Gulbeyaz Can

Quality of life, symptom experience and distress of lung cancer patients undergoing chemotherapy

UNLABELLED The diagnosis of lung cancer in the advanced stage of illness, the poor prognosis associated with the disease, and the side effects of chemotherapy all have an impact on various dimensions of quality of life (QoL). THE PURPOSE OF THE RESEARCH The current study was designed to describe the QoL and symptom distress of lung cancer patients undergoing chemotherapy and to explore the relationships between demographic/treatment-related characteristics and QoL. METHODS AND SAMPLE The sample consisted of 154 lung cancer patients undergoing chemotherapy. The symptom experiences and QoL of lung cancer patients undergoing chemotherapy were evaluated using the Memorial Symptom Assessment Scale and Quality of Life Index - Cancer Version. RESULTS The lung cancer patients had low QoL scores. The scores on the Health and Functioning subscale were the lowest (20.33 ± 5.59), while those of the Family subscale were the highest (27.66 ± 2.77). The most common physical symptoms experienced by lung cancer patients were lack of energy, coughing, pain, lack of appetite, and nausea, while the psychological symptoms were feeling nervous, difficulty sleeping, feeling sad, and worrying. There was a negative relationship between the symptom distress and quality of life scores (r=-0.45; p<0.000). Females and those with low income levels and performance status experienced greater symptom distress. CONCLUSIONS Lung cancer patients receiving chemotherapy suffer many limitations due to the symptoms and disruptions to their QoL, arising from both the disease process and its treatment. Lung cancer patients need to be assessed regularly and supported.

The prevalence and determinants of the use of complementary and alternative medicine in adult Turkish cancer patients.

A study was undertaken to analyze the extent of using complementary alternative medicine (CAM) and to compare sociodemographic and medical characteristics of users and non-users of CAM in Turkish oncology patients. A total of 615 patients with cancer who attended ambulatory patient care units answered the questionnaires. Medical information was reviewed from chart data. Some 291 patients (47.3%) had used at least one type of CAM since the time of initial diagnosis. CAMs almost always consisted of herbal agents (95%). Nettle (Urticae herba) used in conjunction with (88%) or without (56%) various herbal agents were the most popular and prominent CAMs used by patients. Univariate and multivariate comparisons of users and non-users of CAM were performed. In multivariate analysis, female sex (p=0.0006), high income (p=0.0008), advanced stage at diagnosis (p=0.02), and usage of multiple chemotherapy applications (p=0.03) were determined as independent factors for CAM use.

Comparison of the health-promoting lifestyles of nursing and non-nursing students in Istanbul, Turkey.

Undertaking a health-related course at university can facilitate an awareness of health-promoting lifestyles. We carried out a descriptive and cross-sectional study with 1616 university students in Istanbul, Turkey. Students from the nursing schools were compared to those from the schools of social sciences using a Turkish version of the Health-promoting Lifestyle Profile (HPLP) II after a validation study. The nursing students had more positive health-promoting lifestyles than those of the non-nursing students. Furthermore, fourth-year nursing students had higher scores in most of the subscales of the HPLP II than did the students from the lower years; conversely, the fourth-year non-nursing students had lower scores. The sociodemographic variables, self-perceived health status, relations with family and friends, and self-perceived academic performance were associated with the HPLP. The implications are discussed for the curricula and on-campus facilities that focus on health promotion activities.

A comparison of men and women's experiences of chemotherapy-induced alopecia

PURPOSE The effect of alopecia on men and women has not been fully documented in the literature, especially for Turkish cancer patients. The aim of this study was to determine the incidence of chemotherapy-related alopecia and how it affects the body image and quality of life of Turkish male and female cancer patients, in order to identify variables that may be important in the perception of this problem. METHODS This descriptive study was carried out between November 2010 and June 2011 at Istanbul University Institute of Oncology; 201 men and 204 women attended. A face-to-face interview was performed during chemotherapy, and the effects of alopecia on cancer patients were assessed using the Patient Information Form, Body Image Scale, and Nightingale Symptom Assessment Scale. RESULTS The study group consisted of 55.1% female and 44.9% male patients. Most of the patients experienced partial or total alopecia during chemotherapy. There were no differences between men and women with regard to body image in respect of degree of alopecia, but the body image of the male and female patients who had partial or complete alopecia was lower than that in patients who had no alopecia; psychological well-being of women was lower than that in men, because the incidence of alopecia was higher in women. CONCLUSIONS This study contributes new knowledge on the cultural characteristics of Turkish patients, which may assist other researchers working with different international populations. Alopecia is a difficult side effect for both men and women. Health professionals should assess and educate patients differently from the current standard.

