Articles from Asia-Pacific Journal of Oncology Nursing

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):131-133 PMID: 29607372 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):137-155 Today, personalized cancer therapy with targeted agents has taken center stage, and offers individualized treatment to many. As the mysteries of the genes in a cell's DNA and their specific proteins are defined, advances in the understanding of cancer gene mutations and how cancer evades the immune system have been made. This article provides a basic and simplified understanding of the available (Food and Drug Administration- approved) molecularly and immunologically targeted agents in the USA. Other agents may be available in Asia, and throughout the USA and the world, many more agents are being studied. Nursing implications for drug classes are reviewed. PMID: 29607374 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):156-164 Increased incidence of children diagnosed with cancer and survivors was an impact on changes in pediatric hemato-oncology nursing care. In this review article, it is aimed to investigate the new trends and recent care approaches in pediatric oncology nursing. The recent care topics were common in the literature as family-centered care, technology-based care, program development, primary care of child, health-care provider, survivors and home care, and nonpharmacological care. All of the topics contribute to perform evidence-based care for health promotion and well-being in pediatric hemato-oncology nursing. Research reviews showed that many current topics for the care of children and their parents have entered in the literature. There is a need for more randomized controlled studies to improve the level of evidence of new nursing approaches. PMID: 29607375 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):172-177 Objective: Targeted therapy-induced facial skin toxicities may reduce overall quality of life (QoL) in cancer patients. We investigated whether facial skin toxicities affect QoL and attempted to identify factors related to QoL in patients with advanced/recurrent cancer. Methods: We performed a cross-sectional study in 34 outpatients with advanced/recurrent cancer showing targeted therapy-induced facial skin toxicities in Japan between November 2016 and February 2017. For measurement, we used the Kessler Psychological Distress Scale (K6), Mental Adjustment to Cancer (MAC) Scale, and Dermatology Life Quality Index (DLQI). Data were analyzed using Spearman's rank correlation coefficient. Results: Mean DLQI score in 34 patients was 4.59 (standard deviation ± 4.70), which was interpreted as a small effect on a patient's life. Acneiform rash was the most common skin condition noted, followed by xerosis, pruritus, and erythema. Analysis of DLQI scores revealed that symptoms and feelings was the domain most commonly affected among different domains constituting the DLQI. MAC analysis revealed that the fighting spirit score was the highest among MAC scales. We found that age, K6, and fatalism construct in MAC were significantly correlated with total DLQI scores (age: Spearman's ρ= -0.48, P = 0.004; K6: ρ= 0.58, P < 0.001; fatalism; ρ= -0.39, P = 0.025). Conclusions: This is the first study investigating targeted therapy-induced facial skin toxicities in cancer patients. Our results suggest potential negative effects of facial skin toxicities on overall QoL in patients with advanced/recurrent cancer in middle and early old age. PMID: 29607377 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):178-183 Objective: This study is carried out to determine the symptoms and information necessity on chemotherapy (CT) treatment of the women with breast cancer. Methods: A total of 170 women older than 18 years old, who receive CT with breast cancer diagnosis, are volunteered to participate in the study. Mixed method was used in the study. Data are collected using Descriptive Data Form, Interview Form and Memorial Symptom Assessment Scale. Results: As a result of the cluster analysis, four clusters and the symptoms within have been obtained. These are: pain, lack of energy, feeling drowsy, sweat, swelling of hands, and feet in the first cluster; feeling nervous, difficulty sleeping, feeling sad, worrying in the second cluster; nausea, feeling bloating, change in the way food tastes, hair loss, constipation in the third cluster; vomiting, diarrhea, problems with sexual interest, lack of appetite, dizziness, and weight loss in the forth cluster. Women's information necessity related to the CT are follows: the effects of CT, other treatment options beyond CT, complementary methods, the effect of the CT treatment on reproductive health and sexuality, nutrition, and symptom control. Conclusions: The results of this study will enable determination of symptom clusters, which health professionals are easier to focus on these symptoms. An understanding information need of patients can help to ensure that individual's coping strategies and self-management. PMID: 29607378 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):184-194 Objective: This study aimed to explore the experiences of female breast cancer patients undergoing radiotherapy (RT) in a public hospital in Peshawar, Pakistan. Methods: This study employed a descriptive exploratory method. A purposive sample of 14 breast cancer women undergoing RT was selected for this study. Data were collected over the period of 5 months, using a semi-structured interview guide and conducting in-depth face-to-face interviews. These interviews were audio taped and transcribed by a bilingual transcriber. The translated version of the interview was coded, and the analysis was done manually. Results: Four main categories emerged from data analysis, which were: feelings and perceptions of the patients, their challenges, coping strategies, and teaching and informational needs. Conclusions: Women undergoing RT in this culture experience more intense psychological effects, as compared to the physical effects. Keeping in mind, the magnitude of the emotional stress experienced by the participants, recommendations for policy reforms, and training for female RT staff are suggested based on findings of this research. PMID: 29607379 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):195-200 Objective: To evaluate the effectiveness of interventional package on the level of anxiety, depression, and fatigue. Methods: The study was conducted in room no. 5, first floor, B Block, Department of Radiotherapy, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh Quasi experimental pretest-posttest design was used in the study. A total of 60 patients receiving radiotherapy/chemotherapy were assigned in two groups of 30 each, through total enumeration sampling technique. The tools used for the study were Zung Anxiety Scale, Beck Depression inventory, and Fatigue Scale. The protocol used for the study includes the Jacobson's Progressive muscle relaxtion technique, counsling and home care techniques. Results: Sociodemographic variables and clinical profile of participants in both groups were comparable. Interventional package significantly reduces the anxiety, depression, and fatigue (P < 0.001 in 3 variables) in experimental group. Conclusions: Interventional package for patients with cervical cancer proved to be an effective modality in reducing the anxiety, depression, and fatigue. PMID: 29607380 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):201-207 Objective: Sexual function in patients with breast cancer, especially in younger patients, is an important issue from clinical and psychosocial perspectives. Theory of planned behavior (TPB) is one of the important theories that explain the main process of adopting healthy behaviors. This study investigated the effect of education based on TPB on sexual function of women with breast cancer in Mashhad, Iran. Methods: In this quasi-experimental study, 120 women (60 women in education group, 60 women in control group) visiting Razavi Hospital of Mashhad city were studied, selected by using the random method in 2016. The data collection tool was a questionnaire which was completed during the interview. The validity and reliability of this questionnaire were determined through the face and content validity and through Cronbach's alpha and test-retest, respectively. Results: Data were analyzed using statistical SPSS 22 software. Using linear regression analysis, it was determined that attitudes, subjective norm, and perceived behavioral control (PBC) predict 0.85 overall of the total variance of sexual function intention, which among these variables, the effect of the subjective norm was more than the other ones (P < 0.05). After educational intervention, the average rates of knowledge, attitude, PBC, and intention of sexual function in sex education group were significantly increased (P < 0.05); these changes were not meaningful in the control group. There was no statistically significant difference in subjective norm between the two groups after intervention. Conclusions: The results of this research suggest that TPB can be used in sex education interventions and have relevant results. PMID: 29607381 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):217-222 Objective: This study aimed to assess the relationship between religiosity and quality of life (QoL) in patients with breast cancer in a Muslim population. Methods: This descriptive-correlational study was conducted in 84 Muslim patients with breast cancer who were admitted to Ahvaz Shafa Hospital, Iran, during 2015. QoL and religiosity were measured with the Short Form-36 questionnaire and Muslim Religiosity questionnaire based on the Glock and Stark model, respectively. Data were analyzed using a software program for descriptive statistics, the Chi-square test, Pearson's correlation, and an independent sample t-test. Results: Most patients had high religiosity (69%) and moderate QoL (46.5%) scores. Total scores and all subscales scores for QoL were significantly higher in patients with high religiosity than patients with moderate religiosity (P < 0.0001). Moreover, a direct correlation was found between religiosity (total and all subscales) and QoL (total and all subscales) (P < 0.0001). Conclusions: A significant relationship was found between religiosity and QoL in patients with breast cancer. Accordingly, care team members, especially midwifery and nursing staff, should pay more attention to religious beliefs among these patients to improve their QoL. PMID: 29607383 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):223-230 Objective: The aim of this study is to evaluate the effect of nursing intervention on mothers' knowledge of cervical cancer and acceptance of human papillomavirus (HPV) vaccination for their adolescent daughters in Abuja, Nigeria. Methods: This was a quasi-experimental study that utilized two groups pre and post-test design. The study was carried out among civil servant mothers in Bwari (experimental group [EG]) and Kwali (control group[CG]) Area Councils of Abuja, Nigeria. One hundred and forty-six women who met the inclusion criteria were purposively selected for this study. EG consists of 69 women while 77 are from CG. The intervention consisted of two days workshop on cervical cancer and HPV vaccination. Descriptive and inferential analyses of the data were performed using SPSS software 20 version. Results: The mean age of the respondents was 35 years ± 6.6 in the EG and 41 years ± 8.2 in the CG. The mean knowledge score of cervical cancer was low at baseline in both EG (9.58 ± 7.1) and CG (11.61 ± 6.5). However, there was a significant increase to 21.45 ± 6.2 after the intervention in EG (P < 0.0001). The baseline acceptance of HPV vaccination was high in EG after intervention from 74% to 99%. Exposure to nursing intervention and acceptance of HPV vaccination was statistically significant after intervention (P < 0.0001). Conclusions: The nursing intervention has been found to increase mothers' knowledge of cervical cancer and acceptance of HPV vaccination. It is therefore recommended that nurses should use every available opportunity in mothers' clinic to educate on cervical cancer and HPV vaccination. PMID: 29607384 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):231-236 Objective: The majority of problems and symptoms occur in the gastrointestinal system in children with cancer. Parents have difficulty in coping with the nutritional problems and changing routines of children and need support in this respect. This study aimed to assess the nutritional problems of children with cancer and the information needs of their parents. Methods: This descriptive study was performed among children with cancer aged 3-18 years and their parents (n = 69). The data were collected through a data collection form developed by the researchers based on the literature. Results: The most prominent nutritional problems experienced by children were loss of appetite (85.5%), nausea (84.1%), vomiting (81.2%), fatigue (79.7%), and mucositis (66.7%). According to the parents, the factors causing these nutritional problems in children were physiological factors (100%) and the foods given to children in the hospital (65.2%). The parents mostly needed information about food-drug interactions (58.0%), food-disease interactions (52.2%), foods that children with neutropenia should avoid or should eat (neutropenic diet) (46.4%), and frequency of nutritional intake (36.2%). Conclusions: This study has shown that most children experience at least one nutritional problem, and the parents need comprehensive and regular information about nutrition. Pediatric oncology nurses have a significant responsibility in the evaluation, education, and monitoring of these children. PMID: 29607385 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):237-243 Objective: This cross-sectional, quantitative epidemiological study was aimed at finding out the degree of work-related stress among the staff nurses working in oncology. Methods: This study was conducted on 81 out of 100 oncology-trained nurses working in various oncology centers of Indian Army who consented to participate in it. It was carried out in five oncology centers of our organization where oncology-related facilities are available. Predesigned and pretested questionnaire covering their sociodemographic variables in part I and professional life stress scale by David Fontana in part II. The association between stress and various variables was found using Chi-square test. Results: Risk for professional stress was found more among unmarried young respondents of 20-30 years age group. No statistically significant association (P < 0.131) was found between department of posting and level of stress. Nurses reported that they had no time for rest, of whom 62.96% were suffering from moderate range of stress for a busy professional while only one admitted to have severe stress requiring remedial action. While 82.7% felt that they are able to achieve major objectives in life, 71.6% of them reported that they feel inadequately valued for their commitment at work. Conclusions: The main nurses' occupational stressors were criticism, feeling of not being appreciated for hard work, and having time for self. This type of assessment should be carried out in all hospitals so that working conditions for this important component of health care can be improved. PMID: 29607386 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):208-216 [OPEN Access] Objective: Illness-related information can be significant for cancer patients after gastrointestinal (GI) surgery in terms of their performing adaptive tasks. This study longitudinally investigated the health outcomes of Japanese patients who read a booklet about cancer patients' problems and adaption tasks and evaluated the association between the responses to the booklet and the patients' health outcomes. Methods: A questionnaire survey about quality of life (QOL), fatigue, anxiety, cognitive plight, and resilience was administered to postoperative patients with GI cancer 1 week after their discharge from hospital and 6 months after surgery. The questionnaires were returned by email. Results: The mean age of the 32 patients at 1 week was 60.9 years; nearly 68.8% of them were men. As a whole, only two variables, QOL and anxiety, were significantly improved at 6 months over those at 1 week. Three statements were taken to gauge the responses to the booklet. In the two-way ANOVA that took QOL and responses to the booklet as independent variables, the post hoc test found that QOL was significantly improved in patients who agreed with the statement "I vaguely understood the content" or "I will deal with my tasks as described in the scenarios" but not in patients who agreed with the statement "The scenarios reflect my situation." The anxiety in patients who agreed with the statement "The scenarios reflect my situation" was high at both survey points. Conclusions: This study suggests that associations between the responses to the informational booklet and patients' health outcomes partially indicate the directional property of how to support their information usage. PMID: 29607382 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):165-171 [OPEN Access] Objective: Reliable and valid needs assessment measures are important assessment tools in cancer survivorship care. A new 30-item short-form version of the Survivor Unmet Needs Survey (SF-SUNS) was developed and validated with cancer survivors, including hematology cancer survivors; however, test-retest reliability has not been established. The objective of this study was to assess the test-retest reliability of the SF-SUNS with a cohort of lymphoma survivors (n = 40). Methods: Test-retest reliability of the SF-SUNS was conducted at two time points: baseline (time 1) and 5 days later (time 2). Test-retest data were collected from lymphoma cancer survivors (n = 40) in a large tertiary cancer center in Western Australia. Intraclass correlation analyses compared data at time 1 (baseline) and time 2 (5 days later). Cronbach's alpha analyses were performed to assess the internal consistency at both time points. Results: The majority (23/30, 77%) of items achieved test-retest reliability scores 0.45-0.74 (fair to good). A high degree of overall internal consistency was demonstrated (time 1 = 0.92, time 2 = 0.95), with scores 0.65-0.94 across subscales for both time points. Conclusions: Mixed test-retest reliability of the SF-SUNS was established. Our results indicate the SF-SUNS is responsive to the changing needs of lymphoma cancer survivors. Routine use of cancer survivorship specific needs-based assessments is required in oncology care today. Nurses are well placed to administer these assessments and provide tailored information and resources. Further assessment of test-retest reliability in hematology and other cancer cohorts is warranted. PMID: 29607376 [PubMed]

