Susan Storey

COPING STRATEGIES AND INTERVENTIONS FOR COGNITIVE CHANGES IN PATIENTS WITH CANCER

OBJECTIVES To provide a comprehensive summary of the coping strategies and evidence-based interventions used to address cognitive impairment following cancer and cancer treatment. DATA SOURCES Review and synthesis of empirical articles. CONCLUSION Survivors identified a structured environment and validation of their cognitive concerns as essential to adjustment. Although interventional research is still limited, non-pharmacological approaches such as cognitive training programs show the greatest promise. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses must understand the available evidence and provide information and guidance to cancer survivors to address cognitive changes after cancer.

Impact of Malglycemia on Clinical Outcomes in Hospitalized Patients With Cancer: A Review of the Literature

PURPOSE/OBJECTIVES To examine empirical research regarding the role of malglycemia (hyperglycemia, hypoglycemia, or glycemic variability) on clinical outcomes among hospitalized patients with cancer. DATA SOURCES Research articles were obtained from the Ovid, PubMed, and CINAHL® databases. Key words used in the search included hyperglycemia or malglycemia and neoplasm combined with venous thromboembolism, infection, or mortality. DATA SYNTHESIS Eleven research articles were examined reporting the impact of malglycemia on various outcomes, including infection, mortality or survival, length of hospital stay, and toxicity. CONCLUSIONS Findings suggest that malglycemia may have a negative impact on outcomes for hospitalized patients with cancer. Increased rates of infection, mortality, length of stay, and toxicities, as well as decreased survival, were reported. IMPLICATIONS FOR NURSING Oncology nurses play an important role in the identification of patients with malglycemia. Early assessment and intervention for those patients can improve outcomes and quality of life.

A comparative evaluation of antimicrobial coated versus nonantimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial

BACKGROUND Central line-associated bloodstream infections (CLABSIs) are a common life-threatening risk factor associated with central venous catheters (CVCs). Research has demonstrated benefit in reducing CLABSIs when CVCs coated with antimicrobials are inserted. The impact of chlorhexidine (CHG)-impregnated versus non-CHG peripherally inserted central catheters (PICCs) on risk of CLABSI is unknown. Venous thromboembolism (VTE) is also a complication associated with CVCs. This study compares the impact of both PICC lines on these outcomes. METHODS Patients in 3 high-risk units were randomly assigned to receive either a CHG-impregnated or non-CHG PICC line. Laboratory data were collected and reviewed daily on all study patients. The PICC dressing site was assessed daily. Medical record documentation was reviewed to determine presence of CLABSI or VTE. RESULTS There were 167 patients who completed the study. Three patients developed CLABSI (2 in the CHG group, and 1 in the non-CHG group), and 3 patients developed VTE (2 in the non-CHG group, and 1 in the CHG group). No significant relationship was noted between the type of PICC line on development of a CLABSI (P = .61) or VTE (P > .99). A significant difference was noted in moderate bleeding (P ≤ .001) requiring thrombogenic dressing in the patients who had the CHG PICC line. CONCLUSIONS No differences were noted in the development of CLABSI and VTE between the CHG and non-CHG groups.

Relationship of Self-reported Attentional Fatigue to Perceived Work Ability in Breast Cancer Survivors

Background: Breast cancer survivors (BCSs) have identified attentional fatigue, a decrease in the ability to focus, as a persistent daily challenge; however, little is known regarding its impact on work ability. Objective: The purpose of this study was to examine the relationship between attentional fatigue and perceived work ability in BCSs controlling for the known covariates of age, education, household income, and time posttreatment. Methods: A cross-sectional, descriptive design was used. Breast cancer survivors who were currently employed and at least 1 year post–adjuvant treatment participated. Breast cancer survivors completed the Attentional Function Index and Work Ability Index questionnaires. Descriptive statistics, linear regression, and Fisher exact test were used for analysis. Results: Sixty-eight female BCSs, ranging from 29 to 68 years of age (mean, 52.1 [SD, 8.6]) and on average 4.97 (SD, 3.36) years posttreatment, participated. More than one-fourth of BCSs (26.5%) reported poor to moderate perceived work ability, indicating substantial concerns regarding work performance. Attentional fatigue was found to significantly predict perceived work ability (P < .001), explaining 40% of the variance of perceived work ability. Conclusions: Attentional fatigue is a prevalent symptom posttreatment that is negatively related to perceived work ability in BCSs. Implications for Practice: Nurses are in a prime position to assess and intervene to alleviate attentional fatigue to improve work ability. Findings suggest a need for individual, comprehensive survivorship care plans to effectively address symptoms that impact work ability and, ultimately, the quality of life of cancer survivors.

