Search

Abstract: Ovarian cancer, a leading cause of cancer deaths, poses challenges due to insidious development and vague signs and symptoms. Risk factors include age, reproductive history, genetic mutations, and environmental factors. Treatment involves surgery, chemotherapy, and targeted therapy, with nursing interventions focusing on symptom management and supportive care., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives:  The current study sought to evaluate whether nursing narratives can be used to predict postoperative length of hospital stay (LOS) following curative surgery for ovarian cancer., Methods:  A total of 33 patients, aged over 65 years, underwent curative surgery for newly diagnosed ovarian cancer between 2008 and 2012. Based on the median postoperative LOS, patients were divided into two groups: long-stay (>12 days; n  = 13) and short-stay (≤12 days; n  = 20). Patterns in nursing narratives were examined and compared through a quantitative analysis. Specifically, the total number (TN) of narratives pertaining to care and the standardized number (SN), which was calculated by dividing the TN by the LOS, were compared. Experts evaluated the relevance of the phrases extracted. LOS was then predicted using machine learning techniques., Results:  The median postoperative LOS was 18 days (interquartile range [IQR]: 16-24 days) in the long-stay group and 9.5 days (IQR: 8-11.25 days) in the short-stay group. In the long-stay group, surgery duration was longer. Overall, patients in the long-stay group showed a higher volume of nursing narratives compared with patients in the short-stay group (SN: 68 vs. 46, p  = 0.021). Thirty-two of the most frequently used nursing narratives were selected from 998 uniquely defined nursing narratives. Multiple t -tests were used to compare the TN and real standardized number (RSN; minimum p  < 0.1). Mean and standard deviation of classification results of long-short term memory recurrent neural networks for long and short stays were 0.7774 (0.105), 0.745 (0.098), 0.739 (0.107), and 0.765 (0.115) for F1-measure, precision, recall, and area under the receiver operating characteristic, respectively. Agreement between the differential narratives as assessed by statistical methods and the expert response was low (52.6% agreement; McNemar's test p  = 0.012)., Conclusions:  Statistical tests showed that nursing narratives that utilized the words "urination," "food supply," "bowel mobility," or "pain" were related to hospital stay in elderly females with ovarian cancer. Additionally, machine learning effectively predicted LOS., Summary:  The current study sought to determine whether elements of nursing narratives could be used to predict postoperative LOS among elderly ovarian cancer patients. Results indicated that nursing narratives that used the words "urination," "food supply," "bowel mobility," and "pain" significantly predicted postoperative LOS in the study population. Additionally, it was found that machine learning could effectively predict LOS based on quantitative characteristics of nursing narratives., Competing Interests: None declared., (Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: To describe the cancer care process as it is perceived by women with ovarian cancer., Participants & Setting: 18 English-speaking adult women with ovarian cancer were recruited from an advocacy organization for patients with ovarian cancer and the gynecologic oncology clinic at a community-based teaching hospital in Burlington, Massachusetts., Methodologic Approach: A grounded theory approach was used. Data were collected via individual interviews with participants., Findings: An overarching theme of preserving oneself in the face of uncertainty was described by the participants. Trajectories from prediagnosis to treatment were influenced by the quality of patient-provider communication, support from significant others, and self-concept aspects., Implications for Nursing: Comprehensive care that validates patient concerns and supports information exchange is essential. Nurses can promote the physical and psychological well-being of women with ovarian cancer by identifying institutional and community-based resources for support and specialty care.

Lesbian, gay bisexual, transgender, and queer or questioning (LGBTQ) older adults have unique health care needs, especially in the palliative care and hospice setting. In this article, we present a male patient with metastatic ovarian cancer, admitted with worsening dyspnea, now at the end of life. Only his wife was aware of his identified gender, and nondisclosure was very important to him. As he continued to decline, the team navigated LGBTQ-sensitive care within the health care setting, insurance inequalities, and support and communication to his family. This case study summarizes clinical recommendations for the LGBTQ individual in the hospice and palliative care setting, suggesting how our patient's care may have been improved. With the changes in social acceptance and attitudes, the LGBTQ community has become more visible and their numbers appear to be growing. It is important, therefore, that hospice and palliative care providers be educated on their needs to provide competent and inclusive health care.

Objectives: To review heredity cancer syndromes involving the breasts, ovaries, or breast and ovaries. To recommend useful professional and patient resources on cancer genetics. A case study of germline BRCA genetic testing after allogeneic bone marrow transplant is presented., Data Sources: National guidelines, evidence-based summaries, peer-reviewed studies, editorials, and professional Web sites., Conclusion: Advancing genetic/genomic technology in oncology has led to a renaissance of information about hereditary cancer syndromes., Implications for Nursing Practice: Nursing competence in genetics/genomics is necessary to provide evidence-based, personalized care for individuals with cancer. Resources are available to help nurses provide quality cancer genetic informed care., (Copyright © 2019 Northern Illinois University. Published by Elsevier Inc. All rights reserved.)

