Victoria Wochna Loerzel

Transition From Treatment to Survivorship: Effects of a Psychoeducational Intervention on Quality of Life in Breast Cancer Survivors

PURPOSE/OBJECTIVES To examine the effectiveness of a psychoeducational intervention on quality of life (QOL) in breast cancer survivors in post-treatment survivorship. DESIGN A randomized controlled trial. SETTING An academic center collaborating with a regional cancer center in the southeastern United States. SAMPLE 256 breast cancer survivors. METHODS Women were randomly assigned to the experimental or wait control group. The Breast Cancer Education Intervention (BCEI) study was delivered in three face-to-face sessions and five monthly follow-up sessions (three by telephone and two in person). The control group received four monthly attention control telephone calls and the BCEI at month 6. Data were collected at baseline, three and six months after the BCEI for the experimental group, and one month after the BCEI (at month 7) for the wait control group. MAIN RESEARCH VARIABLES Primary endpoints were overall QOL and physical, psychological, social, and spiritual well-being. FINDINGS No differences in QOL were reported at baseline between groups. The experimental group reported improved QOL at three months, whereas the wait control group reported a significant decline in QOL. The experimental group reported continued maintenance of QOL at six months. Although the wait control group reported improved QOL at six months, significant differences continued to exist between the groups. CONCLUSIONS The BCEI was an effective intervention in improving QOL during the first year of breast cancer survivorship. Treatment effects were durable over time. IMPLICATIONS FOR NURSING Post-treatment survivorship has not been empirically studied to a large degree. The BCEI is one of the few interventions demonstrating effectiveness among survivors after primary treatment, suggesting that oncology nurses may be uniquely positioned to provide safe passage using education and support.

Current unmet needs of cancer survivors: Analysis of open-ended responses to the American Cancer Society Study of Cancer Survivors II

Cancer survivors may continue to experience psychosocial and physical needs related to their cancer experience for many years after treatment. The specification of these needs across cancer types and by survivor characteristics may lead to better prevention approaches and clinical responses. Mixed methods were used to examine responses to an open‐ended question about current unmet needs from a survey of 2‐, 5‐, and 10‐year cancer survivors.

Advances and Challenges: Student Reflections From an Online Death and Dying Course.

This study describes nursing students’ reflections on taking an online course on death and dying. In a semistructured paper, students described fears of caring for clients at end of life (EOL), important content learned, and remaining discomforts. Data were analyzed using directed content analysis. Consistent themes were noted among the papers. Student reflections on the knowledge they gained closely followed initial fears. Several students appreciated the ability to reflect on their experiences in a nonjudgmental setting. Overall, the data showed that nursing students can become more confident in EOL care through online education. Knowledge gains and continued fears about the same topics suggest EOL confidence lies along a continuum and may require ongoing education. Future research should focus on offering online continuing education on EOL to practicing nurses.

Application of the CuSum Technique to Evaluate Changes in Recruitment Strategies

Background: While lagging subject enrollment in longitudinal clinical trials is a complex problem, the best recruitment strategy has not been established. Cumulative summation (CuSum) is a statistical process control procedure often applied in quality improvement efforts to detect trend shifts in highly variable serial data. Objectives: To describe changes in efforts to increase referrals and enrollment in a longitudinal quality-of-life breast cancer study, determine effects of changes in referral strategies on enrollment using a novel application of CuSum, and discuss implications of CuSum as a tool for prospectively managing the subject recruitment process. Method: Ten referrals and eight enrollments per month for a total of 31 months were estimated to meet study subject accrual requirements in the clinical trial. The estimates were used as standards in performing CuSum calculations. CuSum was applied to monthly referral and enrollment data and trend graphs were generated. Alterations in recruitment tactics and strategies were evaluated as to whether changes in trend occasioned such alterations. Unplanned changes in trend were noted. Results: While monthly data were highly variable, an average of 8.42 referrals and 5.92 enrollments were realized during Months 1-12. Based on these figures, projected accrual for 31 months would have enrolled only 184 subjects, 66 subjects short of target. CuSum illustrated this trend. Subsequent shifts in enrollment trends were shown with improvements in referral. Discussion: Indications for use of CuSum include (a) earlier detection of enrollment trend shifts, and (b) earlier discrimination between effective and ineffective recruitment. Thus, CuSum has implications for both evaluating the effects of planned and unplanned process changes and for managing the recruitment process.

Cardiac Toxicity Related to Cancer Treatment

Cardiac toxicity is a dose-limiting toxicity that may occur during cancer treatment or several years after therapy ends. Cardiac toxicity may be caused by chemotherapy, biotherapy, and radiation therapy and may result in cardiomyopathy, congestive heart failure, dysrhythmias, and myocardial ischemia. The risk for developing cardiac toxicity varies based on type of treatment, patient age, presence of preexisting or concurrent heart disease, and concomitant treatment. Patients at high risk require careful evaluation and monitoring during and in the years following therapy to detect cardiac changes. Fortunately, cardioprotective agents and newer radiation therapy techniques decrease the risk for treatment-related cardiac toxicity. Oncology nurses can become more informed in the assessment of cardiac toxicity and can arm themselves with knowledge about early identification of symptoms as well as specific agents and treatments that increase risk for cardiac toxicity.

