participants (61·3%) were assessed with third and fourth grade of alopecia. In the Sixth cycle 15 participants (50%) of the study group and 24 participants (75%) of the control group demonstrated third and fourth grade alopecia. Conclusion. A penguin cap can be an effective method to avoid alopecia in patients receiving chemotherapy drugs. However, it is important to bear in mind that because of individual characteristics, liver function and drug regimens it is not successful in all cases. [ABSTRACT FROM AUTHOR]

Salonen P, Tarkka M-T, Kellokumpu-Lehtinen P-L, Koivisto A-M, Åstedt-Kurki P, Kaunonen M. International Journal of Nursing Practice 2011; 17: 396-410 Individual face-to-face support and quality of life in patients with breast cancer Living with breast cancer significantly affects women's quality of life (QOL) creating a need for support that might persist throughout the breast cancer experience. The aim of this study was to assess the effect of individual face-to-face support on women's QOL and identify factors associated with their QOL. A two-group quasi-experimental design was used with a sample of 204 women who was assigned to the intervention ( n = 112) or the control group ( n = 92) in hospital after breast cancer surgery. Data of this study were collected 6 months after the surgery by structured questionnaires and analysed statistically using descriptive statistics and non-parametric tests. Factors predicting poor QOL were investigated using logistic regression models with enter-method. Women in the intervention group reported less arm symptoms and clinically better sexual functioning. Factors related to QOL were age, education, employment status, lymph node status, type of surgery, type of axillary surgery, received chemotherapy, hormonal therapy and ongoing therapy. Factors, predictive of poor QOL, included control group, age, education, type of surgery, type of axillary surgery, chemotherapy and ongoing therapy. Short-term face-to-face education and support intervention might have decreased arm symptoms and increased sexual functioning. Women with breast cancer should be offered systematic support and education, which is tailored to women's individual needs. [ABSTRACT FROM AUTHOR]

Lee YM, Hung YK, Mo FKF, Ho WM. International Journal of Nursing Practice 2010; 16: 508-516 Comparison between ambulatory infusion mode and inpatient infusion mode from the perspective of quality of life among colorectal cancer patients receiving chemotherapy Folfox and Folfiri are active chemotherapy treatments used in advanced colorectal cancer. The total admission for these treatments has been significantly increasing in the study hospital. An ambulatory infusion programme was launched to address the problems of long waiting list and bed shortage. The study objective was to compare the quality of life between patients receiving the chemotherapy treatments in the ambulatory infusion group and the inpatient infusion group. The results showed that some demographic variables of education level, family role and employment status were determinants of the treatment mode. Patients in the ambulatory infusion group of social and global domains performed better than the inpatient group. However, the inpatient group had better quality of life of nauseated symptom at different stages. Some nursing educations should be reinforced to address the symptom management for patients receiving ambulatory infusion at home. The ambulatory infusion programme offered considerable quality of life benefits to colorectal cancer patients receiving chemotherapy. [ABSTRACT FROM AUTHOR]

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]

Aim: Patients with gynaecological cancer often experience high levels of uncertainty in illness during chemotherapy and report unmet supportive care needs. Mobile applications (apps) are increasing being used as an easily accessible alternative to support these patients, but a lack of rigorous trials have been conducted to explore their effectiveness. Based on Mishel's uncertainty in illness theory, the Mobile Gynaecological Cancer Support (MGCS) program is an app‐based program that includes four modules: 1) weekly topics, 2) emotional care, 3) discussion centre and 4) health consultation. The aim of this study is to assess the effectiveness of MGCS for Chinese patients with gynaecological cancer receiving chemotherapy in respect of reducing uncertainty in illness and symptom distress and improving quality of life and social support. Design: A multi‐centre randomized controlled trial will be used. Methods: One hundred and sixty‐eight patients with gynaecological cancer commencing chemotherapy will be recruited from three university affiliated hospitals and assigned to the control or intervention group with block randomization. The control group will only receive routine care. The intervention group will access the MGCS program for 24 weeks and receive routine care. Health outcomes will be evaluated at baseline, 12 weeks, and 24 weeks. Repeated measures multivariate analysis of covariance (intention‐to‐treat) will be used to assess the effectiveness of MGCS. Discussion: This is the first trial to explore the effectiveness of an app‐based program for patients with gynaecological cancer using a robust and rigorous study design in China. If effective, this trial will provide evidence for an app‐based program to support these patients. Impact: The knowledge gained can be applied to develop other culturally appropriate app‐based programs for cancer groups worldwide, and provide evidence for health policymakers to allocate more resources and train staff for e‐health. Trial Registration: ChiCTR2000033678 (Chinese Clinical Trial Registry Registered 08 June, 2020). [ABSTRACT FROM AUTHOR]