Background: High levels of fatigue have been documented in ovarian cancer patients. However, increased levels of fatigue are positively associated with a high risk of sleep disturbance and depression., Objective: To investigate the feasibility of a nurse-led home-based exercise and cognitive behavioral therapy (E&CBT) for ovarian cancer adults with cancer-related fatigue on outcomes of fatigue, plus other secondary outcomes (sleep disturbance and depression), either during or after completion of primary cancer treatment., Design: Randomized, single-blind control trial., Settings: Gynaecologic oncology department of the First Hospital of Jilin University in China., Participants: 72 eligible women who recently had surgery and completed their first cycle of adjuvant chemotherapy were randomly assigned to two groups., Intervention: The experimental group received exercise and cognitive behavioral therapy. Five nurses with nursing master degree were trained to deliver this intervention. Patients received online interventions each week in the patient's place of residence or in the nurse-led clinic, as requested. Home visits, coupled with telephone-based motivational interviews twice a week were available with the permission of the participants. comparison group participants received services as usual., Measurements: The primary outcome was measured by the Chinese version of the Piper Fatigue Scale that has 4 subscales (Behavior, Affect, Sensory, and Cognition). Secondary outcomes were measured using the Self-Rating Depression Scale and the Pittsburgh Sleep Quality Index questionnaire. Repeated-measure ANOVA was used to examine the effectiveness of this intervention in reducing fatigue, depression, and improving sleep quality., Results: For baseline comparisons, no significant differences were found between the two groups. After the interventions, total fatigue scores were significantly reduced from T1 to T2, to T3 in the experimental group (4.37, 4.24, 3.90), respectively. The comparison group showed almost no change in total fatigue score over time. In the repeated measures ANOVA, the differences of behavioral fatigue score (F=11.647, p=0.001) and cognitive fatigue score (F=5.741, p=0.019) were statistically significant for the group by time interaction. After the interventions, the experimental group participants demonstrated significantly lower symptoms of depression compared with the comparison group (T2: p=0.001 and T3: p<0.001). Sleep duration, sleep dysfunction, daytime dysfunction as well as total sleep quality significantly improved., Conclusion: Nurse-delivered home-based E&CBT have measurable benefits in helping women with ovarian cancer to decrease cancer-related fatigue, depressive symptoms, and improving their quality of sleep., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The vast majority of women diagnosed with ovarian cancer present with advanced-stage disease with a five-year survival rate less than 50%. Studies have shown that in the past, gynecologic oncologists were not routinely collaborating with palliative care physicians resulting in goals of care planning often not occurring until the last 30 days before death. In recent years, professional societies have been increasingly more vocal about the importance of incorporating palliative care early in a patient's disease course. As these calls increase, palliative care clinicians will be likely to comanage patients with ovarian cancer and may benefit from additional targeted education on this unique population. We brought together a team of gynecologic oncology and palliative care experts to collate practical pearls for the care of women with epithelial ovarian cancer. In this article, we use a "Top 10" format to highlight issues that may help palliative care physicians understand a patient's prognosis, address common misconceptions about ovarian cancer, and improve the quality of shared decision making and goals-of-care discussions.

Purpose: In contrast to art-therapy, little is known about the role of art-making for people who have been diagnosed with cancer, and even less is known about program-based art-making. This study explored the experience of participation in a visual art-making program for people during and after cancer treatment in the Northern Territory of Australia., Method: A longitudinal, qualitative, single cohort study was undertaken. Eight women diagnosed with breast and/or ovarian cancer participated in weekly art-making sessions over eight weeks, facilitated by two professional artists. Data were collected before, during and after the sessions by interviews and group discussions. The Energy Restoration Framework was used to document and analyse the benefits of participation in terms of the a priori themes of: Expansive, Belonging, Nurturing and Purposeful., Results: The four a priori themes were retained and an additional attribute of an energy restoration activity called Stimulating was added, along with sub-themes, which broadened and deepened understanding of the art-making experience within cancer care., Conclusions: Involvement in an activity that was expansive, new, beautiful and fascinating was highly valued in addition to the appreciation for being with and belonging to a supportive and accepting group facilitated by dynamic artists. There is much scope for continued research and promotion of art-making programs as an adjunct to cancer treatment., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Some guidelines on care for transgender men taking testosterone recommend oophorectomy to prevent ovarian cancer, while others recommend following guidelines for females. A review of the literature finds no strong evidence that transgender men are at increased risk for ovarian cancer. In transgender men taking testosterone without other risk factors, oophorectomy to prevent cancer is unnecessary.

