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   Table of Contents - Current issue
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July-August 2021
Volume 8 | Issue 4
Page Nos. 344-437

Online since Monday, May 31, 2021

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EDITORIALS  

Welcome to New Editorial Board Members Highly accessed article p. 344
Winnie K.W. So
DOI:10.4103/apjon.apjon-213  
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Cancer Rehabilitation-Improving Cancer Survivorship in Singapore p. 346
Matthew Rong Jie Tay, Chin Jung Wong
DOI:10.4103/apjon.apjon-2115  
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Safety and Efficacy of Human Epidermal Growth Factor Receptor 2-Targeted Therapies in Advanced Breast Cancer: A Head-to-Head Comparison of Margetuximab versus Trastuzumab p. 349
Liyi Zhang
DOI:10.4103/apjon.apjon-2128  
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ORIGINAL ARTICLES Top

The Emotional Intelligence, Occupational Stress, and Coping Characteristics by Years of Nursing Experiences of Newly Hired Oncology Nurses p. 352
Ann M Mazzella-Ebstein, Kay See Tan, Katherine S Panageas, Judith E Arnetz, Margaret Barton-Burke
DOI:10.4103/apjon.apjon-2117  
Objective: The objective of the study was to compare and analyze the emotional intelligence, occupational stress, and coping characteristics of three groups of newly hired oncology nurses. Methods: Data for this secondary analysis were collected from a larger study of 114 newly hired nurses at a cancer center in the Northeastern United States. Survey data were collected using the EQi-2.0, the Nursing Stress Scale, and the Ways of Coping Questionnaire. Dimensions of study measures were analyzed based on new graduates, 1–5 years, and >5 years of nursing experience. Analysis of variance was conducted among the three groups followed by Tukey pairwise comparisons analysis when P = 0.05. Results: New graduates scored significantly lower on the self-expression dimension (mean = 96.88; standard deviation [SD] = 13.27) than nurses with >5 years nursing experience (mean = 106.12; SD 15.02) (P = 0.04), and the subdimension, assertiveness (mean = 94.73; SD = 13.87) compared to nurses with >5-year nursing experience (mean = 103.94; SD = 14.86) (P = 0.03). Significantly higher sources of stress for new graduates were death and dying (mean = 16.45; SD = 3.37), and for the associations between the three nursing groups (P = 0.001). New graduate nurses used the problem-focused coping strategy of accepting responsibility (mean = 14.06; SD = 7.28) significantly (P = 0.006) more often than nurses with >5-year experience (mean = 8.54; SD = 4.25), and planful problem solving (mean = 16.76; SD = 5.27) significantly less often (P =.001) than nurses with 1–5-year experiences (mean = 20.12; SD = 7.31). Conclusions: Dimension scores highlight the characteristics of nurses with varying levels of nursing experience onboarding at the same time. Findings may inform model-development for improving nurse-recruitment practices and retention strategies.
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Rethinking the Meaning of “Wellness” for a Person with Cancer: A Qualitative Study to Explore What Elements Constitute “Wellness” p. 360
Jodie Nixon, Raymond Chan, Emma McKinnell, Elizabeth Ward, Elizabeth Pinkham, Laurelie Wishart, Elizabeth Miller, Bena Brown
DOI:10.4103/apjon.apjon-212  
Objective: This study explored what people with cancer and their family members define as wellness, and what they perceive to be the needs to support wellness during the cancer experience. Methods: This study utilized qualitative focus groups underpinned by an interpretative descriptive design. Participants included people with a cancer diagnosis having completed/currently undergoing cancer treatment, and/or family/friends. Participants were invited to share their experience and perceptions of cancer wellness, which was then mapped in relation to Hettler’s six dimensions of wellness. Results: Twenty-six participants (16 people with cancer, ten family/friends) were involved in the process. All six dimensions of wellness were reported by the groups with 19 descriptive content categories that related to these domains. The data revealed that people with cancer and family/friends have individual and diverse meanings of wellness. Participants offered suggestions for strategies to promote wellness relating to the environment and supportive care interventions. Conclusions: People with cancer and their families experience wellness individually. Cancer wellness models should consider the personal nature of wellness in relation to the six domains of wellness when developing wellness programs, including health professional access, an environment that supports wellness, the provision and access to reliable information, and support the key needs of being physically active and financial security.
