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   2021| November-December  | Volume 8 | Issue 6  
    Online since October 4, 2021

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Single-Cell Landscape of Liver Cancer in Response to Immunotherapy
Feiyu Diao
November-December 2021, 8(6):591-593
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Follow-up Care for Patients Receiving Immune Checkpoint Inhibitors
Liyan Zhang, Yuhan Lu
November-December 2021, 8(6):596-603
The rapid advances in cancer immunotherapy using immune checkpoint inhibitors (ICIs) have led to significantly improved survival of patients. But at the same time, it also associates with multiple immune-related adverse events (irAEs). The irAEs can affect a wide range of organs, and induce nonspecific symptoms with delayed onset and prolonged duration that is easily neglected, which may lead to life-threatening disorders. Therefore, follow-up care for patients receiving ICIs for irAEs management has become an essential competency in cancer nursing. There are several guidelines about the management of irAEs, which focused on diagnosis, grading, and treatment. However, studies on relevant follow-up care are rare. Nurses play an important role in follow-up care, whose relevant knowledge and skills are indispensable. Combined with domestic and foreign guidelines and related studies, this paper reviewed the occurrence and characteristics of irAEs and highlighted the contents, timing, models, and effects of follow-up care for patients receiving ICIs, to provide a reference for clinical nursing practice and improve the safety of immunotherapy for patients.
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MET Inhibitor is Expected to Overcome MET Amplification-Induced Immunotherapy Resistance in Non-Small Cell Lung Cancer
Ji Ruan
November-December 2021, 8(6):594-595
  1,438 76 -
Telesimulation Innovation on the Teaching of SPIKES Model on Sharing Bad News
Zohra Kurji, Azaina Aijaz, Amina Aijaz, Zohra Jetha, Shanaz Cassum
November-December 2021, 8(6):623-627
Coronavirus disease 2019 (COVID-19) brought to the world, an unprecedented emergency, which dramatically affected the face-to-face teaching in higher education academia. University faculty and students had to shift overnight to an online and remote course instruction. They were neither trained nor prepared and had limited resources and infrastructure. Palliative Care and Oncology Stream Faculty at Aga Khan University, School of Nursing and Midwifery, Pakistan, piloted an innovative academic project using telesimulation (TS). Trainee nurse interns were taught communication skills and the art of breaking bad news to palliative clients using the SPIKES model through TS. To incorporate best practices for simulation-based experiences, we used the International Nursing Association for Clinical Simulation and Learning to standardize and implement TS with 141 interns. This review article documents how the faculty planned and implemented the TS strategy during COVID-19. It outlines the challenges and the lessons learnt from implementation and feedback from faculty and students. This information could be useful in the future execution of TS, in any communication and counseling course, since COVID-19 has impacted the future educational course design and pedagogy worldwide.
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Definition and recommended cultural considerations for advance care planning in Japan: A systematic review
Ai Chikada, Sayaka Takenouchi, Kazuko Nin, Masanori Mori
November-December 2021, 8(6):628-638
Although Delphi studies in Western countries have provided a consensus for practices pertaining to advance care planning (ACP), their findings may not be applicable to Asian countries with distinct, family-oriented cultures. This systematic review aimed to synthesize the definitions of and evidence for ACP and analyze recommended practices in Japan. We conducted a systematic review using narrative synthesis in December 2018. Key words were searched from Ichushi-Web by NPO Japan Medical Abstracts Society, Citation Information by the National Institute of Informatics, and Japanese Institutional Repositories Online databases. In addition, in August 2019, we conducted hand searching using Google Scholar and Google. We included original Japanese articles that addressed factors regarding ACP (e.g. definitions, elements, roles and tasks, and timing of ACP). Data were synthesized using thematic analysis. The study protocol was registered prospectively (PROSPERO: CRD42020152391). Of the 3512 studies screened, 27 were included: 22 quantitative and 5 qualitative. Five-position statements/guidelines were added by hand searching. Definitions and several distinct practice patterns of ACP and the importance of families' roles were identified. Unique recommendations addressed the importance of properly eliciting patients' preferences that are the best for both patients and families, engaging the public to raise awareness of ACP, and developing policies and guidelines for ACP. We identified the definition of and unique recommendations for ACP based on Japanese cultural values and norms. Further research is needed to evaluate the recommendations provided in this systematic review.
