Lena Sharp

Early self-care rehabilitation of head and neck cancer patients

Abstract Conclusions: No positive effects of early preventive rehabilitation could be identified. The results do not contradict the proposition that rehabilitation based on self-care can be effective but it is important to establish evidence-based training programs and identify proper instruments for selection of patients and evaluation of intervention. Objectives: Patients with head and neck cancer suffer from functional impairments due to intense treatment. In this study, we investigated the effectiveness of an experimental early preventive rehabilitation using hard, objective end points in a nonselective, longitudinal, prospective cohort study. Methods: In all, 190 patients were included in the program and received instructions for training before the start of treatment with the aim of reducing swallowing problems and reducing mouth opening and stiffness in the neck. A control group of 184 patients was recruited. Results: There was no difference in weight loss and 2-year survival between the two groups. No positive effects concerning functional impairments were found in patient-reported outcome measures.

Smoking cessation among patients with head and neck cancer: cancer as a 'teachable moment'.

Many cancer patients continue to smoke past diagnosis and treatment, even though smoking in some cases may cause more side effects and increase the risk of treatment failure. We developed and evaluated a nurse-led smoking cessation programme on 50 patients with head and neck (H&N) cancer undergoing radiotherapy (RT) with 1-year follow-up. To evaluate the effectiveness of the programme (proportion of smoke-free patients), smoking status was tested by measuring carbon monoxide in expired air. Thirty-seven patients (74%) were tested smoke-free weekly during the RT period. At the 1-year follow-up visit, 28 patients (68%) were tested smoke-free. The results indicated that even H&N cancer patients with a heavy smoking history and multiple abuses could quit smoking with systematic support but a more sophisticated evaluation including larger study populations and control groups are needed.

Smoking cessation for patients with head and neck cancer: a qualitative study of patients' and nurses' experiences in a nurse-led intervention

Smoking is a major risk factor for head and neck cancer. Smoking during diagnosis and treatment increases risks for disease recurrence, treatment failure, and increased side effects. Despite recommendations, many patients fail to stop smoking. A theory-based nurse-led intervention program was developed to support smoking cessation. This article describes the program itself and presents a framework approach for analysis of unstructured diary notes to understand the experiences of 13 patients and 2 nurses in regard to the program. The results are presented in 3 major categories: the patient-nurse relationship, factors facilitating or hindering behavioral change, and drug (ab)use. The most salient new finding of the study is the importance of a therapeutic patient-nurse relationship on the smoking cessation process, which was recognized in both patient and nurse diaries. These findings lend further support to known benefits of nurse-led interventions. The situation in Sweden, with radiation therapy given by specialist nurses, allows a unique possibility to integrate smoking cessation programs with existing cancer care. This has made it possible to determine when the patient is well-motivated for change, to balance the smoking cessation process with other care needs, and to view smoking cessation as an intrinsic part of the patients anticancer treatment.

A case study to evaluate a new soft silicone dressing, Mepilex Lite, for patients with radiation skin reactions.

Radiation skin reactions are a known side effect of radiation therapy. Moist desquamation reactions are not only painful but also may be a focus for infection and can be dose limiting. There is a challenge to find a dressing which is protective, comfortable, and a traumatic to delicate irradiated skin. The primary aim of this study was to evaluate patient comfort when using Mepilex Lite in the management of dry and moist desquamation. Secondary objectives included safety, tolerance, and influence on healing. Sixteen patients were recruited at 2 centers in the United Kingdom and in Sweden when they had a RTOG score of 3 and 1 symptom measured by the Radiation-Induced Skin Reaction Assessment tool. Digital photography was used at each weekly visit. Patients completed the Radiation-Induced Skin Reaction Assessment, daily diary cards, and open diaries for quantitative and qualitative evaluation. Some patients found that the dressing minimized pain during dressing changes and was easily lifted and adjusted without loss of adherent properties. A new dressing had a soothing or cooling effect on the skin, and some reported a more normal sleep pattern. The dressing had no negative effect on wound healing. The researchers conclude that the dressing provides a promising alternative to existing dressings and is worthy of further research.

Morbidity of supraomohyoidal and modified radical neck dissection combined with radiotherapy for head and neck cancer : a prospective longitudinal study

The purpose of this study was to show the investigated impact of supraomohyoidal neck dissection and modified radical neck dissection, both combined with radiotherapy, on cervical range of motion (CROM), mouth opening, swallowing, lymphedema, and shoulder function.

When does my treatment start? - The continuum of care for patients with head and neck cancer

BACKGROUND AND PURPOSE The clinical workup of patients with head and neck (H&N) cancer is often time-consuming. The overall time involved is obviously important to the treatment results, since delays in time can increase the risk for clinical upstaging resulting in a worse outcome. Although for ethical considerations, time delay is impossible to study in randomised trials. Major reorganisations for this group of patients have taken place in Stockholm during the 1990s. In this study, we measured the duration of the overall continuum of care experienced by the patients, in different time periods during the 1990s. MATERIALS AND METHODS Two hundred and two patients from the population base of southern Stockholm were identified during different time periods. The continuum of care was identified as the period between the first presentation of the patient to the health care system to the first date of the patients treatment for his/her cancer. This period was divided into several intervals reflecting the patients perspective of his or her continuum of care. These intervals were then compared. RESULTS Median time from first consultation to start of treatment increased between 1994 and 1999 from 67 to 89 days (P = 0.018). The increase of time occurred from referral from first care provider to ENT-specialist, from first visit to ENT-specialist to date of diagnosis. CONCLUSIONS Different parameters such as duration of the continuum of care must be monitored before and after reorganisations.

