Karen Skalla

Neuropsychologic Impact of Standard-Dose Systemic Chemotherapy in Long-Term Survivors of Breast Cancer and Lymphoma

PURPOSE The primary purpose of this study was to compare the neuropsychologic functioning of long-term survivors of breast cancer and lymphoma who had been treated with standard-dose systemic chemotherapy or local therapy only. PATIENTS AND METHODS Long-term survivors (5 years postdiagnosis, not presently receiving cancer treatment, and disease-free) of breast cancer or lymphoma who had been treated with systemic chemotherapy (breast cancer: n = 35, age, 59.1 +/- 10.7 years; lymphoma: n = 36, age, 55.9 +/- 12.1 years) or local therapy only (breast cancer: n = 35, age, 60.6 +/- 10.5 years; lymphoma: n = 22, age, 48.7 +/- 11.7 years) completed a battery of neuropsychologic and psychologic tests (Center for Epidemiological Study-Depression, Spielberger State-Trait Anxiety Inventory, and Fatigue Symptom Inventory). RESULTS Multivariate analysis of variance, controlling for age and education, revealed that survivors who had been treated with systemic chemotherapy scored significantly lower on the battery of neuropsychologic tests compared with those treated with local therapy only (P <.04), particularly in the domains of verbal memory (P <.01) and psychomotor functioning (P <.03). Survivors treated with systemic chemotherapy were also more likely to score in the lower quartile on the Neuropsychological Performance Index (39% v 14%, P <.01) and to self-report greater problems with working memory on the Squire Memory Self-Rating Questionnaire (P <.02). CONCLUSION Data from this study support the hypothesis that systemic chemotherapy can have a negative impact on cognitive functioning as measured by standardized neuropsychologic tests and self-report of memory changes. However, analysis of the Neuropsychological Performance Index suggests that only a subgroup of survivors may experience long-term cognitive deficits associated with systemic chemotherapy.

Quality of Life of Long-Term Survivors of Breast Cancer and Lymphoma Treated With Standard-Dose Chemotherapy or Local Therapy

PURPOSE This study compared the quality of life (QOL) of long-term survivors of breast cancer and lymphoma who had been treated with standard-dose systemic chemotherapy or local therapy only. PATIENTS AND METHODS Long-term survivors (mean, 10.0 +/- 5.3 years after treatment) of breast cancer or lymphoma who had been treated with systemic chemotherapy (breast, n = 141, age = 57.0 +/- 10.1 years; lymphoma, n = 66, age = 55.8 +/- 13.5 years) or local therapy only (breast, n = 294, age = 65.8 +/- 9.1 years; lymphoma, n = 37, age = 50.4 +/- 12.8 years) were interviewed by phone using the Quality of Life-Cancer Survivors Tool. RESULTS Multivariate analysis of covariance, controlling for sex, age, education, stage of disease, and time since last treatment, revealed that survivors who had been treated with systemic chemotherapy scored significantly lower on overall QOL compared with survivors treated with local therapy only (P = .04). Analysis of covariance on the subscale scores revealed that, compared with survivors who received local therapy, survivors treated with chemotherapy scored significantly lower on the Social subscale (P < .0001), but no differences emerged on the Psychological or Spiritual subscales. There was a statistically significant interaction between treatment and diagnosis (P = .01), as measured by the Physical subscale, indicating that lymphoma survivors treated with chemotherapy scored worse than all other groups. CONCLUSION Important QOL differences emerged between the chemotherapy and local therapy groups, suggesting that long-term QOL may vary depending on the type of treatment and diagnosis.

Patients' Need for Information About Cancer Therapy

PURPOSE/OBJECTIVES To obtain detailed information about the preferences of patients with cancer and their need for information about side effects of cancer treatment to design an interactive multimedia educational program. DESIGN Qualitative. SETTING Regional rural academic medical center. SAMPLE 51 patients and 14 spouses of patients who either currently were undergoing or recently had completed chemotherapy or radiation therapy for cancer. METHODS Focus groups. MAIN RESEARCH VARIABLES Information needs and common and distressing symptoms. FINDINGS Patients wanted information about the process of getting treatment, specific side effects that might occur, and the impact of treatment on their lives. Patients sought information from a variety of sources, but many found that other patients were the most helpful source. Although most patients wanted as much information as possible so they would be prepared for whatever happened, some patients preferred to avoid information about possible side effects. Several obstacles related to information were reported, including access to providers, communication difficulties with providers, informational overload, and problems with retention. CONCLUSIONS Several aspects regarding information needs confirmed previous findings, and new aspects were illuminated. This led to a conclusion that multimedia technology offered many advantages to meet these informational needs. IMPLICATIONS FOR NURSING New approaches to patient education that will meet the needs of patients as well as clinicians and educators need to be developed.

