Jennifer Sandson Frank

Attention and memory deficits in breast cancer survivors: implications for nursing practice and research.

Abstract Breast cancer survivors (BCSs) commonly report deficits in attention and memory, cognitive functions crucial for daily optimal functioning. Perceived deficits are reported before, during, and after adjuvant therapy and affect quality of life throughout survivorship. Deficits of attention and memory are particularly disruptive for BCSs working or attending school who report that subtle impairment diminishes their confidence and their performance at all levels of occupation. Chemotherapy and endocrine therapy contribute to attention and memory deficits, but research findings have not fully established the extent or timing of that influence. Fortunately, potential interventions for attention and memory deficits in BCSs are promising. These include cognitive remediation therapies aimed at training for specific areas of deficit, cognitive behavioral therapies aimed at developing compensatory strategies for areas of deficit, complementary therapies, and pharmacologic therapies.

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.

Evaluation of Team-Based Care in an Urban Free Clinic Setting.

This article reports the experiences of a school of nursing, academic health center, and community-based organization working via an interprofessional collaborative practice model to meet the mutual goal of serving the health care needs of an indigent, largely minority population in Birmingham, Alabama. The population suffers disproportionately from chronic health problems including diabetes, obesity, cardiovascular disease, asthma, and mental health disorders. The program emphasizes diabetes management because the academic health center recognized the need for transitional and primary care, including mental health services, for the increasing numbers of uninsured patients with diabetes and its comorbidities. Half of the clinicians involved in this project had no prior experience with interprofessional collaborative practice, and there was confusion regarding the roles of team members from the partnering institutions. Activities involving care coordination consistently received low scores on weekly rating scales leading to the creation of positions for a nurse care manager and pharmaceutical patient assistance program coordinator. Conversely, shared decision making and cooperation ratings were consistently high. Evaluation identified the need for reliable, accessible data and data analysis to target clinically effective interventions and care coordination and to assess cost effectiveness. The strengths, challenges, lessons learned, and next steps required for sustainability of this alignment are discussed.

Cognitive Deficits in Breast Cancer Survivors After Chemotherapy and Hormonal Therapy.

ABSTRACT Adjuvant treatments, specifically chemotherapy and hormonal therapy, have dramatically increased breast cancer survival, resulting in increased attention to the residual effects of treatment. Breast cancer survivors (BCS) frequently report that cognitive deficits are a particular source of distress, interfering with many aspects of quality of life. The literature on neuropsychological performance measures in BCS supports the reality of subtle cognitive deficits after both chemotherapy and hormonal therapy. This premise is supported by recent imaging studies, which reveal anatomical changes after chemotherapy as well as changes in patterns of neural activation while performing cognitive tasks. This review suggests that, even when performance on neuropsychological performance measures is within normal limits, BCS may be using increased cognitive resources in the face of reduced cognitive reserve. Potential interventions for cognitive deficits after adjuvant therapy include prescriptions for healthy living, pharmacotherapy, complementary therapy, and cognitive remediation therapy directed toward specific cognitive deficits or a combination of several strategies.

An Integrative Review of Psychosocial Concerns Among Young African American Breast Cancer Survivors

Background: African American (AA) women are more likely to be given a diagnosis of breast cancer at an early age, experience morbidity after treatment, and exhibit disparities in survivorship. Although psychosocial well-being is largely studied among breast cancer survivors, data are sparse regarding young AA survivors. Objective: This integrative review examined psychosocial concerns in survivorship among young AA survivors using a quality-of-life framework. Methods: PubMed, CINHAL, EMBASE, PsychINFO, and Scopus were searched for articles exploring psychosocial well-being in young AA survivors. Results: The search yielded 237 articles that were retrieved and reviewed for relevance. Of these, 16 articles were selected based on inclusion/exclusion criteria. Data were evaluated and synthesized based on the quality-of-life model. Selected articles omitted the study of several psychological subconstructs and identified existing psychosocial concerns that require mitigation. Conclusions: The review revealed key areas of psychosocial concerns among young AA survivors including ongoing anxiety/depression, cognitive changes, and relationships. Identified gaps include paucity of research with young AA survivors and their residual psychosocial concerns. Implications for Practice: Review findings indicate a need to increase survivorship research on young AA survivors. Researchers, clinicians, and young AA survivors must partner in efforts to understand psychosocial concerns and translate findings into clinical practice (ie, use of psychosocial distress tools, distress de-escalation protocols, and individualized survivorship care plans) toward reduction of quality-of-life health disparities among young AA survivors.