Asia Pac J Oncol Nurs. 2018 Apr-Jun;5(2):134-136 [OPEN Access] Creativity and innovation are words in common use when discussing the challenges facing cancer care delivery. Creativity in cancer care yields almost 3 million hits on Google, while innovation in cancer care yields almost 6 million. For peer-reviewed papers, the figures in Google Scholar are 87,000 and 460,000, respectively. For nurses working on the frontline of cancer care, the challenge is to work through this mass of information to consider how best to approach redesigning the delivery of care to get best outcomes for patients and make best use of the skilled workforce...  PMID: 29607373 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):273-274 Sultan Kav, is a Professor at Baskent University, Faculty of Health Sciences Department of Nursing in Ankara, Turkey. She received her Bachelor of Nursing, Master, and PhD degrees from Hacettepe University School of Nursing in Ankara, Turkey. She has over 25 years experiences in oncology nursing; she is an active member of national and international organizations, namely, Turkish Oncology Nursing Association (TONA), International Society of Nurses in Cancer Care (ISNCC), European Oncology Nursing Society (EONS), ONS, and Multinational Association of Supportive Care in Cancer (MASCC). She was served on ISNCC and EONS Board and former president of EONS. She was the principal investigator of several studies of the education of patients receiving oral cancer agents, which led to develop "The MASCC Teaching Tool for Patients Receiving Oral Agents for Cancer MASCC Oral Agents Teaching Tool (MOATT)©" and the MOATT© User Guide. She is the recipient of the 2010 ONS International Award for Contributions to Cancer Care; before this, she has received MASCC Young Investigator Award in 2004 and MASCC Best Young Investigator Award for her research study "Patient Education and Follow-up for Oral Chemotherapy Treatment in Turkey" in 2005. PMID: 28966953 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):275-282 OBJECTIVE: With the changes in healthcare, patients with cancer now have to assume greater responsibility for their own care. Oral cancer medications with complex regimens are now a part of cancer treatment. Patients have to manage these along with the management of medications for their other chronic illnesses. This results in medication burden as patients assume the self-management. METHODS: This paper describes the treatment burdens that patients endured in a randomized, clinical trial examining adherence for patients on oral cancer medications. There were four categories of oral agents reported. Most of the diagnoses of the patients were solid tumors with breast, colorectal, renal, and gastrointestinal. RESULTS: Patients had 1-4 pills/day for oral cancer medications as well as a number for comorbidity conditions (>3), for which they also took medications (10-11). In addition, patients had 3.7-5.9 symptoms and side effects. Patients on all categories except those on sex hormones had 49%-57% drug interruptions necessitating further medication burden. CONCLUSIONS: This study points out that patients taking oral agents have multiple medications for cancer and other comorbid conditions. The number of pills, times per day, and interruptions adds to the medication burden that patients' experience. Further study is needed to determine strategies to assist the patients on oral cancer medications to reduce their medication burden. PMID: 28966954 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):283-289 OBJECTIVE: The success of oral adjuvant endocrine therapy (OAET) is greatly influenced by patients' level of adherence to treatment. The objective of this study is to measure the prevalence and determinants of adherence to OAET among breast cancer patients in Singapore. METHODS: A cross-sectional survey of patients supplemented by analysis of their prescription records was used to collect data. Adherence to OAET was assessed using the Morisky Medication Adherence Scale-4 items and evaluation of refill gaps. Univariate and multivariate analyses were done to evaluate the association between patients' characteristics and adherence to OAET. RESULTS: A total of 157 women who have started OAET at least 6 months before the time of interview participated in the study, of which less than half (64 patients, 40.8%) of the patients had high adherence. Univariate analysis identified patients who were 57 years or older (P = 0.027), unemployed (P = 0.027), on aromatase inhibitors (P = 0.023), on three or more concurrent medications (P = 0.001), and had one or more comorbidities (P = 0.000) to be significantly more adherent. However, only the number of comorbidities was found to be an independent predictor of adherence in a multiple logistic regression analysis (adjusted odds ratio = 2.60; 95% confidence interval = 1.208-5.593; P = 0.015). Forgetfulness was the main reason for nonadherence mentioned by 63 (67.7%) of the 93 nonadherent patients. CONCLUSIONS: Low level of OAET adherence was found in this study, and forgetfulness was cited as the main reason for nonadherence. Patients were generally receptive to the implementation of various strategies to assist them with their medication-taking behavior. PMID: 28966955 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):290-298 OBJECTIVE: This study was conducted to examine the effect of structured education on medication adherence and self-efficacy through the use of the MASCC Oral Agent Teaching Tool (MOATT) for patients receiving oral agents for cancer treatment. METHODS: This quasi-experimental study has been conducted at two hospitals; 41 patients were included in the study. Data were obtained using a questionnaire, medication adherence self-efficacy scale (MASES), memorial symptom assessment scale, and a follow-up form (diary). Patients were educated through the use of the MOATT at a scheduled time; drug-specific information was provided along with a treatment scheme and follow-up diary. Phone interviews were completed 1 and 2 weeks after the educational session. At the next treatment cycle, the patients completed the same questionnaires. RESULTS: Majority of the patients were receiving capecitabine (90.2%; n = 37) as an oral agent for breast (51.2%; n = 21) and stomach cancer (24.6%; n = 10) treatment. About 90.2% of patients (n = 37) stated that they did not forget to take their medication and experienced medication-related side effects (78%; n = 32). The total score of MASES was increased after the education (66.39 vs. 71.04, P < 0.05). CONCLUSIONS: It was shown that individual education with the MOATT and follow-up for patients receiving oral agents for cancer treatment increased patient medication adherence self-efficacy. PMID: 28966956 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):299-303 Oral anticancer agents, while potentially more convenient and better tolerated than traditional intravenous therapy, come with significant concerns of noncompliance, adverse effects, and high cost. This presents an opportunity for health-care practitioners to develop a method to educate and support patients who are placed on these agents. To provide a detailed example of a currently established oral chemotherapy clinic and provide direction toward setting up a new clinic at other institutions. A description of the establishment of the clinic, how it is run and examples of interventions are provided. Establishment of an oral chemotherapy clinic run by supportive oncology practitioners is feasible and may provide added value to existing oncology care. It can also provide an opportunity to further involve health-care trainees in patient care. PMID: 28966957 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):313-318 Cancer patients with diabetes are at increased risk for developing infections, being hospitalized, and requiring chemotherapy reductions or stoppages. While it has been hypothesized that glycemic control increases the risk for these adverse events, few studies have explored this hypothesis. The purpose of this paper is to discuss the importance of glycemic control in patients with diabetes and cancer during treatment through end of life. Glycemic control was found to play a role; the overall level of health-related quality of life experienced by patients with cancer and diabetes, level of symptom severity experienced and can impact the overall survival of the individual. Evidence-based policies and practice guidelines also need to be developed to help clinicians manage these patients during all phases of care. Using diabetes educators and advance practice, nurses to provide management and care coordination services need to be considered. Survivorship care plans should address both cancer and diabetes management. Finally, glycemic control should continue through end of life, with the main goal of avoiding hypoglycemic events. PMID: 28966959 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):319-322 Radioactive iodine therapy (RAIT) is one of the important treatment modalities in the management of differentiated thyroid cancer (DTC). RAIT with iodine-131 has long been used in the management of DTC for the ablation of residual thyroid or treatment of its metastases. Despite being reasonably safe, radioiodine therapy is not always without side effects. Even relatively low administered activities of RAIT used for remnant ablation have been associated with the more clinically significant side effects of sialadenitis, xerostomia, salivary gland pain and swelling, dry eyes, excessive tearing, or alterations in taste in as many as 25% of patients. Given that there is a lack of comprehensive management of these RAIT-induced adverse effects, this paper explores the use of other nonpharmacological measures and their effectiveness as interventions to minimize salivary gland damage. PMID: 28966960 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):323-329 The epidermal growth factor receptor (EGFR) is actively involved in the growth of multiple tumor types and has been found as an effective treatment target in various solid cancers, for example, lung cancer and head and neck cancer. Of effective drugs which target and inhibit EGFR functions, tyrosine kinase inhibitors have shown promising results, albeit at a cost of side effects, skin toxicity being the most common. This article provides an evidence-based strategy to oncology nurse practitioners in dealing with such toxicity. PMID: 28966961 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):336-341 OBJECTIVE: Cancer patients in Africa face unique challenges such as poverty, access to health care and under-resourced health-care systems. Although quality of life (QoL) of cancer patients has been well researched, the perspectives of cancer patients living in Africa are unknown. The objective was to explore what constitutes QoL for cancer patients accessing public health care in South Africa. METHODS: A qualitative exploratory design was used, and data were gathered by means of in-depth interviews. Purposive sampling selected the participants, and the sample size was determined by saturation (n = 22). The data were analyzed using Patton's method of content analysis. RESULTS: The participants were aged between 20 and 79 years, with an average of 50 years. Most were female and represented seven cultural groups. Four themes that influence QoL arose from the data: psychosocial-, physical-, spiritual and financial factors. CONCLUSIONS: QoL remains a complex phenomenon, enhanced and diminished by various individual factors. Poverty was a major issue and influenced the physical aspects of QoL, as the participants had to be strong enough to work and earn a living. Support from family, friends, and church members enhanced QoL, as well as religion and religious practices. Measuring QoL would be the next step to enable nurses to implement measures to improve QoL. Whether existing QoL instruments would be suitable for this patient population is not known and should be investigated before implementation. PMID: 28966963 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):342-347 OBJECTIVE: Posttumor excision defects can be very large, and many do require postoperative radiotherapy. It is therefore important to provide stable and durable wound coverage to provide ability to withstand radiotherapy as well as providing cover to vital structures. METHODS: Between July 2014 and June 2016, eight females and six male patients with defects around the knee were operated upon using a perforator plus flap from the anterior tibial artery perforator. In all except two patients, the defects were the result of posttumor extirpation, while in the latter, it was due to impending implant exposure following bone tumor excision and tibial prosthesis. A constant perforator at the neck of the fibula was found using hand-held Doppler. The base of the flap was always kept intact. The flap was then transposed toward the defect and inset in a tensionless manner. RESULTS: The average flap dimension was 14 cm × 5.5 cm. The mean follow-up was 11 months (6-20 months). All the flaps survived well except in one patient who developed partial tip necrosis, providing stable coverage of the wound. Two patients developed local recurrence and had to undergo above-knee amputation. CONCLUSIONS: The planning for the reconstruction of defects following tumor resection is to be done in accordance with a multidisciplinary team approach involving oncosurgeon, reconstructive plastic surgeons, and radiation specialist. The perforator plus flap is an excellent choice in defects around the knee to cover neurovascular structures, bone, or implant. PMID: 28966964 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):348-355 OBJECTIVE: This study aimed at exploring the perceived barriers and intention to screen for prostate cancer (PCa). METHODS: A survey questionnaire and a descriptive design were used to collect data from 129 Omani men above the age of 40 years. The questionnaire comprised the International Prostate Symptom Score (IPSS), barriers, and intention to screen scales. The participants were recruited from barbershops located in two cities of Oman. RESULTS: The mean IPSS score was 8.31 ± 3.34 and the majority of participants had mild prostate cancer symptoms (60.4%). The others had moderate (28.7%) or severe symptoms (10.9%). Most men had low-to-moderate intention to screen using the method of digital rectal examination (DRE) (76%) and prostate-specific antigen test (PSA) (69.8%). The most common barriers to screening were fear of finding out something wrong (48.1%), not knowing what will be done during screening (54.3%), belief that PCa is not a serious disease (55.8%), and belief that DRE is embarrassing (56.6%). The significant determinants of intention to screen using DRE were perceived threat of the disease (P = 0.006) and past information from doctors that one has any prostate disease (P = 0.017). The determinants of intention to screen using PSA were perceived threat of the disease (P = 0.025), perceived general health (P = 0.047), and past information from doctors that one has any prostate disease (P = 0.017). CONCLUSIONS: The participants had diminutive intention to undergo PCa screening. Interventions aimed at enhancing PCa disease and risk awareness may help to reduce the barriers and increase PCa screening uptake. PMID: 28966965 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):356-360 OBJECTIVE: Oral cancer is a significant threat to public health all over the world, especially in Southeast Asia. At the present time, screening of oral cancer, its premalignant stages as well as its early detection, is still largely based on visual examination of the mouth. Visual examination is highly subjective and hence lacks the specificity and sensitivity. The objective of this study was to determine the usefulness of toluidine blue in marking a biopsy site in potentially malignant disorders. METHODS: In this study, a total of 500 patients were screened. The study was a case-control study which included 17 lesion cases and 23 normal controls. Toluidine blue staining was taken into consideration to identify clinically doubtful oral potentially malignant lesions and to compare the clinical evaluation with toluidine blue stain followed by a punch biopsy and histological evaluation. SPSS Statistics version 16.0 and Chi-square test were used for statistical analyses. RESULTS: The most common site for potentially malignant lesions was found to be the buccal mucosa. The sensitivity of toluidine blue was found to be 88.89%, while specificity was found to be 74.19%. The positive predictive and negative predictive values were 50% and 97.83%, respectively. P = 0.000672 was considered statistically significant. CONCLUSIONS: The results seem to be promising, but many such studies have to be done at larger scales to exactly help us in identifying the capability of toluidine blue in the long run. PMID: 28966966 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):366-367 PMID: 28966968 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):361-365 [OPEN Access] Recent studies conducted in the local community indicate that the uptake rates of breast and cervical cancer screening among South Asian ethnic minorities are lower than those of the general population. The development of interventions to promote these minorities' awareness of breast and cervical health and the importance of cancer screening is therefore required. This study protocol aims to develop culturally sensitive multimedia interventions to promote awareness of breast and cervical cancer prevention among South Asian women in Hong Kong, and to evaluate the outcomes of such interventions using a Reach-Effectiveness-Adoption-Implementation-Maintenance framework. By using a multimedia approach and developing socio-culturally relevant and linguistically appropriate educational materials, information related to cancer and accessible preventive measures for breast and cervical cancer is expected to be disseminated more effectively among South Asian women and ultimately increase their awareness of engaging in healthy lifestyles and taking part in cancer screening tests. Successful engagement of community partners will enhance the future sustainability of the project. PMID: 28966967 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):330-335 [OPEN Access] OBJECTIVE: Oral mucositis is a frequent clinical condition that has been shown to affect pediatric cancer patients. Oral Mucositis Daily Questionnaire (OMDQ) is one of the few available patient-reported outcome measures to assess the extent and impact of oral mucositis. The objectives of the study were to translate the Mouth and Throat Soreness-Related Questions of the OMDQ into Chinese (OMDQ MTS-Ch) for children and adolescents aged 6-18 years receiving chemotherapy and to evaluate its psychometric properties. METHODS: This was part of a multicenter, prospective cohort study involving two phases. Phase I involved forward-backward translation to fit the cognitive and linguistic age level of the children and adolescents, followed by face and content validation, together with pretesting. In Phase II, which evaluated the internal consistency, test-retest reliability, and discriminant validity, a total of 140 patients completed the OMDQ MTS-Ch for 14 days. RESULTS: The OMDQ MTS-Ch had satisfactory face and content validities. The Cronbach's alpha coefficient of the OMDQ MTS-Ch was 0.984. All of the corrected item-total correlations were higher than 0.90. The test-retest intraclass correlation coefficient between consecutive days for the OMDQ MTS-Ch items ranged from 0.576 to 0.983; the only value that was not over 0.70 was that for the paired study days 7 and 8 for the item of talking. The mean area-under-the-curve OMDQ MTS-Ch item scores were significantly different among patients with different degrees of mucositis severity (P < 0.001), supporting the discriminant validity. CONCLUSIONS: It has been shown that the OMDQ MTS-Ch has a good level of reliability and discriminant validity and can be completed by children aged ≥6 years and adolescents on a daily basis to measure mucositis and its related functional limitations. PMID: 28966962 [PubMed]

Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):304-312 [OPEN Access] The purpose of this paper is to introduce the outline and describe the salient features of the "Joint Guidelines for Safe Handling of Cancer Chemotherapy Drugs" (hereinafter, "Guideline"), which were published in July 2015. The purpose of this Guideline is to provide guidance to protect against occupational exposure to hazardous drugs (HDs) to all medical personnel involved in cancer chemotherapy, including physicians, pharmacists, and nurses and home health-care providers. The Guideline was developed according to the Medical Information Network Distribution Service guidance for developing clinical practice guidelines, with reference to five authoritative guidelines used worldwide. PubMed, Cumulative Index to Nursing and Allied Health Literature, Ichushi-Web, and Cochrane Central Register of Controlled Trials were used for a systematic search of the literature. Eight clinical questions (CQs) were eventually established, and the strength of recommendation for each CQ is presented based on 867 references. The salient features of the Guideline are that it was jointly developed by three societies (Japanese Society of Cancer Nursing, Japanese Society of Medical Oncology, and Japanese Society of Pharmaceutical Oncology), contains descriptions including the definition of HDs and the concept of hierarchy of controls, and addresses exposure control measures during handling of chemotherapy drugs. Our future task is to collect additional evidence for the recommended exposure control measures and to assess whether publication of the Guideline has led to adherence of measures to prevent occupational exposure. PMID: 28966958 [PubMed]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):259-264 OBJECTIVE: Cancer patients often experience a large number of symptoms together. The aim of this study is to determine the symptom clusters in cancer patients at palliative care clinic. METHODS: Hundred and seventy consecutive patients were enrolled in the study. Memorial Symptom Assessment Scale was used for symptom assessment of the patients. RESULTS: The most experienced symptoms by the patients during the past week before hospitalization in palliative care clinic were lack of energy (95.4%), weight loss (91.2%), lack of appetite (89.4%), pain (88.2%), dry mouth (87.6%), feeling sad (87.6%), feeling nervous (82.9%), worrying (81.2%), and feeling irritable (80.6%). Five symptom clusters were defined. First cluster: pain, feeling nervous, dry mouth, worrying, feeling irritable, weight loss; second cluster: feeling drowsy, numbness/tingling in hands/feet, difficulty in sleeping, dizziness, constipation, I do not look like myself; third cluster: nausea, vomiting; fourth cluster: shortness of breath, difficulty in swallowing, cough, change in the way food tastes; and fifth cluster: feeling bloated, problems with urination, diarrhea, itching, mouth sores, hair loss, swelling of arm or legs, change in the skin. CONCLUSIONS: We encountered various symptom clusters in advanced cancer patients. Identification of symptom clusters and knowledge of cluster composition in oncological population may particularly contribute individualization of the treatment. PMID: 28695173 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):224-232 OBJECTIVE: Individuals with diabetes who develop cancer have a worse 5-year overall survival rate and are more likely to develop an infection and/or be hospitalized when compared to those without diabetes. Patients with diabetes and cancer receiving chemotherapy have an increased risk for developing glycemic issues. The relationship between chemotherapy and glycemic control is not completely understood. The aim of this study was to explore the relationship between glycemic control, symptoms, physical and mental function, development of adverse events, and chemotherapy reductions or stoppages in adults with Type 2 diabetes (T2D) and cancer. METHODS: A prospective 12-week longitudinal cohort study recruited 24 adults with T2D, solid tumor cancer, or lymphoma receiving outpatient intravenous chemotherapy. Eighteen individuals completed baseline data and were included in the analysis. A comparative case analysis was performed to analyze the results. RESULTS: Potential predictors of occurrence of an adverse event include sex (relative risk [RR] = 1.5), treatment with insulin (RR = 2.17), years with diabetes (RR = 3.85), and baseline glycated hemoglobin (HbA1c) (odds ratio [OR] = 1.67). Baseline body mass index (BMI) (OR = 1.16) and HbA1c (OR = 1.61) were potentially predictive of a chemotherapy stoppage. CONCLUSIONS: Level of glycemic control at the time an individual begins treatment for cancer appears to contribute to the occurrence of an adverse event, developing an infection and/or being hospitalized during treatment, and the increased risk of having a chemotherapy reduction or stoppage. Clinicians working with patients receiving chemotherapy for a solid tumor cancer who have pre-existing diabetes, need to be aware of how the patients glycemic level at the start of treatment may impact successful treatment completion. PMID: 28695169 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):181-183 Mary Elizabeth is an Oncology Clinical Nurse Specialist from Memorial Sloan-Kettering Cancer Center in New York City, New York. She graduated from University of Delaware in 1985, with a Bachelor's degree in nursing and followed in 1989, with a Masters of Nursing from Columbia University specializing in oncology. Mary Elizabeth works as a Clinical Nurse Specialist in Memorial Sloan Kettering's ambulatory medical oncology consultative services. Her role includes modeling professional practice to the nurses of the services for which she has responsibility including mentoring and precepting nurses who are new to a practice, coordinating and evaluating their clinical experiences, and overseeing their development in the oncology nursing specialty and the ambulatory clinical practice role. Mary Elizabeth regularly "walks the walk" filling in and assisting in busy practices; this helps her maintain knowledge of the latest advances in disease management as well as experience firsthand the challenges of the ambulatory nursing role. Over the past few years, she has been practicing within MSK's busy and growing world - renowned retinoblastoma (RB) clinic. Mary Elizabeth has presented on RB nationally and at international conferences in the hopes of bringing this curable disease to the attention of nurses worldwide. Early diagnosis and early access to treatment can save lives, eyes, and vision. PMID: 28695161 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):184-186 PMID: 28695162 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):187-190 PMID: 28695163 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):191-196 OBJECTIVE: Retinoblastoma is the most common malignancy of the eye and ocular adnexa in the Philippines. It is curable when treated early, but delay in enucleation is common due to the parental refusal of surgery for varied reasons. The aim of this study is to identify the psychosocial barriers and facilitating factors for accepting versus refusing enucleation as treatment for retinoblastoma. METHODS: This is a cross-sectional descriptive study utilizing structured interviews and a questionnaire. It was conducted at the Retinoblastoma Clinic of the Philippine General Hospital. A questionnaire using the Likert scale was constructed after performing key informant interviews and focus group discussions. It was pretested and revised before parents of patients with retinoblastoma were invited to participate in the study. Descriptive statistics, quantitative item analyses using inter-item correlations and item-total correlations was performed. RESULTS: Factors that correlate with refusal to enucleate are the beliefs that cancer is a fatal illness, the fear of unacceptable esthetic outcome of the surgery, and the cost of treatment. Favorable factors include value of life, high regard for the opinion of medical practitioners, and appreciation of the efficacy of treatment. CONCLUSIONS: There are several favorable factors and barriers that health practitioners must consider in facilitating parental decision-making toward enucleation for retinoblastoma. PMID: 28695164 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):197-204 From 7% to 10% of all retinoblastomas and from 44% to 71% of familial retinoblastomas in developed countries are diagnosed in the neonatal period, usually through pre- or post-natal screening prompted by a positive family history and sometimes serendipitously during screening for retinopathy of prematurity or other reasons. In developing countries, neonatal diagnosis of retinoblastoma has been less common. Neonatal retinoblastoma generally develops from a germline mutation of RB1, the retinoblastoma gene, even when the family history is negative and is thus usually hereditary. At least one-half of infants with neonatal retinoblastoma have unilateral tumors when the diagnosis is made, typically the International Intraocular Retinoblastoma Classification (Murphree) Group B or higher, but most germline mutation carriers will progress to bilateral involvement, typically Group A in the fellow eye. Neonatal leukokoria usually leads to the diagnosis in children without a family history of retinoblastoma, and a Group C tumor or higher is typical in the more advanced involved eye. Almost all infants with neonatal retinoblastoma have at least one eye with a tumor in proximity to the foveola, but the macula of the fellow eye is frequently spared. Consequently, loss of reading vision from both eyes is exceptional. A primary ectopic intracranial neuroblastic tumor known as trilateral retinoblastoma is no more common after neonatal than other retinoblastoma. For many reasons, neonatal retinoblastoma may be a challenge to eradicate, and the early age at diagnosis and relatively small tumors do not guarantee the preservation of both eyes of every involved child. Oncology nurses can be instrumental in contributing to better outcomes by ensuring that hereditary retinoblastoma survivors receive genetic counseling, by referring families of survivors to early screening programs when they are planning for a baby, and by providing psychological and practical support for parents when neonatal retinoblastoma has been diagnosed. PMID: 28695165 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):205-208 Retinoblastoma (RB) is the most common primary cancer to affect the eyes in children with approximately 350 cases/year in the United States and 8000 worldwide. Today, sadly, 50% of children with RB worldwide die from their disease. In our experience, utilization of ophthalmic artery chemosurgery (OAC) has transformed the treatment plan for patients; with over 1500 procedures performed, our survival rate exceeds 98%. It is now our standard first-line therapy for RB. OAC is a surgical outpatient procedure which delivers concentrated doses of chemotherapy directly to the tumor without the toxicities of systemic chemotherapy. Our team approach and nursing management of these patients are the focus of this article. Nursing navigation and collaboration after OAC is vital and requires a combined effort by the nurses along with physicians, interventional radiologists, and the patient's families to ensure appropriate follow-up is established. Proper patient education throughout the process is crucial as is open and available communication for parents of patients with the nursing staff. The success in our treatment of this disease can be much accredited to the multidisciplinary team approach, with nursing playing an integral part in the support and management of these patients. PMID: 28695166 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):220-223 The introduction of targeted therapies in cancer treatment was accompanied with promising results including tumor control and patients survival benefits. However, these drugs just like their predecessors were associated with systemic side effects, including frequent and various cutaneous effects. Targeted therapies such as epidermal growth factor receptor, vascular endothelial growth factor receptor, kit, platelet-derived growth factor receptor, and BCR-ABL inhibitors as well as mammalian target of rapamycin inhibitors can induce cutaneous toxicities of varying severity. There are scarce studies on the actual impact of these toxicities on the patients' lives including the physical, social, and psychological aspects and overall quality of life. Patient's perspective in living with and beyond these toxicities remains largely uncharted but essential in optimizing care provided to those receiving treatment with targeted therapies. PMID: 28695168 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):241-249 OBJECTIVE: Patients receiving chemotherapy struggle with the side effects of this treatment. These side effects obligate the patients to use not only the pharmacological methods but also non-pharmacological relaxing methods. This study was conducted to determine the effect of reflexology on chemotherapy-induced nausea, vomiting, and fatigue in breast cancer patients. METHODS: The study was conducted as a pretest-posttest experimental design. The study was conducted with sixty patients, thirty as the control and thirty as the experimental groups. A sociodemographic form, Rhodes index of nausea, vomiting, and retching (INVR), and Brief Fatigue Inventory (BFI) were used to collect the data. Analysis of variance, t-test, percentage calculations, and Chi-square methods were used to evaluate the data. The data obtained were assessed using the "Statistical Package for Social Science 21.0" software. RESULTS: It was determined that the difference between the total mean scores of INVR in the experimental and control groups was significant on the onset and first and second measurements, and the difference between total mean scores of development and distress between the groups was statistically significant in the third measurement (P < 0.05). The results of the study showed that the BFI mean scores of patients in the experimental group gradually decreased in the first, second, and third measurements (P < 0.05). CONCLUSIONS: The present study proved that reflexology decreased the experience, development, distress of nausea, vomiting, and retching as well as fatigue in the experimental group. Hence, the use of reflexology is recommended for chemotherapy-induced nausea, vomiting, and fatigue. PMID: 28695171 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):250-258 OBJECTIVE: The aim of this study was to identify the experiences of breast cancer patients using external breast prostheses (EBP) in the context of the Pakistani society. METHODS: A qualitative descriptive exploratory design was used in the study. In-depth individual interviews were conducted with 15 postmastectomy women using EBP. A semi-structured interview guide with open-ended questions was used for the interviews. The analysis of the data was organized into four categories according to the study questions including reasons for using EBP, feeling about EBP, challenges for using EBP, and coping with lost breast. Each category was further divided into subcategories. RESULTS: Women used EBP because they felt strange, incomplete, and embarrassed in front of other people, due to the asymmetrical shape of the chest after mastectomy. They faced several challenges with regard to obtaining and using the EBP. While EBP was used as an alternative of their lost breast, they experienced sadness and embarrassment. They found it challenging to take care of the EBP and were required to make changes in their lifestyle. However, they accepted living with their lost breast, either through rationalization, family support, or faith and prayers, which helped them to cope. CONCLUSIONS: The study findings have given insight into some real experiences of mastectomy patients. Mastectomy not only affects women's physical health but also their psychological health, as a result of which they become reluctant to socialize. Using EBP can help them to improve their body image and body posture. Health-care providers' support is very important to the families of the patients specifically where patients are very shy to openly seek information due to cultural constraints. PMID: 28695172 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):265-268 The purpose, on the basis of Margaret Newman's theory of health as expanding consciousness in a unitary perspective, was to practice the caring partnership with a client who could not share their desires and find their future direction at a gear change period and document the process of their relational changes within this process. The design was research as praxis. The participant was a patient with cancer and her family in the midst of a difficult health situation. Through caring partnership, a nurse researcher asked to tell "the meaningful events and relationships in their lives" over four in-depth dialogue meetings. Data were collected from the tape-recorded dialogue transcriptions. In the process of caring partnership, the patient and each family member recognized their own pattern and family pattern of "being closed off," their approach to the situation, and found a new direction through this process. The finding suggested that caring partnership as a nursing intervention would be helpful for nurses as well as for patients and their families in difficult health situations. PMID: 28695174 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):269-272 Solitary spinal metastasis with cord compression as the presenting feature of follicular thyroid carcinoma (FTC) is extremely unusual with <10 cases reported in world literature. We hereby present two such cases in a 39-year-old male with lytic lesion left sacral bone with biopsy showing metastatic carcinoma with morphology and immunophenotype of thyroid gland and a 35-year-old female with thoracic vertebral lesions suggestive of metastatic deposit of FTC. Subsequently, both patients were found to have a solitary nodule in the thyroid lobe. They were treated with local radiotherapy (RT) with significant symptomatic relief. The present cases highlight the rarity of FTC to present as upfront solitary vertebral metastases with significant morbidity in young individuals although a slow indolent course with metastases in late stages of disease is more common, debilitating the effect of metastatic lesion requiring RT for pain palliation and the role of supportive nursing care for patient rehabilitation. PMID: 28695175 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):233-240 [OPEN Access] OBJECTIVE: For patients who wish to continue treatment for persistent chemotherapy-induced peripheral neuropathy (PCIPN) while maintaining the quality of life (QOL), the only effective way appears to be the stop-and-go strategy. The objective of the present study was to analyze emotional responses of Japanese patients with colorectal cancer (CRC) experiencing PCIPN for the first time and to consider effective ways of providing supportive nursing care. METHODS: In all, 25 patients with metastatic CRC who had completed more than six courses receiving first-line therapy with modified FOLFOX6 were included. Data were collected through semi-structured interviews. RESULTS: Emotional responses to PCIPN experienced by patients with CRC fell into the following categories: (1) suffering from an inability to cope with the previously unknown sensation of numbness, (2) inability to perform daily living activities activities of daily living [ADL]/instrumental activities of daily living [IADL] independently and feeling fear for physical safety, (3) feeling a sense of relief at being able to live the same life as before, and (4) facing the threat of cancer and tolerating the numbness caused by the life-supporting treatment. Fear, helplessness, dismay and other uncomfortable feelings represented 72.5% of all emotional responses, probably reflecting the lack of effective intervention for PCIPN. CONCLUSIONS: These results suggest that both subjective and objective assessments of PCIPN and proper use of a stop-and-go strategy are essential for treatment continuation and maintenance of patient's QOL; therefore, an integrated approach is desirable. PMID: 28695170 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jul-Sep;4(3):209-219 [OPEN Access] As the global cancer burden grows, so too will global inequities in access to cancer and palliative care increase. This paper will describe the cancer and palliative care landscape relative to nursing practice, education, and research, and emerging global collaborations in the United States (U.S.), Turkey, and Malawi. It is imperative that nurses lead efforts to advance health and strengthen education in these high-need areas. Leaders within the University of Alabama at Birmingham School of Nursing, through a Pan American Health Organization/World Health Organization Nursing Collaborating Center, have initiated collaborative projects in cancer and palliative care between the U.S., Turkey, and Malawi to strengthen initiatives that can ultimately transform practice. These collaborations will lay a foundation to empower nurses to lead efforts to reduce the global inequities for those with cancer and other serious and life-limiting illnesses. PMID: 28695167 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):89-90 Ilana Kadmon, PhD, RN was for many years a nurse specialist in Breast Cancer at Hadassah Medical Center, Jerusalem, Israel. From 2016, she started the role of a nurse academic consultant at the nursing division at Hadassah. Her PhD is from The University of Edinburgh, UK. Her research involved psychosocial aspects of breast cancer, and the role of the breast care nurse (BCN). She was a pioneer in developing the post of the BCN in Israel. This position was initially developed by her at Hadassah and initiated by the Israel Cancer Association. Beyond her clinical expertise, at the Hadassah School of Nursing, she lectures and writes in many areas on breast cancer care in general. She served as a board member of the European Oncology Nursing Society, and was also a member of the Editorial Committee of the European Journal of Oncology Nursing. Moreover, she serves as a reviewer for many nursing journals. She was involved in a mutual international collaborative project with nurses in Tianjin, China. She was there for seminars and initiated some cross-cultural research in the area of partners of women with breast cancer, involving both countries. Moreover, she has been invited to Cyprus, Greece Russia, and Turkey to teach and give workshops. PMID: 28503636 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):95-97 PMID: 28503638 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):104-111 OBJECTIVE: Breast cancer is one of most common cancer types among women in Taiwan. Nurses are in an ideal position to promote breast cancer screening and educate individuals about breast health-related issues. This exploratory study aims to provide preliminary information on Taiwanese nurses' beliefs about breast cancer, breast cancer-related knowledge, and their cancer screening practices. METHODS: In this cross-sectional study, a total of 96 nurses completed self-report questionnaires. RESULTS: Participants were knowledgeable about the different breast cancer screening modalities and the risk factors for breast cancer, but various misconceptions about breast cancer were still observed. Nevertheless, more than 50% of participants reported that they never had clinical breast examinations, ultrasound, and/or mammography screening in the past. CONCLUSIONS: Our study sample demonstrated greater knowledge on modalities of breast cancer screening modalities and the risk factors for breast cancers but lower screening practices. Future studies that examine the impact of demographics and the reinforcing and inhibiting factors related to nurses' screening uptake are warranted. PMID: 28503640 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):112-115 Given the severe shortage of physicians in Israel, the Ministry of Health issued a decree that offered advanced authority and responsibilities to experienced nurses; thus, the status of the nurse specialist (NS) was created. The role of NS in Israel is truly varied, incorporating many different facets that range from stabilizing to changing the existing palliative care (PC) orders, including those involving dosages and methods of care provision, issuing of repeat prescriptions, suspending drug treatment, and prescribing new drugs for a patient according to a protocol issued by a physician. The NS is also authorized to perform many clinical duties that frequently involve direct patient care. According to the different needs of the patients, he/she coordinates with the different members of the interdisciplinary team, who may be suitable to offer further help and support to the client and/or his/her significant others. His/her work keeps him/her in a constant dialogue with other health-care professionals, and as questions arise, he/she answers them and offers support to staff, patients, and family members. In the Middle East, the whole issue of PC is relatively new, and due to cultures, traditions, and religions, a number of difficulties have to be resolved. PMID: 28503641 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):116-119 OBJECTIVE: In patients receiving bone marrow transplantation (BMT), their mucosa becomes altered and sclerotic changes in the female external genital organs occur. Although a few studies have specifically addressed vulvar and vaginal graft versus host disease (VVGvHD) and its repercussions on the sexual health and quality of life of patients, VVGvHD