Objective: The aim of the study was to perform a preliminary comparison of quality of life (QoL) and patient satisfaction in individualized nurse-led follow-up versus conventional medical follow-up in ovarian cancer., Methods: One hundred twelve women who received a diagnosis of ovarian, fallopian tube, or peritoneal cancer, completed primary treatment by surgery alone or with chemotherapy, irrespective of outcome with regard to remission, and expected survival of more than 3 months. Fifty-seven participants were randomized to individualized follow-up and 55 patients to conventional follow-up. Well-being was measured at baseline and at 3, 6, 12, and 24 months after randomization for QoL (QLQ-C30 [European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire], QLQ-Ov28), the Hospital Anxiety and Depression Scale (HADS), and a Patient Satisfaction Questionnaire (PSQ-III). The primary endpoints were the effects of follow-up on each of the scores (via hierarchical mixed-effects model) and on relapse-free time (via Cox model). The total cost of follow-up was compared between each group., Results: There was evidence for a QoL and patient satisfaction benefit for individualized versus standard follow-up (QLQ-C30, P = 0.013; 95% confidence interval, -0.03 to -0.001; PSQ-III P = 0.002; 95% confidence interval, -0.003 to -0.015; QLQ-Ov28, P = 0.14). Hospital Anxiety and Depression Scale data provided no evidence in favor of either treatment (P = 0.42). Delivered to protocol individualized follow-up resulted in a delay in the presentation of symptomatic relapse (P = 0.04), although the effect on survival in this study is unknown. Cost was £700 lower on average for the individualized follow-up group, but the difference was not statistically significant at the 5% level (P = 0.07)., Conclusions: Individualized follow-up was superior to conventional follow-up in 3 of the 4 QoL and patient satisfaction surveys in this preliminary study. Further prospective studies are needed in a larger population.Trial registration number is ISRCTN59149551.

Background: Caregiver burden associated with caring for women with ovarian cancer has received limited focus. However, these patients often have complex needs, requiring a high level of care at home and imposing substantial burdens on caregivers., Objectives: This pilot study assessed the level of caregiver burden experienced by the primary caregivers of patients with end-stage ovarian cancer and identified variables associated with caregiver burden., Methods: Caregiver burden was assessed using the Caregiver Reaction Assessment. Fifty caregivers completed an anonymous and voluntary survey. Pearson correlations and independent samples t tests were used to analyze data., Findings: Most participants were Caucasian, married or living with a partner, and college graduates, with an annual household income of less than $90,000. Caregiver ages ranged from 29-81 years. Participants agreed most with the self-esteem scale, indicating they had pride in caring for their loved ones. Disrupted schedules and financial problems were the most burdensome factors in providing care. Because financial issues affected caregiver burden, nurses should facilitate interdisciplinary support. Future research is needed to determine the impact of nurse-led interventions to reduce caregiver burden.

Background: Ovarian cancer is 1 of the most common malignancies in the female reproductive system. Identification of symptom clusters in ovarian cancer patients may improve management of symptoms., Objective: The objective of this article is to explore the changes in symptom clusters in ovarian cancer patients with adjuvant chemotherapy after surgery at different time points., Methods: Basic details of the patients were documented and a longitudinal investigation was carried out. We used the Memorial Symptom Assessment Scale to examine 115 Chinese ovarian cancer patients' symptom experience at 4 time points: days before chemotherapy (T1), chemotherapy cycle 1 (T2), chemotherapy cycle 3 (T3), and chemotherapy cycle 6 (T4). The exploratory factor analysis was performed to determine the numbers and components of symptom clusters., Results: Symptom clusters varied at different time points, which were classified as pain-related symptom cluster, psychological symptom cluster, menopausal symptom cluster, gastrointestinal symptom cluster, body image symptom cluster, and peripheral neurologic symptom cluster. The gastrointestinal symptom cluster and body image symptom cluster appeared at T1 and remained consistent at T3 and T4, whereas the peripheral neurologic symptom cluster was noted at T3 and T4., Conclusions: Clinicians should prioritize symptom management interventions with ovarian cancer patients to focus on the most severe symptom cluster: psychological symptom cluster at T1, gastrointestinal symptom cluster at T2, and body image symptom cluster at T3 and T4., Implications for Practice: The ability to predict symptom clusters in ovarian cancer patients receiving chemotherapy may help to make optimized clinical decision in advance to alleviate patients' symptoms and improve their life quality.

Approximately 5-10% of breast cancer cases appear in families at a higher rate and at an earlier onset than in the average population. Two known gene defects, BRCA1 and BRCA2, account for the majority of these hereditary related breast cancers. Additionally, BRCA1 and BRCA2 are related to the Hereditary Breast and Ovarian Cancer syndrome (HBOC), where risk for other related cancers are increased. Various health-care professional organizations provide guidelines that speak to the need for conducting risk assessments, but little research has been conducted focusing on the initial screening for this syndrome. This quality improvement project attempts to determine if Nurse Navigators can effectively perform the initial education and screening for HBOC syndrome within a mammography and women's breast imaging setting using a simplified patient history tool. E. M. Rodgers' Diffusion of Innovation model, a map of how new ideas and programs have become adopted and accepted, guided this project's development and implementation. Over the course of 8 weeks, 1,420 women seeking service at 3 mammography and imaging sites were given a new risk assessment tool for HBOC. Additionally, the use of Nurse Navigation to identify women who may be at risk for HBOC was implemented. Two populations seeking service at the study sites were evaluated: (1) women obtaining breast screening/imaging services and (2) women receiving breast biopsy results. Patients identified as "at-risk" were defined by evidence-based practice guidelines from the National Comprehensive Cancer Network and were referred for further genetic evaluation by a genetic professional. During this initial implementation of the HBOC risk assessment program, low participation of screening/imaging patients requesting HBOC education and evaluation occurred (129 screening patients or 9%). High rates of positive biopsy patients (5 patients or 34.7%) werefound to be at risk for HBOC compared to similar studies. Identifying HBOC risk at the time of breast biopsy results gave the opportunity to impact the timing and kind of surgical management of patients at risk for this syndrome.The Commission on Cancer (CoC), an arm of the American College of Surgeons, provides practice guideline standards and accreditation for cancer programs. Patients will become more familiar with being assessed for HBOC and other hereditary cancers during their annual health-care visits and more identification of patients at riskfor HBOC should occur as new CoC 2012 standards requiring hereditary cancer risk assessments for a cancer program's certification are enacted.