The Implementation of a Patient Assistance Program in a Free Clinic Setting: A Case Report.

Abstract:This article describes the implementation of a pharmaceutical Patient Assistance Program in a free clinic, including issues such as navigating complicated pharmaceutical company requirements, obtaining documentation for income verification, engaging healthcare providers, tracking and re-ordering medications, and developing clear expectations for patients. Successes, challenges, and lessons learned are also discussed.

Providing primary care using an interprofessional collaborative practice model: What clinicians have learned

This article details a nurse-led, interprofessional collaborative practice (IPCP) model that was developed to provide primary care to a medically indigent population in Birmingham, Alabama. Funding to develop and implement this project came from a federal Nurse Education, Practice, Quality and Retention award to the University of Alabama at Birmingham (UAB) School of Nursing, with additional support coming from the UAB Hospital and Health System. The clinic is housed within a local community-based, non-profit organization and all services, including supplies and pharmaceuticals, are provided free of charge to this vulnerable population. The IPCP model that was developed includes three primary care teams and incorporates faculty clinicians from a variety of disciplines, including nursing, medicine, optometry, nutrition, mental health, social work and informatics. Evaluation of the project has included annual structured interviews of project personnel, a variety of survey instruments completed electronically at various intervals, and assessments by students as well as patients experiencing team-based care. The focus of this article is the qualitative data collected from structured interviews of clinician faculty annually over the three years of the funded project. The learning, understanding and growth that have taken place by the experienced clinicians from multiple disciplines regarding IPCP are detailed.

Using Data Analytics as Evidentiary Support for Financial Outcome Success in Nurse-Led Population-Based Clinics

Abstract: Achieving the highest quality in health care requires organizations to develop clinical improvements that result in measurable outcomes for success. The purpose of this article is to demonstrate an example of clinical quality improvement through the use of data analytics to generate evidence for financial return on investment in two nurse-led, population-based clinics.

Abstract C24: An integrative review of psychosocial concerns among young African American breast cancer survivors

Background: African American women are more likely to be diagnosed with breast cancer at an early age, more likely to experience morbidity after treatment, and disparities in survivorship. While psychosocial well-being is well known among breast cancer survivors, data are few regarding minorities such as African Americans, particularly those who are young. Objective: This integrative review examines psychosocial concerns in survivorship among young African American breast cancer survivors (YAABCS) using a holistic quality of life framework. Methods: Pubmed, CINHAL, and Scopus were searched for articles exploring psychological or social well-being in YAABCS. Results: The search yielded 264 articles. Thirty-six articles were retrieved and reviewed for relevance. Of these, 14 articles were selected based on inclusion/exclusion criteria. Themes of YAABCS psychosocial concerns were sexuality, mood, social support, and spirituality. Conclusions: The review demonstrated need for further research in YAABCS quality of life to adapt a more fitting quality of life model and to develop culturally-appropriate survivorship interventions. Implications for Practice: Clinicians, researchers, and YAABCS must partner to increase knowledge of the multidimensional survivorship of YAABCS. With knowledge, we may be able to decrease health disparities among YAABCS. The project was funded by an American Cancer Society Doctoral Degree in Nursing Scholarship, Jonas Nurse Leadership Scholarship, and Gladys F. Colvin Doctoral fellowship. Additional support received from a Komen Graduate Training in Disparities Research Award. Citation Format: Timiya S. Nolan, Jennifer Frank, Silvia Gisiger-Camata, Karen Meneses. An integrative review of psychosocial concerns among young African American breast cancer survivors. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C24.