Ausanee Wanchai

Complementary and Alternative Medicine Use Among Women With Breast Cancer: A Systematic Review

Patients with breast cancer use complementary and alternative medicine (CAM) despite the fact that no studies have shown altered disease progression attributable to CAM use. The purpose of this systematic review is to summarize research as it relates to CAM use among women with breast cancer. Among the many findings of the review, biologically based practices were noted as the types of CAM most used by women with breast cancer, followed by mind-body medicine, whole medical systems, and energy medicine. Sources of information about CAM use for women with breast cancer vary widely, including family, friends, mass media, healthcare providers, CAM providers, and self-help groups. Sociodemographic factors that appear to be related to CAM use were younger age, higher education, higher income, married status, involvement in a support group, and health insurance. The reasons for CAM use reported by women with breast cancer were to help healing, to promote emotional health, and to cure cancer. Oncology nurses should learn more about CAM use among women with breast cancer. Open communication about CAM use helps ensure that safe and holistic care is provided. Additional research in this particular area is needed.

A Systematic Review of the Evidence for Complete Decongestive Therapy in the Treatment of Lymphedema From 2004 to 2011

To critically analyze the contemporary published research that pertains to the individual components of complete decongestive therapy (CDT), as well as CDT as a bundled intervention in the treatment of lymphedema.

Nonpharmacologic Supportive Strategies to Promote Quality of Life in Patients Experiencing Cancer-Related Fatigue

Cancer-related fatigue (CRF) is a distressing symptom that affects the quality of life (QOL) of patients with breast cancer and their families. The effectiveness of pharmacologic therapies alone has not been sufficient in the management of CRF; therefore, a combination of pharmacologic and nonpharmacologic approaches is justified. The purpose of this article is to critically review the literature related to nonpharmacologic supportive strategies in enhancing QOL among patients with breast cancer experiencing CRF. The results show that exercises (e.g., home-based exercise, supervised exercise), education and counseling, sleep therapy, and complementary therapy are feasible as effective nonpharmacologic supportive interventions to improve QOL in patients with breast cancer suffering from CRF. Therefore, nurses may consider these nonpharmacologic supportive strategies as adjunctive interventions to pharmacologic interventions in enhancing QOL for patients with breast cancer experiencing CRF. However, because previous studies had some methodologic limitations, such as small sample size, lack of objective measures, or predominantly Caucasian sample, future research to further explore nonpharmacologic interventions in this area is warranted.

Self-management of lymphedema: A systematic review of the literature from 2004 to 2011

Background:Little is known about the effectiveness of activities used to self-manage lymphedema. Objective:The aim of this study was to evaluate the level of evidence of peer-reviewed lymphedema self-care literature published from January 2004 to May 2011. Methods:Eleven major medical databases were searched. Articles were selected for inclusion or exclusion into the category of self-management of lymphedema by topic experts. The definition of self-management included activities that individuals initiate and perform for themselves without the assistance of others. Articles were scored according to the Oncology Nursing Society’s Putting Evidence Into Practice levels of evidence. Results:Sixteen articles met criteria for inclusion in this review, with self-management as the independent variable. Ten categories of self-management were established subsequently and articles were classified by levels of evidence. In these categories, no self-management studies were rated as “recommended for practice,” 2 studies were rated “likely to be effective,” none was rated “benefits balanced with harms,” 7were rated “effectiveness not established,” and 1 was rated “effectiveness unlikely.” Discussion:Few studies included measures of outcomes associated with lymphedema, and there was a scarcity of randomized controlled trials in lymphedema self-management. A demonstrated need exists for the design and testing of self-management interventions that include appropriate outcome measures.

Perspectives of the Breast Cancer Survivorship Continuum: Diagnosis through 30 Months Post-Treatment

This study explored breast cancer survivors’ perspectives regarding their experiences of the survivorship continuum from diagnosis through 30 months post-treatment. The sample included women (N = 379) with newly-diagnosed breast cancer undergoing treatment at a Midwestern university-affiliated cancer center. Semi-structured interviews were conducted using the Lymphedema and Breast Cancer Questionnaire at time of diagnosis, post-operatively, quarterly during the first year, and then semi-annually thereafter through 30 months post-treatment. A mixed-methodology was used to analyze participants’ comments. Themes central to long-term survivorship experiences included social support, positive worldviews, breast cancer and lymphedema health literacy, religious/spiritual beliefs, self-empowerment, and recovery expectations. These themes were consistent with a psychoneuroimmunological model of health in which psychosocial variables mediate stress and influence health outcomes. Qualitative data showed that social support and positive worldviews were the two themes with the most significant impact on long-term breast cancer survivorship experiences. Survivors expressed a need to advance their health care literacy in order to share ownership of breast cancer and lymphedema treatment decisions. Since breast cancer is an immune-mediated disease, long-term survivorship planning should address psychosocial factors that influence the long-term psychological distress associated with immune dysfunction.

