Susan M. Schneider

The influence of uncertainty in illness, stress appraisal, and hope on coping in survivors of breast cancer.

On the basis of Mishel’s uncertainty in illness theory, Lazarus and Folkman’s stress on appraisal and coping, and Herth’s perspective of hope, this cross-sectional, correlational study was designed to examine the influence of uncertainty, stress appraisal, and hope on coping in 71 survivors of breast cancer. Uncertainty was measured by the Mishel Uncertainty in Illness: Community Scale, stress appraisal by the Stress Appraisal Index, hope by the Herth Hope Index, and coping by the Ways of Coping Questionnaires (WCQ).

Chemotherapy-Induced Nausea and Vomiting

Nausea and vomiting (N&V) is among the most distressing side effects of chemotherapy, despite the development of more efficacious antiemetic agents. As many as 60% of patients who receive cancer chemotherapy experience some degree of N&V. However, the actual incidence is difficult to determine with accuracy because of the variety of drugs, doses, and health conditions of the patients who receive cancer treatments. This article examines the state of the science related to chemotherapy-induced nausea and vomiting and reviews both pharmacologic and behavioral strategies that have demonstrated efficacy in managing these distressing symptoms.

Virtual Reality Intervention for Older Women with Breast Cancer

This study examined the effects of a virtual reality distraction intervention on chemotherapy-related symptom distress levels in 16 women aged 50 and older. A cross-over design was used to answer the following research questions: (1) Is virtual reality an effective distraction intervention for reducing chemotherapy-related symptom distress levels in older women with breast cancer? (2) Does virtual reality have a lasting effect? Chemotherapy treatments are intensive and difficult to endure. One way to cope with chemotherapy-related symptom distress is through the use of distraction. For this study, a head-mounted display (Sony PC Glasstron PLM - S700) was used to display encompassing images and block competing stimuli during chemotherapy infusions. The Symptom Distress Scale (SDS), Revised Piper Fatigue Scale (PFS), and the State Anxiety Inventory (SAI) were used to measure symptom distress. For two matched chemotherapy treatments, one pre-test and two post-test measures were employed. Participants were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and received no distraction intervention (control condition) during an alternate chemotherapy treatment. Analysis using paired t-tests demonstrated a significant decrease in the SAI (p = 0.10) scores immediately following chemotherapy treatments when participants used VR. No significant changes were found in SDS or PFS values. There was a consistent trend toward improved symptoms on all measures 48 h following completion of chemotherapy. Evaluation of the intervention indicated that women thought the head mounted device was easy to use, they experienced no cybersickness, and 100% would use VR again.

Interventions to Promote Adherence With Oral Agents

OBJECTIVES The advent of oral therapies has dramatically changed the landscape of cancer therapy. Yet the degree to which patients actually take the prescribed agents as ordered remains unknown. This article outlines the challenges that oral chemotherapy agents present to both patients and providers and suggests interventions for promoting adherence. DATA SOURCES Published articles and web resources. CONCLUSION Barriers and facilitators to medication adherence are reviewed and interventions to promote medication adherence are presented. Strategies that include patient education and symptom management can promote adherence. IMPLICATIONS FOR NURSING PRACTICE Maximizing adherence to oral chemotherapy agents can have many positive outcomes, but most important is improvement in overall survival and life expectancy. Other outcomes include improved safety and quality of life. Patients risk improper dosing and an increase in disease recurrence when there is nonadherence with medications. Correct dosing, education, and symptom management are all critical to ensuring adherence. Nursing interventions that incorporate education, early symptom identification, and reminder prompts can improve outcomes.

Effects of virtual reality on symptom distress in children receiving chemotherapy.