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Anticipatory Grief among Chinese Family Caregivers of Patients with Advanced Cancer: A Cross-Sectional Study p. 369
Wenhua Yu, Qian Lu, Yuhan Lu, Hong Yang, Lichuan Zhang, Renxiu Guo, Xiaoting Hou
DOI:10.4103/apjon.apjon-214  
Objective: The objective of this study was to explore the interrelationship between anticipatory grief (AG), caregiver burden, communication, preparation for death, and coping style. Methods: A convenience sample of 256 Chinese family caregivers of patients with advanced cancer were recruited from an academic cancer hospital between April 2018 and May 2019. This cross-sectional survey included the AG Scale, caregiver burden (Caregiver Reaction Assessment), communication (Caregivers' Communication with Patients about Illness and Death Scale), preparation for death, and coping style (Simplified Coping Style Questionnaire). Structural equation modeling tested the interrelation between them. Results: The final model fitted the data acceptably (χ2 = 25.79, degrees of freedom = 17, P = 0.08, root mean square error of approximation = 0.05, goodness-of-fit index [GFI] = 0.98, adjusted GFI [AGFI] = 0.95, parsimony GFI [PGFI] = 0.46, normed fit index = 0.94, comparative fit index = 0.98). Poor communication contributed to less preparation for death and caregiver burden, which further aggravate AG. Communication was positively associated with AG. In addition, communication and positive coping style interacted to further influence caregiver burden. Conclusions: Preliminary results supported the model and showed that poor communication, less preparation for death, and caregiver burden contributed to AG while positive coping alleviated AG. Findings suggest the need for further studies to explore effective intervention for communication, preparation for death, burden, and coping style of caregivers to ultimately alleviate AG.
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Perceived New Normal and Inner Strength on Quality of Life in Breast Cancer Patients Receiving Adjuvant Endocrine Therapy p. 377
Sujin Ha, Eunjung Ryu
DOI:10.4103/apjon.apjon-2081  
Objective: This study aimed to investigate the differences in symptom experience, inner strength, adherence, and quality of life (QOL) according to the perception of the new normal, and identify the factors related to the QOL of breast cancer patients undergoing adjuvant hormonal therapy based on the theory of inner strength in women. Methods: This cross-sectional study recruited patients with breast cancer receiving adjuvant hormonal therapy in the National Cancer Center. Demographic and clinical characteristics were recorded, and patients were assessed using the M. D. Anderson Symptom Inventory, Connor-Davidson Resilience Scale 2, Morisky Medication Adherence Scale 8, and Functional Assessment of Cancer Therapy-General Scale. Results: After the breast cancer diagnosis, the perception of the new normal showed a significant dependence on pill count and emotional and functional well-being. The hierarchical regression analysis indicated that the new normal, symptom interference, and inner strength after adjusting for age, time since diagnosis, and receiving chemotherapy were significant predictors of QOL in breast cancer patients receiving adjuvant endocrine therapy. The model accounted for 47.8% of the variance in QOL. Conclusions: The theory of inner strength might be a potential pathway in health care to improve patients' QOL during long-term medication. The results of this study have both theoretical and applied implications. The findings can be utilized as evidence for developing an effective intervention that improves the QOL and adherence to adjuvant hormonal therapy of breast cancer patients.
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Transcutaneous Acupoint Electrical Stimulation on Chemotherapy-Induced Constipation for Non-Small Cell Lung Cancer Patients: A Randomized Controlled Trial p. 385
Ting Mao, Xiangyu Liu, Qinqin Cheng, Yongyi Chen
DOI:10.4103/2347-5625.311129  
Objective: Chemotherapy-induced constipation (CIC) adversely affects the quality of life of non-small cell lung cancer (NSCLC) patients. This study aimed to investigate the clinical effects of transcutaneous acupoint electrical stimulation (TAES) on CIC. Methods: Sixty NSCLC patients who received chemotherapy at Hunan Cancer Hospital, Changsha, China, were assigned to the TAES (n = 30) or control (n = 30) group using Research Randomizer. In the TAES group, four acupoints, namely Tianshu, Quchi, Zusanli, and Shangjuxu, were stimulated six times a week, lasting for 4 weeks, while the control group received the usual care. The Bristol Stool Form Scale (BSFS) and the Constipation Assessment Scale (CAS) were used. Results: Both the BSFS and CAS scores for the experimental group were significantly higher than that for the control group (P = 0.004 and P < 0.001 separately). Conclusions: TAES was effective for alleviating constipation in NSCLC patients receiving chemotherapy and was a safe and practical nursing intervention.