Performance care practices in complementary and alternative medicine by Thai breast cancer survivors: An ethnonursing study

The purpose of this study was to explore how Thai breast cancer survivors perform care practices in complementary and alternative medicine to promote their health and well-being. Research was conducted using an ethnonursing method. Data were collected through semi-structured interviews with 17 Thai breast cancer survivors in Thailand. The transcribed interviews were analyzed using the ethnonursing analysis method. The findings showed Thai breast cancer survivors started their care practices in complementary and alternative medicine immediately following a diagnosis of breast cancer. They sought out and gathered alternative medicine information from several sources, such as the people around them, media resources, books, magazines, or newspapers. After gathering information, Thai breast cancer survivors would try out various types of complementary medicines rather than use only one type because of information from other people and their own evaluation. The findings of this study indicate the need for a conversation about complementary medicine use between healthcare providers and Thai breast cancer survivors as an on-going process throughout the cancer trajectory to ensure that safe and holistic care is provided.

Complementary and Alternative Medicine and Lymphedema

OBJECTIVES To review the evidence for the effectiveness of complementary and alternative medicine (CAM) on cancer-related lymphedema. DATA SOURCES CINAHL, PsycINFO, and PubMed (1990-2012). CONCLUSION To date, there is insufficient evidence to draw conclusions about the benefits of CAM use for cancer patients with lymphedema. Although some CAM types may offer positive effects for the management of lymphedema, negative adverse effects have also been observed. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses and therapists should be aware of and ready to educate cancer patients about the potential effects of CAM. A conversation about the potential risks and benefits of CAM use should be provided.

Upper extremity lymphedema: presence and effect on functioning five years after breast cancer treatment.

PURPOSE/OBJECTIVE Our goal was to explore the effects of lymphedema on long-term adjustment among breast cancer survivors, in terms of functioning in important life environments. RESEARCH METHOD/DESIGN Limb volume measurements and psychosocial survey data were collected from women shortly after undergoing surgical intervention for breast cancer and annually thereafter. A subset of these women were selected for the current study because they had preoperative limb volume measurement data, which is best suited to determine presence and severity of lymphedema. Our final sample of 61 women had both the arm measurements (preoperative and 5-year) and survey data (baseline and 5-year) needed for this study, which comprises a secondary cross-sectional analysis of longitudinal data. A correlational approach was used to explore associations among lymphedema (presence, severity, and whether the participant met the criteria for lymphedema at any assessment point since their treatment for breast cancer) and outcome variables (physical functioning, vocational functioning, social functioning, domestic functioning, and sexual functioning). RESULTS Each of the three measures of lymphedema was significantly correlated with domestic functioning, but not with functioning in other common environments. CONCLUSIONS/IMPLICATIONS Long-term breast cancer survivors are at risk for developing secondary conditions, such as lymphedema, to which they must learn to adjust and adapt. Lymphedema may increase risk for compromised functioning in everyday environments, a problem which lies at the heart of rehabilitation. Breast cancer survivorship, therefore, fits well within the scope of a rehabilitation framework.

Thai nurses’ perspectives on the use of complementary and alternative medicine among Thai breast cancer survivors in northern Thailand

Breast cancer survivors are more likely to seek complementary and alternative medicine (CAM) for their health and well-being than other cancer patients. The purpose of the study was to describe how Thai nurses perceive the use of CAM in Thai breast cancer survivors. An ethno-nursing research method was used. Fifteen Thai nurses who had experience in taking care of Thai breast cancer survivors who used CAM from a tertiary care referral and resource centre in the lower northern part of Thailand were interviewed. Two major themes emerged from this study: Meaning of care practices in CAM was seen as: (i) an additional beneficial choice for health; and (ii) emotional and psychological healing. Nurses should be concerned about CAM use in Thai breast cancer survivors. Open communication about CAM helps ensure that safe and holistic care is provided. Further research to enhance integration of CAM into health care is needed.Breast cancer survivors are more likely to seek complementary and alternative medicine (CAM) for their health and well-being than other cancer patients. The purpose of the study was to describe how Thai nurses perceive the use of CAM in Thai breast cancer survivors. An ethno-nursing research method was used. Fifteen Thai nurses who had experience in taking care of Thai breast cancer survivors who used CAM from a tertiary care referral and resource centre in the lower northern part of Thailand were interviewed. Two major themes emerged from this study: Meaning of care practices in CAM was seen as: (i) an additional beneficial choice for health; and (ii) emotional and psychological healing. Nurses should be concerned about CAM use in Thai breast cancer survivors. Open communication about CAM helps ensure that safe and holistic care is provided. Further research to enhance integration of CAM into health care is needed.

Rehabilitation concepts among aging survivors living with and at risk for lymphedema: A framework for assessment, enhancing strengths, and minimizing vulnerability

The leading cause of secondary lymphedema (LE) in developed countries is cancer treatment. It is estimated that more than 11.4 million cancer survivors in the United States are at risk for developing LE. The intersect of the growing aging population and improvement in cancer detection and treatment provides focus on aging and rehabilitation outcomes in detection and management of LE. The complexity of the problem of posttreatment LE and the predicted increase in the number of older cancer survivors led to the mandate for more attention to this multidisciplinary rehabilitation issue in gero-oncology.