Search

Objectives: The objective of this study is to longitudinally examine the coping strategies used by older cancer survivors (≥60 years of age) during COVID-19. Methods: An interpretive descriptive approach was used to collect and analyse qualitative data collected via 1:1 telephone interviews at three timepoints: June/July 2020, January 2021, and March 2021. Main Findings: Coping strategies used by older adults reflected the resources available to them, and their agency in self-triaging and deciding on resources to support their coping. These decisions were impacted by pandemic-imposed restrictions and necessitated readjustment over time. Three themes were developed to describe coping strategies (including any changes): adapting means and methods to connect with others; being intentional about outlook; and taking actions toward a brighter future. Conclusion: Older adults used a variety of coping strategies, though their reliance on resources beyond themselves (e.g., family/friends) indicates a need to add tailored resources to existing professional services.

Objective Gynecological cancer (GC) survivors have unmet needs when they complete primary cancer treatment. Despite this, no known research has summarized these needs and survivors’ suggestions to address them. We conducted a scoping review to fill these gaps and develop a model useful to guide clinical discussions and/or intervention. Methods English, full length, and accessible primary studies describing the needs of GC survivors were included. No restrictions on date nor country of publication were applied. Two reviewers extracted data, which was verified by a third reviewer. Results Seventy-one studies met the inclusion criteria for data extraction. Results were thematically grouped into seven dimensions: physical needs, sexuality-related concerns, altered self-image, psychological wellbeing, social support needs, supporting the return to work, and healthcare challenges and preferences. After consulting with a stakeholder group (a GC survivor, clinicians, and researchers), the dimensions were summarized into a proposed model to guide clinical assessments and/or intervention. Conclusion Results illuminate the diverse needs of GC survivors as they complete primary cancer treatment and their recommendations for care to meet these needs. Practice Implications The resulting model can be used to guide assessments, discussions and/or interventions to optimally prepare GC survivors for transition out of primary cancer treatment.

Continuing education for cancer care providers is essential for promoting high-quality patient care. Simulation-based education can be an effective strategy to educate healthcare professionals; however, there is a lack of synthesized evidence available to inform the delivery of simulation-based education for nurses and physicians across the cancer care continuum. This scoping review aimed to collate and synthesize the literature regarding how simulation has been reported to educate nurses and physicians about cancer care. Scoping review following the JBI methodology. Medline, CINAHL, EMBASE and PsycINFO were searched until July 2021. Unpublished literature was searched using ResearchGate, OpenGrey and open access theses and dissertation databases. Articles were eligible if they discussed how simulation has been utilized to educate nurses and physicians about any aspect of cancer care. Two independent reviewers screened the references, extracted and analysed the data. In total, 19 studies were included. When compared to previous reviews, our findings showed an increase in the use of virtual simulation; however, most interventions reported in-person simulation approaches and focused on improving skills (e.g. practical, communication), knowledge, confidence or decision-making for physicians and nurses caring for patients with a wide variety of cancers. Overall, simulation demonstrated positive results in educating nurses and physicians across the cancer care continuum through improved knowledge, skills and satisfaction. However, simulation interventions can be time-consuming and require significant resources for effective implementation. Although simulation-based education demonstrated promise to educate nurses and physicians across the cancer continuum, it requires a significant allocation of resources to develop and implement these educational strategies. Educators and researchers should be aware of these challenges when planning and implementing simulation-based educational strategies.

Purpose To evaluate the impact of a virtual simulation game (VSG) to improve primary care sexual health services for breast cancer survivors. Methods We developed a VSG to help primary care providers (PCPs) address sexual health disturbances among breast cancer survivors. We used a pretest–posttest design with a series of validated tools to assess the feasibility and perceived impact of the game, including an open-ended question about participants’ perceptions. Quantitative data was analyzed using descriptive and inferential statistics, and qualitative data through an inductive content analysis approach. Results Of the 60 participants, the majority were nurse practitioner students (n = 26; 43.3%); female (n = 48; 80%); and worked full-time (n = 35; 58.3%). Participants perceived the game as feasible and potentially effective. The intervention elicited an improvement in PCPs’ perception of knowledge between pretest and posttest surveys (z = -1.998, p = .046). Professional background and previous exposure to sexual health training were predictors of knowledge perception. Participants described the intervention as an engaging educational strategy where they felt safe to make mistakes and learn from that. Conclusions VSGs can be a potentially effective educational approach for PCPs. Our findings indicate that despite being an engaging interactive strategy, VSG interventions should be tailored for each professional group. Implications for cancer survivors This intervention has the potential to improve the knowledge and practice of PCPs related to breast cancer follow-up care to support comprehensive care for survivors, resulting in a better quality of life and patient outcomes.