Nursing Student End-of-life Care Attitudes After an Online Death and Dying Course

Undergraduate nursing education inconsistently prepares students for their role in providing end-of-life care. Nurses, therefore, experience inadequacies surrounding communication, symptom management, and cultural competence in end-of-life care. The purpose of this study was to evaluate the impact of an online death and dying course on nursing student attitudes and feelings about caring for patients at end of life. Students enrolled in a 16-week online death and dying course were compared with students in a control group on baseline and follow-up Frommelt Attitudes Toward Care of the Dying scale and Death Attitudes Profile–Revised subscale scores and preintervention and postintervention score changes. Students who received the intervention had significant improvements in attitudes toward caring for the dying (F 1,120 = 11.22, P = .0011, effect size = 0.61) and, among students with no religious affiliation, acceptance of death (F 1,117 = 6.07, P = .0152, effect size = 0.46). Postintervention Death Attitudes Profile–Revised death avoidance and approach acceptance subscale scores were predictive of postintervention Frommelt Attitudes Toward Care of the Dying scores. An online death and dying course can positively impact nursing students’ attitude toward death and care of the dying. Students’ general attitudes about death will impact their attitudes of providing end-of-life care.

Posttreatment concerns of older women with early-stage breast cancer.

Background: The majority of older (aged ≥65 years) women diagnosed with breast cancer are in the early stage. However, little is known about older women’s posttreatment concerns in the early stages of survivorship. Objectives: The purpose of this study was to describe posttreatment–related concerns of older, early-stage breast cancer survivors. Methods: Fifty older women who completed treatment for early-stage breast cancer participated. Participants were interviewed within the first year since diagnosis. Content analysis was used to analyze transcripts about concerns after treatment. Results: Older women experienced treatment-related adverse effects, but often discussed non–cancer-related concerns as being more pressing than concerns from breast cancer. Older women accepted treatment-related adverse effects as part of life and often attributed adverse effects to causes other than breast cancer. Older women also engaged in “compartmentalization,” in which they separated past cancer experiences from everyday life. Conclusion: Non–cancer-related concerns often overshadowed concerns from having had breast cancer. Compartmentalization was used to cope with cancer as a past, not current event. Implications for Practice: New insights on how older women view their disease after treatment can guide nurses in educating older breast cancer survivors about treatment-related adverse effects.

“A Bump in the Road”- Older Women's Views on Surviving Breast Cancer

Due to the aging of the Baby Boomer generation, surviving with breast cancer will become more common, but also more complicated, as older women are often dealing with additional chronic illnesses and problems of aging. The purpose of this qualitative study was to explore how older women view surviving breast cancer in context with aging. Findings suggest that most women are able to put their cancer experience in the background and come to view breast cancer as a bump in the road through expecting illness with aging, putting cancer in perspective, and sensing a partnership.

Symptom Experience in Older Adults Undergoing Treatment for Cancer

PURPOSE/OBJECTIVES To explore the symptom experience of older adults receiving cancer chemotherapy in an outpatient treatment setting.
. DESIGN Exploratory, descriptive, cross-sectional study. SETTING A community cancer center in the southeastern United States.
. SAMPLE 100 adults aged 65 years or older undergoing treatment for cancer. METHODS Data were collected from participants at a chemotherapy treatment visit using structured questionnaires. Descriptive statistics were used to examine data. 
T tests and analysis of variance were used to compare symptoms among groups, and Pearson correlations were used to examine relationships among variables. MAIN RESEARCH VARIABLES Cancer treatment-related symptoms, comorbid illnesses, mental health function, and physical function.
. FINDINGS Older adults experience a high number of cancer 
treatment-related symptoms with moderate severity. The most common symptoms included fatigue, bowel disturbances, lack of appetite, hair loss, and drowsiness. Numbness and tingling were the most severe symptoms experienced. The presence of comorbid illness and poor mental functioning affects the number of symptoms experienced. CONCLUSIONS Opportunities exist for clinicians to take steps to assess and manage symptoms common to older adults before serious complications and negative outcomes occur. Future research is needed. IMPLICATIONS FOR NURSING Nurses should consider comorbidities and poor mental functioning in older adults when assessing treatment-related symptoms. Being proactive and assessing and managing symptoms early during treatment may improve outcomes for older patients.
.PURPOSE/OBJECTIVES To explore the symptom experience of older adults receiving cancer chemotherapy in an outpatient treatment setting.
. DESIGN Exploratory, descriptive, cross-sectional study.
 SETTING A community cancer center in the southeastern United States.
. SAMPLE 100 adults aged 65 years or older undergoing treatment for cancer.
 METHODS Data were collected from participants at a chemotherapy treatment visit using structured questionnaires. Descriptive statistics were used to examine data. 
T tests and analysis of variance were used to compare symptoms among groups, and Pearson correlations were used to examine relationships among variables.
 MAIN RESEARCH VARIABLES Cancer treatment-related symptoms, comorbid illnesses, mental health function, and physical function.
. FINDINGS Older adults experience a high number of cancer 
treatment-related symptoms with moderate severity. The most common symptoms included fatigue, bowel disturbances, lack of appetite, hair loss, and drowsiness. Numbness and tingling were the most severe symptoms experienced. The presence of comorbid illness and poor mental functioning affects the number of symptoms experienced.
 CONCLUSIONS Opportunities exist for clinicians to take steps to assess and manage symptoms common to older adults before serious complications and negative outcomes occur. Future research is needed.
 IMPLICATIONS FOR NURSING Nurses should consider comorbidities and poor mental functioning in older adults when assessing treatment-related symptoms. Being proactive and assessing and managing symptoms early during treatment may improve outcomes for older patients.
.

Assessing Nursing Students' Knowledge of Genomic Concepts and Readiness for Use in Practice.

Nurses are expected to apply genomic concepts in clinical practice. This study evaluated undergraduate nursing students’ genomic knowledge and attitudes about using this knowledge in practice. Using a pretest-posttest design, findings indicated that students’ knowledge was poor, but improved over a semester with genomics content. Most students did not feel ready to use this knowledge in the clinical setting. These findings suggest the need for more genomic education in nursing curriculum.