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Introduction: Studies show palliative care delivered concurrently with cancer treatment improves outcomes, yet palliative care integration with inpatient oncology is underused. A promising approach to improve integration is a triggered palliative care consultation (TPCC). This study evaluated the impact of two TPCC approaches on consistency and quality of consult implementation, operationalized as uptake and timeliness, on solid tumor medical and gynecologic oncology services at an academic hospital., Methods: The study timeframe was 2010-2016. TPCC in gynecologic oncology began in 2014 and was supported by a single strategy (written guideline); TPCC in medical oncology began in 2015 and was supported by multiple strategies (e.g. training, chart review). Palliative care consult information was chart abstracted and linked to hospital encounter data. We compared the effect of a single strategy vs. usual care, and multiple strategies vs. a single strategy on implementation. Difference-in-differences modified Poisson regression models evaluated whether implementation differed after TPCC; we estimated adjusted relative risk (aRR), controlling for patient demographic and clinical characteristics., Results: Overall, 8.8% of medical oncology and 11.0% of gynecologic oncology inpatient encounters involved palliative care consultation. In regression analyses, TPCC supported by a single strategy in gynecologic oncology was associated with greater uptake vs. usual care (aRR: 1.45, p < .05), and TPCC supported by multiple strategies in medical oncology was associated with greater uptake vs. a single strategy (aRR: 2.34, p < .001)., Conclusion: Across two inpatient oncology services, TPCC supported by multiple strategies had the greatest impact on uptake. How strategies affect sustained use of palliative care consults remains to be investigated., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The well-being of health care providers may be challenged by their work, with evidence that oncology health care providers are a high-risk group for burnout. The present qualitative pilot study evaluated a mindfulness-based group intervention, referred to as Compassion, Presence, and Resilience Training (CPR-T), for oncology interprofessional teams. The purpose of this study was to elucidate the subjective experience of oncology health care providers receiving CPR-T and their perceptions of its benefits, risks, or challenges. The CPR-T was delivered to providers from two oncology teams in a large cancer center in Canada. Ten of these providers participated in semistructured interviews 1 to 5 months after completing the CPR-T. The interview transcripts were coded using a thematic analysis strategy. Five benefits of the CPR-T were identified: learning to pause, acquiring a working definition of stress and self-care, becoming fully present, building self-compassion, and receiving organizational acknowledgment and recognition of stress. In addition, two participant-identified challenges were recognized: sharing vulnerability within interprofessional teams and committing to a sitting meditation practice. These findings demonstrate positive transformations as a result of the CPR-T, as well as important challenges, and have important implications for holistic health care practice in oncology. Further research is necessary to validate the findings of this explorative study.

The diagnosis of cancer in a child, adolescent, or young adult is an emotionally overwhelming time. To improve the quality of education and support provided to patients and caregivers with a new cancer diagnosis, we executed a quality improvement initiative to (a) define key education milestones for the delivery of essential education during the first 2 months following diagnosis and (b) to define role accountability within the multidisciplinary team for delivery of content and execution of tasks. To develop education milestones, we (a) identified educational content from review of the literature, (b) determined the sequence of content delivery through qualitative interviews with patients and caregivers, and (c) developed education milestones by evaluation of existing workflows. To develop task lists, we (a) determined which multidisciplinary team member was best suited to deliver specific content and (b) defined discrete tasks required to execute education milestones. Key content topics and preferred sequence are as follows: Emotional Adjustment to Diagnosis, When and How to Call the Doctor, Medication Management, Practical Needs, Line Care, and Access to Nontherapeutic Clinical Trials. Eight education milestones were defined across the initial 2 months following cancer diagnosis. The education milestones are paired with task lists. The education milestones and task lists guide the execution of complex education across a multidisciplinary service line in an emotionally challenging time. Early information focuses on essential content, role responsibility is clearly defined, and psychosocial support services are purposefully and iteratively integrated into care during the initial weeks following a cancer diagnosis.