At a population level, there is a poor understanding of the incidence and pre-disposing risk factors of postpartum haemorrhage (PPH) among women with inherited bleeding disorders (IBD).To determine the incidence of PPH, and identify maternal factors associated with risk of PPH among women with IBD.We conducted a retrospective cohort study using data housed within ICES (formerly known as the Institute for Clinical Evaluative Sciences). The cohort included women with an in-hospital, live or stillborn delivery, between January 2014 and December 2019. The primary outcome was PPH (identified by ICD-10 code O72). PPH incidence and risk factors were compared between women with and without IBD. Temporal trends were assessed using the Cochrane-Armitage test. Between group differences were assessed using standardised differences (std. difference).Total 601,773 women were included; 2002 (.33%) had an IBD diagnosis. PPH incidence was 1.5 times higher (7.3 vs. 4.9 cases/100 deliveries, std. difference .1) among women with IBD compared to women without. Women with IBD were slightly older (31.7 vs. 30.7 years), had higher rates of hypertension, previous PPH, and induction of labour. Women with IBD were more frequently diagnosed with anaemia (4.8% vs. 1.8%; std difference .17) and had lower haemoglobin levels at admission for delivery compared to women without IBD.This study contributes to the literature regarding obstetric bleeding among women with IBD, showing that anaemia at delivery may be an important risk factor for PPH. Given their predisposition to anaemia, clarifying this relationship will optimise management and outcomes.

Fear of cancer recurrence (FCR) is a common concern for both cancer patients and their caregivers. Attachment insecurity is an established contributor to poorer mental health, particularly as it relates to social support. This study sought to evaluate whether attachment and caregiver experiences in cancer care were predictors of FCR.A cross-sectional questionnaire study involving partner-caregivers of patients with ovarian cancer was conducted. Correlation analyses and multiple hierarchical regressions were used to determine the roles of attachment and caregiving experiences in cancer care on FCR, including the possible moderating role of attachment on the relationship between caregiving experiences and FCR.Participants (n = 82), mostly identified as white men, had post-secondary education and incomes of over $100,000 CAD, and cared for patients with advanced ovarian cancer. Forty percent of participants had clinically elevated FCR. Among the evaluated caregiving experiences in cancer care, caregiving workload (r = 0.33; p = 0.005), needing more help from healthcare providers (r = 0.28; p = 0.02), and lacking time for social relations because of caregiving (r = 0.47; p 0.001) correlated with FCR. Attachment anxiety correlated significantly with FCR (r = 0.43; p 0.001), but attachment avoidance did not. Attachment anxiety (ΔRPartner-caregiver attachment anxiety correlates with FCR; however, this does not influence FCR's relationship with poorer perceived support from cancer care institutions. Partner-caregivers may benefit from psychotherapies for FCR and more practical support from cancer care teams.

Objective:Fear of Cancer Recurrence (FCR), Health Anxiety (HA), worry, and uncertainty in illness are psychological concerns commonly faced by cancer patients. In survivorship research, these similar, yet different constructs are frequently used interchangeably and multiple instruments are used in to measure them. The lack of clear and consistent conceptualization and measurement can lead to diverse or contradictory interpretations. The purpose of this scoping review was to review, compare, and analyze the current conceptualization and measurements used for FCR, HA, worry, and uncertainty in the breast cancer survivorship literature to improve research and practice.Inclusion Criteria:We considered quantitative, qualitative, and mixed methods studies of breast cancer survivors that examined FCR, HA, worry, or uncertainty in illness as a main topic and included a definition or assessment of the constructs.Methods and Analysis:The six-staged framework was used to guide the scoping review process. Searches of PubMed, CINAHL, and PsycINFO databases were conducted. The principle-based qualitative analysis and simultaneous content analysis procedures were employed to synthesize and map the findings.Findings:After duplicate removal, the search revealed 3,299 articles, of which 82 studies met the inclusion criteria. Several critical attributes overlapped the four constructs, for example, all were triggered by internal somatic and external cues. However, several unique attributes were found (e.g., a sense of loss of security in the body is observed only among survivors experiencing FCR). Overall, findings showed that FCR and uncertainty in illness are more likely to be triggered by cancer-specific factors, while worry and HA have more trait-like in terms of characteristics, theoretical features, and correlates. We found that the measures used to assess each construct were on par with their intended constructs. Eighteen approaches were used to measure FCR, 15 for HA, 8 for worry, and 4 for uncertainty.Conclusion:While consensus on the conceptualization and measurement of the four constructs has not yet been reached, this scoping review identifies key similarities and differences to aid in their selection and measurement. Considering the observed overlap between the four studied constructs, further research delineating the unique attributes for each construct is warranted.