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Oral Immune-Related Adverse Events – Current Concepts and their Management
Mohamed Faizal Asan, Renita Lorina Castelino, Subhas G Babu, Kumuda Rao, Vaibhav Pandita
November-December 2021, 8(6):604-609
Recent advent of immune checkpoint inhibitors (ICIs) have made significant improvement in the treatment outcome of cancer patients. They are also known to increase the overall survival in many malignancies. They target key immune checkpoints, acting on the cytotoxic T-lymphocyte antigen-4, programmed death-1 (PD-1), and PD-1 ligand 1 pathways. ICIs are effective in cancer therapy, but also possess various adverse effects that are termed together as immune-related adverse events (irAEs). Information focusing only on the oral reactions of irAEs is scanty in the literature. Therefore, we performed a computerized database search in PubMed and Google Scholar to identify and collect data regarding the oral adverse effects of ICIs. The early recognition of oral irAEs and appropriative intervention may help in improving the quality of life in patients. This paper presents a brief review of oral irAEs and their management.
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Occurrence of Type 1 Diabetes in a Patient Enrolled in an Immunotherapy Combination Phase 1 Clinical Trial: A Case Study
Sheena Charles, Anna Poullard
November-December 2021, 8(6):737-739
Advances in cancer immunotherapy treatments have shown promising results in patients with metastatic malignancy who have been refractory to prior treatments. Immune checkpoint inhibitors such as pembrolizumab in combination with other systemic agents may unleash immune-related adverse events (irAEs). Immunotherapy-induced Type 1 diabetes is rare; however, if left undiagnosed, it may cause life-threatening metabolic endocrinopathies. Advanced practice registered nurses are in a unique position to recognize and identify this irAE and in doing so can provide pathways for early diagnosis and treatments, thus leading to improved clinical and patient outcomes.
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Health-Promoting Lifestyle in Colorectal Cancer Survivors: A Qualitative Study on the Experiences and Perspectives of Colorectal Cancer Survivors and Healthcare Providers
Elahe Ramezanzade Tabriz, Monir Ramezani, Abbas Heydari, Seyed Amir Aledavood
November-December 2021, 8(6):696-710
Objective: Understanding the experiences of survivors and healthcare providers about health-promoting lifestyle (HPL) in colorectal cancer (CRC) survivors is important in planning for coping with the disease, managing treatment side effects, increasing survival, and improving quality of life (QOL). This study was conducted to explore the experiences and perspectives of CRC survivors and healthcare providers about HPL in CRC survivors. Methods: This descriptive qualitative study was performed in 2020 at Omid and Imam Reza Hospitals in Mashhad, Iran. Participants were CRC survivors (n = 12) and healthcare providers (n = 33) who were selected by purposive sampling. Data were collected using in-depth semi-structured interview by face to face and then analyzed by Zhang and Wildemuth content analysis method. MaxQDA software was used to organize the data. Results: Following the treatment of cancer, CRC survivors seek to make changes in lifestyle and they choose a HPL that maintains or improves their health. HPL in CRC survivors includes nutrition, activity and rest, health responsibility, interpersonal relations, spiritual growth, and psychological management. The results showed that HPL can lead to motivation, the ability to self-care and improve daily performance, reduce treatment complications, and increase the QOL. Conclusions: CRC survivors can help change their lifestyle patterns with healthy eating, treatment adherence, regular physical activity, and good sleep habits. Furthermore, effective personal and social relationships, spiritual growth, and management of psychological disorders develop health-promoting behaviors in them. CRC survivors also face challenges and limitations in their life after treatment; identifying the components of a HPL in CRC survivors can lead to desirable care, treatment, education, and counseling services.