Multidimensional Needs of Caregivers for Patients With Cancer

This pilot study describes the multidimensional (physical, psychological, social, and spiritual) needs of caregivers of cancer survivors. A regional comprehensive cancer center and nine community-based rural and urban cancer clinics in New Hampshire assembled a convenience sample. Patients with cancer completed an online survey, the cancer survivor Web-based needs assessment survey (CS-WEBS), to identify needs and desire for intervention. Patients then identified a caregiver who was recruited to complete a caregiver version of the CS-WEBS. Caregivers reported challenges within all four domains of the survivorship model. The highest reported physical symptoms were fatigue, insomnia, and weight gain. Social symptoms included financial issues. Although visiting nurse services were the most commonly used resource, many caregivers used no supportive services. The most common caregiver task was listening and talking. Caregivers frequently experienced fatigue, anxiety, and insomnia. Exploring effective ways to alleviate their symptom burden should be a priority. Local and national attention should be directed toward easing the financial burden of caring for a patient with cancer.

Spiritual Assessment of Patients With Cancer: The Moral Authority, Vocational, Aesthetic, Social, and Transcendent Model

PURPOSE/OBJECTIVES To explore the nature of spiritual care in patients with cancer and discuss the Moral Authority, Vocational, Aesthetic, Social, and Transcendent (Mor-VAST) Model, a new theoretical model for assessment. DATA SOURCES Published articles, online references. DATA SYNTHESIS Discussions regarding spirituality often do not occur for a variety of reasons but may affect physical and spiritual health of an individual. CONCLUSIONS Assessment of spirituality should be an integral part of cancer care. The Mor-VAST model can assist clinicians in discussing spirituality. IMPLICATIONS FOR NURSING Nurses should be aware of resources for referral to chaplaincy, but they can be a part of the process of spiritual support. Educational opportunities are available for nurses who wish to address their own spirituality so they can address spirituality comfortably and confidently with their patients.

Assessing cancer survivors' needs using web-based technology: A pilot study

Development of cancer survivor resources has been hampered by lack of knowledge regarding survivors’ needs. The main study aim was to pilot test a Web-based cancer survivor needs assessment survey. The second aim was to pilot three sampling approaches. This cross-sectional study was conducted at the Norris Cotton Cancer Center and nine community-based clinics serving urban and rural populations. Population-based and convenience sampling approaches were used to recruit 547 participants over 4 months. Participants completed a Web-based cancer survivor needs assessment survey. Respondents were mainly white (98%), married (71%) women (80%) with a college education (96%). Although most (66%) (n = 362) had been diagnosed with breast cancer, other cancer diagnoses were represented. Participants reported fatigue (47%), forgetfulness (39%), joint pain (34%), anxiety (31%), trouble sleeping (28%), peripheral neuropathy (27%), inflexibility (23%), and weight gain (23%). Survivors with nonbreast solid tumor malignancies reported more problems than those with breast or hematologic malignancies (P range = .037 to <.0001). Most survivors requested assistance for losing weight (74.2%), decreasing fatigue (50%), and improving flexibility (69.3%), sleep (68.5%), and memory (60.2%). Results supported that cancer survivors struggle with many enduring problems. Web-based technology will facilitate future exploration of unmet needs.

Building a collaborative hematology/oncology advanced nursing practice: part I.

This feature provides a platform for oncology nurses to illustrate the many ways that leadership may be realized and professional practice may transform cancer care. Possible submissions include but are not limited to overviews of projects, accounts of the application of leadership principles or theories to practice, and interviews with nurse leaders. Descriptions of activities, projects, or action plans that are ongoing or completed are welcome. manuscripts should clearly link the content to the impact on cancer care. manuscripts should be six to eight double-spaced pages, exclusive of references and tables, and accompanied by a cover letter requesting consideration for this feature. ACHPN, is a nurse practitioner in palliative care service, both in Dartmouth-Hitchcock Medical Centers Norris Cotton Cancer Center at Valley Regional Hospital in Cla-remont, NH. A group of advanced practice nurses (APns) in a comprehensive cancer center met personal and professional challenges by developing an intentional collaborative group practice. The group, comprised of nurse practitioners (nPs) and clinical nurse specialists (cnss), practiced in a comprehensive cancer center with a long history of using APns but no direct APn leadership or purposeful collaboration with other APns. Amidst a rapidly expanding cancer center, the hematology/oncology nPs and cnss faced challenges related to professional development, reporting structure, role, and accountability. This article is the first in a two-part series that describes the development of a collaborative APn group designed to address the challenges. Outcomes from the purposeful collaborative practice will be discussed in part ii. Historically, the model for APn practice at the academic cancer center was based on seven nP and physician subspecialty teams in the outpatient setting. The teams were designated as hematology/oncology disease management groups and practiced relatively independently of each other. Eight nPs functioned in the disease management groups, and one cns practiced on the inpatient oncology unit in a traditional cns role. in addition, two other nPs were members of the palliative care service and practiced regularly in the hematology/oncology setting. The individuals formed the core group that set out to form a new collaborative APn practice. not unlike collaboration negotiations between individual physicians and APns, the group had to identify and integrate multiple personal agendas and fuse them into mutually agreeable goals. The goals were developed in response to issues such as accountability, role identification, clinical practice, education, and academic productivity. role responsibilities for the nPs were quite diverse and encompassed functions typically performed by …