Purpose Although the year after cancer treatment is challenging for all cancer survivors, older adults (≥60 years) face additional challenges due to age-related decline and high rates of comorbidity. There is a paucity of research on how health service interruptions from the COVID-19 pandemic have impacted the experience of older cancer survivors. In this study we explore older cancer survivors' reflections on the pandemic and their suggestions for future care delivery when traditionally offered resources are not available. Methods We conducted 1:1 telephone interviews with adults 60 years and older previously diagnosed with breast and colorectal cancer and recently (≤12 months) discharged from their cancer care team. We analyzed the data using descriptive thematic analysis. Results The mean sample (n = 30) age was 72.1 years (SD 5.8, Range 63–83) of whom 57% identified as female. Participants described personal and societal implications of the pandemic. that affected their ability to navigate social support, and public and clinical landscapes. These reflections informed their suggestions for future health care delivery, such as how they could have been better prepared to self-manage their post-cancer treatment journey. Participants recommendations were grouped into four sub-themes: 1) enhanced baseline information; 2) facilitate caregiver support and engagement; 3) greater technology integration; and 4) sustained use and public appreciation of personal protective equipment. Conclusion Older cancer survivors appreciate the needed shift to virtual appointments and services during the COVID-19 pandemic. Specific strategies to bolster older adults existing strengths and improve their readiness to engage in these measures are critical.

Background: Fear of cancer recurrence (FCR) is a common concern for posttreatment cancer survivors. In this secondary analysis we explore cancer survivors’ unsolicited narratives on a survey about FCR. Methods: We used an interpretive descriptive approach and statistical analyses to explore these narratives and determine the characteristics of survivors who did and did not provide narratives. Findings: We developed three themes based on our analysis: describe posttreatment experiences; elaborate or contextualize FCR responses and use their voice toward change in cancer care. Those who provided narratives had lower overall FCR. Most narratives were used to provide context to responses or to indicate that some survey items were irrelevant. Conclusion: Our results highlight potential reasons for unsolicited narratives on a survey and illuminate the potential value of expressive interventions for cancer survivors. Results indicate the usefulness of mixed methods approaches where survey respondents are offered space to provide open text.

Purpose Older cancer survivors are among the most vulnerable to the negative effects of COVID-19 and may need specific survivorship supports that are unavailable/restricted during the pandemic. The objective of this study was to explore how older adults (≥ 60 years) who were recently (≤ 12 months) discharged from the care of their cancer team were coping during the pandemic. Methods We used a convergent mixed method design (QUAL+quan). Quantitative data were collected using the Brief-COPE questionnaire. Qualitative data were collected using telephone interviews to explore experiences and strategies for coping with cancer-related concerns. Results The mean sample age (n = 30) was 72.1 years (SD 5.8, range 63–83) of whom 57% identified as female. Participants’ Brief-COPE responses indicated that they commonly used acceptance (n = 29, 96.7%), self-distraction (n = 28, 93.3%), and taking action (n = 28, 93.3%) coping strategies. Through our descriptive thematic analysis, we identified three themes: (1) drawing on lived experiences, (2) redeploying coping strategies, and (3) complications of cancer survivorship in a pandemic. Participants’ coping strategies were rooted in experiences with cancer, other illnesses, life, and work. Using these strategies during the pandemic was not new—they were redeployed and repurposed—although using them during the pandemic was sometimes complicated. These data were converged to maximize interpretation of the findings. Conclusions Study findings may inform the development or enhancement of cancer and non-cancer resources to support coping, particularly using remote delivery methods within and beyond the pandemic. Clinicians can engage a strengths-based approach to support older cancer survivors as they draw from their experiences, which contain a repository of potential coping skills.