This study tested the premise that virtual reality (VR) as a distraction intervention could mitigate chemotherapy-related symptom distress in children with cancer aged 10-17 years. Cancer treatments are intensive and difficult to endure. Distraction interventions are effective because the individual concentrates on pleasant or interesting stimuli instead of focusing on unpleasant symptoms. VR as a distraction intervention is both immersive and interactive. For this study the individual wore a Virtual IO(R) headset during a single intravenous chemotherapy treatment. Participants chose one of three commercially available, CD ROM-based scenarios: Magic Carpet, Sherlock Holmes Mystery, and Seventh Guest(R). An interrupted time series design with removed treatment was used to answer these research questions: (1) Is VR an effective distraction intervention for reducing chemotherapy-related symptom distress in children? and (2) Does VR have a lasting effect? The convenience sample consisted of 11 children receiving outpatient chemotherapy. The Symptom Distress Scale (SDS) and the State-Trait Anxiety Inventory for Children (STAIC-1) were used to measure the dependent variable of symptom distress. Repeated-measures ANOVA were used for data analysis. Data analysis of the SDS suggested that the VR intervention was effective at reducing the level of symptom distress immediately following the chemotherapy treatment (p <.10), but did not have a lasting effect. Analysis of the STAIC-1 demonstrated high levels of anxiety during the initial chemotherapy treatment that decreased during subsequent treatments. State anxiety levels were not influenced by the VR intervention. This study supports the application of VR as a distraction intervention.

A Prospective Randomized, Placebo-Controlled Skin Care Study in Women Diagnosed With Breast Cancer Undergoing Radiation Therapy

PURPOSE/OBJECTIVES To compare the effectiveness of three different skin care products versus a placebo in reducing the incidence of radiation therapy-induced skin reactions prophylactically. DESIGN Prospective randomized, double-blinded, placebo-controlled study. SETTING A radiation oncology department at a National Cancer Institute-designated comprehensive cancer center in the southeastern United States. SAMPLE 208 women with breast cancer who were to receive whole breast radiation therapy. METHODS Patients were invited to participate after radiation therapy was documented as part of their treatment plan. Patients applied a skin care product starting on the first day of treatment and were assessed weekly by their radiation oncology nurse. MAIN RESEARCH VARIABLES Skin reaction score and skin product. FINDINGS None of the products were statistically better than placebo in preventing skin reactions. Increases in skin reaction over time did not vary with treatment group for the linear (p = 0.16) and nonlinear (p = 0.94) effects of time and for both time components tested together (p = 0.41). CONCLUSIONS Ninety-five percent of women participating in this study experienced a radiation therapy-induced skin reaction. IMPLICATIONS FOR NURSING The development of guidelines to support safe patient care is encouraged because patients prefer to take action rather than do nothing. However, the findings do not demonstrate improved clinical outcomes with the use of skin care products. Healthcare providers should proactively educate patients about acute skin reactions and self-care strategies to minimize skin breakdown.

Effect of virtual reality on time perception in patients receiving chemotherapy

PurposeVirtual reality (VR) during chemotherapy has resulted in an elapsed time compression effect, validating the attention diversion capabilities of VR. Using the framework of the pacemaker–accumulator cognitive model of time perception, this study explored the influence of age, gender, state anxiety, fatigue, and cancer diagnosis in predicting the difference between actual time elapsed during receipt of intravenous chemotherapy while immersed in a VR environment versus patient’s retrospective estimates of time elapsed during this treatment.Materials and methodsThis secondary analysis from three studies yielded a pooled sample of N = 137 participants with breast, lung, or colon cancer. Each study employed a crossover design requiring two matched intravenous chemotherapy treatments, with participants randomly assigned to receive VR during one treatment. Regressions modeled the effect of demographic variables, diagnosis, and Piper Fatigue Scale and State Anxiety Inventory scores on the difference between actual and estimated time elapsed during chemotherapy with VR.ResultsIn a forward regression model, three predictors (diagnosis, gender, and anxiety) explained a significant portion of the variability for altered time perception (F=5.06, p = 0.0008). Diagnosis was the strongest predictor; individuals with breast and colon cancer perceived time passed more quickly.ConclusionsVR is a noninvasive intervention that can make chemotherapy treatments more tolerable. Women with breast cancer are more likely and lung cancer patients less likely to experience altered time perception during VR (a possible indicator of effectiveness for this distraction intervention). Understanding factors that predict responses to interventions can help clinicians tailor coping strategies to meet each patient’s needs.