Effects of alopecia on body image and quality of life of Turkish cancer women with or without headscarf

PurposeThe aim of this study was to find out the effects of chemotherapy-related alopecia on body image and quality of life of Turkish women who have cancer with or without headscarves and factors affecting them.MethodsThis descriptive study was conducted with 204 women who received chemotherapy at the Istanbul University Institute of Oncology, Turkey. The Patient Description Form, Body Image Scale and Nightingale Symptom Assessment Scale were used in data collection. Statistical analyses were performed using descriptive statistics and non-parametric tests. Logistic regression analysis was done to predict the factors affecting body image and quality of life of the patients.ResultsNo difference was found between women wearing headscarves and those who did not in respect of their body image. However, women who wore headscarves who had no alopecia felt less dissatisfied with their scars, and women not wearing headscarves who had no alopecia have been feeling less self-conscious, less dissatisfied with their appearance. There was difference in terms of quality of life: women wearing headscarves had worse physical, psychological and general well-being than others.ConclusionAlthough there were many important factors, multivariate analysis showed that for body image, having alopecia and wearing headscarves; and for quality of life, having alopecia were the variables that had considerable effects.

Taxane-induced nail changes: Predictors and efficacy of the use of frozen gloves and socks in the prevention of nail toxicity.

PURPOSE The primary endpoint of this study was to determine predictors of taxane-related nail toxicity. The secondary endpoint was to evaluate the efficacy of the use of frozen gloves and socks in the prevention of taxane-related nail toxicity. METHODS This descriptive, interventional, cross-sectional study was conducted with 200 patients. The patients were assigned to the frozen gloves/socks intervention group or control group. Frozen gloves/socks were applied only in hourly taxane-based treatments. The Patients Record Forms of the clinic were used in data collection. Nail changes were graded using the NCI Common Toxicity Criteria for each patient and treatment. Logistic regression analysis was performed to predict the factors that affect nail changes. RESULTS The majority of the patients enrolled in the study were women diagnosed with breast cancer. The two groups were statistically similar for the cancer diagnosis, type and number of taxane cycles administered. Grade 1 nail toxicity was found in 34%, grade 2 in 11%, and grade 3 in 5.5% patients. Taxane-related nail toxicity was higher in patients who were female, had a history of diabetes, received capecitabine in conjunction with docetaxel and had breast or gynecological cancer diagnosis. Nail changes increased with an increase in the number of taxane cycles administered, BMI and severity of treatment-related neuropathy. CONCLUSIONS The multivariate analysis demonstrated that BMI, breast or ovarian cancer diagnosis and the number of taxane cycles administered were the independent factors for this toxicity. No statistically significant difference in nail toxicity incidence and time to occurrence of nail changes was found between the intervention and the control groups.

Evaluating Palliative Care Needs in Middle Eastern Countries

BACKGROUND Cancer incidence in Middle Eastern countries, most categorized as low- and middle-income, is predicted to double in the next 10 years, greater than in any other part of the world. While progress has been made in cancer diagnosis/treatment, much remains to be done to improve palliative care for the majority of patients with cancer who present with advanced disease. OBJECTIVE To determine knowledge, beliefs, barriers, and resources regarding palliative care services in Middle Eastern countries and use findings to inform future educational and training activities. DESIGN Descriptive survey. SETTING/SUBJECTS Fifteen Middle Eastern countries; convenience sample of 776 nurses (44.3%), physicians (38.3%) and psychosocial, academic, and other health care professionals (17.4%) employed in varied settings. MEASUREMENTS Palliative care needs assessment. RESULTS Improved pain management services are key facilitators. Top barriers include lack of designated palliative care beds/services, community awareness, staff training, access to hospice services, and personnel/time. The nonexistence of functioning home-based and hospice services leaves families/providers unable to honor patient wishes. Respondents were least satisfied with discussions around advance directives and wish to learn more about palliative care focusing on communication techniques. Populations requiring special consideration comprise: patients with ethnic diversity, language barriers, and low literacy; pediatric and young adults; and the elderly. CONCLUSIONS The majority of Middle Eastern patients with cancer are treated in outlying regions; the community is pivotal and must be incorporated into future plans for developing palliative care services. Promoting palliative care education and certification for physicians and nurses is crucial; home-based and hospice services must be sustained.

Nursing education in Turkey.