Objectives: To examine the relationship of the Childhood Cancer Symptom Cluster-Leukemia (CCSC-L) with health-related quality of life (HRQOL)., Sample & Setting: 327 children receiving treatment for acute lymphoblastic leukemia from four pediatric oncology programs across the United States., Methods & Variables: Participants completed fatigue, sleep disturbance, pain, nausea, and depression symptom questionnaires at four time points; these symptoms comprised the CCSC-L. HRQOL was measured at the start of postinduction therapy and then at the start of maintenance therapy. Relationships between the CCSC-L and HRQOL scores were examined with longitudinal parallel-process modeling., Results: The mean HRQOL significantly increased over time (p < 0.001). The CCSC-L had a significant negative association with HRQOL scores at the start of postinduction therapy (beta = -0.53, p < 0.005) and the start of maintenance therapy (beta = -0.33, p < 0.015). Participants with more severe symptoms in the CCSC-L over time had significantly lower HRQOL at the start of maintenance therapy (beta = -0.42, p < 0.005)., Implications for Nursing: Nurses are pivotal in providing management strategies to minimize symptom severity that may improve HRQOL.

Objective: to identify, in scientific productions, nursing interventions in palliative care in children and adolescents with cancer., Method: integrative review of the literature through the databases: CINAHL, MEDLINE, IBECS, LILACS and SCIELO, carried out in October and November 2017., Results: we analyzed 18 articles that met the inclusion criteria. The results showed that, among the articles selected, Brazil is the country with the largest number of publications and that interventions such as music therapy, massage, ludic application, early consultation of palliative care, social interventions and physical exercises aimed at the resolution of a specific symptom obtained better results when compared to interventions that aimed at the comprehensiveness of palliative care., Final Consideration: we conclude that greater emphasis should be given to palliative care in academic and professional training and that further studies in search of the best evidence should be conducted to support nursing Evidence-Based Practices.

Background: Pain is one of the most feared of all symptoms for the cancer patient. Some studies estimate that up to 90% of all cancer patients experience pain. Advances in pharmaceuticals and expert provider knowledge have improved pain management overall for the patient with cancer; however, complementary therapies can synergize medications to provide optimal pain relief while decreasing the side effect profile. Despite this, nurses may have limited access to such resources. Many therapies can be administered directly by the bedside/chairside nurse with minimal training and the nurse can then teach the patient and family how to use the selected complementary therapy after leaving the hospital or clinic., Objectives: The oncology nurse will be able to identify several easy-to-implement complementary therapies that can supplement pharmacologic pain management for cancer patients., Methods: As a quality project, comfort kits, containing such items as handheld massagers, guided imagery audiotapes, and aromatherapy essential oils, were distributed for use with patients through unit-based pain resource nurses., Analysis: More than 500 comfort kit items were tracked by the pain clinical nurse specialist during the comfort kit trial, both by medical record review and by follow-up phone calls to patients. During the comfort kit trial, average pain intensity decreased by 2.25 points on a 0-10 scale in the 24-hour period after use of the item from the comfort kit. Patients also had an overall decrease in the use of pharmacologic pain interventions and an increase in ambulation in the 24-hour period after implementation., Conclusions: Comfort kits allow nurses easy access to inexpensive tools to supplement pharmaceutical pain management. Optimizing nonpharmacologic pain management can increase patient and nurse satisfaction, improve overall pain management, and decrease untoward side effects., (Published by Elsevier Inc.)

Objective: To identify the frequency and intensity of Moral Distress, and to analyze the associations between Moral Distress and sociodemographic and labor characteristics of the nursing team of a Hematology-Oncology., Method: A cross-sectional study was carried out with 46 nursing professionals from a Hematology-Oncology sector of a hospital institution in Rio Grande do Sul State, Brazil, through the application of the Moral Distress Scale - Brazilian version. In the data analysis, descriptive statistics and nonparametric association tests were used., Results: Mortal Distress intensity of 3.27 (SD= 1.79) and frequency of 1.72 (SD= 1.02) were found in this team. The Moral Distress of greater intensity and frequency were related to the denial of the role of Nursing as a patient's advocate and the disrespect to the patient's autonomy, respectively., Conclusion: It is suggested a greater space for discussion among professionals, multiprofessional team and managers, so that adequate conditions of action and communication are provided.