Contains fulltext : 288352.pdf (Publisher’s version ) (Open Access) OBJECTIVE: Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors. Yet the prevalence of FCR and predisposing factors remain inconclusive. To support targeted care, we provide a comprehensive overview of the prevalence and severity of FCR among cancer survivors and patients, as measured using the short form of the validated Fear of Cancer Recurrence Inventory (FCRI-SF). We also report on associations between FCR and clinical and demographic characteristics. METHODS: This is a systematic review and individual participant data (IPD) meta-analysis on the prevalence of FCR. In the review, we included all studies that used the FCRI-SF with adult (≥18 years) cancer survivors and patients. Date of search: 7 February 2020. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS: IPD were requested from 87 unique studies and provided for 46 studies comprising 11,226 participants from 13 countries. 9311 respondents were included for the main analyses. On the FCRI-SF (range 0-36), 58.8% of respondents scored ≥13, 45.1% scored ≥16 and 19.2% scored ≥22. FCR decreased with age and women reported more FCR than men. FCR was found across cancer types and continents and for all time periods since cancer diagnosis. CONCLUSIONS: FCR affects a considerable number of cancer survivors and patients. It is therefore important that healthcare providers discuss this issue with their patients and provide treatment when needed. Further research is needed to investigate how best to prevent and treat FCR and to identify other factors associated with FCR. The protocol was prospectively registered (PROSPERO CRD42020142185).

Simulation-based education can be an effective strategy to educate nurses and physicians across the continuum of cancer care. However, there is still a lack of studies collating and synthesizing the literature around the types, functionalities and delivery systems of simulation-based education to educate different professional groups about cancer care. To collate and synthesize the literature on how simulation has been used to educate nurses and physicians about cancer care. Scoping review methodology according to the Joanna Briggs Institute framework. Published literature is going to be searched through Medline (OVID), CINAHL, EMBASE and PsycINFO. Unpublished literature will be searched through ResearchGate, OpenGrey and open access theses and dissertations. Articles will be considered if the population is nurses (including nurse practitioners) and/or physicians, if they use any type of simulation as an educational strategy as the concept of interest, and if the context is cancer care. This review will consider experimental, quasi-experimental, observational, quantitative and qualitative studies designs, text and opinion papers and unpublished literature. Results from this scoping review will generate a solid underpinning for nursing and medical community to empower evidenced innovation through the further development of simulation-based educational interventions.

Ovarian cancer is typically characterized by late-stage diagnoses, frequent recurrences, and treatment changes. Ovarian cancer caregivers (OCC) are thus heavily involved with cancer care and often are highly distressed. We explored the relationship with OCC distress and caregiving experiences within the healthcare system and with the healthcare providers (HCP), using a cross-sectional questionnaire study. OCC provided sociodemographic and patient medical information, and completed measures of consequences of caregiving and needs from HCP, and of depression and anxiety. We recruited participants through advertisements and two cancer centers. N = 82 OCC provided complete questionnaires. Participants on average were 57.2 years old, English-speaking white men, and were partnered for 28.5 years. On average, patients were diagnosed at stage III, and treated with surgery and chemotherapy. Eight percent met clinical cut-offs for depression (23.2% in sub-clinical range), and 23.2% met clinical cut-offs for anxiety (20.7% in sub-clinical range). Depression and anxiety were significantly correlated with lacking time for social relationships, higher workload, lacking information, and needing more help from HCP. Only depression was correlated with problematic quality of information from HCP. OCC distress is related to their caregiving roles within the cancer care system, and how HCP support them in their responsibilities, which may contribute to a lack of time to access their supports. Perceived involvement by the HCP has an important influence on OCC distress. Higher demands of caregiving and insufficient support from the cancer care system may relate to increased distress. Our study supports the need for better integration of caregiver supports from within the healthcare system.

Despite the availability of guidelines about the different types of review literature, the identification of the best approach is not always clear for nursing researchers. Therefore, in this article, we provide a comprehensive guide to be used by health care and nursing scholars while choosing among 4 popular types of reviews (narrative, integrative, scoping, and systematic review), including a descriptive discussion, critical analysis, and decision map tree. Although some review methodologies are more rigorous, it would be inaccurate to say that one is preferable over the others. Instead, each methodology is adequate for a certain type of investigation, nursing methodology research, and research paradigm.

