Sherry A. Looker

Are Cancer Survivors/Patients Knowledgeable about Osteoporosis? Results from a Survey of 285 Chemotherapy-Treated Cancer Patients and Their Companions.

OBJECTIVE This study assessed osteoporosis knowledge deficits among cancer patients and their spouses/partners. DESIGN Single-institution survey (modified version of the Osteoporosis Knowledge Assessment Tool). SETTING The Mayo Clinic in Rochester, Minnesota. PARTICIPANTS Consecutive chemotherapy-treated cancer patients (n = 285) with their spouses/partners (n = 101). OUTCOME MEASURES The main outcome was the percentage of cancer patients who incorrectly conveyed that 1) cancer treatment strengthens bones (or did not know) and/or 2) male cancer patients are not at risk for osteoporosis (or did not know). ANALYSES Test scores and 95% confidence intervals (CI) as well as the correlation between patient and spouse/partner scores, are reported. RESULTS 39% of patients (95% CI, 32% - 48%) thought cancer treatment strengthened bones or did not know, and 39% (95% CI, 32% - 48%) either answered that osteoporosis almost never occurred in men or did not know. The mean correct score on the modified Osteoporosis Knowledge Assessment Tool was 6.7 (95% CI, 6.7, 7.9), and scores from patients correlated with companion scores (r = 0.42; P < .001). CONCLUSIONS AND IMPLICATIONS Chemotherapy-treated cancer patients and their companions have knowledge deficits concerning osteoporosis. Educational initiatives to increase awareness may be of value.

Cancer patients' and patient advocates' perspectives on a novel information source : A qualitative study of The Art of Oncology, When the Tumor Is Not the Target

Kristin S. Vickers, Section of Patient Education and Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN Julie C. Hathaway, Section of Patient Education, Mayo Clinic, Rochester, MN Christi A. Patten and Matthew M. Clark, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN Teresa L. Britt, Nursing Research, Mayo Clinic, Rochester, MN Sherry A. Looker, Department of Medical Oncology, Mayo Clinic, Rochester, MN Phaedra T. Johnson, Department of Psychology, University of Wisconsin-Stout, Menomonie, WI Charles L. Loprinzi, Department of Medical Oncology, Mayo Clinic, Rochester, MN

Cancer Patients and Their Companion Animals: Results from a 309-Patient Survey on Pet-Related Concerns and Anxieties During Chemotherapy

The purpose of this study was to explore whether cancer patients, who are actively receiving cancer therapy and who sometimes have only a few months to live, have anxieties or concerns that arise as a result of not being able to care for their pets during their illness or after their demise. A survey was developed and utilized among such patients to assess whether they had pet-related concerns and anxieties and to determine whether they desired more information on available pet-related resources. Three hundred nine patients completed the survey, and 170 (55%) had a pet(s). The majority described that their pets helped them during their cancer. Only 4% of all patients and 7% of the pet owners desired more information on community resources for pet care, and 80% of pet owners had family members who were already helping them with pet care. Cancer patients appear to benefit from their pets and report few pet-related concerns. Healthcare providers at other medical centers should consider determining whether their patients have needs and anxieties related to caring for their pets and whether educational efforts should be put forth to focus on such issues.

Capecitabine and Temozolomide: Design, Implementation, and Preliminary Outcomes From a Pilot Project to Ensure Safe Prescribing of Oral Chemotherapy

Without adequate safety measures, oral chemotherapy can lead to undetected dosing errors. The Mayo Clinic launched a project to ensure that all capecitabine and temozolomide prescriptions receive an independent double check.

Hand Massage for Cancer Patients Undergoing Chemotherapy as Outpatients: A Pilot Study

Context There are no studies on the effect of volunteer‐provided hand massage in a busy chemotherapy outpatient practice. Objective To assess the feasibility of introducing hand massage therapy into an outpatient chemotherapy unit and to evaluate the effect of the therapy on various symptoms experienced by cancer patients. Design A pilot, quasi‐experimental, pretest–posttest study. Setting Chemotherapy outpatient clinic of a large tertiary care academic medical center. Patients/Participants Forty chemotherapy outpatients. Intervention After being approached by a trained volunteer from a hand massage team, patients consented to receive a 20‐minute hand massage before chemotherapy that was individualized according to patient preference and expressed needs. Main Outcome Measures The visual analog scale (VAS) was used to measure pain, fatigue, anxiety, muscular discomfort, nervousness, stress, happiness, energy, relaxation, calmness, and emotional well‐being (on a scale from 0–10) before and after the intervention; a satisfaction survey was administered after the therapy. Patients’ demographic data were summarized with descriptive statistics, and VAS total scores were compared between groups at each time point with the two‐group t test. Feasibility was evaluated from the number of patients who were approached, received a hand massage, and completed the study surveys. Results Of the 40 participants, 19 were men (mean age, 59.5 years). Significant improvement after hand massage was indicated by VAS scores for fatigue, anxiety, muscular discomfort, nervousness, stress, happiness, energy, relaxation, calmness, and emotional well‐being (P < .05). Pain scores also improved, but the difference was not statistically significant (P = .06). All patients indicated that they would recommend hand massage to other patients, and 37 were interested in receiving it during their next chemotherapy treatment.