Background: Oncology nurses have an important role in identifying mental health distress; however, the research to date indicates that oncology nurses often do not accurately detect this distress., Objectives: The aim of this study is to explore oncology nurses' perspectives on indicators of distress in patients, the strategies they use in identifying these signs of distress, and the barriers they face in recognizing these indicators., Methods: Twenty oncology nurses were interviewed. The study used the grounded theory method of data collection and analysis., Findings: Nurses relied on a number of emotional and behavioral indicators to assess distress. Nurses reported that indicators of mental health distress often were expressed by patients or their caregivers. Strategies to identify distress were limited, with nurses reporting that their only method was directly asking the patient. Barriers to identifying distress included patients concealing distress, nurses' lack of training, and time constraints.

Background:: For the experience of end-of-life care to be 'good' many ethical challenges in various relationships have to be resolved. In this article, we focus on challenges in the nurse-next of kin relationship. Little is known about difficulties in this relationship, when the next of kin are seen as separate from the patient., Research Problem:: From the perspective of nurses: What are the ethical challenges in relation to next of kin in end-of-life care?, Research Design:: A critical qualitative approach was used, based on four focus group interviews., Participants:: A total of 22 registered nurses enrolled on an Oncology nursing specialisation programme with experience from end-of-life care from various practice areas participated., Ethical Considerations:: The study was approved by the Norwegian Social Science Data Service, Bergen, Norway, project number 41109, and signed informed consent obtained from the participants before the focus groups began., Findings and Discussion:: Two descriptive themes emerged from the inductive analysis: 'A feeling of mistrust, control and rejection' and 'Being between hope and denial of next of kin and the desire of the patient to die when the time is up'. Deductive reinterpretation of data (in the light of moral distress from a Feminist ethics perspective) has made visible the constraints that certain relations with next of kin in end-of-life care lay upon the nurses' moral identity, the relationship and their responsibility. We discuss how these constraints have political and societal dimensions, as well as personal and relational ones., Conclusion:: There is complex moral distress related to the nurse-next of kin relationship which calls for ethical reflections regarding these relationships within end-of-life care.

Objectives: To understand the context for implementing ProsCare by prostate cancer specialist nurses (PCSNs) and, in doing so, further develop the intervention and implementation strategy., Sample & Setting: 30 PCSNs participated in four semistructured focus groups to evaluate a telephone-based supportive care intervention led by nurses for men with advanced prostate cancer., Methods & Variables: Data were coded into the Consolidated Framework for Implementation Research to evaluate the ProsCare program content and guide the implementation and evaluation of this targeted program for men with advanced prostate cancer., Results: Participants strongly endorsed specific ProsCare program components amid a recommendation of delivery mechanisms and a comprehensive centralized implementation strategy, including PCSN role promotion, education, and professional development., Implications for Nursing: PCSNs validated ProsCare and supported its implementation as a supportive care intervention. ProsCare is a feasible nurse-led intervention closely matched with men's supportive care needs and the PCSN scope of practice.

Objectives: To explore how nurses perceive their self-efficacy and performance in supporting self-management among patients with incurable cancer, and whether these perceptions differ between community and hospital nurses., Sample & Setting: 222 hospital nurses (n = 94) and community nurses (n = 128) working with adult patients with incurable cancer., Methods & Variables: An online survey included the Self-Efficacy and Performance Into Self-Management Support instrument. Possible differences in age, gender, work setting, and additional training in oncology between groups were explored., Results: Nurses felt confident about their self-efficacy, particularly in assessing patients' knowledge and beliefs and in advising about their disease and health status. Nurses felt less confident in their performance, particularly in the use of technology (arranging follow-up care), but also in agreeing on collaborative goals and assisting patients in achieving these goals. Compared to hospital nurses, community nurses reported significantly higher scores on self-efficacy and performance., Implications for Nursing: More effort is needed to increase nurses' confidence in providing self-management support, with a focus on arranging follow-up care with the use of technology and on collaborating with patients in setting and achieving goals.