Objective: To provide recommendations for a surveillance regimen that leads to the largest overall survival benefit for patients after curative treatment for Stage I–IV colon and rectal cancer. Methods: Consistent with the Program in Evidence-Based Care’s standard approach, guideline databases, i.e., MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO, were systematically searched. Then, we drafted recommendations and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. Results: Four systematic reviews and two randomized controlled trials were identified that provided evidence for recommendations. Conclusions: For patients with stage I–III colon cancer, a medical history and physical examination should be performed every six months for three years; computed tomography (CT) of the chest-abdomen-pelvis (CT CAP) should be performed at one and three years, or one CT CAP could be performed at 18 months; the use of carcinoembryonic antigen (CEA) is optional if CT imaging is being performed; and surveillance colonoscopy should be performed one year after the initial surgery. The frequency of subsequent surveillance colonoscopy should be dictated by previous findings, but generally, colonoscopies should be performed every five years if the findings are normal. There was insufficient evidence to support these recommendations for patients with rectal cancer, Stage IV colon cancer, and patients over the age of 75 years. Patients should be informed of current recommendations and the treating physician should discuss the specific risks and benefits of each recommendation with their patients.

Objective: To provide recommendations for preferred models of follow-up care for stage I-IV colorectal (CRC) cancer survivors in Ontario; to identify signs and symptoms of potential recurrence and when to investigate; and to evaluate patient information and support needs during the post-treatment survivorship period. Methods: Consistent with the Program in Evidence-Based Medicine’s standardized approach, MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO databases were systematically searched. The authors drafted recommendations and revised them based on the comments from internal and external reviewers. Results: Four guidelines, three systematic reviews, three randomized controlled trials, and three cohort studies provided evidence to develop recommendations. Conclusions: Colorectal cancer follow-up care is complex and requires multidisciplinary, coordinated care delivered by the cancer specialist, primary care provider, and allied health professionals. While there is limited evidence to support a shared care model for follow-up, this approach is deemed to be best suited to meet patient needs; however, the roles and responsibilities of care providers need to be clearly defined, and patients need to know when and how to contact them. Although there is insufficient evidence to recommend any individual or combination of signs or symptoms as strong predictor(s) of recurrence, patients should be educated about these and know which care provider to contact if they develop any new or concerning symptoms. Psychosocial support and empathetic, effective, and coordinated communication are most valued by patients for their post-treatment follow-up care. Continuing professional education should emphasize the importance of communication skills and coordination of communication between the patient, family, and healthcare providers.

Background Fear of cancer recurrence (FCR) is a common concern for survivors. Oncology nurses have a unique opportunity to identify survivors at increased risk of heightened FCR. Understanding predictors of FCR would be useful for this purpose; however, results about FCR predictors are inconsistent. Objective To examine empirically inconsistent predictors of FCR as guided by Leventhal's Commonsense Model. Methods A cross-sectional survey design was used to assess FCR, sociodemographic and clinical characteristics, and characteristics of the self (self-esteem and generalized expectancies) among cancer survivors. Structural equation modeling was used to examine predictors of FCR. Results Among 1001 participants, the mean time since diagnosis was 9.07 years, and most were diagnosed with breast cancer (65.93%). The strongest predictor of higher FCR was belief that knowing someone with a recurrence affects one's own level of FCR, although knowing someone with a recurrence actually predicted lower FCR. Other significant predictors of higher FCR were having 1 or more symptoms attributed to cancer, lower self-esteem, younger age, female gender, lower pessimism, longer time since diagnosis, and active follow-up at the survivorship clinic. Conclusion Cancer survivors' perceptions are among an important series of variables that may predict higher levels of FCR. Oncology nurses are uniquely situated to identify the subset of cancer survivors with levels of FCR requiring professional intervention. Implications for practice Oncology nurses can use the predictors indicated in this study to identify survivors with greatest need for coping with FCR to facilitate expedient intervention and/or referral to psychosocial providers.

PURPOSE Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis. METHODS We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514). RESULTS A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges’s g) were found both at postintervention ( g = 0.33; 95% CI, 0.20 to 0.46; P < .001) and at follow-up ( g = 0.28; 95% CI, 0.17 to 0.40; P < .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; g = 0.42) were larger than those of traditional CBTs ( g = 0.24; β = .22; 95% CI, .04 to .41; P = .018). At follow-up, larger effects were associated with shorter time to follow-up (β = −.01; 95% CI, −.01 to −.00; P = .027) and group-based formats (β = .18; 95% CI, .01 to .36; P = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR. CONCLUSION Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition—for example, worry, rumination, and attentional bias—rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients’ FCR presentation.

