Jennifer R. Bail

Interventions for Cognitive Deficits in Breast Cancer Survivors Treated With Chemotherapy.

Background: Cognitive deficits are distressing adverse effects of chemotherapy that have a negative effect on quality of life in breast cancer survivors (BCSs). Cognitive deficits in cancer survivors are a top research and clinical practice priority. Objective: The aims of this study were to describe cognitive deficits that occur after chemotherapy, describe deficits in BCSs treated with chemotherapy within a framework of cognitive reserve and neuroplasticity, and discuss cognitive interventions (ie, cognitive training interventions, compensatory strategies with cognitive training interventions, pharmacological interventions, and complementary and integrative medicine interventions). Methods: PubMed search yielded 21 intervention studies of cognitive deficits in BCSs. Results: Cognitive training interventions and compensatory strategies with cognitive training resulted in improvement of cognitive deficits. Methylphenidate did not result in cognitive improvement. Modafinil showed improvement in attention. Some complementary and integrative medicine interventions are promising. Conclusions: Cognitive training has been most beneficial. Effectiveness of pharmacologic and complementary and integrative medicine interventions has not yet been established. Implications for Practice: While limited evidence is available to guide clinical management of cognitive deficits in BCSs, validating patients’ symptom experience and evaluating co-occurring symptom clusters such as fatigue, sleep, and depression, are suggested.

Nutritional Status and Diet in Cancer Prevention

OBJECTIVES To discuss the relationship between weight management and diet and cancer prevention, current nutritional guidelines, and evidence-based strategies to reduce cancer risk. DATA SOURCES Current nutritional guidelines, journal articles published between 2012 and 2015, and internet resources. CONCLUSION Evidence indicates that attaining and/or maintaining a healthy weight and adopting a diet that is primarily plant-based, low in red and processed meats, simple sugars, and refined carbohydrates, limits alcohol, and relies on food for nutrients can aid in preventing cancer. IMPLICATIONS FOR NURSING PRACTICE Nurses can take the lead to educate patients and families about weight management and diet and to promote adherence to nutritional guidelines.

Weight Management and Physical Activity Throughout the Cancer Care Continuum.

Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, “Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum.” Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight‐management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64‐89.

Lessons Learned from the Young Breast Cancer Survivorship Network

The Young Breast Cancer Survivors Network (Network) is an academic and community-based partnership dedicated to education, support, and networking. The Network used a multi-pronged approach via monthly support and networking, annual education seminars, website networking, and individual survivor consultation. Formative and summative evaluations were conducted using group survey and individual survivor interviews for monthly gatherings, annual education meetings, and individual consultation. Google Analytics was applied to evaluate website use. The Network began with 4 initial partnerships and grew to 38 in the period from 2011 to 2017. During this 5-year period, 5 annual meetings (598 attendees), 23 support and networking meetings (373), and 115 individual survivor consultations were conducted. The Network website had nearly 12,000 individual users and more than 25,000 page views. Lessons learned include active community engagement, survivor empowerment, capacity building, social media outreach, and network sustainability. The 5-year experiences with the Network demonstrated that a regional program dedicated to the education, support, networking, and needs of young breast cancer survivors and their families can become a vital part of cancer survivorship services in a community. Strong community support, engagement, and encouragement were vital components to sustain the program.

Telehealth intervention for Latina breast cancer survivors: A pilot:

Aim: This study was a pilot test of the Latina Breast Cancer Survivorship Intervention, a survivorship self-management intervention delivered via telephone. Materials and methods: This study used a wait-list control design with random assignment to either (1) support and early education or (2) support and delayed education. Latina breast cancer survivors were recruited through the Florida Cancer Data System Registry. Latinas with stage I–III breast cancer who completed primary cancer treatment 3 years prior to study enrollment were eligible. The Latina Breast Cancer Survivorship Intervention consisted of three education sessions delivered weekly via telephone and six telephone support calls, both delivered by a native Spanish speaker. Primary outcome variables included physical well-being, emotional well-being, fatigue, pain, and depressive symptoms. Data collection occurred at baseline, 3 months, and 6 months. Results: In total, 40 Latina breast cancer survivors who were middle-aged to older, married, with health insurance, and Spanish as preferred language enrolled in the Latina Breast Cancer Survivorship Intervention. Data were analyzed using mean change scores. Overall, physical and emotional well-being remained similar over time with well-being scores poorer compared with the general population. Pain levels improved over 6 months and showed a high effect size. Fatigue scores improved at 3 months and showed a moderate effect size. Depressive symptoms remained elevated but were not clinically significant. Conclusion: Telephone-based Latina Breast Cancer Survivorship Intervention reached Latina breast cancer survivors for survivorship education and support. Self-management of pain and fatigue showed improvement over time.

Psychological Symptoms in Advanced Cancer

OBJECTIVES To discuss psychological symptoms among patients with advanced cancer, assessment of psychological symptoms, and evidence-based strategies to manage psychological symptoms. DATA SOURCES Current cancer-care guidelines and journal articles. CONCLUSION Psychological symptoms are prevalent among patients with advanced cancer and may not be evident without appropriate screening. Distressed patients may not meet criteria for a full clinical psychiatric diagnosis, but may still benefit from interventions to improve quality of life. IMPLICATIONS FOR NURSING PRACTICE Nurses can improve the lives of patients by assessing for psychological symptoms; providing appropriate referrals, treatment, and/or follow-up; and recommending integrative methods for psychological symptom self-management.

