Search

The Oncology Nursing Society's (ONS's) position on quality cancer care states that 'quality cancer care incorporates the individual with cancer (and the family) as fully informed partners and decision makers' (ONS, 1997). Patients diagnosed with breast cancer are inundated with information, and oncology nurses help these patients receive quality cancer care by providing and explaining information related to their diagnosis and treatment. This information allows patients to participate in meaningful collaborative decision making. Prognostic tumor markers have provided information that can determine the natural history of breast cancer, identify women with high-risk or aggressive tumors, and help to establish a disease prognosis. [ABSTRACT FROM AUTHOR]

PURPOSE/OBJECTIVES: To identify and compare symptom clusters in individuals with chronic health problems with cancer as a comorbidity versus individuals with chronic health problems who do not have cancer as a comorbidity and to explore the effect of symptoms on their quality of life. DESIGN: Secondary analysis of data from two studies. Study 1 was an investigation of the efficacy of an intervention to improve medication adherence in patients with rheumatoid arthritis (RA). Study 2 was an investigation of the efficacy of an intervention for urinary incontinence (UI) in older adults. SETTING: School of Nursing at the University of Pittsburgh. SAMPLE: The sample for study 1 was comprised of 639 adults with RA. The sample for study 2 was comprised of 407 adults with UI. A total of 154 (15%) subjects had a history of cancer, 56 (9%) of the subjects with RA and 98 (25%) of the subjects with UI. METHODS: Analysis of existing comorbidity and symptom data collected from both studies. MAIN RESEARCH VARIABLES: Symptom clusters, chronic disease, and cancer as a comorbidity. FINDINGS: Individuals with chronic health problems who have cancer may not have unique symptom clusters compared to individuals with chronic health problems who do not have cancer. CONCLUSIONS: The symptom clusters experienced by the study participants may be more related to their primary chronic health problems and comorbidities. IMPLICATIONS FOR NURSING: Additional studies are needed to examine symptom clusters in cancer survivors. As individuals are living longer with the disease, a comprehensive understanding of the symptom clusters that may be unique to cancer survivors with comorbidities is critical. [Abstract for this article also available on page 41 of printed version. The full text of this article can be accessed at www.ons.org/publications/journals/ONF [ABSTRACT FROM AUTHOR]

Objectives: To phenotype the psychoneurologic (PN) symptom cluster in individuals with metastatic breast cancer and associate those phenotypes with individual characteristics and cancer genomic variables from circulating tumor DNA., Sample & Setting: This study included 201 individuals with metastatic breast cancer recruited in western Pennsylvania., Methods & Variables: A descriptive, cross-sectional design was used. Symptom data were collected via the MD Anderson Symptom Inventory, and cancer genomic data were collected via ultra-low-pass whole-genome sequencing of circulating tumor DNA from participant blood., Results: Three distinct PN symptom phenotypes were described in a population with metastatic breast cancer: mild symptoms, moderate symptoms, and severe mood-related symptoms. Breast cancer TP53 deletion was significantly associated with membership in a moderate to severe symptoms phenotype (p = 0.013)., Implications for Nursing: Specific cancer genomic changes associated with increased genomic instability may be predictive of PN symptoms. This finding may enable proactive treatment or reveal new therapeutic targets for symptom management.

Objectives: To explore genes in the nuclear factor E2-related factor 2 antioxidative response elements (Nrf2-ARE) signaling pathway using a multiomics approach for associations with variability of cancer-related fatigue (CRF) in postmenopausal women with early-stage hormone receptor-positive breast cancer., Sample & Setting: Postmenopausal women (N = 116) with early-stage hormone receptor-positive breast cancer were recruited from western Pennsylvania., Methods & Variables: Candidate genes from the Nrf2-ARE pathway were investigated for associations with CRF occurrence and severity. Associations were evaluated using logistic regression for occurrence and linear regression for severity., Results: The rs2706110 TT genotype in NFE2L2 was associated with a 3.5-fold increase in odds of CRF occurrence. The cytosine-phosphate-guanine (CpG) site cg22820568 in PRDX1 was associated with CRF occurrence and severity., Implications for Nursing: Biomarkers based on Nrf2-ARE genes may help to identify women at increased risk for more severe CRF and to develop targeted interventions.