Caregivers of patients with ovarian cancer experience distress related to caregiving difficulties within cancer care. Attachment insecurity is a well-known protector of distress, particularly as it relates to support from others. Using multivariate analyses, this study sought to determine the contribution of attachment insecurity and experiences with cancer care on symptoms of depression and anxiety, and investigated whether attachment insecurity moderated the relationship between caregiving experiences and distress. Multiple hierarchical regression analyses were conducted as part of a larger cross-sectional questionnaire study of distress among partners of patients with ovarian cancer. Participants (n = 82) were predominantly male, white, had household incomes over $100,000 and postsecondary education. Caregiving experiences explained 56% of the variance in depression, and 28% of the variance in anxiety. Specifically, lack of time for social relations as a result of caregiving significantly predicted depression and anxiety. Attachment anxiety correlated with both depression and anxiety, but attachment avoidance did not. Neither attachment anxiety nor attachment avoidance significantly contributed to distress variance, and neither moderated any of the relationships between caregiving experiences and distress outcomes. This study highlights the importance for cancer care to recognize the effect of caregiving responsibilities upon caregivers’ mental health, regardless of vulnerability to distress.

Background Building research capacity in nursing academic units continues to be a challenge. There are a number of external contextual factors and internal factors that influence individual faculty as well as the collective to engage successfully in research. Purpose The overall aim of this opinion article is to provide an overview of the current external and internal, processes and structures, relevant to capacity of nursing faculty to engage in research. Methods To inform the external context, we reviewed national research funding trends for nursing. To inform the internal context, we provided an exemplar of the internal processes and structures designed to support research capacity building within our academic unit. Results Canadian Institutes of Health Research funding trends for research grants led by nurse principal applicants increased between 2010 and 2013, followed by a steady decline. In 2017 to 2018, there were only 24 research grants led by nurse principal applicants. These external challenges coupled with the traditional internal barriers, such as the imbalance between teaching and research time, threaten research capacity for nursing academics. Conclusion Organizational strategies to promote research capacity within academic nursing units are a necessary requirement to move forward.

Fear of cancer recurrence (FCR) is a pervasive concern for people living with cancer. The rapidly expanding FCR literature has been weakened somewhat by use of miscellaneous FCR measures of varying quality. The Fear of Cancer Recurrence Inventory (FCRI) has been widely used in observational and intervention studies and the FCRI severity subscale, also known as the FCRI-Short Form (FCRI-SF), is often used to identify potential cases of clinically significant FCR. Given the FCRI’s increasing use in research and clinical practice, we aimed to provide an overview, critique, and suggested improvements of the FCRI. Studies citing the original FCRI validation paper were identified and synthesised using narrative and meta-analytic methods. The 42-item FCRI has demonstrated a reasonably robust 7-factor structure across evaluations in multiple languages, although certain subscales (eg, Coping) demonstrate sub-optimal reliability. Confirmation of the cross-cultural equivalence of several FCRI translations is needed. Meta-analysis of FCRI-SF scores revealed a combined weighted mean score of 15.7/36, a little above the lowest proposed cut-off score (≥13) for clinical FCR. Depending on the FCRI-SF cut-off used, between 30.0% and 53.9% of the cancer population (ie, patients and survivors) appear to experience sub-clinical or clinical FCR. Higher FCRI scores were associated with younger age and female gender, pain/physical symptoms and psychological morbidity, consistent with the FCR literature generally. Issues regarding the application and interpretation of the FCRI remain. Whether the FCRI is well suited to assessing fear of progression as well as recurrence is unclear, the meaningfulness of the FCRI total score is debatable, and the use of the FCRI-SF to screen for clinical FCR is problematic, as items do not reflect established characteristics of clinical FCR. Refinement of the FCRI is needed for it to remain a key FCR assessment tool in future research and clinical practice.

Networking with individuals on a similar journey through graduate studies has been identified as an important influence in the experience of doctoral and postdoctoral students. Through the Board of Directors of the Canadian Association of Nurses in Oncology/Association canadienne des infirmières en oncologie (CANO/ACIO), student members were encouraged to establish a Doctoral Student Network (DSN) that would enable a connection through education and common interest in oncology and cancer care. Since its inception, the DSN has been dynamic in how it has addressed the evolving needs of members and in providing development opportunities to group members. To uncover and describe key aspects of its evolution, a document analysis was undertaken to reveal themes pertaining to capacity development and leadership voice as paths to leadership for DSN members. The results of this study suggest that the DSN provides a supportive environment for postgraduate nurses across Canada to connect with others in their peer group to foster engagement in educational, professional, and scholarly activities, as well as highlighting opportunities for other professional organizations interested in establishing a support network for graduate student members.