Background: Oral antiproliferative therapies have become increasingly important in the treatment of tumors. To ensure patient safety, medical care is focused on adherence and side effects., Objectives: To meet increased personnel and time requirements, delegation of tasks to nonmedical specialists (NMS) may be a solution; however, presently, little is known about the options in Germany., Method: At least 3,300 members of the German Society for Hematology and Medical Oncology (DGHO), 580 members of the Professional Association of Office-Based Hematologists and Oncologists in Germany (BNHO), and 1,500 members of the Conference on Oncology Nursing and Pediatric Nursing (KOK) were contacted via a web-based survey. The survey focused on the feasibility of oncology nurse consultation as an additional consulting service for patients undergoing oral tumor therapy., Results: In total, 255 (physicians) and 206 (NMS) questionnaires were evaluable; 90.9% of the physicians were hematologists/oncologists, 87.8% advocated oncology nurse consultation, 34.1% had previously implemented/scheduled such consultations, 58.3% of the NMS were nursing staff, 46.1% had advanced training in oral tumor therapy, 94.2% were interested in further qualifications, 37.8% worked at facilities with established/planned nurse consultations, and 62.1% personally conducted/preferred conducting consultations., Conclusions: Throughout Germany, there seems to exist a group of qualified NMS who are motivated to provide care to patients undergoing oral tumor therapy. Particular physicians actively support these nurse consultations. Extensive implementation of delegation concepts in standard care of patients undergoing oral tumor therapy is not yet underway., (© 2019 S. Karger AG, Basel.)

Objective: To introduce effectiveness of tumor treating fields (TTFields), how to care for the patient with this type of treatment, and the critical role the nurse plays in educating the patient about this innovative treatment., Data Sources: Published research and articles in both nursing and medical journals., Conclusion: TTFields are an antimitotic therapy delivered via transducer arrays that are worn on the scalp to treat newly diagnosed and recurrent glioblastoma, the most aggressive primary brain cancer. Oncology nurses are integral in educating and supporting the patient in its use and managing its of treatment., Implications for Nursing Practice: Nurses are on the front line of educating the patient, caregivers, and the larger body of clinicians who deliver care to these patients. Education provided by nurses increases the patients' knowledge, and thus compliance, as well as the overall outcome through proper usage of TTFields., (Copyright © 2018. Published by Elsevier Inc.)

Background: By using the body's own protective system to fight cancer, immunotherapy is not only effective but also is associated with fewer side effects than chemotherapy., Objectives: This article provides an overview of four types of immunotherapy (monoclonal antibodies, chimeric antigen receptors, immune checkpoint inhibitors, and cancer vaccines) and discusses the critical role assumed by nurses in the care of patients receiving immunotherapy., Methods: A review of the literature was undertaken to identify, describe, and compare the types of immunotherapy used and studied for use in pediatric oncology., Findings: Nurses caring for pediatric patients with cancer may have little experience with immunotherapy. However, they should become knowledgeable about it, particularly as it becomes further integrated into pediatric cancer treatments.

Objective: To describe best practices and guidelines in symptom management at the end of life for adults with malignant glioma., Data Sources: Journal articles, evidence-based reviews, textbooks, and clinical guidelines., Conclusion: Symptom management is an essential element of end-of-life care that aims to preserve dignity and quality of life for patients with glioma and their family caregivers., Implications for Nursing Practice: Advance care planning using a holistic approach to the patient's symptoms experience and goals of care are necessary to develop, implement, and evaluate outcomes of an evidence-based plan of care tailored for each patient and family., (Copyright © 2018. Published by Elsevier Inc.)

Objective: To describe the currently accepted standard-of-care practice for surgical and medical management of newly diagnosed high-grade glioma., Data Sources: Peer-reviewed journals, nationally accepted guidelines, and personal experience of the authors., Conclusion: There is a widely accepted standard-of-care treatment protocol for patients with newly diagnosed high-grade glioma that includes maximal safe resection followed by radiation therapy with concurrent and adjuvant temozolomide. The regimen is well-tolerated and side effects are manageable., Implications for Nursing Practice: Nurses who are involved in the care of patients with newly diagnosed high-grade glioma should be familiar with the regimen and its side effects to provide crucial patient and caregiver education in an accurate and beneficial manner., (Copyright © 2018. Published by Elsevier Inc.)