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Integration of Machine Learning and Blockchain Technology in the Healthcare Field: A Literature Review and Implications for Cancer Care
Andy SK Cheng, Qiongyao Guan, Yan Su, Ping Zhou, Yingchun Zeng
November-December 2021, 8(6):720-724
This brief report aimed to describe a narrative review about the application of machine learning (ML) methods and Blockchain technology (BCT) in the healthcare field, and to illustrate the integration of these two technologies in cancer survivorship care. A total of six eligible papers were included in the narrative review. ML and BCT are two data-driven technologies, and there is rapidly growing interest in integrating them for clinical data management and analysis in healthcare. The findings of this report indicate that both technologies can integrate feasibly and effectively. In conclusion, this brief report provided the state-of-art evidence about the integration of the most promising technologies of ML and BCT in health field, and gave an example of how to apply these two most disruptive technologies in cancer survivorship care.
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Caring Partnership within Newman's Theory of Health as Expanding Consciousness: Aiming for Patients to Find Meaning in Their Treatment Experiences
Satoko Imaizumi, Aya Honda, Yoshimi Fujiwara, Yukako Iio
November-December 2021, 8(6):725-731
Despite the continuous advances in cancer treatment, many patients undergoing cancer treatment still suffer because of inability to find meaning in their treatment experiences. Nurses involved also suffer because they prioritize the implementation of treatment protocols rather than providing holistic care. Therefore, special care is needed in clinical settings. This report aimed to demonstrate helpfulness and possibility of “caring partnership” with patients in the treatment phase on the basis of Margaret Newman's theory of health as expanding consciousness. Caring partnership is a nursing intervention in a unitary and relational perspective that helps patients and nurses make a difference. For this intervention, patients need to recognize their own pattern in the relationship to exert their own strengths in finding meaning to their cancer treatment experience and so their lives, while nurses are encouraged to partner with them, trusting patients' own power and becoming a rich environment for them. Hence, dialog is necessary to facilitate patients' pattern recognition in process of the patient-nurse partnership. Three cases are presented for each treatment phase (perioperative, chemotherapy treatment, and prolonged postoperative self-care management). Through caring partnership with an oncology certified nurse, the patients found meaning in their treatment experiences and exerted their own inner strength to establish a new way of life, and the nurses reconfirmed what nursing was. From the theoretical viewpoint, caring partnership was helpful for patients in distress and was possible in clinical settings even with partial involvement during a treatment phase.
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When Things Happen – The Story of COVID-19, Palliative Care, and An NGO
Ayda G Nambayan, Rumalie A Corvera, Loyda Amor N Cajucom, Carmel D Vicencio
November-December 2021, 8(6):732-736
Several natural disasters and the appearance of the coronavirus disease 2019 (COVID-19) pandemic created stressful situations to many health-care workers in the Philippines. New health-related challenges surfaced, and health-care workers felt lost since many of the challenges were either directly or indirectly caused by the fast-spreading coronavirus infections and its variants. Further, the way people die also changed, causing confusion and influencing the Filipino grief and bereavement processes. In response to the need of the health-care workers, a nongovernmental organization (NGO) through its education portal created and offered free webinars, aimed to help health-care workers understand and make sense of what was happening, thus empowering them with knowledge on how to manage the challenges and provide better care to the patients and the community as well. This article relates the process of planning and implementing online webinars during the era of social distancing and COVID-19 pandemic.