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Factors Related to Resilience, Anxiety/Depression, and Quality of Life in Patients with Colorectal Cancer Undergoing Chemotherapy in Japan p. 393
Saori Tamura
DOI:10.4103/apjon.apjon-2099  
Objective: This study clarifies the relationship between resilience and anxiety and depression, quality of life (QOL), and other related factors that influence colorectal cancer patients undergoing chemotherapy. Methods: This cross-sectional study focused on outpatients with colorectal cancer undergoing chemotherapy. A questionnaire including the Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, the MOS 12-item Short-Form Health Survey, and items based on a literature review was administered between August 2019 and August 2020. SPSS version 26 was used for data analysis. Correlation analysis and t-test were applied. In addition, Amos version 26 was used and structural equation modeling was applied to create a causal model. Results: A total of 121 participants (94.5%) were included in the study. The goodness of fit (GFI) of the causal model was GFI = 0.94, adjusted GFI = 0.906, comparative fit index = 0.997, and root mean square error of approximation = 0.011. Resilience had a negative effect on anxiety and depression and a positive effect on QOL. Depression had a negative effect on QOL. Conclusions: The results of this study indicate that resilience is a predictor of anxiety, depression, and QOL in colorectal cancer patients undergoing chemotherapy. Therefore, I believe that it is important to enhance resilience in order to maintain and improve patients’ mental health and QOL. In addition, since resilience was affected by cancer metastasis and the presence of metastasis was a predictor of resilience, it is a challenge to explore interventions to enhance resilience, especially in patients with metastasis.
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Predicting the Risk of Psychological Distress among Lung Cancer Patients: Development and Validation of a Predictive Algorithm Based on Sociodemographic and Clinical Factors p. 403
Xu Tian, Yanfei Jin, Ling Tang, Yuan-Ping Pi, Wei-Qing Chen, Maria F Jimenez-Herrera
DOI:10.4103/apjon.apjon-2114  
Objective: Lung cancer patients reported the highest incidence of psychological distress. It is extremely important to identify which patients at high risk for psychological distress. The study aims to develop and validate a predictive algorithm to identify lung cancer patients at high risk for psychological distress. Methods: This cross-sectional study identified the risk factors of psychological distress in lung cancer patients. Data on sociodemographic and clinical variables were collected from September 2018 to August 2019. Structural equation model (SEM) was conducted to determine the associations between all factors and psychological distress, and then construct a predictive algorithm. Coincidence rate was also calculated to validate this predictive algorithm. Results: Total 441 participants sent back validated questionnaires. After performing SEM analysis, educational level (β = 0.151, P = 0.004), residence (β = 0.146, P = 0.016), metastasis (β = 0.136, P = 0.023), pain degree (β = 0.133, P = 0.005), family history (β = −0.107, P = 0.021), and tumor, node, and metastasis stage (β = −0.236, P < 0.001) were independent predictors for psychological distress. The model built with these predictors showed an area under the curve of 0.693. A cutoff of 66 predicted clinically significant psychological distress with a sensitivity, specificity, positive predictive value, and negative predictive value of 65.41%, 66.90%, 28.33%, and 89.67%, respectively. The coincidence rate between predictive algorithm and distress thermometer was 64.63%. Conclusions: A validated, easy-to-use predictive algorithm was developed in this study, which can be used to identify patients at high risk of psychological distress with moderate accuracy.
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The Turkish Validity and Reliability Study of Palliative Performance Scale p. 413
Gonca Oguz, Gülçin Şenel, Nesteren Koçak, Şerife Karaca
DOI:10.4103/apjon.apjon-2111  
Objective: The Palliative Performance Scale version 2 (PPSv2) is a useful tool designed to assess the performance status of palliative care patients. The aim of this study was to translate the PPSv2 into Turkish and to test the validity and reliability of Turkish PPSv2 (PPS-TR) in cancer patients receiving palliative care. Methods: The translation of PPSv2 into Turkish was implemented using a forward–back forward procedure. The patients were allocated from inpatient palliative care unit, consultations from oncology services, palliative care polyclinic, and consultations from emergency unit. The inter-rater and intra-rater reliabilities were tested in a pilot study with 51 patients. The cross-sectional study consisted of 280 patients. The relationship between PPS-TR, Katz Index of Independence in Activities of Daily Living (Katz ADL), and Karnofsky Performance Scale (KPS) was also measured. Construct validity was assessed by observing the test capacity across patient groups based on the place of care. Results: Intraclass correlation coefficients (ICCs) at Time 1 and Time 2 were 0.982 (95% confidence interval [CI]: 0.972–0.989) and 0.991 (95% CI: 0.986–0.995). ICCs of intra-rater agreements were at least 0.956 (95% CI: 0.909–0.977) for three raters. KPS, Katz ADL, and PPS-TR scores of outpatients were significantly higher than those of inpatients and emergency. There was a perfect correlation between PPS-TR and KPS, while the correlation of PPS-TR with Katz ADL was almost perfect. Conclusions: The PPS-TR is a reliable and valid tool for assessment of performance status of cancer patients receiving palliative care.