Chemotherapy Acute Infusion Reactions: A Qualitative Report of the Perspectives of Patients With Cancer

Objective: A growing number of cancer antineoplastic agents can cause life-threatening acute infusion reactions. Because previous studies have not studied these reactions from the perspective of patients, this study was undertaken with that objective in mind. Methods: Patients who had an acute infusion reaction were interviewed based on the Leventhal model. Once saturation of content was achieved, interviews were transcribed and analyzed with qualitative methodology. Results: Twenty-one patients were enrolled. Most were women (n = 15); the median age was 58 years, and paclitaxel was the most common inciting agent. Three themes emerged. First, these reactions are frightening; patients made remarks such as “I was just thinking oh my God, I am dying.” Second, prior education about these reactions seemed to mitigate this fear, “Basically everything the nurses told me potentially could happen, like happened. So, I was prepared.” Third, when health-care providers were prompt and attentive during the reaction, patients described less fear with future chemotherapy, “So no, I’m really not fearful about going in tomorrow because I know they’ll be there and they’ll be watching me.” Conclusion: These reactions evoke fear which can be mitigated with education prior to and with prompt responsiveness during the acute infusion reaction.

Alternative Outpatient Chemotherapy Scheduling Method to Improve Patient Service Quality and Nurse Satisfaction

INTRODUCTION Optimal scheduling and calendar management in an outpatient chemotherapy unit is a complex process that is driven by a need to focus on safety while accommodating a high degree of variability. Primary constraints are infusion times, staffing resources, chair availability, and unit hours. METHODS We undertook a process to analyze our existing management models across multiple practice settings in our health care system, then developed a model to optimize safety and efficiency. The model was tested in one of the community chemotherapy units. We assessed staffing violations as measured by nurse-to-patient ratios throughout the workday and at key points during treatment. Staffing violations were tracked before and after the implementation of the new model. RESULTS The new model reduced staffing violations by nearly 50% and required fewer chairs to treat the same number of patients for the selected clinic day. Actual implementation results indicated that the new model leveled the distribution of patients across the workday with an 18% reduction in maximum chair utilization and a 27% reduction in staffing violations. Subsequently, a positive impact on peak pharmacy workload reduced delays by as much as 35 minutes. Nursing staff satisfaction with the new model was positive. CONCLUSION We conclude that the proposed optimization approach with regard to nursing resource assignment and workload balance throughout a day effectively improves patient service quality and staff satisfaction.

Should Vital Signs Be Routinely Obtained Prior to Intravenous Chemotherapy? Results From a 2-Center Study.

BACKGROUND The American Society of Clinical Oncology and the Oncology Nursing Society have issued guidelines stating that the vital signs of patients should be routinely checked on days that intravenous chemotherapy is administered. This study sought evidence to justify this approach. METHODS This trial focused on consecutive patients with cancer from 2 institutions and evaluated outcomes during the first cycle of gemcitabine-based chemotherapy. The primary end point of the study was a visit to the ED, hospitalization, or death during the first cycle of chemotherapy. RESULTS Medical records from 1,158 patients were reviewed, and vital signs were checked in 589 patients on day 1 and in 486 on day 8. A total of 148 patients (12.8%) were evaluated in the emergency department (ED), 145 (12.5%) were hospitalized, and 11 (0.9%) died during their first cycle of chemotherapy. In multivariate analyses, which were adjusted for age, sex, cancer type, role of chemotherapy, number of chemotherapy drugs administered on day 1, and institution, checking vital signs on day 1 was associated with neither higher rates of ED visits nor with increased hospitalization; however, checking vital signs on day 8 was associated with higher rates of ED visits (odds ratio [OR]: 3.71; 95% confidence interval [CI]: 2.18-6.22; P < .0001) and higher rates of hospitalizations (OR: 3.98; 95% CI: 2.34-6.73; P < .0001). CONCLUSION This study suggests a need for additional, evidence-based data to support the routine checking of vital signs prior to administering cancer chemotherapy.