can be overlooked by health practitioners. The objective of the study is to describe the initiation of a health care clinic specializing in VVGvHD in a general tertiary hospital. METHODS: A VVGvHD clinic was founded as a part of BMT daycare in a joint initiative of the nursing staff and the medical director of the department and a gynecologist specializing in vulva and vaginal disease. Patients were assessed for vulvovaginal symptoms, such as dryness, burning, itching, pain to touch, pain during intercourse, and dysuria. These patients might be subsequently referred to the VVGvHD clinic according to their needs assessed by daycare nurses. Treatment guidelines were developed by the specialist gynecologist. RESULTS: A total of 81 women aged 2-66 years (median age = 38 years) visited the clinic from 2009 to 2015. Of these women, 70 received an allogeneic transplant and 11 underwent autologous transplantation before consultation in our clinic. VVGvHD was detected in 54% of the patients. CONCLUSIONS: The VVGvHD clinic was developed to fulfill the specific needs of female patients who underwent BMT. The pioneer clinic was founded as a joint effort of the multidisciplinary team. Evidence supporting the optimum treatment for this condition is insufficient. This was the main reason for performing this study to explore the clinic that was newly based in Israel. VVGvHD may be a fluctuating condition with frequent deterioration and improvement. Therefore, regular clinical examinations are necessary. PMID: 28503642 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):120-121 PMID: 28503643 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):122-126 Many controversies have come to light related to breast cancer screening recommendations for average- and high-risk populations. This manuscript focuses on factors to consider when coordinating and conducting breast cancer screening programs in an average or "healthy women" population. As presented at the 2016 ONS Congress, a brief comparison of current screening recommendations among various organizations for early detection of breast cancer is provided. Lessons learned regarding key components of successful screening programs such as being patient focused, accessible, and sustainable are shared. Practice implications such as gaining confidence in providing individualized patient education, encouraging every woman to discuss her risk of breast cancer with her health-care provider, advocating for patients needs and being involved in or aware of clinical and translational research on the efficacy of the clinical breast examination and screening services are critical roles for nurses and advanced practice nurse providers. PMID: 28503644 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):140-146 OBJECTIVE: Cancer is a leading cause of death worldwide. Likewise, in Pakistan, it is a major health problem, with an approximate increase each year. Cancer treatment, particularly chemotherapy, produces a detrimental effect on individuals' well-being. Since the past few years, quality of life (QOL) is considered as the primary goal of cancer treatment in patients' survival. This study aimed to assess the QOL and its determinants in adult cancer patients undergoing chemotherapy treatment. METHODS: An analytical cross-sectional design was employed to achieve the study objectives, utilizing consecutive sampling technique. A total of 150 adult (>19 years) cancer patients were recruited from a Tertiary Care Hospital in Karachi, Pakistan. The data were collected using the Functional Assessment of Cancer Therapy-General, a QOL questionnaire. Multiple linear regression was run to determine the effect of predictor variables, with a mean QOL score. RESULTS: The overall mean score of QOL as 57.37. The domains of physical and emotional well-being were mainly affected by the chemotherapy treatment. Variables such as no previous hospitalization and no significant changes in life events were positively associated with the QOL. On the other hand, being female, unemployed, chemotherapy side effects (>1 week), impaired socialization, and discrimination by family/relatives were negatively associated with the QOL. CONCLUSIONS: The study findings suggested an overall low QOL among adult cancer patients undergoing chemotherapy treatment. It is recognized as a stressful treatment, which adversely affects the QOL of cancer patients. Interventions should focus on both the physical and psychological issues and need to be addressed to improve the QOL of adult cancer patients. PMID: 28503647 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):147-154 OBJECTIVE: This study illuminates the degree of psychological stress response experienced by spouses of cancer patients when given bad news at three different times (notification of the name of the disease, notification of recurrence, and notification of terminality) as well as the factors that influence the response and the health status of the spouse as measured by health-related quality of life (QOL). METHODS: A total of 203 individuals (57 men and 146 women) who had received the three types of news were surveyed using a self-report questionnaire on psychological stress response, marital satisfaction, and health-related QOL scales. RESULTS: The degree of the psychological stress response was the highest for notification of terminality, followed by notification of the name of the disease, and notification of recurrence. The influencing factors varied depending on the notification period. Although no significant difference was observed for health-related QOL among the three notification types, significant differences were observed for certain items when compared with national standard values. CONCLUSIONS: When a notification of terminality, which produced the highest psychological stress response, is given, providing care that considers health-related QOL is necessary not only for patients but also for their spouses. PMID: 28503648 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):155-161 OBJECTIVE: The aim of this methodological study is to establish the validity and reliability of the Turkish version of "A Questionnaire for Measuring Attitudes toward Cancer (Cancer Stigma) - Patient version." METHODS: The sample comprised oncology patients who had active cancer treatment. The construct validity was assessed using the confirmatory and exploratory factor analysis. RESULTS: The mean age of the participants was 54.9±12.3 years. In the confirmatory factor analysis, fit values were determined as comparative fit index = 0.93, goodness of fit index = 0.91, normed-fit index=0.91, and root mean square error of approximation RMSEA = 0.09 (P <0.05) (Kaiser-Meyer-Olkin = 0.88, χ(2) = 1084.41, Df = 66, and Barletta's test P <0.000). The first factor was "impossibility of recovery and experience of social discrimination" and the second factor was "stereotypes of cancer patients." The two-factor structure accounted for 56.74% of the variance. The Cronbach's alpha value was determined as 0.88 for the two-factor scale. CONCLUSIONS: "A questionnaire for measuring attitudes toward cancer (cancer stigma) - Patient version" is a reliable and valid questionnaire to assess stigmatization of cancer in cancer patients. PMID: 28503649 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):162-167 OBJECTIVE: The main symptom of lung cancer is dyspnea which can lead to depression, anxiety, limited independent activities, and decreased quality of life. The purpose of this study was to identify the effect of airflow stimulation from a hand-held fan as nonpharmacological palliative intervention on dyspnea in patients with lung cancer. METHODS: This study used open, randomized, controlled, crossover trial design involved 21 participants. Diaphragmatic breathing technique was used in control arm. RESULTS: Wilcoxon test result showed that airflow stimulation significantly influenced dyspnea scale (P = 0.003) and respiratory rate (RR) (P = 0.008). Combination of airflow stimulation and diaphragmatic breathing can lower both dyspnea scale and RR significantly (P < 0.0001). CONCLUSIONS: This combination can be applied on nonhypoxemic dyspneic lung cancer patients. PMID: 28503650 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):168-172 OBJECTIVE: Cancer is one of the four leading causes of death in children. Its courses of diagnosis and treatment can cause physiologic symptoms and psychological distress that secondarily affect children's quality of life and participation in daily activities. The aim of this study was to investigate the effect of play-based occupational therapy on pain, anxiety, and fatigue in hospitalized children with cancer who were receiving chemotherapy. METHODS: Two hospitalized children with acute lymphoblastic leukemia at least 4 months after diagnoses who received two courses of chemotherapy participated in this pilot study. Takata Play History and Iranian Children Participation Assessment Scale were used to develop intervention protocol. Nine, 30-45 min play-based occupational therapy sessions took place for each child. Children filled out the Faces Pain Scale, Visual Fatigue Scale, and Faces Anxiety Scale before and after each intervention session. RESULTS: Pain, anxiety, and fatigue levels decreased in both participants. Furthermore, the results showed a relationship between pain, anxiety, and fatigue variables in these children. CONCLUSIONS: Play-based occupational therapy can be effective in improving pain, anxiety, and fatigue levels in hospitalized children with cancer receiving chemotherapy. PMID: 28503651 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Apr-Jun;4(2):173-179 OBJECTIVE: The purpose of this study was to reveal experiences of caregivers whose spouses were receiving chemotherapy for colorectal cancer and their expectations from nursing services. METHODS: This is a qualitative study. The caregivers were interviewed at their home. Sampling criteria were volunteering to participate in the study, being able to understand Turkish, not having speech or hearing problems and offering care to spouses with primary colorectal cancer. The interviews continued until concepts likely to be responses to research questions repeatedly appeared. Fourteen caregivers with spouses receiving chemotherapy for colorectal cancer comprised the study sample. Data were collected with a descriptive characteristics form and a semi-structured interview at in-depth interviews after making appointments with the caregivers on the phone. The steps followed in the content analysis were coding data, an organization of codes and themes, description of findings and evaluation of findings. RESULTS: Experiences of the caregivers whose spouses were receiving chemotherapy for colorectal cancer and their expectations from nursing services were found to comprise the following themes "Facing the Disease," "Difficulties Encountered," "Continuing to Live," and "Provision of Health Care Services." CONCLUSIONS: The results of the study revealed that cancer and its treatment affected not only cancer patients but also their spouses offering care. Nurses giving care at oncology clinics, public health centers, and home can make care plans based on the four themes emerging in this study and can detect problems earlier and create appropriate solutions to them. They will contribute to the literature revealing needs of people offering care to oncology patients as well. PMID: 28503652 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):4-5 David Makumi is an award-winning cancer control leader. The US Oncology Nursing Society. (ONS) awarded him the prestigious Distinguished Award for contribution to cancer care in 2011. The following year, the International Society of Nurses in Cancer Care presented him with the Past President Award for his work in designing low-cost models of increasing access to breast cancer screening. David is the East Africa Regional Cancer Programs Manager for the Aga Khan University Hospital. He has been involved in cancer advocacy on policy and legislation for over 10 years. David is currently the Chair of the Kenya Network of Cancer Organizations, thus he represents civil society on the Board of the National Cancer Institute of Kenya. At the international level, David sits on the International Advisory Panel of the ONS. David, a registered nurse, has a Postgraduate Diploma in Palliative Care from Dundee University and a Higher Education Diploma in the same from Oxford Brookes University. He has been involved in several initiatives aimed at networking cancer care nurses in Africa to share knowledge, experience, and expertise. PMID: 28217723 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):6-17 Quality of life (QOL) has been studied extensively among cancer populations in high income countries where cancer care resources are available to many. Little is known concerning the QOL of cancer groups residing in Africa where resources can be scarce. The integrative review of the literature explored and critically examined studies that had addressed QOL in female cancer survivors in Africa. The extent to which QOL studies incorporated a cultural perspective was also examined. Research studies published between 2005 and 2015 were retrieved from five databases: CINAHL, MEDLINE, SCOPUS, ProQuest dissertations and Theses full text, and GlobalHealth. Primary qualitative or quantitative studies regardless of sample size or setting were included. A total of 300 studies were identified and 28 full text studies were retrieved and assessed for eligibility. Eight studies met inclusion criteria. Factors that affected the QOL were socio-demographic especially age, education, employment, income and residence; illness-related factors such as having advanced cancer and multiple symptoms; treatment-related factors associated with surgery and radiotherapy; psychosocial factors such as support and anxiety; and cultural factors including fatalism and bewitching. Practice implications entail increasing awareness among nurses and allied healthcare providers of the potential effects on QOL of a cancer diagnosis and treatment of female cancers such as pain, fatigue, sexual dysfunction, hormonal and body image changes, anxiety, depression and cultural practices. Failure to identify and deal with these may result in poor treatment adherence, low self-esteem, and ultimately poor QOL. PMID: 28217724 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):18-22 This article describes the current state of cancer nursing and the various challenges that hinder the provision of effective nursing care to cancer patients in Nigeria. The major issue identified was the lack of specialized oncology nursing education which should actually form a basis for nurses to practice in the oncology setting. Other issues include poor facilities for oncology nursing care, lack of specific cancer centers resulting in the management of cancer patients in non-specialist wards. It is therefore recommended that solidified structure be put in place in order to establish and strengthen the nursing curriculum which has a strong potential for improving the knowledge and skills of nurses to care for people living with cancer in Nigeria. PMID: 28217725 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):23-28 OBJECTIVE: The objective of this study was to describe the experiences of Zambian nurses caring for women with advanced breast cancer. METHODS: We used a qualitative descriptive design and purposive sampling. Seventeen in-depth interviews were conducted with registered nurses practicing in the Cancer Diseases Hospital and the University Teaching Hospital, Lusaka, Zambia, and analyzed using thematic analyses. RESULTS: Two themes emerged from the data - caring for women with advanced breast cancer is challenging and the good outweighs the bad. The majority of the participants agreed that caring for women with advanced breast cancer and witnessing their suffering were challenging. Not having formal education and training in oncology nursing was disempowering, and one of the various frustrations participants experienced. The work environment, learning opportunities, positive patient outcomes, and the opportunity to establish good nurse-patient experiences were positive experiences. CONCLUSIONS: Although negative experiences seemed to be overwhelming, participants reported some meaningful experiences while caring for women with advanced breast cancer. The lack of formal oncology nursing education and training was a major factor contributing to their negative experiences and perceived as the key to rendering the quality of care patients deserved. Ways to fulfill the educational needs of nurses should be explored and instituted, and nurses should be remunerated according to their levels of practice. PMID: 28217726 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):29-37 OBJECTIVE: Adequate knowledge of parents' perception of quality of pediatric cancer care helps to identify the areas of care improvement which would contribute to disease outcome in regard to the quality of life and satisfaction with the care provided. The aim of the study was to assess the parents' perception of the quality of Pediatric Oncology Inpatient Care at Kenyatta National Hospital. METHODS: A cross-sectional descriptive quantitative and qualitative study was undertaken using a pretested semi-structured questionnaire and a focused group discussion guide. Assessment of parents' perception of quality of care was done in relation to the institution's structures and care delivery processes. These included the ward environment, resources for cancer treatment, care processes, service providers, and parents' knowledge empowerment. Participants were systematically selected. Parents' perception was defined as satisfaction or dissatisfaction with the care provided. Data were analyzed using SPSS version 20.0 (Armonk, NY: IBM Corp.) and presented as frequencies and percentages. Chi-square was used to test the significant association between variables. Level of significance was set at a P ≤ 0.05. RESULTS: A total of 107 respondents were interviewed and 57.9% were satisfied with the overall quality of care they received. The determinants of overall satisfaction in this study were found to be related to resources for cancer treatment (odds ratio [OR] =3.10; 95% confidence interval [CI] =1.39-6.90; P = 0.005), care delivery processes (OR = 2.87; 95% CI = 1.28-6.43; P = 0.009), and the ward environment (OR = 2.59; 95% CI = 1.17-5.74; P = 0.018). CONCLUSIONS: The parents were moderately satisfied with the oncology care services their children received. The gaps identified in service delivery included those related to the availability of the required resources for efficient care delivery and also educational as well as psychosocial needs of the parents. PMID: 28217727 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):38-44 OBJECTIVE: The survival rate for children with leukemia has increased dramatically since the late 1990s; treatment effects of the disease can be extremely stressful for families. Research on psychological and socioeconomic effects of leukemia treatment had been conducted in Western countries, but little is known within Africa including Kenya. METHODS: This was a cross-sectional study with a sample of 62 out of 72 parents of children undergoing leukemia treatment at Kenyatta National Hospital. Data were collected between May and August 2015 using structured questionnaires while qualitative data were collected using focus group discussions. This manuscript is based on quantitative data which were entered into EpiData version 3.1 and analyzed using SPSS version 20. Psychological distress index was created by counting the number of psychological experiences reported by respondents. Kendall's tau-b was used to test the association between the psychological distress index and socioeconomic characteristics; P ≤ 0.05 was considered statistically significant. RESULTS: The respondents experienced anxiety, shock, and fatigue. Spending a higher proportion of family's income was associated with higher psychological distress index (P = 0.009). The economic challenge led to significantly heightened tension in the family (P = 0.021). CONCLUSIONS: Financial challenge is a major cause of psychological distress thus needs for financial support through collaboration with government institutions, for example, NHIF, development agencies, and nongovernment organization who can contribute toward the treatment cost. Need to decentralize effective leukemia treatment centers. Psychological support and counseling should be done to alleviate tension. The nurse needs to be empathetic when caring for the child and family as well as to apply the ethical principles of justice and beneficence so that the child gets the best care despite the financial challenge. PMID: 28217728 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):50-52 This mini-review aims to introduce Margaret Newman's theory of health as expanding consciousness and caring partnership as a nursing intervention. Emanating from a unitary and transformative perspective of nursing, caring partnership enables nurses to identify with cancer patients as well as to help the patients find meaning in their situation and their lives. In genuine patient-nurse interactions, both patients and nurses experience higher levels of consciousness. PMID: 28217730 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):69-76 OBJECTIVE: The aim of this study was to assess the impact of radiotherapy (RT) on psychological, financial, and sexual aspects in postmastectomy carcinoma breast patients affecting their quality of life (QOL) before, during, and after RT with a strong emphasis on their management and rehabilitation aspects. METHODS: A cross-sectional study carried out in a specialized institution, comprising sixty women. Two standardized questionnaires European Organization for Research and Treatment of Cancer (EORTC) 30-item Quality of Life Questionnaire and Quality of Life Questionnaire breast cancer-23 (QLQ-BR23) for health-related quality, translated and validated for the Hindi language were used. The scores' manual of the EORTC was used to calculate the domain scores of the questionnaires. RESULTS: According to the first questionnaire, the emotional function was most affected even at onset of RT treatment and it was worst at the completion of RT treatment with a mean score of 63.75. The global QOL score was also worst at the end of radiation treatment with a mean score of 32.36, while the score 3 months after completion of treatment was 68.16. The symptoms with the highest scores were insomnia with a worst scoring at completion of treatment (29.99), fatigue (26.57), and pain (23.05). According to the QLQ-BR23, the mean score for side effects such as sexual functioning was minimum 0.55 at the completion of RT, which improved to 11.66 on the first follow-up after 3 months. Mean future perspective score which was 57.22 before the start of RT which was reduced to 50.55 at completion, which means that many women experience side effects of RT and impaired sexual satisfaction. CONCLUSIONS: Women with breast cancer showed changes in the following domains: financial, emotional, sexual satisfaction, and future prospects. The most frequently mentioned symptoms were fatigue, insomnia, and pain. PMID: 28217733 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):77-83 OBJECTIVE: The main aim of this study was to investigate the factor structure and psychometric properties of the Brief Illness Perception Questionnaire (BIPQ) in Turkish cancer patients. METHODS: This methodological study involved 135 cancer patients. Statistical methods included confirmatory or exploratory factor analysis and Cronbach alpha coefficients for internal consistency. RESULTS: The values of fit indices are within the acceptable range. The alpha coefficients for emotional illness representations, cognitive illness representations, and total scale are 0.83, 0.80, and 0.85, respectively. CONCLUSIONS: The results confirm the two-factor structure of the Turkish BIPQ and demonstrate its reliability and validity. PMID: 28217734 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):53-60 [OPEN Access] OBJECTIVE: Postoperative patients with gastrointestinal (GI) cancer have multiple adaptation tasks and care needs to improve their quality of life (QOL). Whether their supportive care needs differ according to their physical and psychosocial conditions is unclear. This study investigated patients' (1) physical and psychosocial conditions (QOL, fatigue, anxiety, cognitive plight, and resilience) and (2) responses to an informational booklet describing cancer patients' problems and adaptation tasks, and examined the association between the two factors. METHODS: A questionnaire survey was conducted to postoperative patients with GI cancer. RESULTS: The mean age of the 69 respondents was 63 years; 59.4% of the respondents were men. Nine patients who did not read the booklet showed high fatigue and cognitive plight and low QOL. The patients (36.2%) who chose "I vaguely understood the content" showed low scores for resilience and cognitive plight while those (8.5%) who chose "I will deal with my tasks as described in the scenarios" showed high scores for both of these variables. CONCLUSIONS: The condition of some patients continued to be highly affected by their cancer. In terms of understanding the contents of the booklet, resilience was significant, and cognitive plight did not necessarily have a negative impact. The provision of information by means of a booklet might not be suitable for patients who are highly affected by their cancer. Patients may need additional support to be able to make good use of the information provided in such a booklet. PMID: 28217731 [PubMed - in process]