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The Effect of Pain Self-Management Education on Pain Severity and Quality of Life in Metastatic Cancer Patients p. 419
Mahsa Musavi, Simin Jahani, Marziyeh Asadizaker, Elham Maraghi, Sasan Razmjoo
DOI:10.4103/apjon.apjon-2097  
Objective: Proper pain control in cancer patients is one of the prime needs of metastatic cancer patients. It is, then, one of the essential objectives of health care workers. The present study aimed to pinpoint the impact of pain self-management education on the pain severity and the quality of life in patients with metastatic cancers using complementary medicine approaches. Methods: This clinical trial study was performed in the Oncology Specialty Clinic of Ahvaz Golestan Hospital on 82 metastatic cancer patients picked based on inclusion criteria. They were randomly assigned to two groups: the intervention group and one as the control group. In the intervention group, pain self-management was taught in the three steps of providing information, skill development, and guidance. Self-management approaches were also practically taught face to face along with feedback. Furthermore, the quality of life was measured at 1-and 3-month follow-ups and the pain severity was measured during 7 weeks. In the control group, the quality of life questionnaire and the pain severity checklist were given to the participants to fill out. Finally, data were analyzed through SPSS version 22 in general and repeated-measures ANOVA and Friedman tests. Results: It was observed that after the intervention, the trend of pain severity during weeks 1–7 was significantly different in the intervention and control groups (P < 0.0001). In addition, a significant difference was observed for the quality of life at 1 and 3 months after the intervention between the two studied groups (P < 0.0001). Conclusions: Findings of the present study indicate a positive impact of pain self-management on improving pain severity and the indicators of quality of life in metastatic cancer patients. Accordingly, the current study findings can help nurses, nursing students, and other team members improve pain control skills and subsequently increase the quality of life in patients with metastatic cancers.
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The Mediating Effect of Positive Illness Cognitions on Experiential Avoidance and Quality of Life in Breast Cancer Patients p. 427
Jing Han, Li Zhang, Yao Zhang, Ruijin Tang
DOI:10.4103/apjon.apjon-20102  
Objective: Illness cognition plays an essential role during physical, psychological, and social adjustment among patients with cancer. The present study aims to explore the mediating effects of positive illness cognition on experiential avoidance and quality of life (QOL) in this population. Methods: Between August 2017 and June 2019, we recruited 312 patients with breast cancer in the treatment period from a general tertiary hospital's breast department using convenience sampling. We used the Illness Cognition Questionnaire, the Acceptance and Action Questionnaire II, and the Functional Assessment of Cancer Therapy-Breast Scale. Results: The mean score of QOL was 93.39 (SD: 18.60) for patients with breast cancer. Positive illness cognition was closely related to the QOL and experiential avoidance. Experiential avoidance significantly negatively correlated with QOL (r = −0.59, P < 0.01) and positive illness cognition (r = −0.60, P < 0.01), while positive illness cognition significantly positively correlated with QOL (r = 0.82, P < 0.01). Positive illness cognition had a mediating effect between experiential avoidance and QOL (effect size: −0.56), accounting for 87.14% of the total effect. Conclusions: The QOL was low in Chinese patients with breast cancer. Positive illness cognition had a mediating effect between experiential avoidance and QOL. Caregivers should indirectly improve patients' QOL with breast cancer by improving their positive illness cognition levels.
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SHORT REPORT Top

Chemotherapy-Induced Nausea and Vomiting in Breast Cancer Patients: A Multicenter Prospective Observational Study p. 433
Xinjuan Huang, Xuying Li, Jinhua Li, Lu Luo, Hongyun Chen, Yan Tan, Tao Wei, Xingfeng Li, Liwen Guo, Jing Cheng
DOI:10.4103/apjon.apjon-2120  
Objective: This study aimed to assess the occurrence of chemotherapy-induced nausea and vomiting (CINV) in acute phase (24 h after chemotherapy) and delayed phase (2–5 days after chemotherapy) after standard antiemetic therapy and to explore the risk factors of CINV in the acute and delayed phases. Methods: This prospective and observational study analyzed the data of 400 breast cancer patients scheduled for chemotherapy in two hospitals. The self-report survey was developed to assess the occurrence of CINV and their associated factors. On day 2 and day 6 of chemotherapy, CINV was evaluated by the Multinational Association of Supportive Care in Cancer Antiemetic Tool (MAT). The incidence of acute and delayed CINV was expressed as frequency and percentage. Results: Among 400 patients, 29.8% and 23.5% experienced acute and delayed CINV, respectively. Logistic regression analysis showed that the risk factors associated with acute CINV included pain/insomnia, history of CINV, and highly emetogenic chemotherapy. The history of motion sickness (MS), history of CINV, number of chemotherapy cycles completed, and the incidence of acute CINV were significant risk factors for delayed CINV (all P < 0.05). Conclusions: The results of this study are helpful for nurses to identify high-risk patients with CINV, formulate effective treatment plans, and reduce the incidence of CINV.
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