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   Table of Contents - Current issue
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March-April 2021
Volume 8 | Issue 2
Page Nos. 107-223

Online since Friday, January 29, 2021

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POSITION STATEMENT  

Position Statement on Cancer Nursing's Potential to Reduce the Growing Burden of Cancer across the World p. 107
Patsy Yates, Andreas Charalambous, Laura Fennimore, Brenda Nevidjon, Winnie KW So, Eunyoung E Suh, Emma Woodford, Annie Young
DOI:10.4103/2347-5625.308313  
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EDITORIAL Top

BRAF Mutations and Resistance of Non-Small Cell Lung Cancer to BRAF-Targeted Therapies Using Liquid Biopsy p. 110
Ming Li, Xiaoying Zhang
DOI:10.4103/2347-5625.308303  
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PERSPECTIVE Top

Topological Data Analysis: A New Method to Identify Genetic Alterations in Cancer p. 112
Jie Yu, Xinzhong Chang
DOI:10.4103/2347-5625.308301  
Cancer is the largest health problem worldwide. A number of targeted therapies are currently employed for the treatment of different cancers. Determining the molecular mechanisms that are necessary for cancer development and progression is the most critical step in targeted therapies. Currently, many studies have identified a large number of frequently mutated cancer-associated genes using recurrence-based methods. However, only the cancer-associated mutations with a mutation frequency >15% can be identified by these methods. In other words, they cannot be used to identify driver genes that have low mutation frequency but play a major role in tumorigenesis and development. Thus, there is an urgent need for a method for identifying cancer-associated genes that are not based on recurrence. In a study, recently published in Nature Communications, research team led by Prof. Raúl Rabadán from the Columbia University successfully devised a novel topological data analysis approach to identify low-prevalence cancer-associated gene mutations using expression data from multiple cancers.
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REVIEW ARTICLE Top

Effects of Dyadic Interventions on Quality of Life among Cancer Patients: An Integrative Review Highly accessed article p. 115
Abha Sharma, Chongjit Saneha, Warunee Phligbua
DOI:10.4103/apjon.apjon_63_20  
Interventions delivered to cancer patients along with their caregiver as a unit of care indicates dyadic intervention. With the shift of care to home, dyadic interventions are being popular among cancer care. This review aims to identify the dyadic interventions targeting quality of life (QOL) of cancer patient. The current review examined different dyadic interventions for cancer patients from January 2009 to January 2020. PubMed, Psych-info, and CINAHL databases were searched, and 27 studies were included in the review. There were different dyadic interventions for cancer patients including skill based, psychosocial (psycho-educational, educational, counseling), yoga, mindfulness, coping, dance, writing, training along with education, and counseling. Interventions were different in mode of delivery, duration, and delivery personnel. Interventions had improved some aspects of QOL among cancer patients as well as caregivers. Although some aspects of QOL were improved, precise dose and use of different approaches together could be integrated to develop further interventions. Further intervention based on strong theoretical framework guided by the standard protocol is recommended.
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ORIGINAL ARTICLES Top

Barriers and Challenges to Cervical Cancer Screening, Follow.Up, and Prevention Measures among Korean Immigrant Women in Hawaii p. 132
Eurina Yujin Cha, Hans Chun
DOI:10.4103/2347-5625.308302  
Objective: Despite being the fastest-growing population in the United States, Asian American women have one of the lowest cancer screening rates and the least attention given to cancer-related research. Cervical cancer screening disparities among Korean immigrant women (KIWs) in Hawaii have been reported. Methods: The qualitative ethnographic study was to explore the health barriers and challenges of cervical cancer prevention among KIWs in Hawaii. The Social Ecological Model was used to guide the study. Data were collected using individual structured interviews with 20 KIWs aged 21–65 years. The data were coded and analyzed to identify themes in exploring health barriers. Results: The findings revealed that participants (a) lacked knowledge about the U.S. health-care system; (b) lacked access; (c) had limited resources regarding cervical cancer screening communicated in Korean; (d) lacked an understanding of cultural and psychosocial beliefs on preventive care; (e) lacked female and Korean-speaking providers; and (f) experienced language barriers and limited coverage of health insurance. Conclusions: A multicomponent intervention combining individual and community-based, Internet-accessible, culturally, and linguistically appropriate approaches may enhance effective cervical cancer screening rates and positive health outcomes among KIWs in Hawaii.