Addressing distress in head and neck cancer patients: A quality improvement project.

43 Background: To better address the emotional needs of cancer patients by improving mental health care in Head and Neck Cancer (HNC) Medical oncology at Norris Cotton Cancer Center, Lebanon, NH, through implementing an evidence-based process for identifying and managing psychological distress. METHODS Using quality improvement methods, mental health care in HNC Medical Oncology was evaluated and revised November 2010 through April 2012. In January 2011, a two-component intervention was put into routine care including 1) the validated National Comprehensive Cancer Network (NCCN) distress thermometer (DT) and 2) a treatment decision algorithm. A licensed nursing assistant administered the DT and providers reviewed results as part of the clinical exam. Heightened distress was defined as a score of ≥ 4. Screening processes were improved through Plan-Do-Study-Act (PDSA) cycles. RESULTS Prior to January 2011, identification of distress was based on providers clinical assessment. Of 104 patients seen between November 2010 and January 2011, 25% (26) were diagnosed with psychological problems. Cause-effect diagraming suggested that lack of a formalized process for distress assessment contributed to missed diagnoses. Providers were unfamiliar with mental health resources. As reported in Psycho-Oncology 21(Suppl. 1): 51(2012) after implementing process changes, bi-weekly distress screening rates rose from 0% to 38% between January and July 2011. With additional PDSA cycles, these rates increased to 74% between October 2011 and April 2012. Similar to proposed benchmarks, 84% (47) of newly diagnosed patients (56) were assessed for distress. Furthermore, of 138 unique patients seen, 71% (98) were screened for distress and 47% (46) of these had heightened distress. Providers addressed the needs of all those identified. Improvement was attributed to the empowerment of staff and participation of senior leadership. Barriers included a heavy reliance on the presence of trained staff. CONCLUSIONS Quality improvement methods can be applied to the cancer setting in order to create systems of care, which more reliably identify and address distress. Teams, however, must be invested in the work and receive support from senior leadership.

Building a collaboration of hematology-oncology advanced practice nurses part II: Outcomes

This feature provides a platform for oncology nurses to illustrate the many ways that leadership may be realized and professional practice may transform cancer care. Possible submissions include, but are not limited to, overviews of projects, accounts of the application of leadership principles or theories to practice, and interviews with nurse leaders. Descriptions of activities, projects, or action plans that are ongoing or completed are welcome. manuscripts should clearly link the content to the impact on cancer care. manuscripts should be six to eight double-spaced pages, exclusive of references and tables, and accompanied by a cover letter requesting consideration for this feature. For more information, contact Associate Editor mary Ellen smith glasgow, PhD, rn, cs, at maryellen .smith.glasgow@drexel.edu or Associate Editor Judith K. Payne, PhD, rn, AOcn, at payne031@mc.duke.edu. Anna D. Schaal, RN, MS, ARNP, is a hematology nurse practitioner, Karen A. Skalla, MSN, ARNP, AOCN, is an oncology nurse practitioner, Tamsin J. Mulrooney, ARNP, PhD, OCN, was an oncology nurse practitioner when the article was written, Diane Stearns, MSN, ARNP, is hematology nurse practitioner, and Ellen M. Lavoie Smith, PhD, APRN-BC, AOCN, is an assistant professor and director of hematology/oncology advanced practice nursing and the Cancer Survivor Program, all in the Norris Cotton Cancer Center at Dartmouth Hitchcock Medical Center in Lebanon, NH. Mulrooney now is a nurse educator for Genentech BioOncology in the New England region of the United States. Mention of specific products and opinions related to those products do not indicate or imply endorsement by the Oncology nursing Forum or the Oncology Nursing Society.