Impact of hyperglycemia and age on outcomes in patients with acute myeloid leukemia

PURPOSE/OBJECTIVES To examine the prevalence and impact of hyperglycemia on health outcomes (number of neutropenic days, infection, and hospital length of stay) in patients hospitalized for acute myeloid leukemia (AML) receiving initial induction therapy.
. DESIGN Retrospective, descriptive study.
. SETTING A large urban hospital in Indianapolis, Indiana.
. SAMPLE 103 patients with AML and a subset of 41 patients aged 65 years or older. 
. METHODS Demographics and medical information were extracted from electronic health records. Serum-fasting blood glucose was used to assess glycemic status. The association of hyperglycemia with the health outcomes was analyzed. A subset of patients aged 65 years or older was also analyzed.
. MAIN RESEARCH VARIABLES Hyperglycemia, age, and health outcomes in patients with AML.
. FINDINGS Forty patients experienced hyperglycemia during initial induction for AML. In the larger sample, no associations were noted between hyperglycemia and health outcomes. A significant relationship (p = 0.022) was noted between hyperglycemia and infection in patients aged 65 years or older. Patients aged 65 years or older had 5.6 times the risk of developing infection as those aged younger than 65 years. Although not statistically significant, patients aged 65 years or older with hyperglycemia had 2.5 more days of neutropenia and 1.5 days longer hospital length of stay. 
. CONCLUSIONS This study provides preliminary evidence that hyperglycemia is prevalent during initial induction for AML and may have harmful consequences, particularly for patients aged 65 years or older. More research is needed to determine clinically significant levels of hyperglycemia and their impact on health outcomes.
. IMPLICATIONS FOR NURSING Oncology nurses can assess and proactively collaborate with members of the healthcare team to implement strategies to prevent or mitigate the harmful consequences of hyperglycemia.

Measurement of hyperglycemia and impact on health outcomes in people with cancer: Challenges and opportunities

PROBLEM IDENTIFICATION Poor health outcomes have been associated with hyperglycemia in patients with and without diabetes. However, the impact of hyperglycemia on the health-related outcomes of patients with cancer has shown conflicting results. The purpose of this review was to explore definitions and measurement issues related to the assessment of hyperglycemia and the subsequent impact on the findings of health-related outcomes in adults with cancer.
. LITERATURE SEARCH Four electronic databases were searched. DATA EVALUATION A total of 30 articles were reviewed. Quantitative articles were synthesized using integrative review strategies. 
. SYNTHESIS Three key gaps were identified in the literature. CONCLUSIONS This review highlights the inconsistencies in measuring or assessing hyperglycemia and the lack of standardized guidelines in treating hyperglycemia. Failure to have a standard approach to the measurement and management of hyperglycemia impedes the ability of healthcare providers to determine the significance of its impact on health outcomes. Further research is needed to establish appropriate measurement guidelines to address hyperglycemia in people with cancer.
. IMPLICATIONS FOR PRACTICE Evidence-based measurement and treatment guidelines are needed to inform and assist healthcare providers with clinical decision making for people with cancer who experience hyperglycemia.

Addressing cognitive impairment after breast cancer: What do women want?

Purpose: Cognitive symptoms in breast cancer survivors (BCSs) are common and have a disruptive impact on daily life. Breast cancer survivors frequently engage in self-management strategies to lessen the impact of these cognitive symptoms. There is little information from the perspective of BCS as to their preference of interventions. The purpose of this study was to explore how BCSs cope and self-manage the symptoms associated with cognitive changes, their preferences for the type of intervention(s), and perceived facilitators and barriers to interventions. Methods: A qualitative descriptive study using content analysis was conducted. Semistructured telephone interviews were conducted with 13 BCSs. Results: Breast cancer survivors articulated that validation and self-management strategies were used to relieve cognitive symptoms. Nonpharmacologic, evidence-based interventions that use a combined onlinein-person approach and include follow-up with healthcare providers are preferred by BCSs. Ease of use, accessibility, and convenience were identified by BCSs as most important to facilitate participation. Cost, time intensiveness, and distance to travel hampered participation. Conclusions: Patient-centered interventions tailored to meet the needs of BCSs should be considered when implementing programs or interventions to maximize their utilization and benefit. The process of implementation should be dynamic and include an ongoing collaboration between BCSs and clinical nurse specialists.

Comorbidity, Physical Function, and Quality of Life in Older Adults with Acute Myeloid Leukemia

Purpose of ReviewThe purpose of this study is to describe the pathology, impact of comorbidities, functional limitations, symptoms, and quality of life (QOL) related to treatment of acute myeloid leukemia (AML) in older adults.Recent FindingsAML is a rare aggressive hematologic disease that occurs most often in older adults. The prognosis for older patients with AML is markedly worse due to genetic mutations and patient characteristics such as comorbidities and functional limitations. Patient characteristics may influence treatment decisions, as well as impact symptoms, functional ability, health-related outcomes, and QOL.SummaryAs the population continues to age, the number of people diagnosed with AML is expected to increase. Better management of comorbidities is imperative to improving QOL and other treatment-related outcomes. Prospective, longitudinal, and multi-site studies are warranted to further understand the interaction between these characteristics on symptoms, outcomes, and QOL.

Controlling Malglycemia in Patients Undergoing Treatment for Cancer

Patients with or without preexisting diabetes undergoing treatment for cancer may be at risk for malglycemic events. Malglycemia, particularly hyperglycemia and diabetes in patients with cancer, may lead to adverse outcomes. Prevention, prompt recognition, and early intervention to regulate malglycemia can optimize the effects of cancer treatment, minimize the harmful consequences, and improve quality of life for patients with cancer. The development of evidence-based standards of care and protocols are needed to guide clinical practice when caring for patients with cancer.