The old adage "meeting of the minds" is always an exciting and motivating experience. I only wish that every healthcare provider could share this type of encounter in his or her professional career. Fortunately, I was lucky enough to meet Renee almost 20 years ago when we were both assigned to facilitate a metastatic breast cancer support group. Her role was the clinical social worker, and mine was to provide knowledge and education as the oncology educator. We were a fabulous team.

Objective: To describe the indications for convection-enhanced delivery in the treatment of glioblastoma, highlighting candidates for the delivery method, mechanics of drug delivery, and management of acute and long-term complications., Data Sources: A conceptual framework drawn from published literature as well as author's expert experiences., Conclusion: Convection-enhanced delivery is an established method of delivering new therapies to patients with glioblastoma. Management of both acute and long-term complications is often drug dependent., Implications for Nursing Practice: Nurses should be able to recognize and manage potential complications during the infusion of agents delivered via convection-enhanced delivery. Post-infusion symptoms may worsen because of immunologic responses related to the drug and management should be directed toward symptom relief and support without interference on the immunologic response., (Copyright © 2018. Published by Elsevier Inc.)

Venous flare reaction, a localized allergic response associated with the administration of an irritant, is one of the most common chemotherapy infusion-related reactions. Etoposide, a drug commonly used in patients with lung cancer, has been reported to be an irritant with vesicant properties depending on the volume administered. This article presents the case of a patient who has a venous flare reaction immediately following the administration of etoposide for the treatment of diffuse large B-cell lymphoma. Managing such complications is crucial to maintaining patient safety. Proper training and education should be incorporated into nursing practice when identifying, preventing, and managing such reactions.

Objective: To present and describe three emerging areas of glioma research: volumetric imaging analysis, molecular profiling, and the use of liquid biopsies., Data Sources: Published manuscripts and textbook chapters., Conclusion: As new imaging and molecular technologies for the patient with glioma become main-stream, precise care can be individualized and personalized., Implications for Nursing Practice: Oncology nurses caring for patients with gliomas can gain knowledge of emerging research and help increase accessibility to this technology by referring patients to clinical trials that apply this technology., (Copyright © 2018. Published by Elsevier Inc.)

Objectives: To identify the tumors included in the WHO classification of low-grade gliomas, and review the importance of molecular biomarkers and their implication for treatment, prognosis, and outcomes., Data Sources: Published research, clinical guidelines, educational articles in oncology journals, and Web-based resources., Conclusion: Molecular neuropathology has influenced the reclassification of low-grade gliomas and, as such, has provided patient-specific treatments with improving outcomes., Implications for Nursing Practice: Nurses play a key role in patient education and communication with the patient's interdisciplinary care team. Understanding the molecular neuropathology that determine treatment recommendations and in turn recognizing and identifying complications provides improved patient/caregiver satisfaction and outcomes., (Copyright © 2018. Published by Elsevier Inc.)

Background: As the population of older adults continues to increase, the healthcare system must adapt to respond to their unique and complicated health needs. More than half of all patients diagnosed with cancer in America are aged 65 years or older. The appropriate care for older adult patients with cancer requires a holistic approach with careful coordination of interprofessional providers., Objectives: This article aims to describe the components of the comprehensive geriatric assessment, summarize the importance of exercise in older adults, discuss the harms of polypharmacy, and evaluate the initiatives to improve geriatric nursing education., Methods: The literature was reviewed and summarized to provide information on comprehensive geriatric assessment, exercise, polypharmacy, and geriatric nursing education., Findings: Numerous assessment tools can help guide the care of older adult patients with cancer. Because many nurses have little formal geriatric-specific training, there is a growing need for targeted education to ensure best practices.