Asia Pac J Oncol Nurs. 2017 Jan-Mar;4(1):45-49 [OPEN Access] Cancer is the third highest cause of death in Kenya, preceded by infectious and cardiovascular diseases, and in most cases, diagnosed in later stages. Nurses are the primary caregivers, assessing and managing these patients in the clinic, in inpatient settings, and in rural and remote communities. While cancer rates remain high, the burden to the patient, the caregiver, and society as a whole continues to rise. Kenya's poverty complicates cancer even further. Many Kenyans are unaware of cancer's signs and symptoms, and limited diagnostic and treatment centers are available. Despite these barriers, there is still hope and help for those in Kenya, who suffer from cancer. The World Health Organization has stated that palliative care is a basic human right and nurses providing this care in Kenya are making efforts to support cancer patients' ongoing needs, in order to promote compassionate palliative care and prevent suffering. The purpose of this paper is to address the palliative care needs of patients with cancer in Kenya by providing education to nurses and influencing health-care policy and education at micro and macro levels. A case study weaved throughout will highlight these issues. PMID: 28217729 [PubMed - in process]

Asia Pac J Oncol Nurs. 2016 Oct-Dec;3(4):309-311 Haeok Lee, PhD, RN, FAAN who is a Korean-American nurse scientist, received her doctor al degree from the Nursing Physiology Department, College of Nursing, University of California, San Francisco (UCSF), in 1993, and her post doctor al training from College of Medicine, UCSF. Dr. Lee worked at Case Western Reserve University and University of Colorado Health Sciences Center. She has worked at the UMass Boston since 2008. Dr. Lee has established a long-term commitment to minority health, especially Asian American Pacific Islanders, as a community leader, community health educator, and community researcher, and all these services have become a foundation for her community-based participatory research. Dr. Lee's research addresses current health problems framed in the context of social, political, and economic settings, and her studies have improved racial and ethnic data and developed national health policies to address health disparities in hepatitis B virus (HBV) infections and liver cancer among minorities. Dr. Lee's research, which is noteworthy for its theoretical base, is clearly filling the gap. Especially, Dr. Lee's research is beginning to have a favorable impact on national and international health policies and continuing education programs directed toward the global elimination of cervical and liver cancer-related health disparities in underserved and understudied populations. PMID: 28083546 [PubMed - in process]