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An Exploration of the Challenges for Oncology Nurses in Providing Hospice Care in Mainland China: A Qualitative Study p. 139
Ruishuang Zheng, Qiaohong Guo, Zhiqian Chen, Lili Ma, Susan McClement
DOI:10.4103/apjon.apjon_62_20  
Objective: Although there has been an increasing emphasis on assisting nurses with providing quality hospice care to patients and family members, few studies have explored the challenges that oncology nurses face when delivering hospice care in the Chinese cultural context. The objective of this study was to elucidate the challenges for oncology nurses in providing hospice care for terminally ill cancer patients in mainland China. Methods: A descriptive qualitative study with purposive sampling using audio-recorded fact-to-face interviews. A total of 13 hospice nurses from four hospitals in Beijing, mainland China, participated in this study. Data collection was from April to June 2019, and thematic analysis method was used to analyze the data. Results: Challenges identified by hospice nurses in providing hospice care for terminally ill cancer patients included: (1) public misperception on hospice care, (2) lack of financial support, (3) fear of medical disputes and legal action, (4) shortage of human resources, (5) insufficient specialization and lack of “hierarchy” training on hospice care, (6) inexperience in communication skills, and (7) lack of self-care and stress management skills. Conclusions: It is imperative and critical for the government, health-care institutions, and hospice care providers to clearly understand the challenges that currently exist in providing hospice nursing. Joint efforts are needed to overcome those challenges, which might result in qualified hospice nurses and provide evidence for further development of hospice care in mainland China.
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Posttreatment Anxiety, Depression, Sleep Disorders, and Associated Factors in Women Who Survive Breast Cancer p. 147
Penelope Aggeli, Georgia Fasoi, Afroditi Zartaloudi, Konstantinos Kontzoglou, Michael Kontos, Theocharis Konstantinidis, Ioannis Kalemikerakis, Ourania Govina
DOI:10.4103/apjon.apjon_65_20  
Objective: Breast Cancer Survivors (BCSs) experience negative effects on their physical and mental health, including sleep disorders, after the completion of treatment and over the whole spectrum of survival. The aim of this study was to investigate the levels of posttreatment anxiety, depression, and sleep disorders exhibited by women who have survived breast cancer. Methods: A descriptive, cross-sectional study was conducted with a population of 170 BCSs, who were monitored as outpatients by two surgical departments of a central Athens hospital for between one and five–5 years after completing their therapy. The data were collected between November 2019 and March 2020 and included demographic and clinical characteristics, as well as the Athens Insomnia Scale to measure sleep disorders and the Hospital Anxiety and Depression Scale to assess the incidence of mental disorders. Results: The majority of the patients were aged 61–70 years (41.4%), married (56.9%), with two children (56.3%), and graduates of higher education (41.8%). Of the total population, 53.5% had sleep disorders, 29.4% anxiety, and 18.2% depression. Insomnia had a moderately positive correlation with both anxiety and depression (r = 0.598, P < 0.001 and r = 0.584, P < 0.001, respectively), while a strongly positive correlation was found between depression and anxiety (r = 0.683, P < 0.001). Sleep disorders were associated with factors such as profession (P < 0.001), income (P = 0.01), the number of minor children (P = 0.021), and the number of pathological problems (P = 0.003); anxiety was related to the number of minor children (P = 0.008) and the use of drug therapy to treat mental disorders (P = 0.038); while for depression, the relevant factors were the duration of treatment (P = 0.029), the number of minor children (P < 0.001), the use of medication for treatment of mental disorders (P = 0.008), and sleep disorders (P = 0.003). Conclusions: Women who have survived breast cancer in Greece show a high rate of anxiety and depression related to the disease, as well as sleep problems that are partly associated with their psychological status, but are also affected by parameters such as income, type of profession, and the presence of minor children in the household.