Problem Identification: Cancer prehabilitation programs have been reported as effective means of improving quality of life (QOL) in people with cancer, but research is lacking. The aim of this systematic review is to explore the characteristics of cancer prehabilitation programs and their effects on QOL in people with cancer., Literature Search: A systematic review of databases (PubMed, MEDLINE®, Cochrane Library, EMBASE, CINAHL®, Scopus®) was performed using key terms., Data Evalution: Data were extracted, and the Physiotherapy Evidence Database scale was used to assess the quality of the studies., Synthesis: 12 randomized, controlled trials with a total of 839 people with cancer were included in this review. Of these, seven cancer prehabilitation programs focused on physical interventions, three focused on psychological interventions, and two focused on multimodal interventions., Implications for Nursing: Oncology nurses could provide various cancer prehabilitation programs to patients who decide to undergo cancer-related treatment. Additional research on this subject should involve careful consideration of QOL instruments and sample size when designing the intervention.

Objectives: To examine symptom occurrence and severity and overall health-related quality of life (HRQOL) in patients receiving cancer therapy guided by genomic profiling (matched therapy) and patients receiving nonmatched therapy., Sample & Setting: A retrospective and secondary analysis of data from 129 individuals with breast or gynecologic cancer receiving care at a regional outpatient cancer center., Methods & Variables: Descriptive statistics and multiple linear regression analyses were performed. Study variables included symptom occurrence and severity, HRQOL, and person- and health-/illness-related factors. Symptom occurrence and severity were measured by the Therapy-Related Symptom Checklist (TRSC), and HRQOL was measured by the HRQOL-Linear Analogue Self-Assessment., Results: Individuals receiving matched therapy had lower mean TRSC scores compared to individuals receiving nonmatched therapy, but the difference was not statistically significant. HRQOL scores among individuals receiving matched therapy were not significantly higher than those receiving nonmatched therapy. Individuals with higher TRSC scores had significantly lower HRQOL., Implications for Nursing: The effects of matched therapy on an individual should be examined. Study findings are an initial step in understanding the symptom occurrence and severity and HRQOL.

An article by Lally et al. (2018) in the current issue describes the process of collecting end-user feedback from a sample of rural Nebraskan women with breast cancer regarding a web-based, psychosocial distress management program, CaringGuidance™. The current article uses that study to inform discussion on future work in the realm of interventions for rural cancer survivors.

Background: Biosimilars provide opportunities for improving healthcare access and outcomes and reducing overall healthcare costs for patients with cancer., Objectives: The purpose of this article is to explore the history of biosimilars, regulatory pathways, and barriers to biosimilar approval. This article also aims to describe the patient and clinician barriers to biosimilars use and the progress that has been achieved since the first biosimilar approval in Europe in 2006 and in the United States in 2015., Methods: A literature search was conducted to retrieve articles that are highly relevant to the history of biosimilars development and regulatory pathways in the United States, Europe, Asia, and Canada. Patient and clinician perspectives on safety issues and concerns regarding immunogenicity and bioequivalence that limit use of biosimilars are also included., Findings: Patient and provider concerns regarding immunologic patient safety issues, such as immunogenicity, lack of comparability, and low biosimilarity, still exist. The clinical safety, efficacy, and tolerability of biosimilars are among the top concerns in patients, prescribers, and clinicians.

The best gift a patient ever gave me was a recipe. It was handwritten on a small piece of lined paper, all in capital letters. The recipe was for zucchini bread and was given to me by Mr. S, a lung cancer survivor in his early 80s who I had been following in the cancer survivorship clinic that I started at the VA where I work in New England. He came to see me every three to six months for clinic visits and computed tomography scans to monitor for recurrence of his lung cancer.

Culturally competent care is contingent on knowledge of the unique values and attributes of diverse communities. This article focuses on Islamic perspectives of suffering and meaning in illness as they relate to cancer care. Personal narrative and evidence-based information are integrated to inform a holistic nursing approach to the care of Muslim patients, particularly when supporting them and their families through suffering in the context of malignancy or significant illness.

Adolescents and young adults (AYAs) with cancer aged 15-39 years have unique medical, psychosocial, and informational needs. At the time of diagnosis, they are often going through important life milestones, such as establishing their independence, attending school or work, and maintaining romantic and/or family relationships. This article describes some of the critical time points for AYAs with cancer and the resources available to support the nursing profession in meeting the unique care needs of this population.