Asia Pac J Oncol Nurs. 2016 Oct-Dec;3(4):312-315 Disparities in cancer care are a reality of the modern world. Unfortunately, current clinical research is in the hands of for-profit pharmaceutical companies and of researchers from the developed world. Problems specific to cancer care in developing countries and among deprivileged populations are ignored. Independent clinical research can offer new valuable knowledge and identify affordable and cost-effective treatments. As such, research not depending on commercial sponsors should become one of the important avenues to alleviate the problem of cancer disparities. PMID: 28083547 [PubMed - in process]

Asia Pac J Oncol Nurs. 2016 Oct-Dec;3(4):324-334 OBJECTIVE: Although remarkable progress in the pharmacological components of the prevention and treatment of hepatitis B virus (HBV) and liver cancer has been achieved, HBV-related stigma is recognized as a major barrier to HBV management. The purpose of this Revised Social Network Model (rSNM)-guided review was to examine the existing research literature about HBV-related stigma among Asians and Asian immigrants residing in other countries. METHODS: A scoping review of literature was conducted to determine the depth and breadth of literature. Totally, 21 publications were identified. The review findings were linked with the concepts of rSNM to demonstrate how individual factors and sociocultural contexts shape and affect the experience of HBV-related stigma. RESULTS: Most studies were quantitative cross-sectional surveys or qualitative methods research that had been conducted among Chinese in China and in the USA. The three concepts in rSNM that have been identified as important to stigma experience are individual factors, sociocultural factors, and health behaviors. The major factors of most studies were on knowledge and attitudes toward HBV; only three studies focused on stigma as the primary purpose of the research. Few studies focused on the measurement of stigma, conceptual aspects of stigma, or interventions to alleviate the experience of being stigmatized. CONCLUSIONS: The scoping review revealed the existing depth and breadth of literature about HBV-related stigma. Gaps in the literature include lack of research address group-specific HBV-related stigma instruments and linkages between stigma and stigma-related factors. PMID: 28083549 [PubMed - in process]

Asia Pac J Oncol Nurs. 2016 Oct-Dec;3(4):344-351 OBJECTIVE: The highest prevalence of HIV infection occurs in Sub-Saharan Africa and hepatitis B virus (HBV), and hepatitis C virus (HCV) prevalence are the second highest in Sub-Saharan Africa including Malawi. Health-care workers (HCWs) play an important role in the prevention of, response to, and management of these infectious diseases. There is, however, no published research about the level of knowledge and attitudes toward HIV, HBV, and HCV infection among Malawian HCWs. The purpose of this study was to explore and determine the knowledge of and attitudes toward HIV, HBV, and HCV among a targeted population of Malawian HCWs. METHODS: A cross-sectional community-based participatory research with 194 HCWs was completed employing health survey method. The project was a collaborative effort between nursing faculties in the USA and Malawian. A one-way analysis of variance (ANOVA) with the Bonferroni adjustment for multiple comparisons was used to assess the differences in knowledge and attitude among three subgroups of HCWs. RESULTS: Of 194 of Malawian HCWs surveyed, 41% were support staff, 37% were nursing students, and 22% were health-care professionals. Both health-care professionals and support staff had high knowledge scores related to HIV/AIDS, and their attitudes were mainly positive. However, a series of one-way ANOVAs revealed significant differences in knowledge and attitude toward HIV/AIDs, HBV, and HCV among HCWs (P < 0.01). The majority had less knowledge about HBV and HCV and more negative attitudes toward hepatitis. CONCLUSIONS: This study highlights the ongoing need for reducing negative attitudes toward HIV, HBV, and HCV; and providing health education among HCWs, especially focusing on HBV and HCV prevention. The findings of the research project can be used to develop interventions addressing low HBV- and HCV-related knowledge and attitudes. PMID: 28083551 [PubMed - in process]

Asia Pac J Oncol Nurs. 2016 Oct-Dec;3(4):352-356 PMID: 28083552 [PubMed - in process]

Asia Pac J Oncol Nurs. 2016 Oct-Dec;3(4):357-364 Nursing management of venous access devices (VADs) requires knowledge of current evidence, as well as knowledge of when evidence is limited. Do you know which practices we do based on evidence and those that we do based on institutional history or preference? This article will present complex VAD infection and occlusion complications and some of the controversies associated with them. Important strategies for identifying these complications, troubleshooting, and evaluating the evidence related to lack of blood return, malposition, infection, access and maintenance protocols, and scope of practice issues are presented. PMID: 28083553 [PubMed - in process]

Asia Pac J Oncol Nurs. 2016 Oct-Dec;3(4):365-369 OBJECTIVE: Several biomarkers may be used to detect harmful exposure and individual susceptibility to cancer. Monitoring of biomarkers related to exposure may have a significant effect on early detection of cell transformation, thereby aiding the primary prevention of various chronic and malignant diseases. Nurses who handle cytotoxic drugs are exposed to carcinogenic agents, which have the potential to interrupt the cell cycle and to induce chromosomal aberrations. The presence of high chromosomal aberrations indicates the need for intervention even when exposure to these carcinogens is low. METHODS: Nationally representative samples of 552 nurses were investigated by a follow-up monitoring system. The measured biomarkers were clinical laboratory routine tests, completed with genotoxicological (chromosome aberrations [CAs] and sister chromatid exchanges [SCEs]) and immunotoxicological monitoring (ratio of lymphocyte subpopulations and lymphocyte activation markers) measured on peripheral blood lymphocytes. Results were compared to the data of 140 healthy, age-matched controls. RESULTS: In nurses exposed to cytostatics, we observed a significantly increased frequency of CAs and SCEs compared with those in the controls. Cytostatic drug exposure also manifested itself in an increased frequency of helper T lymphocytes. Genotoxicological and immunotoxicological changes, as well as negative health effects (i.e., iron deficiency, anemia, and thyroid diseases), increased among cytostatic exposed subjects. CONCLUSIONS: These results raised concerns about the protection of nursing staff from chemical carcinogens in the working environment. PMID: 28083554 [PubMed - in process]