Objectives: The life of a family caregiver changes in many ways when cancer is diagnosed. Changes regard also financial costs. To the authors' knowledge, little work has been done to estimate the costs associated with caregiving for cancer patients. The aim of the present study is to evaluate for the first time in literature the economic changes among family caregivers of advanced ovarian cancer during the first-line treatment in an Italian survey., Methods: Between January 2009 and June 2014, the primary family caregivers of patients with advanced ovarian cancer (N = 172) were recruited from to the Division of Gynecologic Oncology of the University Campus Bio-Medico of Rome within 4 weeks of the patient's new diagnosis. Caregivers reported demographic, medical information, and economic cost, such as traveling to and from medical appointments, waiting with patients for appointments, missing work, and attending to patients who are hospitalized., Results: Between January 2009 and June 2014, 172 primary family caregivers of patients with advanced ovarian cancer were enrolled in the study. The mean age of the study cohort was 54.01 years. They reported 3% of missing workdays. The mean cost for all caregivers was &OV0556;1,888,732 per year. Therefore, the mean cost for each caregiver was &OV0556;10,981 annually., Conclusions: This economic analysis of caregiving in patients with advanced ovarian cancer reports the significant burden that cancer treatment places on both families and society. These findings underscore the importance, when appropriate, of including valid estimates of the cost of informal caregiving when evaluating the cost-effectiveness of cancer treatments.

Ovarian cancer is the most fatal of all gynecologic malignancies. Despite the lack of a recommended screening test for ovarian cancer, NPs can identify risk factors, ensure patients are aware of subtle symptoms, and provide adequate testing and analysis of results.

Purpose: This study explored the views and experiences of women following treatment for ovarian cancer who had received long-term (at least 3 years) nurse-led telephone follow-up. Exploring the long-term experiences of follow-up for women with ovarian cancer provides important information regarding the coping processes of cancer survivors that can inform the development of innovative and patient-centred approaches of cancer follow-up., Methods: This is a qualitative study approach using interpretative phenomenological analysis (IPA). Eleven women were identified by a clinical nurse specialist as having received nurse-led telephone follow-up for a period of at least 3 years. These women were interviewed in person or over the telephone using a semi-structured interview schedule; interviews were audio-recorded and transcriptions were analysed using IPA., Results: Nurse-led telephone follow-up was felt to support a reassertion of self and a rejection of patient identity. Three core themes emerged regarding the positive impact of nurse-led telephone follow-up: 'Somebody was looking out for me' highlights the perception of increased psychosocial support; 'It's just reassurance' includes both the deep trust in the expertise of the nurse and the reassurance of the continued blood tests; and 'Time was never an issue' presents the perception of relaxed follow-up appointments with time to talk and the perceived practical benefits of this approach., Conclusions: Nurse-led telephone follow-up was broadly recommended for women following treatment for ovarian cancer, particularly for those later on in the survivorship trajectory when focus may move from biomedical aspects of cure to holistic approaches to well-being. Remote interventions which provide a perception of a consistent and constant source of medical and psychosocial support may support adaption to cancer survivorship by enabling a reassertion of self and a rejection of patient identity.

Ovarian cancer, known as a "silent killer", is the leading cause of gynecologic cancer death. Standard treatments for ovarian cancer are debulking surgery combined with platinum chemotherapy drugs to prolong the survival of patients. According to clinical trials run by the American Society of Gynecologic Oncology, patients who received intraperitoneal (IP) chemotherapy survived longer on average than patients who received intravenous chemotherapy alone. Thus, intraperitoneal chemotherapy is a new potential approach for treating ovarian cancer patients. However, the toxicities and undesirable complications of IP chemotherapy are the major challenges of this treatment approach. This article helps nurses recognize the toxicities and complications of IP chemotherapy and may be used as reference for future revisions to patient care guidelines.

We explored the experiences of Ashkenazi Jewish and French Canadian women and meanings attributed to their hereditary breast and ovarian cancer (HBOC) risk. We purposively sampled 40 BRCA1 or BRCA2 (BRCA) mutation carriers and conducted theoretically driven semistructured interviews. According to content analysis, participants from these two ethnocultural groups held divergent meanings associated with being a BRCA carrier and different views pertaining to the illness experience and risk awareness. All participants identified a genetic basis; however, the French Canadian women also expressed other causes. The French Canadian women reported not knowing other carriers in their social environment, whereas the Ashkenazi Jewish women emphasized a strong sense of community contributing to their ethnic risk awareness. Based on these findings, we suggest that French Canadian women could benefit from greater awareness of the HBOC genetic risk and that health care providers should consider ethnically related and individual-based experiences and meanings during counseling.