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Development of A Nurse-Led Educational Intervention Program in Managing the Nutrition Impact Symptom Cluster in Patients with Nasopharyngeal Carcinoma following the Medical Research Council Framework
Wenli Xiao, Carmen WH Chan, Jinnan Xiao, Cho Lee Wong, Ka Ming Chow
November-December 2021, 8(6):653-661
Objective: This article aimed to report the experience of developing a complex nurse-led, theory-driven, and evidence-based educational intervention program intended to manage the nutrition impact symptom cluster experienced by patients with nasopharyngeal carcinoma (NPC) during radiotherapy, based on the Medical Research Council (MRC) framework. Methods: The “development” and “feasibility and piloting” phases of the MRC framework were used to guide the intervention development. The development phase included identifying the evidence base through a systematic review, exploring the relevant and guiding theory to enhance the effectiveness of the intervention and conducting a qualitative study to identify the intervention modelling. For the feasibility and piloting phase, we conducted a pilot study to examine the feasibility and estimate the effectiveness of the intervention. Results: The systematic review revealed that nurse-led educational interventions were used commonly for symptom cluster management, with promising effectiveness. The theoretical foundation was provided by the Theory of Unpleasant Symptoms, which indicates that an educational intervention can help patients to manage symptom cluster by influencing psychological, situational, and physiological factors. The qualitative study further provided contents of the intervention based on the perspectives of NPC patients and health professionals. The resulting program involves a nurse-led, family caregiver involvement, educational intervention with two sessions that uses a booklet as a medium. The pilot study found that conducting the educational intervention program was feasible and it also had some favorable effects on managing the nutrition impact symptom cluster in NPC patients. Conclusions: The MRC framework provided a strong structure with which to develop a complex intervention for nutrition impact symptom cluster management through a theory-driven and evidence-based approach. The evaluation of the intervention, the delivery process and the mediation mechanism of change using a rigorous randomized controlled trial design is recommended.
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Factors Affecting Jordanian Women's Surgical Treatment Decisions for Early-Stage Breast Cancer
Rana F Obeidat, Mahmoud Al Masri, Mohammad Marzouq
November-December 2021, 8(6):711-719
Objective: This study aimed to assess factors influencing surgical treatment decisions for early-stage breast cancer among Jordanian women. Methods: A descriptive correlational survey design was utilized to meet the study objective. A total of 180 Jordanian women diagnosed with unilateral early-stage breast cancer (Stages I–II) were recruited from the radiotherapy departments and outpatient surgical and breast cancer clinics at King Hussein Cancer Center (KHCC). Participants completed a structured questionnaire consisting of the Arabic version of the Depression Anxiety Stress Scale, Breast Surgery Beliefs and Expectations Scale, and the Arabic version of the Control Preference Scale. Results: The majority of the participants underwent mastectomy as a definitive surgical treatment (i.e. 67%). Only stage at diagnosis and having a second opinion about surgical treatment options were significantly associated with the type of surgical procedure women opted for. The overwhelming majority of the participants in both groups cited the items of “Minimize the chance of breast cancer coming back” and “Minimize the chance of dying of breast cancer” as very important in their decisions for surgical treatment of unilateral early-stage breast cancer. Women who cited the item “remove breast for peace of mind” as important/very important were more likely to opt for mastectomy than women who cited the item as not important. Conclusions: Mastectomy is the preferred surgical treatment option for the majority of Jordanian women diagnosed with unilateral early-stage breast cancer at KHCC.
  406 64 -
Unmet Supportive Care Needs Survey among Male Partners of Gynecological Cancer Survivors in Indonesia
Yati Afiyanti, Dewi Gayatri, Besral Besral, Haryani Haryani, Dyah Juliastuti
November-December 2021, 8(6):662-669
Objective: The number of gynecological cancer survivors is increasing in Indonesia, and these women often require physical and emotional support from their male partners as primary caregivers. However, the male caregiver's need for biological, psychological, and social support is often neglected. This study aims to assess the demographic and clinical determinants affecting the unmet supportive care needs of the gynecological cancer survivors' husbands in Indonesia. Methods: This cross-sectional survey involved 152 husbands of survivors who were recruited by a consecutive sampling method in two national referral hospitals. A self-administered Cancer Survivors' Partners Unmet Needs Questionnaire was used for data collection. Multiple linear regression was performed to analyze the data. Results: The majority of participants (97.4%) reported at least one unmet need. The primary unmet needs were legal services (71.1%), financial support (70.4%), cancer recurrence concerns (69.7%), and ongoing health support (66.4%). These needs were significantly associated with the wife's radio-chemotherapy and lower household income (P < 0.01) and also related to the husband's education level, duration of caregiving, and wife's cancer stage. Conclusions: Husbands of gynecological cancer survivors in Indonesia reported a need for legal, financial, and health-care information and assistance. Multidisciplinary professionals should be involved in developing policy and interventions which facilitate the social-economic protection of survivors and their husbands, as well as comprehensive care needs to enhance the women's survival rate.
