Cancer survival rates are generally increasing in the United States. These trends have been partially attributed to improvement in therapeutic strategies. Cancer immunotherapy is an example of one of the newer strategies used to fight cancer, which primes or activates the immune system to produce antitumor effects. The first half of this review paper concisely describes the cell mechanisms that control antitumor immunity and the major immunotherapeutic strategies developed to target these mechanisms. The second half of the review discusses in greater depth immune checkpoint inhibitors that have recently demonstrated tremendous promise for the treatment of diverse solid tumor types, including melanoma, non-small cell lung cancer, and others. More specifically, the mechanisms of action, side effects, and patient and family management and education concerns are discussed to provide oncology nurses up-to-date information relevant to caring for cancer-affected patients treated with immune checkpoint inhibitors. Future directions for cancer immunotherapy are considered.

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Successful targeting and inhibition of the cytotoxic T-lymphocyte-associated antigen 4 and programmed cell death-1 protein/programmed cell death ligand 1 immune checkpoint pathways has led to a rapidly expanding repertoire of immune checkpoint inhibitors for the treatment of various cancers. The approved agents now include ipilimumab, nivolumab, pembrolizumab, atezolizumab, durvalumab, avelumab, and cemiplimab. In addition to antitumor responses, immune checkpoint inhibition can lead to activation of autoreactive T-cells resulting in unique immune-related adverse events (irAEs). Therefore, it is imperative that oncology nurses, and other clinicians involved in the care of cancer patients, are familiar with the management of irAEs which differ significantly from the management of adverse events from cytotoxic chemotherapy. Herein, we review the mechanisms of irAEs and strategies for management of irAEs and highlight similarities as well as differences among clinical guidelines from the National Comprehensive Cancer Network, American Society of Clinical Oncology, Society for Immunotherapy of Cancer, and European Society for Medical Oncology. Understanding these similarities and key differences will facilitate the development and implementation of a practice site-specific plan for the management of irAEs.

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Objective: To validate EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires and to measure the health-related quality of life (HRQOL) of women with breast cancer in Singapore during their first 4 years of post-diagnosis and treatments. Methods: A quantitative and cross-descriptive sectional study. All of 170 subjects were recruited in a Singapore tertiary cancer center. The European Organization for Research and Treatment-QOL questionnaire and breast cancer specific module (EORTC QLQ-C30 and QLQ-BR23) were used to measure the HRQOL among women with breast cancer. All statistical tests were performed using SPSS Version 18. The reliability of the EORTC QLQ-C30 and QLQ-BR23 questionnaires was examined using Cronbach's alpha test. EORTC QLQ-C30 was validated against EuroQol Group's 5-domain questionnaires (EQ5D) by examining its concurrent validity using Pearson Product Moment Correlation to calculate the total scores. Results: The Cronbach's alpha coefficient results for EORTC QLQ-C30 and QLQ BR-23 were 0.846 and 0.873 respectively which suggested relatively good internal consistency. The correlation between EORTC QLQ-C30 and EQ5D QOL instruments demonstrated a modest linear relationship (r=0.597; P<0.001) that indicated a moderately strong correlation between the two measures. The study showed that Singaporean women with breast cancer had enjoyed high levels of HRQOL during their first 4 years of survivorship but they had significant concern over the financial impact of breast cancer. One of the key findings was younger women had experienced more physical and psychosocial concerns than older women. Conclusion: The EORTC QLQ-C30 and QLQ-BR23 questionnaires are feasible and promising instruments to measure the levels of HRQOL in Singaporean women with breast cancer in future studies.

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Diagnosed with cancer is a traumatic event; it does not only affect the diagnosed patients, but also their caregivers. It brings along negative impacts on biopsychosocial health to the caregivers. Supportive interventions are essential for the caregivers to go through the cancer trajectory. In the past, interventions were being delivered in either face-to-face format or delivering written documents. Although Internet becomes a popular platform for delivering interventions given its substantial growth in usage, the effectiveness of this mode of intervention delivery is unclear. The aim of this review is to review existing literatures regarding efficacy of web-based interventions in psychological outcomes of cancer caregivers. A Literature search was performed in December 2012 from seven databases, including, Ovid MEDLINE, EMBASE, PsycINFO, CINHAL, ERIC, British Nursing Index and EBM Reviews. The following keywords were used in the search but were not limited to "paediatric", "parent", "caregiver", "cancer", "web-based", and "psycho education". Totally 4668 citations were identified, after excluding the duplicated and irrelevant citations; finally six studies were included in this review. A review of the literatures identified that the web-based interventions including either online support group only or a combination of informational website and online support group significantly improved coping skills, in a way reduced anxiety, stress, depression, burden, as well as negative mood and perceived bonding in cancer caregivers. It is concluded that a web-based format as a potential platform for delivering intervention to the caregivers of cancer patients for its unique advantage of easy accessibility, and no geographic or time barriers.