Problem Identification: To map key concepts underpinning work-related studies about nurses with cancer and identify knowledge gaps., Literature Review: A search was conducted in the PubMed®, CINAHL®, and PsycINFO® databases for articles about nurses with cancer and work-related topics published through March 2023., Data Evaluation: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist was used to report results, and the JBI critical appraisal tools were used to assess the quality of studies. Eleven articles were included., Synthesis: The following four critical concepts were identified: role adjustments at work, cancer impacts on work, organizational support, and translating insights gained from cancer experience into work. Research gaps identified by the scoping review were a lack of theoretical or conceptual frameworks, lack of syntheses of main ideas, and lack of clear data about participants' socioeconomic status across studies., Implications for Research: Minimal research exists to map predictors, outcomes, or intervention targets to guide organizational strategies to support nurses' retention in the nursing workforce. A guiding framework, recruitment of diverse nurses, and focus on the four critical concepts identified in this scoping review are suggested for future research.

Objectives: To describe area deprivation, anxiety, depression, relative dose intensity of first-line metastatic breast cancer (MBC) treatment, and survival in Black and White women who had died from triple-negative MBC, including interaction analysis., Sample & Setting: This cohort study drew from a database of women who had died from MBC (N = 53)., Methods & Variables: Descriptive statistics, independent t tests, analysis of variance, and Mann-Whitney U tests were used, and effect sizes were calculated., Results: Compared with White women, Black women reported higher anxiety and depression at MBC baseline. Black women living in areas of higher deprivation experienced shorter overall survival than White women living in similar areas (9.9 months versus 24.6 months). These results were not statistically significant, likely because of a small sample size, but were clinically meaningful., Implications for Nursing: Black and low-income women with breast cancer experience inferior survival as compared with White and higher-income women. Newer explanatory models for racial disparity in cancer outcomes include the assessment of neighborhood deprivation. White women may be less affected by their neighborhood, even when living in areas of greater deprivation influencing cancer outcomes. This merits further exploration.

Problem Statement: To describe research mentorship strategies needed to strengthen oncology nursing science and ensure that a cadre of nurse scientists are available to carry out the research mission of the Oncology Nursing Society (ONS)., Design: Multimethod consensus-building approach by content experts of the ONS Research Mentorship Task Force and approval by the ONS Board of Directors was employed., Data Sources: Expert opinion, surveys, notes from an all-day research mentorship retreat, and literature review were used., Analysis: Content analysis was used to synthesize notes from the research mentorship retreat., Findings: Various strategies were identified to strengthen the pipeline of oncology nurse scientists and promote development across the career trajectory., Implications for Practice: Mentorship is essential to advance the growth and impact of oncology nursing science and requires support throughout the career trajectory.

Objectives: This study identified women with unique trajectories of executive function, concentration, and visual working memory before and during adjuvant therapy for breast cancer, and examined phenotypic and genotypic predictors associated with subgroups., Sample & Setting: 399 postmenopausal women, of whom 288 were women with early-stage breast cancer and 111 were women without breast cancer, matched on age and years of education to the women with breast cancer, and all at an urban cancer center., Methods & Variables: A repeated-measures design was used; assessments occurred before adjuvant therapy and every six months post-therapy initiation. Group-based trajectory modeling determined subgroups. Multinomial logistic regression identified phenotypic and genotypic characteristics., Results: Three executive function and concentration trajectory subgroups were identified., Implications for Nursing: Advancing age, greater pretherapy fatigue, and poorer pretherapy cognitive function are associated with the low subgroups. DNA repair and oxidative stress mechanisms may be involved in the cognitive changes that women experience.