ABSTRACTObjective:Demoralization is a common problem among medical inpatients with such serious health problems as cancer. An awareness of this syndrome, a knowledge of what defines it, and a plan for how to intervene are limited among nursing teams. Nurses are uniquely poised to efficiently provide brief interventions that address demoralization in their patients. To our knowledge, there are no interventions that train nurses to distinguish and treat demoralization in their patients. The objective of the present study was to determine the acceptability, feasibility, and impact of a novel educational intervention for nurses., Method: An educational training video was created and delivered to staff nurses (N = 31) at oncology staff meetings to test the feasibility and acceptability of this intervention. Assessments of nurses' knowledge about demoralization and intervention methods were administered immediately before and after the training intervention and through a web-based survey 6 weeks post-intervention. McNemar's test for dependent categorical data was utilized to evaluate change in survey responses at the three timepoints., Results: Nurses' understanding of the concept of demoralization and appropriate interventions significantly improved by 30.3% from pre- to posttest (p ≤ 0.0001). These improvements persisted at 6 weeks post-intervention (p ≤ 0.0001). At 6-week follow-up, 74.2% of participants agreed or strongly agreed that the training had positively changed their nursing practice, 96.8% reported that this training benefited their patients, and 100% felt that this training was important for the professional development of nurses., Significance of Results: This pilot intervention appeared feasible and acceptable to nurses and resulted in increased understanding of demoralization, improved confidence to intervene in such cases, and an enhanced sense of professional satisfaction among inpatient oncology floor nurses.

Purpose: A large number of patients attend for radiotherapy daily. Primary nurses in the study settings aim to individualize care for their patients. The individual characteristics of patients may determine their perceptions of nursing care, and provide guidance in tailoring their care. This study aimed to assess patients' personal characteristics on their perceptions of individualized care (IC) provided by nurses during a course of radiotherapy, and to determine predictor variables that may inform nursing practice., Methods: This cross-sectional, exploratory study was conducted in three radiotherapy departments in Australia. Patients (n = 250) completed the Individualized Care Scale&#95;Patient (ICS&#95;P). Data were analyzed using descriptive and inferential statistics, univariate analysis, and multiple regression analysis., Results: Males reported significantly higher perceptions of IC than females in 7/9 subscales. Patients with head and neck and prostate cancer, as well as those requiring hospitalization during radiotherapy, scored significantly higher in 5/9 subscales. Courses > 30 days, those not receiving chemotherapy, and partnered patients reported greater IC across all subscales. Gender and hospitalization were the main predictor variables for IC., Conclusion: Patients reported moderately high levels of IC during their radiotherapy; however, standard demographic information may provide limited insight into improving care for the individual. Patient characteristics routinely chosen, such as age, gender, and education may not predict how patients perceive their care or support the tailoring of interventions to improve IC. Researching a range of related patient characteristics may prove a more useful concept for future nursing studies aiming to predict outcomes to tailor nursing practice.

Background: Patients with cancer often experience prominent deficiencies in cancer care in the immediate period following initial cancer diagnosis., Objectives: This article aims to determine whether the inclusion of a gastrointestinal (GI) oncology nurse navigator (ONN) on the multidisciplinary cancer care team is associated with improved quality of care for patients., Methods: This retrospective study compared randomly selected patients with GI cancer with and without an ONN. Two endpoints, the time from diagnosis to treatment and the average number of missed appointments, were evaluated through a review of healthcare records using the Epic electronic health records system., Findings: Patients with an ONN had a shorter time lapse between diagnosis and treatment commencement (p < 0.001). In this group, the average time spent between initial diagnosis and the start of treatment was 15.15 days, compared to 42.93 days for patients who were not part of the multidisciplinary cancer care model.

I worked for the Louisiana Tumor Registry for years, coding pathology reports and doing my part to make a difference, but ultimately, I grew bored. I wanted to hear the stories behind the reports I entered into a database and craved interaction with patients. When the opportunity to become a patient navigator presented itself, I jumped at the chance. I sold myself as an eager and capable member of the community who knew the patients' frustrations firsthand. I guess it worked, because I was hired by the Louisiana Cancer Control Program in July 2010 as a patient navigator for patients beginning cancer treatment.