The definition of a 'good death' is centred on being peaceful, dignified and pain free. The preferred place of death has also been highlighted as an important concept in defining a good death (Cox, Almack, Pollack, & Seymour, 2011). Seventy percent of Australians express the desire to spend their last days at home. In reality only 16% of people die at home (Preferred Place of Death, 2008). With 10% of Australians dying in residential aged care facilities and approximately 20% in hospices, the rest die in hospitals (Parish et al., 2006). Family support and the family's care giving ability play a major role in determining whether a person is able to die at home. Other factors include the availability of medical and nursing care. This story has been written with the consent of Kelly's husband. All efforts have been made to maintain privacy and confidentiality: Pseudonyms have been used.

Background: Women diagnosed with ovarian cancer face a multitude of physical, psychological, and social issues. However, existing research has typically focused on those newly diagnosed with an initial occurrence or recurrence or women with advanced disease. As such, few studies have examined women's experiences across the illness trajectory and the impact of ovarian cancer on their everyday lives., Objective: This research explores women's lived experiences of ovarian cancer and how they negotiate and make sense of illness-related issues., Methods: Sixteen women participated in face-to-face interviews and e-mail follow-ups that were informed by hermeneutic and social phenomenological approaches., Results: Five broad themes emerged from data analysis related to changes in health status and the body, disruptions to everyday activities and relationships, uncertainty, and coping and finding meaning in illness. These themes reflect the structures of participants' experiences and constitute the essence of living with ovarian cancer, "cautious optimism.", Conclusions: This research contributes to our understanding of women's lived experiences of ovarian cancer across the illness trajectory; specifically, the findings indicate that embodiment and relationships were a central focus for participants as they sought to cope with myriad issues resulting from ovarian cancer., Implications for Practice: Insight into women's ovarian cancer experiences can help nurses in their provision of care to this population. Furthermore, the findings can inform support interventions for affected women across the illness trajectory, as participants' experiences show that support needs often persist following treatment as women negotiate survivorship or recurrence.

The recruitment and accrual of participants for cancer clinical trial research is often challenging. Chronic low accrual rates negatively influence the findings and generalizability that can be drawn from the available pool of research. There is a need for further evidence regarding both unsuccessful and successful approaches and useful strategies that investigators have used to counter common recruitment challenges. During recruitment for an intervention study examining the safety, efficacy, and feasibility of a potentially novel supportive therapy, a variety of steps were taken to avoid and subsequently overcome potential and real recruitment challenges the investigators faced. In this article the authors provide an overview of common recruitment challenges as well as the actual challenges encountered, procedures and strategies implemented to counter these challenges, while investigating the combined intervention of flaxseed oil, fasting, caffeine, and exercise in women with recurrent or multi-drug resistant stage III or IV ovarian cancer., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Ovarian cancer is the fifth most common cancer affecting women in the UK today, with associated statistics illustrating a steadily increasing rate, particularly in women aged 65 and over (Cancer Research UK, 2013). There are no recognised preventative measures and no effective screening tool. Although evidence suggests that the majority of women experience a variety of non-specific symptoms in the year before diagnosis, the disease it is not commonly recognised until an advanced stage, leading to increased mortality and morbidity. This highlights the need to raise awareness among health professionals and women as a whole, as early recognition undoubtedly improves ovarian cancer survival. Best clinical practice in the UK for the recognition and initial management of ovarian cancer is provided by the National Institute for Health and Care Excellence (NICE). Clinical guideline CG 122 (NICE, 2011) and quality standard QS 18 (NICE, 2012) use relevant clinical evidence to define high-quality care standards for ovarian cancer management. Accurate staging of ovarian cancer is essential to the provision of individualised care and management. However, there is currently no single test that provides a reliable indicator of ovarian malignancy. At present, risk-of-malignancy scores are calculated by serum cancer antigen 125 (CA 125) levels, ultrasound score and menopausal status. These are widely used to identify women who are at high risk and require referral to a specialised gynaecological oncology service. Women diagnosed with ovarian cancer require information and support. The clinical nurse specialist acts as a key worker, providing communication, support and holistic care throughout a woman's cancer journey. The value of this role cannot be underestimated. Surgery followed by platinum-based chemotherapy is the usual standard treatment pathway, although individualised assessment and management may deviate from it. Early disease may be successfully treated with surgery alone; advanced disease may require complex management and treatment. New treatments such as bevacizumab show promise of improving ovarian cancer outcomes.

Oncology professionals are fully aware that the five-year mark of being disease-free after the diagnosis of cancer is not a magical number. Cancer is now considered a chronic disease and recurrence can happen at any time, which is unexpected and frightening. Yet, for me, and for many other cancer survivors, the five-year mark is one to be celebrated.