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Association among the Prevalence of Sarcopenia without Obesity, Nonsarcopenic Obesity, Sarcopenic Obesity, and Metabolic Syndrome in Cancer Survivors: Based on Korea National Health and Nutrition Examination Survey
Yoon Jin Park, Young Mee Lee
November-December 2021, 8(6):679-686
Objective: In this study, we aimed to investigate the association among the prevalence of sarcopenia without obesity, nonsarcopenic obesity, sarcopenic obesity, and metabolic syndrome in cancer survivors using data from the 4th and 6th Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative data source. Methods: The 4th and 6th KNHANES was conducted in 2008–2011. Data from cancer survivors were obtained including 133 obese patients without sarcopenia, 98 obese patients with sarcopenia, and 87 patients with sarcopenia but without obesity. SPSS 22.0 was used for statistical analysis with complex sample survey modules and commands. Results: The prevalence of metabolic syndrome was 25.3% in the sarcopenia without obesity group, 61.7% in the nonsarcopenic obesity group, and 67.3% in the sarcopenic obesity group, showing the highest rate in the sarcopenic obesity group, with a significant difference among the three groups (P < 0.001). Conclusions: In this study, the prevalence of metabolic syndrome was 25.3%, 61.7%, and 67.3% in the sarcopenia without obesity, nonsarcopenic obesity, and sarcopenic obesity groups, respectively, showing that the sarcopenic obesity group had the highest metabolic syndrome rate. Based on these results, various education programs for the prevention and treatment of metabolic syndrome should be developed for cancer patients.
  378 72 -
Self-Transcendence of Japanese Female Breast Cancer Patients with Hereditary Breast and Ovarian Cancer Syndrome
Sanae Aoki, Sawa Fujita
November-December 2021, 8(6):670-678
Objective: The present study examined self-transcendence of Japanese female breast cancer patients with hereditary breast and ovarian cancer (HBOC) syndrome. Methods: Semi-structured interviews were conducted with 13 women with HBOC in their thirties to sixties, who consented to participate in the study. The obtained data were analyzed using a modified grounded theory approach. Results: The analysis yielded seven categories of self-transcendence in women with HBOC: (1) the ability to face oneself while seeking optimal strategies to continue living; (2) the ability to come to terms with blood conditions inherited from previous generations; (3) the ability to use one's own experiences as a patient with HBOC to help others; (4) the ability to share mutual support with others; (5) the ability to accept the diverse views on HBOC; (6) the ability to break free from fixed ideas and live with HBOC; and (7) the ability to live with future perspectives. Conclusions: The self-transcendence of Japanese female breast cancer patients with HBOC can be described as not giving up; confronting one's lineage, which is passed down from generation to generation, even as one is haunted and emotionally affected by the lifelong risk of developing cancer or facing death; and valuing not just oneself but also others through interactions with them. These abilities formed the foundation for the self-transcendence of the women in this study. In addition, because the women with this condition started valuing not just themselves but also others, they developed the ability to accept the diverse views surrounding HBOC and to coexist with their condition while being forward-looking.