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Psychoeducational Nursing Intervention for Symptom Management in Cancer Patients: A Randomized Clinical Trial p. 156
Marina de Góes Salvetti, Suzana Cristina Teixeira Donato, Caroline Silva Pereira Machado, Natalia Gondim de Almeida, Daniela Vivas Dos Santos, Geana Paula Kurita
DOI:10.4103/apjon.apjon_56_20  
Objective: The objective of this study was to assess the effects of a psychoeducational intervention upon symptom control and quality of life (QoL) among cancer patients. Methods: This was an open randomized clinical trial (RCT) conducted at the Cancer Institute of the State of São Paulo. The RCT comprised 107 outpatients in chemotherapy or radiation for malignant neoplasms. Participants were randomized to control group (usual treatment) or intervention group (IG) (psychoeducational intervention) with assessments at baseline and upon completion of the intervention. Sociodemographic information, clinical data, QoL, functionality, and symptoms were assessed. This trial is registered with the Brazilian Clinical Trials Registry number RBR-9337nv. A mixed-effects model was applied to compare the effects of the intervention between the groups. Results: The most frequent symptoms were fatigue (76.6%), insomnia (47.7%), pain (42.1%), and loss of appetite (37.4%). The symptom intensity analysis suggests that insomnia was the strongest symptom, followed by fatigue, loss of appetite, and pain. The IG experienced a significant improvement in terms of loss of appetite (P = 0.002) and a tendency toward less insomnia (P = 0.053). Conclusions: The intervention significantly reduced appetite loss in cancer patients. Despite no effects observed in global QoL or functionality, the intervention yielded a tendency to improve insomnia, and this outcome should be investigated in future studies.
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Supportive Care Needs and Health-Related Quality of Life of Esophageal Cancer Survivors p. 164
Eunju Choi, Soo Hyun Kim, Young Whee Lee, Hwasoon Kim, Young Mog Shim, Genehee Lee, Deborah L Volker
DOI:10.4103/apjon.apjon_60_20  
Objective: The aim of this study is (1) to describe the prevalence and correlates of unmet needs among esophageal cancer survivors (ECS) in Korea and (2) to identify the association between unmet needs and health-related quality of life (HRQOL). Methods: We used a cross-sectional descriptive study design. Participants were 118 ECS from a hospital in Korea who received surgery at least 12 months before participating. We collected data including the Supportive Care Needs Survey-short form 34 and to measure HRQOL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 with a self-report questionnaire. Results: Participants' mean age was 65.2 years, and 92.4% were male. Among five domains of supportive care needs, unmet need prevalence ranged from 0.8% to 50%. The most commonly reported domains of unmet needs were Health System and Information and Physical and Daily Living. Participants with unmet needs in Psychological Needs, Physical and Daily Living Needs, and Patient Care and Support Needs demonstrated significantly poorer HRQOL in almost all measured domains. Conclusions: Our finding suggests that Korean ECS had substantial unmet needs, especially in the Health System and Information domain. Psychological, Patient Care and Support, and Physical and Daily Living Needs were related to HRQOL. The study can advance understanding of priority issues in ECS.
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Relationships among Social Support, Coping Style, Perceived Stress, and Psychological Distress in Chinese Lung Cancer Patients p. 172
Xu Tian, Yanfei Jin, Hui Chen, Ling Tang, Maria F Jiménez-Herrera
DOI:10.4103/apjon.apjon_59_20  
Objective: Social support is associated with improved psychological distress in cancer patients. This study investigates the impact of social support on Chinese lung cancer patients' psychological distress and further clarifies the mediating role of perceived stress and coping style. Methods: A cross-sectional survey study examined social support and psychological distress in 441 patients diagnosed with lung cancer from seven hospitals in Chongqing, China, between September 2018 and August 2019. Coping style and perceived stress were considered to be potential mediators of adjustment outcomes. Results: We found a detection rate of 17.7% for psychological distress among Chinese lung cancer patients. Social support was in significantly negative association with psychological distress, which was partially mediated by confrontation coping and perceived stress. Conclusions: Social support appears to contribute to ameliorate psychological distress by enhancing confrontation coping with cancer and enhancing perceived stress. There is a need for the development and evaluation of psychological intervention program to enhance the buffering effects of social support in lung cancer patients.