Asia Pac J Oncol Nurs. 2016 Oct-Dec;3(4):370-381 OBJECTIVE: Identify symptom clusters based on symptoms experienced by patients with advanced nonsmall cell lung cancers (NSCLCs), and examine the relationship between the symptom clusters and impairment in everyday life and quality of life (QOL). METHODS: Using the M.D. Anderson Symptom Inventory, 9 symptom items and the QOL Questionnaire (QLQ-C-30) evaluation apparatus from the European Organization for Research and Treatment of Cancer, we evaluated symptom severity, interference in daily life, and QOL. Factor analysis and multiple regression analysis techniques were used. RESULTS: Sixty patients with advanced NSCLCs seen in pulmonary medicine departments were included in the study. The average age of patients was 64.33 (standard deviation = 11.40). Thirty-six were male and 24 were female. Three symptom clusters were identified as fatigue/anorexia cluster (dry mouth, altered the sense of taste, drowsiness, fatigue/tiredness, and lack of appetite), pain cluster (anxiety, sadness, and pain), numbness cluster (numbness, leg weakness, and distress). The pain cluster had the strongest influence (adjusted R(2) = 0.355) on daily life (emotions) while the numbness cluster most strongly affected walking. The fatigue/anorexia cluster explained 22.7% of role function variance. This symptom clustering may be unique among patients with advanced NSCLCs. CONCLUSIONS: Each of these clusters affected QOL and everyday life with varying degrees of influence. In clinical screening assessments, focusing on symptom clusters could provide tailored management strategies for patients with advanced NSCLCs. These care strategies may improve outcomes specifically for advanced NSCLCs patients. PMID: 28083555 [PubMed - in process]

Asia Pac J Oncol Nurs. 2016 Oct-Dec;3(4):382-389 OBJECTIVE: Urological cancer and its surgeries have great impact on male sexuality which could have physical or emotional consequences. In India, speaking openly about the sexual matter is a taboo and an aspect considered forbidden. Therefore, the aim of the present study is to develop an information booklet about male sexual dysfunction and assess its impact on knowledge of patients with urological cancers. METHODS: Information booklet was developed after literature review, and its content validity was established. Reliability of the questionnaire was 0.95. A randomized control trail using pre- and post-test design was used for 30 male urological cancer patients and was assigned to experimental group (15) who received information booklet and control group (15) who received standard treatment. Subjects in the experimental group were provided with opinionnaire during posttest. Data were analyzed using descriptive and inferential statistics. RESULTS: In experimental group, 40% of the subjects were ≤ 40 years, whereas 27% in the control group (P = 0.699). The pre- and post-mean difference score was significantly higher in experimental group (mean difference - 5) than control group (mean difference - 0.4). All subjects (100%) opined that the information booklet was useful, adequate, self-explanatory, sequential, and clear. CONCLUSIONS: Information in the booklet will help subjects to understand the common sexual problems after urological surgeries and help them to cope with the problems, thereby improving their quality of life. PMID: 28083556 [PubMed - in process]

Asia Pac J Oncol Nurs. 2016 Oct-Dec;3(4):390-395 OBJECTIVE: This study aimed to assess the nutritional status of cancer patients and the self-care measures they adopted as a response to nutritional problems. METHODS: This descriptive study included seventy cancer patients staying in the oncology and internal disease clinics of a university hospital in Turkey. Data were collected using a questionnaire with 29 questions. RESULTS: The mean age of participants was 40.2 ± 1.82 years. Approximately, 62.9% of the patients ate only half of the meals offered to them, 65.7% experienced weight loss, and 45.7% had difficulty eating their meals on their own. Moreover, 47.1% of the patients received nutritional support and nutritional problems were observed in 71.4% of the patients; 80% were unable to eat hospital food, 54.3% had an eating disorder related to a special diet, 30% suffered from loss of appetite, 27% had nausea, and 14.3% had difficulty swallowing. Furthermore, 48.5% of patients responded that they ate home-cooked food or ordered food from outside when questioned about the self-care measures taken to avoid the aforementioned nutritional problems. CONCLUSIONS: Most of the cancer patients had serious nutritional problems and ate home-cooked food and used nutritional supplements to overcome these problems. Oncology nurses are responsible for evaluating the nutritional status of cancer patients and eliminating nutritional problems. PMID: 28083557 [PubMed - in process]

Asia-Pacific Journal of Oncology Nursing 2016 3(3):214-217 Many barriers exist regarding access to support and information for parents with cancer who are parenting dependent children and young people. There is little known about how nurses in acute settings support parents with dependent children. Many complexity factors exist which can increase the risk of behavioral problems in children when a parent has a cancer diagnosis. A recent study presented in this editorial identifies how there is a lack of confidence and skill experienced by specialist nurses in acute oncology settings regarding the needs and well-being of children where there is a cancer diagnosis in the family. Recommendations are identified for developing practice in this area and on increasing awareness of the needs of children and young people.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):218-219Noted physician, Sr. William Osler, is credited with saying, "Care more particularly for the individual patient than for the special features of the disease". Osler understood that each patient for whom we care is first and foremost a person, who also happens to be living with a particular illness. In addition to understanding the nature of the patient's illness, therefore, it is also critically important that we come to understand the patient's unique story and set of circumstances. Doing so allows us to engage with patients in a way that affirms their sense of dignity and personhood. Drawing on the exemplar of cancer cachexia, this editorial reminds clinicians of the importance of Osler's sage advice to attend to patient dignity and personhood, and provides nurses with direction about how they can do that in practice.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):220-225 According to the guidelines published by the WHO in 2010, palliative care has been defined as "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual." Intervention provided as a part of the palliative care has to be by health professionals who strictly work as a part of the multidisciplinary team and have been specifically trained to an optimal level of competency in the field. Two key problem areas in palliative care which a physiotherapist deals with are poor physical function and pain. This article deals with the following issues: (1) What is palliative care education and its importance? (2) Current scenario of palliative care in medical and allied fields internationally. (3) Current scenario of palliative care education in medical and allied fields in India. (4) Proposed curriculum guidelines for palliative care in physiotherapy.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):226-232 Factors affecting the health outcomes of cancer patients have gained extensive research attention considering the increasing number and prolonged longevity of cancer survivors. Breast cancer survivors experience physical, psychological, social, and spiritual challenges. This systematic literature review aims to present and discuss an overview of main issues concerning breast cancer survivors after treatment. Treatment-related symptoms as well as psychosocial and spiritual aspects of breast cancer survivors are evaluated. Moreover, the benefits of intervention for emotional, physical, social, and spiritual needs of the patient during the survivorship are investigated. This review also proposes avenues for future studies in this field and develops a new, integrated, and complete interpretation of findings on the holistic well-being of women with breast cancer. Thus, this study provides clinicians with a more comprehensive source of information compared with individual studies on symptom experiences.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):233-240 Oncology nursing, like many other nursing fields, often provides nurses with the opportunity to get to know their patients and their families well. This familiarity allows oncology nurses to show a level of compassion and empathy that is often helpful to the patient and their family during their struggle with cancer. However, this familiarity can also lead to a profound sense of grief if the patient loses that struggle. This self-study provided me the opportunity to systematically explore my own experience with grief as an oncology nurse, helping me to identify specific stressors and also sources of stress release.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):241-251 Complementary therapies (CTs) are nonconventional supportive therapies, which are used by the patients with cancer. The use of CTs has been known to alleviate symptoms as a result of chemotherapy and to improve quality of life. However, if CTs are inappropriately used, there may be adverse reactions or no effect resulting in poor support of the cancer treatment. Nurses play an important role in supporting patients with cancer who often seek information regarding CTs. Within their scope of practice, it is expected that nurses have sufficient knowledge about the safety and effective use of CTs, and positive attitudes toward supporting patients who wish to use CTs. This review aims to examine existing literature regarding nurses&#39; knowledge and attitudes toward CTs for patients with cancer. English language articles obtained from recognized nursing and midwifery databases such as CINAHL, Google Scholar, Medline, ProQuest Central, and Scopus for the period between 2002 and 2015 were searched. A total of 96 articles were retrieved using the search terms with only 13 eligible articles meeting the inclusion criteria. Three major themes were identified by the thematic analysis of reviewed studies: nurses&#39; knowledge about CTs, nurses&#39; attitudes toward CTs, and sources information about CTs. The majority of studies investigating nurses&#39; knowledge and attitudes toward the use of CTs for oncology was conducted in developed countries. Overall, it was identified that nurses need to improve their knowledge and skills about CTs so that they were more confident to assist patients in integrating conventional treatment and CTs for cancer management.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):252-258 Objective: Although much has been documented about the experience of breast cancer, the accounts of young women have been relatively neglected, despite that around 20% of the breast cancer diagnoses occur in women under the age of 50. In particular, the voices of young women diagnosed during pregnancy are missing from research. Breast cancer is the most common cancer associated with pregnancy, and it is diagnosed in about 1 in 3000 pregnancies. Methods: This study presents data from three women drawn from a larger study of women who had been diagnosed under the age of 45 and had completed their treatment for breast cancer. Semi-structured qualitative interviews were undertaken, with a methodology informed by social constructionist grounded theory and feminism. Results: The findings here report the ways that having breast cancer during pregnancy disrupted taken-for-granted assumptions about their pregnancies, new motherhood, and their future life course, and how this occurred within the context of gendered ideas about femininity and motherhood. Conclusions: Breast cancer during pregnancy has a far-reaching impact on young women's lives, and women affected may need practical support in caring for young children, and counselling may be appropriate. Further research is needed in this important area.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):259-265 Objective: This paper summarizes the barriers and challenges in cancer care reported from a validation project of a self-management intervention handbook from Chinese-American cancer patients with limited English proficiency (LEP). Methods: Seven health-care providers (HCPs) and 16 Chinese-American cancer survivors with LEP were invited to validate a self-management intervention handbook through networking sampling method. Bilingual versions were developed and validated using the repeated translation process. Online and paper-based survey and interview were conducted to collect information on the perception of barriers and experiences on cancer care. Data were analyzed by the content analysis method. Results: The HCPs reported a bilingual self-management handbook which is useful and feasible for patient self-management. The challenges in giving cancer care to LEP patients included: patients do not engage in discussion, different cultural health beliefs, unable to speak to patients in their primary language, and patients are less likely to discuss emotional and social challenges during treatments. The common barriers and experiences during cancer care included: limited understanding about treatment/medication and side effects, language barriers such as unable to communicate to make the decision, unable to understand information related to resources and do not know what questions to ask, and do not know what to expect during their cancer treatment. Conclusions: The current findings highlight the need of cancer self-management support for culturally diverse LEP cancer patients. Further research can include applying the supportive intervention to all LEP cancer patients.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):266-271 Objective: This study aims to describe the factors affecting successful nursing care intervention on sexuality. Methods: A one-group pre- and post-test design was used. Fifty-three cervical cancer survivors and their spouses were administered with nursing care intervention on sexuality in three sessions and evaluated after 6 weeks. Results: Sexual intervention reduced dyspareunia symptoms, improved vaginal lubrication, improved sexual satisfaction, and enhanced sexual arousal, sexual desire, and orgasm among cancer survivors and their spouses. The other influencing factors also simultaneously contributed to the success of nursing care intervention. Conclusions: Nursing care intervention on sexuality could be a part of supportive nursing care and an important aspect in standard nursing care for cancer patients in Indonesia.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):272-280 Objective: This study was to examine the effect of complementary therapy (CT) for nurses with high stress levels. It was taken before we employ this technique for cancer survivors because cancer patients are a heterogeneous group that requires substantial resources to investigate. Methods: A quasi-experimental design with five groups was employed for this study. The groups were examined whether there were effects for reducing the stress and the differences in effectiveness among four intervention groups and a nonintervention group. Stress relief was measured using pulse rate and blood pressure measurements and the short form of the profile of mood states (POMS-SF). The participants practiced the therapy for 20 min twice per week for 3 weeks. A two-way factorial analysis of variance was used to analyze the data. Results: The study enrolled 98 nurses (92 female and 6 male) with a mean age of 37.3 &#177; 10.5 years (range: 22&#8211;60 years). Fifty-nine nurses had 10 or more years of nursing experience. There were significant differences in pulse rate and the POMS-SF scores. All groups were effective for reducing the stress level of high-stress nurses, whereas four intervention CT groups were not more effective than nonintervention group. Conclusions: The complementary therapies were useful for nurses with high stress levels. Thus, they can be used as a self-management tool for such nurses. Afterward, we will use the CT for cancer survivors to determine whether it can improve the quality of life of cancer patients.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):281-288 Objective: This study aims to determine the attitude of Jordanian physicians toward disclosure of cancer information, comfort and use of different decision-making approaches, and treatment decision making. Methods: A descriptive, comparative research design was used. A convenience sample of 86 Jordanian medical and radiation oncologists and surgeons practicing mainly in oncology was recruited. A modified version of a structured questionnaire was used for data collection. The questionnaire is a valid measure of physicians&#39; views of shared decision making. Results: Almost 91&#37; of all physicians indicated that the doctor should tell the patient and let him/her decide if the family should know of an early-stage cancer diagnosis. Physicians provide abundant information about the extent of the disease, the side effects and benefits of the treatment, and details of the treatment procedures. They also provided less information on the effects of treatment on the sexuality, mood, and family of the patient. Almost 48&#37; of the participating physicians reported using shared decision making as their usual approach for treatment decision making, and 67&#37; reported that they were comfortable with this approach. The main setting of clinical activity was the only factor associated with physicians&#39; usual approach to medical decision making. Moreover, age, years of experience, and main setting of clinical activity were associated with physicians&#39; comfort level with the shared approach. Conclusions: Although Jordanian physicians appreciate patient autonomy, self-determination, and right to information, paternalistic decision making and underuse of the shared decision-making approach persist. Strategies that target both healthcare providers and patients must be employed to promote shared decision making in the Jordanian healthcare system.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):289-296 Objective: The main objective of this study was to identify the problems of Nepalese breast cancer survivors living in an urban area who had completed their treatment for at least 6 months. Methods: A cross-sectional descriptive study was conducted to assess the problems of breast cancer survivors who were registered at the Nepal Cancer Support Group. Fifty-one women who were diagnosed with breast cancer (Stage 0 to III) and were currently disease-free were enrolled in the study. They were interviewed using structured interview schedule using the Breast Cancer Prevention Trial Symptom Scale. Statistical analysis was carried out with SPSS (version 16). Results: The mean age of the women at the time of enrollment was 47.3 years. The most common modality of treatment they received was the combination of surgery, chemotherapy, and radiotherapy (84&#37;). Top five symptoms experienced by the survivors on the basis of frequency and severity were tiredness (61&#37;), lack of energy (57&#37;), forgetfulness (57&#37;), lack of interest in sex (52&#37;), general body aches (49&#37;), and feeling of worrisome and anxiousness about future (49&#37;). Women with age &#60;45 years at diagnosis had higher mean rank score in psychological (24.7) and social problems (23.9) in comparison to women aged &#8805;45 years. There was a significant relationship between severe psychological (34.9 vs. 19.6; P &#61; 0.001) and social problems (29.1 vs. 21.2; P &#61; 0.03), with the time since primary treatment completion of &#60;1 year. Conclusions: Nepalese breast cancer survivors were found to have multiple physical, psychological, and social problems and might require special attention during follow-up visits.