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The Effect of an Information Support Program on Self-Efficacy of Prostate Cancer Patients during Hormonal Therapy
Rui Yang, Zhenqi Lu, Xiaofeng Gu, Bo Dai
November-December 2021, 8(6):639-652
Objective: This study was conducted to evaluate the effect of an information support program on the self-efficacy (SE) of prostate cancer (PCa) patients receiving hormonal therapy (HT). Methods: Based on the information support program constructed in a previous study, a randomized controlled trial was conducted in a cancer hospital in Shanghai, China. One hundred subjects were randomly divided into two groups. The control group was provided routine care and communication, and the experimental group participated in an informational support program. Three months later, the following outcomes were compared between the two groups: information acquisition, disease knowledge mastery, SE, healthy behavior adherence, health-related quality of life (HRQoL), and serum prostate-specific antigen (PSA) levels. t-test and Wilcoxon rank-sum test were used to compare the differences between the two groups, and intention-to-treat analysis was used to increase the reliability of the results. Results: After the intervention, information acquisition, disease knowledge mastery, and the SE and healthy behavior adherence of the experimental group were significantly increased compared with the control group, whereas the HRQoL and PSA did not significantly differ from that observed in the control group. Conclusions: The results showed that information support programs improve information acquisition, disease knowledge mastery, SE, and healthy behavior adherence among PCa patients receiving HT.
  332 81 -
The Effectiveness of Complementary Therapy as Mind–Body Practice on Quality of Life among Cancer Survivors: A Quasi-Experimental Study
Kayo Inoue, Kazuko Onishi, Harue Arao
November-December 2021, 8(6):687-695
Objective: This study aimed to investigate quality of life (QOL) improvement in long-term cancer survivors using complementary therapy (CT) as mind–body practice. Methods: A quasi-experimental study including intervention and control groups was conducted. Participants in the intervention group engaged in CTs, including music therapy, progressive muscle relaxation, and deep-breathing exercises for 8 weeks at home. QOL was evaluated in both the groups using Short Form-8 (SF-8) questionnaire before the experiment and at 4 and 8 weeks after starting the experiment. To examine QOL, we compared SF-8 subscale scores, the physical and mental component summaries of QOL. Results: Cancer survivors were assigned to the intervention and control groups, comprising 69 and 59 individuals. There were no significant differences in QOL between the two groups with low scores, but there was a significant difference in the mental aspect of QOL in 4 weeks, indicating that the intervention group was lower than the control group. Meanwhile, the intervention group tended to experience increased changes in the mental aspect of QOL in 8 weeks compared to 4 weeks, although there was no significant difference. Conclusions: CT did not exhibit an effect on QOL among cancer survivors, especially in 4 weeks. This might have been due to sample size, participants' potential low compliance resulting in an inability to confirm whether the CTs were performed accurately and continuously, and consideration of what CT suited them. Meanwhile, CT may require a longer time to increase QOL. We recommend further studies to address these factors when conducting CT as mind–body practice.
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Glycemic Excursion, Adverse Drug Reactions, and Self-Management in Diabetes Patients Undergoing Chemotherapy: A Literature Review
Naoko Terao, Kumi Suzuki
November-December 2021, 8(6):610-622
The purpose of this study was to identify the state of self-management in patients with diabetes who underwent chemotherapy, by referring to fluctuations in glycemic excursion and adverse drug reaction. We conducted a literature search in May 2021 using PubMed, CINAHL, and Ichushi-Web databases with “Cancer AND Diabetes AND Chemotherapy” as keywords. Based on our criteria, 25 articles were selected, and a review matrix sheet was created for the analysis of fluctuations in glycemic excursion and any adverse drug reaction to diabetes in patients undergoing chemotherapy. Substantial increases and unpredictable fluctuations in glycemic excursion were observed in these patients. In addition, an increase or change in the treatment dose was prevalent. Primarily, peripheral neuropathy and infection were reported as common adverse drug reactions. The risk of adverse drug reactions was especially high for patients with diabetes undergoing chemotherapy; furthermore, among this cohort, the detrimental effects were more likely to exacerbate into a severe condition that required special attention. Almost inevitably, the implementation rate of diabetes self-management programs decreased on the 8th week after the commencement of chemotherapy. Considering the findings of large individual differences in fluctuation in this cohort, tailored assistance that is appropriate for each patient's chemotherapy regimen or blood glucose level is of paramount importance. Support of patient self-management to achieve stable blood glucose levels and thus prevent adverse drug reactions was a key component in the successful completion of chemotherapy and improved patient outcomes for this group of special needs patients.
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