Intention to leave the workplace among nurses working with cancer patients in acute care hospitals in Sweden

PURPOSE To examine associations between perceived leadership and intention to leave the workplace due to job dissatisfaction among registered nurses (RNs) who care for patients with cancer. We also examine intention to leave in relation to proportion of cancer patients, length of time in practice, perceived adequacy of cancer care education, and burnout. METHODS AND SAMPLE The data originated from the Swedish component of RN4CAST, based on a survey of RNs working with in-patient care in all acute care hospitals in Sweden. The 7412 RNs reporting ≥10% patients with cancer on their unit were included in this analysis. Data were collected on perceptions of work environment, burnout, future employment intentions, and demographic characteristics. Additional questions related to cancer care. KEY RESULTS About 1/3 of all RNs intended to leave their workplace within the next year. Intention to leave was more prevalent among RNs reporting less favourable perceptions of leadership, who had worked ≤ two years as RN, who reported having inadequate cancer care education, and with higher burnout scores. Associations between leadership and intention to leave were stronger among RNs in the profession > two years, who reported having adequate cancer care education, and with lower burnout scores. CONCLUSIONS Perception of leadership is strongly associated with intention to leave among RNs in both specialized and general cancer care. This suggests a crucial area for improvement in order to reduce turnover rates.

Frequency and severity of skin reactions in patients with breast cancer undergoing adjuvant radiotherapy, the usefulness of two assessment instruments - a pilot study.

Acute radiation skin reactions (ARSR) are a major problem in curative radiotherapy (RT). A number of studies have failed to show a positive effect of different skin care products to reduce or prevent ARSR. The aims for this study were to describe frequency and severity of ARSR in patients with breast cancer undergoing adjuvant RT and to test the suitability in clinical use of two assessment instruments. A majority (93%) of the 93 patients with breast cancer included in this study developed ARSR, most of them mild reactions. Low scores for pain and itching (VAS) were reported. ARSR were assessed using the modified version of RTOG/EORTC acute radiation morbidity scoring criteria and the World Health Organisation (WHO) grading system for acute and subacute toxicity by two independent observers after the completion of RT. The percentages of discordant assessment between the two observers were 21% for the WHO scale and 32% for the RTOG/EORTC. Severe ARSR, classified as grades 2-4 on both instruments resulted in good agreement between the two instruments. However, the assessments using RTOG/EORTC resulted in an almost 10% higher proportion of severe ARSR. Comparisons of health related quality of life and sleep revealed no statistically significant differences between patients with mild or severe ARSR assessed by the RTOG/EORTC scale with the exception of cognitive functioning. The use of assessment instruments to describe treatment-related symptoms is complicated and clinical experience is not always enough. More research is needed to validate these instruments to guarantee sound and precise assessments.

'Why is there another person's name on my infusion bag?' Patient safety in chemotherapy care - a review of the literature.

PURPOSE Approximately 10% of all patients is in some way harmed by the health care system. Risk factors have been identified and patients with cancer are at high risk due to the seriousness of the disease, co-morbidity, often old age, high risk treatments such as chemo and radiotherapy. Therefore, a closer look on safety for patients undergoing chemotherapy is needed. The aim of this study was to identify and evaluate interventions for improved patient safety in chemotherapy care. METHOD We undertook a review of the available evidence regarding interventions to improve patient safety in relation to chemotherapy care. RESULTS We found 12 studies describing the following interventions; 1) Computerized Prescription Order Entry (CPOE), 2) Failure Mode and Effect Analysis (FMEA) and Lean Sigma, 3) Error reporting and surveillance systems, 4) Administration Checklist and 5) Education for nurses. Even if all five interventions showed positive effects in patient safety, the evidence level is rather weak due to design, sample size and the difficulties involved measuring patient safety issues. CONCLUSIONS Three studies with fairly high evidence level showed that computerized chemotherapy prescriptions were significantly safer than manual prescriptions and could therefore be recommended. For the other remaining interventions, more research is needed to assess the effect on improved patient safety in chemotherapy care. There is a need for more rigorous studies with sophisticated design for generating evidence in the field.

Care Diaries: A Way of Increasing Head and Neck Cancer Patient's Involvement in Their Own Care and the Communication Between Clinicians

Head and neck (H&N) cancer patients and their families meet a large number of clinicians during their long treatment period and many of them find it difficult to understand all the information given concerning their illness, treatment, and care. We have developed a care diary for these patients and their families, used also by the clinicians involved, to improve communication and patient involvement. The present survey was an evaluation of the helpfulness of those diaries. Anonymous answered questionnaires were collected from 42 H&N cancer patients, 28 family members, and 47 clinicians of different categories. Altogether 85% of the respondents stated that the care diaries had a positive effect on information, in general, and communication. It is recommended that care diaries should be implemented in the standard care for H&N cancer patients and their families. To improve the clinical value, it is particularly important to inform the clinicians on how to use the care diaries. The content and layout of the care diaries needs to be developed according to suggestions given from the respondents in this survey.