Purpose of the Research: Intraperitoneal (IP) chemotherapy is a viable and superior treatment to standard intravenous (IV) chemotherapy in women with small volume residual ovarian cancer following optimal debulking. Despite this clinical advantage, widespread adoption of the treatment regimen has been hampered by concerns related to toxicities and complications. The purpose of this descriptive study was to describe nursing implications related to toxicities, complications and clinical encounters in 17 women with ovarian cancer who received IP chemotherapy., Methods and Sample: Women with ovarian cancer who received IP chemotherapy at one NCI-designated comprehensive cancer center were accrued. Data related to IP chemotherapy summary, clinical encounters and admissions were obtained through comprehensive chart audits., Key Results: Common treatment-related toxicities included nausea and vomiting, fatigue, hypomagnesia, pain, neuropathy, anemia, and constipation. Reasons for dose-modifications were multi-factorial, and were primarily related to catheter complications and chemotherapy toxicities. The number of clinical encounters was high, and they were primarily related to admissions for inpatient IP chemotherapy and follow-up clinic visits., Conclusions: Treatment-related toxicities and complications were common in women with ovarian cancer who received IP chemotherapy. Use of IP chemotherapy results in multiple clinical encounters, such as outpatient clinic visits and inpatient admissions. Nursing is a critical part of the interdisciplinary approach in caring for women treated with IP chemotherapy. Interdisciplinary teams with high levels of knowledge and skills related to IP chemotherapy administration are needed to manage treatment-related toxicities and complications, and support multiple clinical encounters during treatment., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Because of the significantly increased lifetime risk of ovarian cancer associated with inheritance of a germline mutation in the BRCA1/2 genes, women with a deleterious mutation are recommended to undergo risk-reducing salpingo-oophorectomy at age 35 years or once child-bearing is complete. Significant time is often spent by nurses trained in genetics providing counseling to improve the decision-making process. The decision to undergo surgery is complex and laden with several sources of uncertainty., Objective: We conducted a qualitative study among female carriers of deleterious BRCA1/2 mutations to address these uncertainties., Methods: Twelve qualitative interviews were conducted with women who had received a positive BRCA1/2 test result to explore their understanding of ovarian cancer risk, prevention options, and resource needs. Qualitative content analysis was performed., Results: Significant information gaps in level of risk, other factors associated with ovarian cancer, and details of prophylactic oophorectomy were identified. Personal experience with cancer colored the degree of risk perception associated with the inherited mutation. Fear of the adverse effects of surgical menopause, both physiological and psychosocial, was common. Women expressed interest in hearing from other women facing the same decision., Conclusions: Women facing the decision to undergo risk-reducing salpingo-oophorectomy have several information gaps and unmet needs despite comprehensive counseling., Implications for Practice: Based on our findings, we make specific recommendations that will guide nursing practice and future research.

Purpose/objectives: To identify women's information and communication preferences about treatment-focused genetic testing (TFGT) in the ovarian cancer context., Research Approach: A qualitative interview study., Setting: Two familial cancer services and a gynecologic oncology clinic at a major teaching hospital in Australia., Participants: 22 women diagnosed with ovarian cancer who had either advanced disease and had previously undergone TFGT (n = 12) or had been diagnosed in the previous 6-20 weeks with ovarian cancer and had not undergone TFGT (n = 10)., Methodologic Approach: Participants were interviewed individually about actual and hypothetical views of TFGT. The interviews were transcribed and organized into themes using qualitative analysis software., Findings: Most women wanted to be informed about TFGT prior to their surgery for ovarian cancer. The majority preferred to receive the information verbally; slightly more women preferred their medical oncologist to deliver the information compared to a genetic specialist or oncology nurse. Women preferred the focus of pretest information to be on them and their treatment., Conclusions: Women diagnosed with ovarian cancer want information about genetic testing early with focus placed on the potential benefits of genetic testing on treatment., Interpretation: The findings of this study provide much-needed guidance to oncology nurses and other oncology healthcare professionals about when, what, and how information about TFGT should be delivered to patients diagnosed with ovarian cancer. Supportive patient education materials now need to be developed to assist these women in making informed decisions about genetic testing., Knowledge Translation: Knowing that women do want TFGT, how they want it presented and by whom, and the content and level of detail that women want means that TFGT can now be presented as an option to women newly diagnosed with ovarian cancer, which may influence firstline treatment. The findings also provide the knowledge required to prepare education tools to assist oncology nurses involved in frontline care.

Purpose/objectives: To explore ovarian cancer survivors' experiences of self-advocacy in symptom management., Research Approach: Descriptive, qualitative., Setting: A public café in an urban setting., Participants: 13 ovarian cancer survivors aged 26-69 years with a mean age of 51.31., Methodologic Approach: Five focus groups were formed. Focus group discussions were audio recorded and transcribed verbatim. The content was analyzed using the constant comparison method with axial coding. In-depth interviews with 5 of the 13 participants occurred via telephone one to five months after each focus group meeting to clarify and expand on identified themes. Preliminary findings were shared with all participants for validation., Findings: Two major themes emerged from the data: (a) knowing who I am and keeping my psyche intact, and (b) knowing what I need and fighting for it. Exemplar quotations illustrate the diverse dimensions of self-advocacy. In addition, a working female-centric definition of self-advocacy was attained., Conclusions: Women have varying experiences with cancer- and treatment-related symptoms, but share a common process for recognizing and meeting their needs. Self-advocacy was defined as a process of learning one's needs and priorities as a cancer survivor and negotiating with healthcare teams, social supports, and other survivors to meet these needs., Interpretation: This phenomenologic process identified key dimensions and a preliminary definition of self-advocacy that nurses can recognize and support when patients seek and receive care consistent with their own needs and preferences., Knowledge Translation: Self-advocacy among female cancer survivors is a process of recognizing one's needs and priorities and fighting for them within their cancer care and life. Practitioners can support female cancer survivors through the process of self-advocacy by providing them with skills and resources in making informed choices for themselves.