Engaging an Urban African American Community to Deliver Cognitive Health Education to Breast Cancer Survivors

Little is known about cognitive changes among African American (AA) breast cancer survivors (BCS). Here, we report our experience with engagement of leaders of urban AA churches in Birmingham, Alabama to deliver and evaluate Think Well: Healthy Living to Improve Cognitive Function, an educational cognitive health program for BCS. The Think Well team engaged leaders of urban AA churches using a 7-step process: 1) identify leaders, 2) develop connection with leaders, 3) assess AA community preferences, 4) tailor for cultural relevance, 5) plan seminars, 6) deliver seminars, and 7) evaluate cultural relevance and overall program quality. Program evaluation was via a 22-item survey and sociodemographic questionnaire. Data from AA participants were analyzed using SPSS. The engagement process resulted in sustained partnerships with three urban AA churches and delivery of three Think Well seminars to 172 participants. Of the 172 participants, 138 (80%) AA participants (40 BCS, 98 co-survivors) returned the program survey. Respondents reported Think Well to be culturally relevant (90%) and of high quality (94%). Think Well was developed and evaluated with the collaboration of urban AA church leaders. Engaging church leaders facilitated reach of AA BCS. Partnership facilitated a culturally relevant, high quality program for AA BCS and co-survivors.

Cognitive Changes: Educating Breast Cancer Survivors With the Think Well: Healthy Living to Improve Cognitive Function Program

&NA; Cognitive changes may occur after cancer treatment and interfere with day‐to‐day activities of breast cancer survivors. Current guidelines recommend validating cognitive concerns, increasing patient education, and suggesting appropriate interventions. Educational programs, including Think Well: Healthy Living to Improve Cognitive Function, can increase the awareness of cognitive changes and provide strategies for self‐management to breast cancer survivors and their family and friends. AT A GLANCEOncology nurses can validate cognitive changes that breast cancer survivors experience after cancer treatment and encourage healthy lifestyles.The Think Well program adapts evidence‐based guidelines into the curriculum and educates patients on cognitive changes and healthy living strategies.Oncology nurses can deliver the Think Well program in community settings, such as rural areas where resources may be limited.

A home-based mentored vegetable gardening intervention demonstrates feasibility and improvements in physical activity and performance among breast cancer survivors: Home-Based Mentored Vegetable Gardening

The current study assessed the feasibility of a mentored home‐based vegetable gardening intervention and examined changes in health‐related outcomes among breast cancer survivors (BCS).

Abstract B15: Assessing the feasibility of an online cognitive health education program to address cognitive changes among breast cancer survivors

Background: Currently in the United States, there are an estimated 3.5 million breast cancer survivors (BCS), of which up to 75% in treatment and 35% after treatment report cognitive changes. To increase awareness of cognitive changes after treatment and promote healthy living to address those changes among BCS, Think Well: Healthy Living to Improve Cognitive Function (TW) was developed. The TW curriculum was evidence-based in knowledge of cognitive changes and potential compounding effects of unhealthy lifestyle behaviors (i.e., poor nutrition, lack of physical activity, and inadequate sleep hygiene), as well as complex issues occurring with return to work. The resulting TW program addressed cognitive health, cognitive changes after treatment, healthy living strategies to promote cognitive function (i.e., nutrition, physical activity, stress management, and sleep), brain exercises (i.e., crossword puzzles, problem solving, and learning new activities), and compensatory strategies (i.e., using a planner, setting reminders, and note taking). Through the use of community engagement, the TW program was delivered over a two year period (2014-2016) in community settings throughout North Central Alabama. Purpose: To assess the feasibility of disseminating a web-based TW. Methods: A web-based TW was developed from the existing evidence-based TW program consisting of: 1) cognitive changes after treatment; 2) healthy living strategies to promote cognitive function; 3) brain exercises; and 4) compensatory strategies. Delivery of the web-based TW was via the website (www.ThinkWell.tips) and employed: 1) videos; 3) downloadable tip sheets; 4) events calendar; and 4) links to other websites for additional resources. The website was launched October 15, 2015. Website use was measured via Google Analytics for the time period of October 15, 2015 - June 20, 2016. Results: Google Analytics revealed 1,546 sessions, 1,177 users, and 2,224 page views for the designated time period as well global users (i.e., United States, Russia, United Kingdom, China, Japan, Germany, Netherlands, Canada, and Brazil). The most visited pages included cognitive changes, nutrition, tip sheets, and events. Discussions/Conclusions: Results demonstrated that dissemination of a web-based TW was feasible and may have a global impact. To improve awareness of the TW website, future dissemination methods include distribution of business cards at professional/community events and engaging existing partners to disseminate via social media. Further TW website enhancements include a cognitive health blog and links to healthy living mobile applications and cognitive training platforms. Acknowledgement: Think Well is supported by a grant from the North Central Alabama Affiliate of Susan G. Komen. Authors are also supported by funding: Susan G. Komen Graduate Traineeship in Disparities Research, Robert Wood Johnson Foundation Future of Nursing Scholarship, American Cancer Society Doctoral Degree Scholarship in Cancer Nursing (DSCN-15-073-01 and DSCN-16-066-01), Jonas Nurse Leaders Scholarship, and Gladys Farmer Colvin Doctoral Fellowship. Citation Format: Jennifer Bail, Timiya S. Nolan, Jacqueline Bui, Silvia Gisiger-Camata, Karen Meneses. Assessing the feasibility of an online cognitive health education program to address cognitive changes among breast cancer survivors. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B15.