Asia-Pacific Journal of Oncology Nursing 2016 3(3):297-305Objective: Breast cancer is the most common cancer in women worldwide. The effects of overall diet quality instead of single nutrients after breast cancer diagnosis on mortality have been a growing area of research interest. The aim of this systematic review was to investigate the relationship between the Healthy Eating Index (HEI)/the Alternative Healthy Eating Index (AHEI) and risk of breast cancer mortality or survival rates as a primary outcome, and some related inflammatory factors, as secondary outcomes among postdiagnosed women. Methods: This study methodology was performed based on the Preferred Reporting Item for Systematic Review and Meta-analysis statement recommendation and had been registered at PROSPERO (registration number: CRD42015015605). The systematic search was conducted in the electronic databases including PubMed, ISI, Scopus, Cochrane, and Google before July 2016. Researches that had not reported risk of breast cancer mortality or survival rates separately were excluded from the study. Similarly, this review excluded studies which only had examined the HEI or AHEI without reporting their association with the risk of mortality or survival rates. Results: After primary search, of 643 studies identified, 4 studies including eligible criteria were selected for the final assessment. All selected studies had been conducted in the USA and used self-report food-frequency questionnaire for diet quality assessment. In two studies HEI-2005, in one study AHEI, and in another study AHEI-2010 were applied. Meta-analysis result showed no significant association between these indexes and risk of breast cancer mortality/survival among women with this malignancy [relative risk: (RR) 1.04; 95&#37; confidence interval (CI): 0.69&#8211;1.56; P &#61; 0.87]. Conclusions: Regarding the adherence HEI/AHEI, we found no association between mentioned indexes and risk of mortality or survival from breast cancer in women with breast cancer. However, evidence in this field is limited and inconsistence and further studies are needed.

Asia-Pacific Journal of Oncology Nursing 2016 3(2):118-120 [OPEN Access] Cancer care is an evolving specialty, and nurses have been pivotal in that evolution. Often with the closest relationship with the patient, privy to the details of their anxieties, and personal journey, nurses are uniquely situated to assist in the provision of psychosocial care to patients and the multidisciplinary team with an overview of the patient's health status, including the level of multifactorial and complex distress. Despite the advent of effective radiation oncology, surgery, and chemotherapy, we know that cancer still is often thought of as being synonymous with death, pain, and suffering. [1] As cancer became recognized as a disease, and in those early years, the predictions of survivorship or the extension of life was limited or guarded and often the sole focus of cancer care. More recently, cancer care programs have recognized the emotional pain and distress patients and families experience with the diagnosis and treatment of cancer and now seek to provide support as a matter of compassion and comfort. This awareness has led to the creation of a new field of cancer care called Psychosocial Oncology or Psycho-Oncology. As this new discipline joined the cancer care team and supported the provision of good clinical care, research became the requisite addition to this discipline. Credible research demonstrated value and enabled practitioners to provide empirically based psychosocial oncology interventions. Early psychosocial studies [...]

Asia-Pacific Journal of Oncology Nursing 2016 3(2):121-124 [OPEN Access] This article reflects on the development and implementation of a consumer engagement in teaching initiative by the authors. The authors highlight the challenges of engaging undergraduate nursing students on the psychosocial aspects of living with cancer and other chronic illnesses when students have very limited personal and professional experiences to draw on. The authors discuss how they have responded to these challenges by integrating the voices of consumers into their classrooms. Speakers from consumer advocacy organization, Cancer Voices SA, participated in a series of tutorials in a 1st year topic in the Undergraduate Nursing Program at the School of Nursing and Midwifery, Flinders University. Student feedback from the implementation of the initiative indicated that students found consumers' stories and experiences of living with cancer, "moving and powerful" and that they encouraged students to question their assumptions about the psychosocial impacts of cancer on individuals and families. The importance of good communication in reducing patient distress was identified by students as an important element of consumers' experiences of the health care system as was the need for transparency and information sharing between health care providers across the health care system. For many students, consumers' stories and experiences had reinforced students' commitment to studying nursing and pursuing a career in nursing. The article concludes that involving consumers in the education of health care professionals encourages a much deeper understanding of and empathy for how patients experience disease, which is integral to the provision of patient-centered and holistic care.

Asia-Pacific Journal of Oncology Nursing 2016 3(2):125-136 [OPEN Access] Several psychosocial care interventions have been found effective in improving psychosocial outcomes in cancer patients. At present, there is increasingly being asked for information on the value for money of this type of intervention. This review therefore evaluates current evidence from studies investigating cost-effectiveness or cost-utility of psychosocial care in cancer patients. A systematic search was conducted in PubMed and Web of Science yielding 539 unique records, of which 11 studies were included in the study. Studies were mainly performed in breast cancer populations or mixed cancer populations. Studied interventions included collaborative care (four studies), group interventions (four studies), individual psychological support (two studies), and individual psycho-education (one study). Seven studies assessed the cost-utility of psychosocial care (based on quality-adjusted-life-years) while three studies investigated its cost-effectiveness (based on profile of mood states [mood], Revised Impact of Events Scale [distress], 12-Item Health Survey [mental health], or Fear of Progression Questionnaire [fear of cancer progression]). One study did both. Costs included were intervention costs (three studies), intervention and direct medical costs (five studies), or intervention, direct medical, and direct nonmedical costs (three studies). In general, results indicated that psychosocial care is likely to be cost-effective at different, potentially acceptable, willingness-to-pay thresholds. Further research should be performed to provide more clear information as to which psychosocial care interventions are most cost-effective and for whom. In addition, more research should be performed encompassing potential important cost drivers from a societal perspective, such as productivity losses or informal care costs, in the analyses.

Asia-Pacific Journal of Oncology Nursing 2016 3(2):137-147 [OPEN Access] A cancer diagnosis and subsequent treatment is a stressful experience with the potential for long-term health consequences for both patients and their caregivers. It is now well-established that psychological stress is associated with detrimental effects on physical health. Recent studies have investigated the link between telomeres, the protective cap at the end of chromosomes, and stress, suggesting that stress potentially impacts on cellular aging through telomere shortening, with subsequent consequences for health. This review aims to familiarize the reader with the pertinent literature exploring the relationship between telomeres and psychological and behavioral factors and propose future directions for telomere research in psycho-oncology.

Asia-Pacific Journal of Oncology Nursing 2016 3(2):148-156 [OPEN Access] This review aimed to identify the unmet supportive care needs to conduct an integrative review of the literature, to identify the unmet supportive care needs of Arab people affected by cancer (patients and caregivers), and the impact of these needs on quality of life and psychosocial well-being. In July 2015 databases, search engines and electronic list servers were searched, with no limit on the year of publication. Reference lists of included articles and published reviews were also hand searched. Six studies met the inclusion criteria. Most studies examined the supportive care/unmet needs of Arab cancer patients and their family caregivers. Language, communication, information, and the need to get relief from dependency were the most frequently reported unmet needs among Arab cancer patients. For immigrant Arab patients, physical unmet needs were higher than other migrant groups and native Anglo-Australians. Arab caregivers' unmet needs included concerns about providing suitable care for their family member, sharing their experience with other caregivers, obtaining information, and, in the case of pediatric cancers, dealing with siblings' emotional reactions. The existing literature exploring the unmet supportive care needs of Arab people affected by cancer is limited suggesting that comprehensive studies are needed to enhance our understanding of these needs and to inform service planning.

Asia-Pacific Journal of Oncology Nursing 2016 3(2):157-169 [OPEN Access] Cancer support group has been studied as an intervention to improve patient psychosocial well-being. The effectiveness of support groups among Asian breast cancer (BC) patients has been unclear and received limited attention to the evidence of its effectiveness. The social-cognitive processing theory underlies the principles of support groups and advocates that a positive, supportive social environment can improve cognitive processing. The purpose of this paper is to present an integrative review of research evidence on the effectiveness of cancer support groups with Asian BC patients. Empirical studies related to support group among Asian and Asian American BC patients published between 1982 and April 2014 are reviewed. There are 15 studies selected (12 from the Asian-Pacific region and 3 from Western countries). The review includes 1 qualitative study, 3 descriptive studies, 1 mixed method design, and 10 experimental or quasi-experimental studies. The support group intervention activities include psycho-educational program such as health education, problem-solving, and stress management. These studies support the effectiveness of support group in alleviating psychological distress and supporting quality of life of Asian BC women. Overall, there is limited research on the use and effectiveness of support groups with Asians cancer patients in Asia and in Western countries. Without accounting for Asian immigrants overseas, the Asian population is expected to grow from 4.3 to 5.3 billion by 2050. As cancer patients become more diverse due to global emigration, more rigorous studies examining the effectiveness of psychosocial intervention among transcultural cancer patients are needed.

Asia-Pacific Journal of Oncology Nursing 2016 3(2):170-175 [OPEN Access] Objective: This cross-sectional prospective study aimed to explore the relationship between psychological factors and breast cancer incidence. Methods: The subjects who scheduled to receive mammography screening were recruited from a medical center's outpatient department in Taiwan. Psychological factors used for measurement were stress, anxiety, and depression. Results: A total of 1160 questionnaires were completed, which underwent statistical analysis using independent t-test, Chi-square test, Pearson's correlation, and multiple logistic regression. There were statistically significant differences in the average scores of the two groups with and without breast cancer for psychological factors of anxiety (t = &#8722;2.071; P = 0.039), depression (t = &#8722;3.035; P = 0.002), and stress (t = &#8722;4.087; P < 0.001). The crude odds ratio of the two groups showed that subjects with borderline anxiety were 2.576 times ( P = 0.001) more likely to have breast cancer as compared to subjects with no anxiety. Subjects with depression were 4.078 times (P = 0.03) more likely to have breast cancer as compared to subjects with no depression. Every point added to the average total stress score increased the additional risk of breast cancer by 1.124 times (P < 0.001). Conclusions: After making adjustments on educational factors, the results conclude that psychological factors such as stress, anxiety, and depression can be considered predictors of breast cancer risk. To prevent and control breast cancer in women, the findings suggest that nurses should consider adding emphasis on psychological factors in women's health education.