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Objective: The purpose of this study was to investigate the levels of unmet needs and quality of life (QOL) among family caregivers (FCs) of cancer patients and to characterize the relationship between unmet needs and QOL. Methods: A descriptive correlation design was used. Data were collected by convenience sampling during 2013 from 191 FCs of cancer patients who visited an outpatient cancer center in a general hospital in Korea. The comprehensive needs assessment tool for cancer-caregivers and the Korean version of the Caregiver QOL Index-Cancer were used to measure unmet needs and QOL, respectively. Results: FCs of cancer patients had a variety of unmet needs with prevalence ranged from 57.0% to 88.9%, depending on the domain. The domain with the highest prevalence of unmet needs was healthcare staff, followed by information/education. The mean QOL score was 74.62, with a possible range of 0-140. A negative correlation was found between unmet needs and QOL. Stepwise multiple regression analysis showed that unmet needs relating to health/psychological problems, practical support, family/social support, in addition to household income, cohabitation with the patient, and patient's age, explained 52.7% of the variance in QOL. The most influential factor was unmet needs relating to health/psychological problems, which accounted for 35.7% of the variance. Conclusions: The results of this study indicate that oncology professionals need to develop interventions to improve the QOL of FCs by focusing not only on information/educational needs of patient care but also on physical and psychological needs of FCs.

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Approximately 3.1 million women in the US are living with breast cancer and up to 75% of these women experience cancer-related cognitive impairment (CRCI). CRCI is described as impairments in memory, verbal fluency, thought processes, and attention span. Despite the high prevalence of breast cancer, only a few studies have been published on CRCI and most of these studies primarily focused on its pathophysiological mechanism. However, recent evidence has demonstrated that breast cancer patients with CRCI are more likely to have high level of psychologic distress, suggesting a possible relationship between CRCI and psychologic distress. This review aims to examine existing literature that describes CRCI in relation to psychological distress among breast cancer patients. One thousand four hundred and ninety-eight articles were searched using PubMed, CINAHL, and PsycINFO. Thirteen studies met inclusion criteria, and one article was additionally pulled from article reference lists. Of these19 studies, psychologic distress has been operationalized in varied ways such as anxiety (n = 3), depression (n = 2), both anxiety and depression (n = 4), stress (n = 4), worry (n = 2), mental fatigue (n = 1), and undefined psychological distress (n = 2). Except for six studies designed as a longitudinal study, the rest of studies used a cross-sectional design. Twelve studies used both subjective and objective measures to assess cognitive function. We found that the patients with high psychological distress displayed lower performance on cognitive function tests. Our finding indicates that psychological variables contributed to CRCI that breast cancer patients experienced. Areas for further investigation are proposed that will advance the care of breast cancer patients with CRCI.

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Moderate-to-severe pain is a common problem experienced by patients with cancer. Although analgesic drugs are effective, adverse side effects are common and some analgesic drugs are addictive. Nonpharmacological treatment may be a way to treat cancer pain without causing negative side effects. Mindfulness is used as an effective nonpharmacological treatment to improve quality of life (QoL) and to address psychological problems including distress, anxiety, stress, and depression. However, the effect of mindfulness on pain severity has not been sufficiently investigated. Therefore, a systematic review was undertaken to describe the effectiveness of mindfulness interventions for pain and its underlying pathophysiologic mechanisms. The search was conducted in PubMed, Ovid MEDLINE, and CINAHL and included only empirical studies published from 2008 to 2017. Search terms included mindfulness, mindfulness-based intervention, meditation, cancer, pain, and cancer-related pain. Six studies met the search criteria. These studies tested several types of intervention including mindfulness-based stress reduction, mindfulness-based cognitive therapy, meditation with massage, and mindful awareness practices. Study outcomes include improved pain severity, anxiety, stress, depression, and QoL. However, most studies reviewed were conducted in the United States and Denmark. Further research is needed to test culturally appropriate mindfulness interventions to reduce pain.