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Development of Self-Management Support Program for Elderly Patients with Lung Cancer Receiving Molecularly-Targeted Therapy p. 180
Akiko Fukawa
DOI:10.4103/apjon.apjon_58_20  
Objective: Recently, Japan has seen an increase in the number of elderly patients with lung cancer, and oral molecularly targeted therapy has become an increasingly common treatment option for these patients. Accordingly, we have developed the Self-Management Support Program for Elderly Patients with Lung Cancer who are Receiving Molecularly-Targeted Therapy. The purpose of this study is to evaluate this program based on the responses of nurses to a survey regarding the program's usability by general nurses. Methods: We developed the program based on our previous study and the existing literature. To evaluate the program, general nurses interested in caring for elderly patients with lung cancer or patients with other forms of cancer receiving oral agents, took part in the survey about the program's appropriateness and usefulness. Results: Twenty-seven nurses took part in the survey. More than 90% of nurses agreed or slightly agreed with these statements: “the purpose of the program is appropriate,” “the program is suitable for patients,” “The program is useful for general nurses,” and “The program is useful for nurses in providing patient support.” However, some of them commented, “Nurses do not have enough time to answer outpatients' queries” and “I'm afraid that general nurses can't use this program, because they don't have enough knowledge about lung cancer patients and oral agents.” Conclusions: The study demonstrated that the self-management support program was appropriate. Further studies are necessary to modify this program to make it useful for nurses in the clinical setting. To further examine its effectiveness, in future, the program needs to be made available to elderly patients with lung cancer who are receiving molecularly targeted therapy with oral agents in the outpatient department.
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Oncology Nurses' Needs Respecting Healthy Work Environment in Iran: A Descriptive Exploratory Study p. 188
Mozhgan Soheili, Fariba Taleghani, Fariba Jokar, Maryam Eghbali-Babadi, Mehran Sharifi
DOI:10.4103/apjon.apjon_64_20  
Objective: The work environment of oncology nurses is often unpleasant due to the complexities of cancer treatment and care. Yet, there is limited information about their perspectives on healthy work environment (HWE) and their HWE-related needs. This study aimed to explore oncology nurses' HWE-related needs. Methods: This descriptive exploratory qualitative study was conducted in 2018–2019. Participants were 52 nurses and 11 oncology specialists, nursing instructors and managers, and occupational and environmental health experts, who had the experience of promoting nurses' work conditions. They were recruited from eight teaching specialty cancer treatment centers in different cities of Iran (Tehran, Isfahan, Mashhad, Shiraz, and Babolsar). Data were collected via semi-structured interviews. Data were analyzed via conventional content analysis. Results: Oncology nurses' HWE-related needs were grouped into the four main categories of physical–structural improvement, mental health improvement in work environment, organizational improvement, and sociocultural improvement. Conclusions: A wide range of physical–structural, mental health, organizational, and sociocultural improvements should be made to oncology nurses' work environment in order to fulfill their HWE-related needs. Health-care managers can use the findings of the present study to create HWE for oncology nurses.
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Bedside Blood Transfusion – What Nurses Know and Perform: A Cross-Sectional Study from A Tertiary-Level Cancer Hospital in Rural Kerala p. 197
Irene Elizabeth Jogi, Nithya Mohanan, Nisanth Menon Nedungalaparambil
DOI:10.4103/apjon.apjon_50_20  
Objective: Nursing professionals are expected to have updated knowledge of clinical blood transfusion guidelines while catering to cancer patients requiring bedside transfusions. Methods: A cross-sectional study was conducted to evaluate the knowledge and current practice of nurses at a tertiary-level cancer hospital in rural Kerala using a pretested self-administered structured 20-item questionnaire, and results were analyzed. Results: Among 246 nurses who participated, a response rate of 93.08% (n = 229) was obtained. Mean scores of 4.64 ± 1.20 out of eight for knowledge-based questions (58.00%) and 6.16 ± 1.49 out of 12 for practical aspects (51.33%) were obtained among respondents. Whereas overall scores were fair (84.28% and 65.94% nurses scoring ≥50% in knowledge-based and practice-based questions, respectively), we noticed poor knowledge-level scores for the key aspects such as time taken for cross-matching, cross-match test taking least time, storage temperature, and mandatory transfusion-transmitted infection tests before initiating transfusion. Poor scores were also noted for key clinical practices relating to warming of blood products, posttransfusion patient monitoring, rate of nonemergency blood transfusions, administration of premedications, and disposal of blood bags among the respondents. Data also revealed that there was a lack of adherence to a uniform cannula size for routine blood transfusion among nurses. Work experience or qualification had no significant relation to the nurses' scores for knowledge or practice-based questions. Conclusions: Overall, a fair amount of theoretical and practical knowledge about bedside transfusion practices were observed among nurses with some inconsistencies not related to qualification or work experience. This illuminates inherent lacunae in the existing training system and merits urgent redressal.