Patients approaching the end of their life may be unable to tolerate the administration of oral medication owing to their underlying disease and/or symptoms, such as nausea and vomiting. Subcutaneous infusion is an alternative route of administration that offers a number of advantages over oral and intravenous routes. This product focus article provides an overview of subcutaneous infusion, including how the selection of the most appropriate infusion device can greatly contribute to the overall comfort of the patient. This in turn minimises the potential for premature device loss, which can lead to repeated insertion procedures for the patient, increases the potential for infection, and has resource implications. The article then describes the recently developed neria soft infusion set, as well as providing case studies of its use.

Purpose: To describe the lived experience of women diagnosed with ovarian cancer using individual interviews., Data Sources: Eleven women who had been diagnosed with ovarian cancer within the past five years were interviewed with open-ended guiding questions. The narrative responses were analyzed for constitutive patterns and relational themes according to Diekelmann and Allen's hermeneutic phenomenological process., Conclusions: This phenomenological study gave voice to the women's experience with ovarian cancer. The following six constitutive patterns and associated themes emerged: (a) The Revelation, (b) Jeopardy, (c) On the Lookout, (d) Becoming Normal, and (e) Living Every Moment., Implications for Practice: An understanding of the common experiences and shared meanings of women with ovarian cancer may contribute to earlier diagnosis and improved quality of life. The women identified symptoms that should generate concern when reported to providers, potentially leading to diagnostic testing. The experiences may also serve to inform the development of interventions aimed at meeting the needs of women diagnosed with ovarian cancer., (©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.)

Purpose/objectives: To describe experiences of self-management and transitioning among women with ovarian cancer., Research Approach: Interpretive description., Setting: Participants' homes., Participants: Purposive sample of 10 women with ovarian cancer., Methodologic Approach: Individual interviews about women's self-management and transition experiences., Main Research Variables: Self-management, transitions, and ovarian cancer., Findings: Participants self-managed to increase their sense of control and to self-advocate. They managed their care one step at a time to prevent becoming overwhelmed. Common transitions were diagnosis, surgery and recovery, starting chemotherapy, managing symptoms, and recurrence. Transitions were challenging, even if previously experienced, and influenced the ability and willingness of women to self-manage. Barriers and facilitators to self-management were identified., Conclusions: The approach to self-management of one step at a time is somewhat illusory, as women face multiple transitions simultaneously. The short trajectory of ovarian cancer leaves little time between transitions and an awareness of mortality. Women are forced to confront goals of care quickly, which may affect their ability to self-manage., Interpretation: Women with ovarian cancer need clinical and social support to prioritize and manage transitions. Introducing palliative care shortly after diagnosis could facilitate women's anticipation of and adjustment to transitions.

Purpose/objectives: To explore the meaning, function, and focus of prayer for patients with advanced cancer, and to identify the effects of prayer on their coping., Research Approach: Qualitative, descriptive design using focus groups., Setting: Three cancer centers that are part of a university-affiliated comprehensive cancer network in the northeastern United States., Participants: 13 adult, female outpatients receiving active treatment for ovarian or lung cancer., Methodologic Approach: Two semistructured, focus group interviews were conducted. Audiotapes were transcribed verbatim. Data were coded and analyzed using standard content analysis procedures., Main Research Variables: Prayer and coping., Findings: Four themes emerged: finding one's own way, renewed appreciation for life, provision of strength and courage, and gaining a stronger spiritual connection. In addition, praying for others, conversational prayer, petitionary prayer, ritual prayer, and thanksgiving prayer were used most often by participants to cope., Conclusions: The findings support prayer as a positive coping mechanism for women with advanced ovarian or lung cancer., Interpretation: The study provides knowledge about prayer as a source of spiritual and psychological support. Oncology nurses should consider the use of prayer for patients coping with advanced cancer.

Ovarian cancer is the most lethal form of gynaecological cancer. It can be difficult to diagnose, with the majority of diagnoses made at a late stage of disease. An integrative literature review was conducted to explore the ovarian cancer diagnostic journey of women and to examine the potential contribution of using a person-centred approach. Factors associated with ovarian cancer diagnostic delay were described in terms of two phases. The principles of person-centred health care (PCHC) were identified. This paper proposes utilising the principles of PCHC to improve women's experience of the diagnostic journey. Specific strategies are suggested for each delay phase to enhance the experience for women. Whilst the challenges in diagnosing the disease are likely to remain until a screening test is available, it is hoped that by implementing strategies based upon PCHC, nurses may facilitate the ovarian cancer diagnostic process and improve the diagnostic experience for women.

New evidence has emerged concerning the persistent presence of a combination of symptoms that can be indicative of ovarian cancer. Professionals need to be aware of this evidence and incorporate it into their practice. Ovarian Cancer Canada (OCC) has implemented an innovative program in selected Canadian universities, as a method to educate undergraduate medical and nursing students about ovarian cancer. Survivors Teaching Students has been offered to 3,620 undergraduate students. This article presents the evaluation of the program using pre and post session surveys. Overall, students reported a change in knowledge related to the progression of ovarian cancer, symptoms of ovarian cancer, risk factors for the disease, and perspectives about what a woman with ovarian cancer might feel on being diagnosed. Having survivors provide the classroom session brought "a face and a voice" to the issue of ovarian cancer for the students.