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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.

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Objective: The aim of the study was to introduce and evaluate the compliance to documentation of situation, background, assessment, recommendation (SBAR) form. Methods: Twenty nurses involved in active bedside care were selected by simple random sampling. Use of SBAR was illustrated thru self-instructional module (SIM). Content validity and reliability were established. The situation, background, assessment, recommendation (SBAR) form was disseminated for use in a clinical setting during shift handover. A retrospective audit was undertaken at 1 ^st week (A1) and 16 ^th week (A2), post introduction of SIM. Nurse's opinion about the SBAR form was also captured. Results : Majority of nurses were females (65%) in the age group 21-30 years (80%). There was a significant association (P = 0.019) between overall audit scores and graduate nurses. Significant improvement (P = 0.043) seen in overall scores between A1 (mean: 23.20) and A2 (mean: 24.26) and also in "Situation" domain (P = 0.045) as compared to other domains. There was only a marginal improvement in documentation related to patient's allergies and relevant past history (7%) while identifying comorbidities decreased by 40%. Only 70% of nurses had documented plan of care. Most (76%) of nurses expressed that SBAR form was useful, but 24% nurses felt SBAR documentation was time-consuming. The assessment was easy (53%) to document while recommendation was the difficult (53%) part. Conclusions: SBAR technique has helped nurses to have a focused and easy communication during transition of care during handover. Importance and relevance of capturing information need to be reinforced. An audit to look for reduced number of incidents related to communication failures is essential for long-term evaluation of patient outcomes. Use of standardized SBAR in nursing practice for bedside shift handover will improve communication between nurses and thus ensure patient safety.

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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.

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Objective: This descriptive and cross-sectional study was undertaken to determine the factors affecting cancer patients' quality of life. Methods: We collected data from 352 chemotherapy patients of an Outpatient Chemotherapy Unit in a state hospital. We included volunteered chemotherapy patients with a signed informed consent and at least 50 Karnofsky Performance Scale points. We gathered data by Personal Information Form and Nightingale Symptom Assessment Scale (N-SAS) and analyzed via basic descriptive statistics and linear regression analysis. Results: Patients were women (54.8%), married (83.5%), elementary school graduates (57.1%), housewives (44.6%) and undergoing fluorouracil-based therapy (47.2%), and almost all patients had religious and cultural rituals for the disease. Women experienced worse physical and social well-being than men (P = 0.001, P = 0.0001). Singles had worse psychological and general well-being (P = 0.0001, P = 0.0001). Housewives had the worst physical and social well-being (P < 0.05). No relationship existed between education level and life quality (P > 0.05). Breast cancer and sarcoma patients had the worst social well-being than other cancer patients. The N-SAS points of patients were not affected by blessings/prays, vow/sacrifice, consulting local herbalists and visiting "ocaks (folk physicians)" (P > 0.05). Patients with bad quality of life practiced lead pouring and amulets (P < 0.05). Gender was the first factor affecting the quality of life. Conclusion: Advanced studies on individual quality of life factors affecting cancer would empower nurses for better personal care techniques and patients for easily overcoming the disease.

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Objective: Neurological complications such as chemotherapy-induced peripheral neuropathy (CIPN) and neuropathic pain are frequent side effects of neurotoxic chemotherapy agents. An increasing survival rate and frequent administration of adjuvant chemotherapy treatments involving neurotoxic agents makes it imperative that accurate diagnosis, prevention, and treatment of these neurological complications be implemented. Methods: A consideration was undertaken of the current options regarding protective and treatment interventions for patients undergoing chemotherapy with neurotoxic chemotherapy agent or experience with CIPN. Current knowledge on the mechanism of action has also been identified. The following databases PubMed, the Cochrane Library, Science Direct, Scopus, EMBASE, MEDLINE, CINAHL, CNKI, and Google Scholar were searched for relevant article retrieval. Results: A range of pharmaceutical, nutraceutical, and herbal medicine treatments were identified that either showed efficacy or had some evidence of efficacy. Duloxetine was the most effective pharmaceutical agent for the treatment of CIPN. Vitamin E demonstrated potential for the prevention of cisplatin-IPN. Intravenous glutathione for oxaliplatin, Vitamin B6 for both oxaliplatin and cisplatin, and omega 3 fatty acids for paclitaxel have shown protection for CIPN. Acetyl-L-carnitine may provide some relief as a treatment option. Acupuncture may be of benefit for some patients and Gosha-jinki-gan may be of benefit for protection from adverse effects of oxaliplatin induced peripheral neuropathy. Conclusions: Clinicians and researchers acknowledge that there are numerous challenges involved in understanding, preventing, and treating peripheral neuropathy caused by chemotherapeutic agents. New insights into mechanisms of action from chemotherapy agents may facilitate the development of novel preventative and treatment options, thereby enabling medical staff to better support patients by reducing this debilitating side effect.