Purpose/objectives: To examine beliefs regarding the necessity of chemotherapy and knowledge of breast cancer and its treatment in African American women with newly diagnosed breast cancer, and to explore factors associated with women's beliefs and knowledge.
., Design: Descriptive, cross-sectional study.
., Setting: Six urban cancer centers in Western Pennsylvania and Eastern Ohio.
., Sample: 101 African American women with newly diagnosed breast cancer. 
., Methods: Secondary analysis using baseline data collected from participants in a randomized, controlled trial at their first medical oncology visit before the first cycle of chemotherapy.
., Main Research Variables: Belief in chemotherapy, knowledge of cancer and recommended treatment, self-efficacy, healthcare system distrust, interpersonal processes of care, symptom distress, and quality of life.
., Findings: African American women endorsed the necessity of chemotherapy. Most women did not know their tumor size, hormone receptors, specific therapy, or why chemotherapy was recommended to them. Women who perceived better interpersonal communication with physicians, less self-efficacy, or were less involved in their own treatment decision making held stronger beliefs about the necessity of chemotherapy. Women without financial difficulty or having stronger social functioning had more knowledge of their cancer and recommended chemotherapy. 
., Conclusions: African American women with newly diagnosed breast cancer generally agreed with the necessity of chemotherapy. Knowledge of breast cancer, treatment, and risk reduction through adjuvant therapy was limited.
., Implications for Nursing: Oncology nurses could help advocate for tailored educational programs to support informed decision making regarding chemotherapy acceptance for African American women.

Purpose/objectives: To comprehensively assess the patient and illness or treatment factors that may predict nonadherence to adjuvant endocrine therapy and to explore whether an interaction occurs between these factors in women with breast cancer., Design: Repeated-measures design., Setting: The Outpatient Services of the Women's Cancer Program at the University of Pittsburgh Cancer Institute and participants' homes., Sample: 91 women with early-stage breast cancer who received endocrine therapy., Methods: Adherence was assessed continuously for the first 18 months of endocrine therapy. Patient and illness or treatment factors were assessed at four time points (Time 1 to Time 4). Time 1 (baseline) was within two weeks prior to the initiation of endocrine therapy. Times 2-4 occurred at six-month intervals, as many as 18 months after Time 1., Main Research Variables: Adherence, patient factors, and illness or treatment factors., Findings: Adherence to endocrine therapy declined significantly during the first 18 months of treatment in women with breast cancer. The presence of negative mood and symptoms before starting treatment predicted nonadherence to endocrine therapy over time. Perceptions of financial hardship, symptoms, disease stage, and more complex medication regimens intensified the effect of negative mood on adherence over time., Conclusions: Women with breast cancer may be at risk for nonadherence to prescribed endocrine therapy if they experience depression or anxiety and symptoms prior to initiating therapy., Implications for Nursing: Oncology nurses should be alert to women with breast cancer who are depressed or anxious or who are experiencing symptoms. Management of negative mood and symptoms may result in better adherence.

Purpose/objectives: To discuss the process, considerations, benefits, and challenges of the nurse as principal investigator in a cancer care drug trial., Data Sources: Published articles, anecdotal experience, and completed research studies., Data Synthesis: The specific processes that must be considered are funding sources, protocol development, trial implementation, dissemination of results, and ethical implications involved in industry sponsorship. Specific protocols are designed for evaluating adverse events. Working with pharmaceutical companies to receive financial support offers advantages but poses additional issues for consideration., Conclusions: Nurses can serve successfully as principal investigators in medication trials for cancer care. Regulatory bodies and specific procedures, as well as general considerations, mandate and guide investigator conduct when embarking on a pharmaceutical trial., Implications for Nursing: Oncology nurse researchers can look to pharmaceutical companies for potential funding in the evaluation of medications used in cancer care.

Purpose/objectives: To describe the foundational work and implementation of a nurse practitioner (NP) curriculum geared toward oncology nurses. The study is selective (not comprehensive) and reflective of one school's experience., Data Source: Journal articles, curriculum guidelines, anecdotal experience, and interviews., Data Synthesis: The NP is used more frequently in oncology, both as a clinician and for other aspects of advanced practice nursing. NPs must be prepared to fulfill graduate criteria as outlined by definitive sources for curriculum development., Conclusions: Schools must work with employers, graduates, and patients in conducting outcome evaluations to measure safety issues and role effectiveness of oncology NPs (ONPs), as well as fulfillment of all aspects of the advanced nursing practice role., Implications for Nursing Practice: If healthcare employers continue to rely heavily on the use of ONPs, schools of nursing must be prepared to graduate safe clinicians, experts in oncology, and advanced practice nurses, all combined into one graduate. This difficult task requires evaluation of current practices.