A lthough Nightingale’s work in Turkey during the Crimean War in 1854 is often cited as the beginning of modern nursing, nursing itself did not begin in Turkey until the War of Tripoli in 1911 and the Balkan War in 1912. The first training of nurses began in 1912, with 3 caregiver courses opened by the Ottoman Red Crescent Association. The first Turkish nursing school was established in 1925 after the establishment of the Turkish Republic in 1923, in accordance with the reforms (alphabet reform, hat and clothing reform, enfranchisement of women) made by Ataturk. In 1959, the first 4-year education for the bachelor’s degree in nursing started at the University of Ege. Until 1997, various types and levels of nursing education programs were created such as high-school diploma program, associate degree program, high-school certificate program, and baccalaureate program. In 1997, all schools of nursing were changed to 4-year programs at the university level. Currently, there are 86 schools of nursing providing a bachelor’s degree. The baccalaureate degree programs are 4 years in length and given by 63 higher-education schools of health, 10 schools of nursing (4 of which are affiliated to public and 6 to private universities), and 13 faculties of medical sciences– nursing program (10 of which are affiliated with public and 3 to private universities). Nursing students are admitted through a highly competitive General University Entrance Examination, which is organized by the Turkish Higher Education Council. In the past, an admission requirement for baccalaureate programs in nursing was being a woman. This admission requirement was changed, and since April 2007, men also have been accepted into nursing programs. The concept of male nurse, which is one of the important developments in the history of Turkish nursing, is a very new concept for our country. Most students thought that male students were appropriate for the role of the caregiver and that the nursing profession should be done by both sexes. The baccalaureate science degree programs in nursing include 9 basic nursing courses: Fundamentals of Nursing, Medical Nursing, Surgical Nursing, Women’s Health and Obstetrics Nursing, Children’s Health and Diseases Nursing, Mental Health Nursing, Community Health Nursing, Nursing Management, and Education in Nursing. According to the European Union (EU) requirement for the number of hours of nursing education, 2,300 clinical and 2,300 theoretical hours are completed during the length of nursing education to educate nurses as generalists rather than specialists. Clinical nursing education is carried out by faculty members of nursing schools after completion of or in conjunction with theoretical courses. In some schools, clinical training opportunities and qualified educators were limited. During clinical practice, most students have great difficulty putting theory into clinical practice because some clinical skills learned in the skills laboratory are not practiced in quite the same way in the hospital. The EU standards dictate the need for a ‘‘registration exam,’’ but graduates from nursing programs are not required to take a registration examination in Turkey. Some schools participate in student and academic staff exchange programs with European countries, as part of the Socrates and Erasmus Programmes. These programs are lifelong learning programs for the mobility of university students (http://ec.europa.eu/education/index_en.htm). In Turkey, the MSc (1968) and PhD (1972) programs started to enable university graduate nurses to specialize and increase their knowledge and skills in a particular area, in depth. These programs are offered only by some schools of nursing and school of health sciences at public and private universities. Admission requirements for postgraduate programs include bachelor’s degree in nursing for master’s degree and MSN for the doctorate program, satisfactory scores on the LES (Graduate Studies Entrance Exam) and the English-language proficiency test, and a test of general nursing knowledge that is administered by each school. Postgraduate programs include fundamentals of nursing, medical nursing, oncological nursing, surgical nursing, surgery nursing, forensic nursing, gynecology and obstetric nursing, pediatric nursing, psychiatry nursing, public health nursing, nursing management, and nursing education.

A psychometric validation study of the Quality of Life and FAMCARE scales in Turkish cancer family caregivers.

PurposeThe aim of this study was to assess the psychometric validation of the Quality of Life and FAMCARE scales in Turkish family caregivers of cancer patients.MethodsThis is a descriptive study involving 100 family caregivers of cancer patients. The validity and reliability study of the scales was performed in two phases. Phase I focused on the construction of the Turkish version of the instruments and pilot testing. Phase II was the psychometric assessment of the scales.ResultsThe caregivers stated that the two questionnaires were easy to read and to understand. However, the psychometric validation performed afterwards revealed that both the ordering of the factor loadings and content of the scales were influenced by prevailing characteristics of Turkish society. Caregivers were satisfied with the care their patients received, and family concerns were the most negatively affected quality-of-life (QOL) dimensions. Factors affecting the QOL and satisfaction with care were age, co-residence, relationship to patient, gender of the patients and caregivers, stage of the disease of the patient and marital status of the caregivers.ConclusionPsychometric validation of the Quality of Life and FAMCARE scales demonstrates that these culturally adapted scales are valid and reliable tools to assess the QOL and satisfaction of Turkish family caregivers of cancer patients.

Non-pharmacological interventions used by cancer patients during chemotherapy in Turkey

PURPOSE Although there are many non-pharmacological practices being recommended for symptom management, most patients prefer to use pharmacological interventions. This study assesses the non-pharmacological interventions used by cancer patients for symptom management during chemotherapy and the factors affecting its use. METHOD This study was conducted at the Istanbul University Institute of Oncology, Turkey, with 202 patients. Personal characteristics, illness-related characteristics, symptom severity and non-pharmacological interventions used by the patients were assessed by using Patient Description Form, ECOG and Nightingale Symptom Assessment Scale. RESULTS Most of the patients in this study were living in Istanbul, 58.4% were women, 78.7% were married and their mean age was 48.82 ± 1.44. Most of the patients experienced different symptoms related to chemotherapy, but only a small number of patients preferred to use and benefited from the non-pharmacological interventions in their symptom management. There were different factors affecting the well-being of the patients, but only being young was found to be an important variable in the use of psychological interventions (OR 3.06 [95% CI 1.17-7.96]). CONCLUSIONS Physicians remain the central figure in the treatment of cancer patients, so oncologists and oncology nurses should be more proactive and innovative in their patient care, education, and counseling to maximize the use of non-pharmacological interventions that may be helpful in symptom management. Further research evaluating the use and effectiveness of non-pharmacological interventions on symptom management in cancer patients is needed.