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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.

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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.

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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.

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Objective: This exploratory, quantitative, descriptive study was undertaken to explore the relationship between clinical performance and anticipated retention in nursing students. Methods: After approval by the university's Human Subjects Committee, a sample of 104 nursing students were recruited for this study, which involved testing with a valid and reliable emotional intelligence (EI) instrument and a self-report survey of clinical competencies. Results: Statistical analysis revealed that although the group average for total EI score and the 6 score subsets were in the average range, approximately 30% of the individual total EI scores and 30% of two branch scores, identifying emotions correctly and understanding emotions, fell in the less than average range. This data, as well as the analysis of correlation with clinical self-report scores, suggest recommendations applicable to educators of clinical nursing students. Conclusions: Registered nurses make-up the largest segment of the ever-growing healthcare workforce. Yet, retention of new graduates has historically been a challenge for the profession. Given the projected employment growth in nursing, it is important to identify factors which correlate with high levels of performance and job retention among nurses. There is preliminary evidence that EI "a nontraditional intelligence measure" relates positively not only with retention of clinical staff nurses, but with overall clinical performance as well.

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Objective: Job stress and burnout levels of oncology nurses increase day-by-day in connection with rapidly increasing cancer cases worldwide as well as in Turkey. The purpose of this study was to establish job stress and burnout levels of oncology nurses and the relationship in between. Methods: The sample of this descriptive study comprised of 189 nurses that are selected by nonprobability sampling method, employed by 11 hospitals in Istanbul. Survey form of 20 questions, Job Stressors Scale and Maslach Burnout Inventory (MBI) were used during collection of data. Data were evaluated using percentage, Kruskal-Wallis, Mann-Whitney U and Spearman correlation analyses. Results: In the study, there was a positively weak correlation between "Work Role Ambiguity" subdimension of Job Stressors Scale and "Emotional Exhaustion" and "Personal Accomplishment" subdimensions, whereas a positively weak and medium correlation was encountered between "Work Role Conflict" subdimension and "Emotional Exhaustion" and "Depersonalization" subdimensions. A negatively weak correlation was found between "Work Role Overload" subdimension and "Emotional Exhaustion" and "Depersonalization" subdimensions. Conclusion: A significant relationship was established between subdimensions of job stress level and of burnout level, that a lot of oncology nurses who have participated in the study wanted to change their units, because of the high attrition rate.

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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.

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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.

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Objective: The objective of the study is to evaluate the use of the Pap smear screening method for detection of precancerous lesions. Methods: All women who visited the outpatient gynecology clinic of the Department of Obstetrics and Gynaecology at King Georges Medical University, Lucknow, UP, India, over 1 year for different clinical problems were recruited for the study. A total of 1650 women who were sexually active and over 21 years of age were enrolled in the study. A clinical examination, an examination per speculum, and a vaginal examination were performed and a history taken for all women. A Pap smear was used for all women to screen for cervical cancer. The smear was obtained using an Ayre spatula and spread over a marked glass slide, which was placed in 95% ethyl alcohol and sent to the Department of Pathology for cytopathological examination. All data were recorded using a predetermined pro forma. Women who had visible malignant cervical lesions were excluded from the study. Results: Most women were in the age range of 30–50 years and multiparous. Vaginal discharge was the most common complaint, occurring in 36.96% of the women. An irregular menstrual cycle was the complaint of 12.78% and abdominal pain of 25.63% of women, while 15.15% were asymptomatic. The Pap smear test of 93.57% of the women was adequately taken, while 6.42% of the individuals had an inadequate sample. The test was negative for malignancy in 48.84%, and 42.66% had infection or inflammation. Atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL) were detected in 2.90%, 5.09%, and 0.48%, respectively. Women with Pap tests positive for ASCUS, LSIL, and HSIL underwent a colposcopy and guided biopsy. Conclusions: Women with an abnormal Pap test should undergo a colposcopy, and those with abnormal colposcopy findings should be advised to undergo a biopsy. A Pap smear is simple, noninvasive, cost-effective, and easy to perform for detection of precancerous lesions in a gynecological patient.