Purpose: Little is known about how caring for someone affects the caregiver's health behaviours. We explore behaviour changes and their determinants in caregivers of women with ovarian cancer., Methods: Caregivers of 101 women with ovarian cancer completed a questionnaire 1.5-6 years after their family member's cancer diagnosis, providing information about their current health behaviours, height, weight and changes in these compared with pre-diagnosis. Information about the impact of ovarian cancer, other stressful events and distress was also collected for patients and caregivers. Logistic regression was used to determine characteristics associated with negative changes., Results: Half (54%) of caregivers did not meet Australian physical activity guidelines, 71% were overweight/obese, 40% ate <2 serves of fruit and 80% <5 serves of vegetables/day, 37% consumed >2 alcoholic drinks/occasion and 10% were smokers. Overall, 56% reported ≥ 1 negative change since their family member's diagnosis, with many decreasing their physical activity (42%) and/or gaining weight (35%). Caregivers were more likely to report negative changes if they had only school-level education (OR 3.0, 95%CI 1.1-8.4), they were unable to carry out usual daily activities due to caregiving (OR 2.0, 95%CI 0.7-5.4), they were clinically distressed (OR 3.4, 95%CI 1.1-10.1) or caring for a woman whose disease impacted on her usual daily activities (OR 4.3, 95%CI 1.4-13.2)., Conclusions: Many caregivers of women with ovarian cancer do not meet Australian health guidelines and more than half describe negative changes after becoming a caregiver. More attention should be given to cancer caregivers with high physical and emotional demands.

Purpose/objectives: To investigate sexual self-concept, sexual relationships, and sexual functioning, and the relationship between these and certain demographic variables of Irish women, following a diagnosis of gynecologic cancer., Design: Descriptive, correlational., Setting: Outpatient gynecologic oncology clinic in a large university hospital in Southern Ireland., Sample: 106 women with a diagnosis of and treatment for various gynecologic cancers (cervical, ovarian, endometrial, and vulvar)., Methods: The Body Image Scale, Sexual Esteem Scale, and Sexual Self-Schema Scale were administered to women a minimum of six weeks postdiagnosis of any form of gynecologic cancer to measure sexual self-concept; the Intimate Relationships Scale to measure sexual relationships; and the Arizona Sexual Experiences Scale to measure sexual functioning., Main Research Variables: Sexual self-concept, body image, sexual esteem, sexual self-schema, sexual relationships, and sexual functioning., Findings: Participants reported negative changes in relation to their sexual self-concept, sexual relationships, and sexual functioning. Participants reported negative changes in relation to all stages of the sexual response cycle., Conclusions: Gynecologic cancer has the potential to negatively affect a woman's sexual self-concept, sexual relationships, and sexual functioning. Sexuality is a multidimensional construct and must be measured in this way., Implications for Nursing: Healthcare professionals must use a holistic approach when providing information and support to patients with gynecologic cancer. Information must be provided to women on how cancer and its treatment has the potential to affect their sexual self-concept, sexual relationships, and sexual functioning, including information on how to overcome these alterations.

Background: Women undergoing surgery for ovarian cancer are severely ill and are high users of health services. Contributing to these increased utilization rates are the multiple modalities used to treat ovarian cancer and the complications and side effects from those treatments., Objective: The purpose of this study was to evaluate the effectiveness of an intervention provided by advanced practice nurses and a psychiatric consultation-liaison nurse on patients' self-report of healthcare utilization compared with an attention control intervention in women undergoing surgery for a suspected diagnosis of ovarian cancer., Methods: A two-group, experimental, longitudinal design was used to compare women who were assigned randomly to the intervention group or to an attention control group at baseline within 48 hours after surgery and 1, 3, and 6 months after surgery. Healthcare utilization was measured as the number of self-reported inpatient admissions and outpatient visits, including emergency room visits, oncology outpatient visits, and primary care visits. Nurse interventions consisted of 16 contacts: symptom management, counseling, education, direct nursing care, coordination of resources, and referrals. The attention control interventions consisted of nine contacts that included instructions on use of a symptom management toolkit and strategies on how to manage symptoms., Results: There were no differences in hospitalizations and oncology outpatient visits between the two groups. The main finding of this study was a significant difference in the number of primary care visits between the two groups. Women in the attention control group went to their primary care providers more often than the intervention group. The women who reported more visits also reported more depressive symptoms. In addition, a trend was found in the number of emergency room visits between the two groups. The intervention group visited the emergency room more often because the nurse instructed patients to go when they recognized symptoms that needed urgent care after hours., Discussion: Women in the intervention group appropriately used the emergency room to manage their problems after hours, whereas more women in the attention control group reported significantly more primary care visits. These findings highlight the need for healthcare providers representing various disciplines to coordinate services across specialties, especially for women who have depressive symptoms.

This article considers the nature of ovarian cancer, the effect this diagnosis may have on patients, their families and carers, and the treatment options available. The importance of the role of the nurse in providing support and information for women undergoing treatment is discussed.