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Identification of Psychological and Social Problems in Caregivers of Individuals Diagnosed with Hematologic Malignancy p. 204
Yasemin Karacan, Yeliz Akkus, Emine Tulay Ozcelik, Ridvan Ali
DOI:10.4103/apjon.apjon_53_20  
Objective: Caring for patients with hematological malignancy could lead to many problems in different aspects regarding the lives of caregivers. However, there is limited data on the emotional and social problems of caregivers, who deal with patients of hematological malignancy. The aim of this study is to determine the emotional and social problems in caregivers of individuals diagnosed with hematological malignancy. Methods: The study was carried out descriptively to identify the emotional and social problems in the relatives of the patients diagnosed with hematological malignancy as their caregivers, as well as the factors affecting these problems. The data of the study were collected with the Introductory Information Form and Identification of Emotional and Social Problems Form that were administered to the relatives of the patients. The data were evaluated by using Spearman's Rho correlation analysis and the Logit analysis in Statistical Package for the Social Sciences software. Results: Among the caregivers, 59.8% were in the age group of 30–51 years, and 66.2% were female. Of the caregivers, 70.1% had difficulty in fulfilling their responsibilities. Spiritual distress had the highest score among the emotional problems, and experiencing caregiver strain had the highest score among the social problems. In the Logit model, the changes in the professional life was the variable that affects the emotional and social problems the most and significantly. In addition, emotional problems were affected by the financial problems at a statistically significant level. Conclusions: In this study, it is suggested that the caregivers should be provided with certain conveniences in their professional lives based on the fact that the problem, which affected emotional and social problems the most, is the change in the professional life; it is recommended that further studies should be carried out on the caregivers.
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Which Domains of Social Support Better Predict Quality of Life of Women with Breast Cancer? A Cross-Sectional Study p. 211
Hadi Zamanian, Mona Daryaafzoon, Sahar Foroozanfar, Zinat Fakhri, Tina Jalali, Amene Ghotbi, Mohammadali Amini-Tehrani
DOI:10.4103/apjon.apjon_47_20  
Objectives: The study aimed at investigating the specific role of social support types (SSTs) on quality of life (QoL) and its domains of women with breast cancer in Iran. Methods: In this cross-sectional study, a number of 223 women with breast cancer visiting three cancer centers of Tehran, Iran, participated from October 2014 to May 2015. Medical Outcome Study-Social Support Scale and Functional Assessment of Cancer Therapy-Breast Cancer were used for data gathering. Backward multiple regression was utilized, adjusted by age, education, and family size. Results: The study indicated positive correlations between all SSTs and QoL domains, whereas only positive social interaction (PSI) showed a significant association with physical well-being. PSI showed the only predictive performance in terms of all QoL outcomes, beyond the covariates. Conclusions: The study revealed the PSI as the most influential support type to enhance all domains of QoL of women with breast cancer.
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Outcome of Patients Treated with Hematopoietic Stem Cell Transplantation: Results from A Single Center p. 218
Gholamreza Bahoush
DOI:10.4103/apjon.apjon_55_20  
Objective: Hematopoietic stem cell transplantation (HSCT) is known as one of the most advanced and modern treatments in the world for various diseases which do not respond well to other therapies. Evaluating outcomes of these patients, especially in newly developed centers, can crucially help in developing and improving the quality of these centers. Methods: In a retrospective analytical cohort study, we statistically analyzed all patients treated with HSCT in the Bone Marrow Transplant Unit of the Ali-Asghar Pediatric Hospital affiliated to Iran University of Medical Sciences. The demographic information as well as all information concerning each patient's transplant process was extracted and statistically analyzed using SPSS Version 23. Results: The mean neutrophilic and platelet engraftment days were, respectively, 16 (range = 12–21) and 22 (range = 15–34) days after HSCT, while the neutrophilic engraftment occurred significantly earlier in allogeneic transplants compared to the autologous ones (P = 0.020). The total event-free survival (EFS) rate of the patients based on the median follow-up of 12 months was 11.50% ± 53.60%. Based on the total follow-up period, the estimated total EFS rate of the patients was calculated as 35.20% ± 13.50%. The estimated EFS rate was found to be better in patients who had undergone allogeneic transplantation than those who received an autologous transplant (P = 0.780). Conclusions: The HSCT results at our center are comparable to those at other centers in Iran. We argue that the facility can provide adequate therapy to patients requiring HSCT, on the proviso that some organizational limitations are addressed.
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