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The current era is characterized by the vibrant and rapidly evolving communication technologies. Communication in any form has evolved and now includes media such as Facebook, Twitter, and Instagram to report a few. Communicating and consuming information has shifted from the more traditional ways to new ones as part of this communication evolution. Cancer is an area of healthcare where such social media have been championed either to promote public awareness and drive campaigns or influence political decision-making. Although health-care lags behind many other industries in adopting social media as a part of a business or policy strategy, the increasing engagement of patients, the public, and the policymakers in social media raised the need for integrating these tools as a part of an overall program to support the strategic imperatives of the health care. As these and other new ways to communicate are introduced to the world and injected into our cultural and political systems, the question that raises here is: “How successful are social media in influencing health policy?”

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The interconnections of spirituality, spiritual care (SC), and patient-centered care (PCC) have implications for advanced practice nurses (APNs) and specialty care nurses (SNs) in their everyday practice. Spirituality has been identified as an inner resource for health, promoting hope, coping, and resilience during illness concerns; encouraging health promotion and maintenance; and improving patient outcomes. SC supports this inner resource and is provided by others. Systems can help facilitate SC by supporting the inter-personal relationships as well as transdisciplinary collaborations of PCC models. SC and PCC occur within inter-personal relationships and specific healthcare environments or systems when implementing them within a spirituality framework. This article provides a brief review on conceptual definitions of spirituality, SC, and PCC models and their relationship to each other within the inter-personal connections. Exploration of implementing such care in practice is presented. Search parameters for this review included manuscripts which provided conceptual as well as quantitative and qualitative research between 1990 and 2018, in English only, with keywords of spirituality, SC, PCC, nurse, nurse practitioner, APNs, and systems. Databases searched included CINHAL, Medline, PubMed, ALTA Religion, Psych-INFO, and Ovid. Articles included in this review were based on research of the above concepts as well as operationalizing the concepts into practice.

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Objective: Sleep disorder and fatigue are among a few major concerns of breast cancer survivors across the survivorship trajectory. The purpose of this pilot study was to examine feasibility and trends in multiple outcomes after a 6-week Qigong exercise program in breast cancer survivors. Methods: Eight female adults (mean age 55.4 ± 9.4 years, mean time after the completion of cancer treatment 3.9 ± 5.7 years) who had a diagnosis of breast cancer and were at least 3 months postcompletion of primary cancer treatment prior to participation in this study. Baseline evaluation was administered using subjective questionnaires on sleep quality, insomnia, fatigue, and quality of life. All subjects participated in two training sessions to learn the "Six Healing Sound" Qigong exercise and attended group Qigong sessions once per week in the following 6 weeks. In addition to the group sessions, subjects were asked to perform the Qigong exercises twice at home right before going to bed in the evening and immediately after getting up in the morning. Following the 6-week intervention, subjects were re-assessed using the same questionnaires. Pre- and post-intervention scores were analyzed for statistical significance. Results: Compliance rate was 89.6% for group sessions and 78.5% (ranging from 65.6% to 90.7%) for daily home Qigong exercises. No participant reported any adverse event or side effect during the study. All participants indicated in the end-intervention questionnaire that they would highly recommend the intervention to others. Significant improvements were observed in sleeping quality score (from 10.3 ± 3.6 to 5.4 ± 2.3, P < 0.01), insomnia index score (from 16.2 ± 3.2 to 6.8 ± 4.8, P < 0.01), fatigue score (from 60.3 ± 9.4 to 49.1 ± 8.6, P < 0.01), and SF-36 score (from 66.8 ± 7.7 to 80.9 ± 3.9, P < 0.01). Conclusions: Results of this single arm pilot study showed the feasibility and potential of "Six Healing Sounds" Qigong exercise for improving sleep and other symptoms in breast cancer survivors.

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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.

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