Gefitinib (Iressa¿, ZD1839) and Tyrosine Kinase Inhibitors: The Wave of the Future in Cancer Therapy

Targeted therapies are one of the latest innovative trends in cancer therapy. The epidermal growth factor receptor (EGFR) is a target found in high concentrations in several solid tumors including lung, breast, colorectal, and brain. Tyrosine kinase inhibitors, such as gefitinib (IressaTM, ZD1839), block the EGFR. As a result, there is inhibition of cellular proliferation, promotion of apoptosis, and inhibition of anti-angiogenesis. Gefitinib has demonstrated significant efficacy in non-small-cell lung cancer (NSCLC), leading to FDA approval for treatment of this refractory disease. Phase 2 trials with gefitinib for platinum refractory NSCLC reported disease response and symptom improvement. Early results of phase 2 studies of gefitinib, combined with standard chemotherapy in colorectal cancer, showed a 75% response rate compared with 55% with standard therapy alone. Gefitinib, combined with flutamide, produced an additive growth inhibition in prostate cancer. A phase 2 trial of gefitinib in first-relapse glioblastoma multiforme demonstrated median overall survival from treatment start of 39.4 weeks compared with 40 weeks with standard chemotherapy. Gefitinib is an oral agent with a mild toxicity profile, and thus, may be an optimal addition to chemotherapeutic regimens for some solid tumors. Gefitinib is potentially a vital and useful weapon in the arsenal of cancer therapies.

Evaluation of a Cancer Survivorship Protocol

This article describes the implementation and evaluation of a survivorship protocol for cancer survivors to improve knowledge about their disease and decrease anxiety. The study included a convenience sample of 30 cancer survivors at an outpatient community cancer center in the southeastern United States following completion of acute oncology treatment. One month after the survivorship protocol was delivered, knowledge about diagnosis, treatments, recommended follow-up, signs of recurrence, and late side effects increased. Anxiety scores were lower one month after the intervention, and satisfaction with the protocol was high. The results demonstrated that the survivorship protocol is a feasible method of educating cancer survivors, supporting the Institute of Medicines recommendation that strategies for delivering education to cancer survivors are important. Survivors have additional needs that must be addressed following treatment, and a survivorship protocol can provide the knowledge survivors need to participate in their own health care.

PCA safety data review after clinical decision support and smart pump technology implementation.

Introduction Medication errors account for 20% of medical errors in the United States with the largest risk at prescribing and administration. Analgesics or opioids are frequently used medications that can be associated with patient harm when prescribed or administered improperly. In an effort to decrease medication errors, Duke University Hospital implemented clinical decision support via computer provider order entry (CPOE) and “smart pump” technology, 2/2008, with the goal to decrease patient-controlled analgesia (PCA) adverse events. Methods This project evaluated PCA safety events, reviewing voluntary report system and adverse drug events via surveillance (ADE-S), on intermediate and step-down units preimplementation and postimplementation of clinical decision support via CPOE and PCA smart pumps for the prescribing and administration of opioids therapy in the adult patient requiring analgesia for acute pain. Discussion Voluntary report system and ADE-S PCA events decreased based upon 1000 PCA days; ADE-S PCA events per 1000 PCA days decreased 22%, from 5.3 (pre) to 4.2 (post) (P = 0.09). Voluntary report system events decreased 72%, from 2.4/1000 PCA days (pre) to 0.66/1000 PCA days (post) and was statistically significant (P < 0.001). There was a difference in the ADE-S data for causality (P < 0.0001) with sleep apnea and renal insufficiency approaching significance. Voluntary report system safety event were statistically significant for obesity [body mass index (BMI) ≥30] and weight. Conclusion This study demonstrated a decrease in PCA events between time periods in both the ADE-S and voluntary report system data, thus supporting the recommendation of clinical decision support via CPOE and PCA smart pump technology.