Cancer represents a major disease burden worldwide. Despite continuous advances obtained in medical therapies recently, resistance to standard drugs and adverse effects still represent important causes of therapeutic failure. There is growing evidence that the gut microbiota can affect the response to chemo‐ and immunotherapeutic drugs by modulating efficacy and/or toxicity, and diet is the most important factor affecting the gut microbiota. In this study, we assessed the auxiliary antitumor effects of immunomodulatory fungal proteins from Hericium erinaceus (HEP) administered with the chemotherapy drug 5‐Fluorouracil (5‐Fu), and we attempted to identify new potential prebiotic bacteria for auxiliary antitumor treatment. There were 1,455 proteins identified from H. erinaceus. In a xenografted mouse model of cancer, HEP with 5‐Fu significantly suppressed tumor growth, inhibited inflammatory markers such as interferon (IFN)‐γ, interleukin (IL)‐1β, IL‐2, IL‐6, tumor necrosis factor (TNF)‐α, and lipopolysaccharide (LPS), and regulated the expression of Akt, CCDN1, CKD4, FOXM1, MMP7, MYC, PPAR‐α, and PPAR‐γ. 16S rRNA sequencing showed that HEP ameliorated the dysbacteriosis induced by 5‐Fu, as it inhibited certain aerobic and microaerobic bacteria including Parabacteroides, Flavobacteriaceae, Christensenellaceae, Anoxybacillus, Aggregatibacter, Comamonadaceae, Planococcaceae, Desulfovibrionaceae, Sporosarcina, Staphylococcus, Aerococcaceae, and Bilophila in the xenografted mice, and increase some probiotic bacteria such as Bifidobacterium, Gemellales, Blautia, Sutterella, Anaerostipes, Roseburia, Lachnobacterium, Lactobacillus, and Desulfovibrio. This demonstrates that HEP could promote the antitumor efficacy of 5‐Fu by improving the microbiota composition, the immune inflammatory response, and homeostasis. [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]

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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]

Although symptoms during cancer treatments are prevalent and are important clinical outcomes of childhood cancer, the symptom experiences of Puerto Rican children along with the symptom alleviation/care practices that parents provide during cancer treatments have received limited attention. To examine the occurrence/severity of symptoms on the Therapy-Related Symptom Checklist-Children (TRSC-C), reported by mothers of Puerto Rican children undergoing cancer treatments and identifying mothers' symptom alleviation/management strategies. Descriptive study conducted between January and May 2012. Mothers of 65 Puerto Rican children/adolescents undergoing cancer treatments responded to the Spanish versions of the TRSC-C, Symptom Alleviation: Self-Care Methods, and a Demographic and Health form. The children/adolescents' mean age was 9.2 (1-17) years; 62% were boys; 56 had chemotherapy; 9 had chemoradiotherapy. Children diagnoses were 35.4% leukemia, 24.6% solid tumors, 24.6% nervous system tumors, and 15.4% other. On the TRSC-C, the symptoms experienced by 70% or more of the children were: irritability (77%), nausea (75%), and hair loss (72%). On the Symptom Alleviation: Self-Care Methods, the most commonly reported symptom alleviation category was 'taking prescribed medicines.' Puerto Rican mothers reported the use of alleviation practices to treat their children experiencing symptoms during pediatric cancer treatments. Patients and caregivers need to be educated about treatment-induced side effects, and the life-threatening consequences of underreporting and undermanagement. Symptoms should always be addressed at the time of initiation of primary or adjuvant cancer therapy because pretreatment symptoms may persist or get worse across the trajectory of treatment. A continuous assessment and management of symptoms during the childhood cancer trajectory can optimize clinical care and improve quality of life of patients and families. [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 To explore family members' experiences when their loved one is undergoing chemotherapy treatment as an outpatient for newly diagnosed colorectal cancer and to develop an explanatory theory of how they process their main concern. Background Most individuals with cancer are now treated as outpatients and cared for by family members. International research highlights the many side effects of chemotherapy, which in the absence of specific information and/or experience can be difficult for family members to deal with. Unmet needs can have an impact on the health of both patients and family members. Design Classic grounded theory methodology was used for this study. Method Using classic grounded theory methodology, family members ( n = 35) of patients undergoing chemotherapy treatment for cancer were interviewed (June 2010-July 2011). Data were analysed using the concurrent processes of constant comparative analysis, data collection, theoretical sampling and memo writing. Findings The main concern that emerged for participants was fear of emotional collapse. This fear was dealt with through a process conceptualized as 'Emotional Resistance Building'. This is a basic social process with three phases: 'Figuring out', 'Getting on with it' and 'Uncertainty adjustment'. The phases are not linear, but interrelated as participants can be in any one or more of the phases at any one time. Conclusion This theory has the potential to be used by healthcare professionals working in oncology to support family members of patients undergoing chemotherapy. New ways of supporting family members through this most difficult and challenging period are articulated within this theory. [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 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 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 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 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 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 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]