Background: Height measurement is a key clinical component to measure body mass index and body surface area used for patient care, including calculating chemotherapy doses. Some patients cannot feasibly or safely stand for height measurement because of a number of diseases and disabilities. The literature is unclear regarding alternatives to standing height for patients unable to stand., Objectives: The purpose of this research study was to test equivalence of a number of measurements to find a reliable alternative to standing height for ambulatory oncology clinic patients who are unable to or cannot safely stand., Methods: A repeated-measures design was used to measure the height of 60 volunteer adult participants using a convenience sample of 30 men and 30 women. Standing height was compared to self-reported height, recumbent length, arm span, half-arm span, demispan, and knee height measurements., Findings: Results indicated that demispan was equivalent to standing height with a mean difference of -0.69. A practice change to use demispan in patients who cannot stand has been proposed and accepted at the authors' organization. The use of demispan was a feasible alternative to standing height in cost of supply and technique.

Problem Identification: Pediatric oncology phase 1 clinical trials (P1Ts) are essential to developing new anticancer therapies; however, they raise complex ethical concerns about balancing the need for this research with the well-being of participating children. The purpose of this integrative review was to synthesize and appraise the evidence of how P1T participation, which begins with consent and ends with the transition off the P1T, can affect the well-being (either positively or negatively) of children with cancer. The Resilience in Individuals and Families Affected by Cancer Framework, which has an outcome of well-being, was used to synthesize findings., Literature Search: Articles on the experiences of child (n = 21) and adult (n = 31) P1T participants were identified through systematic searches., Data Evaluation: Articles were evaluated on rigor and relevance to P1T participant experiences as high, medium, or low., Synthesis: Minimal empirical evidence was found regarding the effect of P1T participation on the well-being of children with cancer. Adult P1T participant experiences provide insights that could also be important to children's P1T experiences., Implications for Practice: To achieve a balanced approach in P1T consent discussions, nurses and healthcare providers who work with children considering participation in a P1T should share the potential effect of participation on participants' well-being.

Objectives: To provide insight into people's experiences in dealing with the consequences of head and neck cancer (HNC) in daily life and their needs for self-management support., Sample & Setting: 13 people with HNC who were successfully treated in the Department of Radiation Oncology at the Erasmus MC Cancer Institute in Rotterdam, the Netherlands., Methods & Variables: Two focus groups and six individual interviews; data were analyzed with directed content analysis., Results: Most patients wished to receive professional support for dealing with post-treatment consequences. Apart from physical complaints, patients had difficulties in dealing with the emotional aspects of HNC and its treatment and struggled with building self-confidence to move on with their lives. Patients mentioned the importance of relatives being there for them but complained that their needs were not always met. Support from fellow patients was valued for their empathetic capacity., Implications for Nursing: Nurses must provide self-management support that meets people's integral needs inherent in living with the consequences of HNC, particularly in the initial post-treatment period. Practical interventions could be useful.

Objective: To adapt the contents of the Nursing Activities Score (NAS) tool to assist patients with cancer., Method: Methodological research that according to the Delphi Technique is a method aiming at the validation of content through agreement of experts., Results: It took two rounds of opinion of experts, which added content contributions without modifying the structure and score of the original tool. The level of agreement ranged from 71 to 86%, and biological factors and assistance were more suggested: Monitoring and controls; Laboratory investigations; Support and care for family members and patients; Intravenous replacement; Renal support; Management activities., Conclusion: A high level of complexity of patients with cancer, and the demand for care and biopsychosocial-spiritual care was diagnosed. This tool will enable the measurement of the workload of the Oncology Nursing team, which can contribute to the staffing dimensioning.

Nurses are often the first to recognize and respond to children's symptoms. This descriptive, exploratory study characterized how pediatric oncology health care providers characterize and assess children's cancer-related symptoms. The study also explored challenges associated with symptom assessment and information perceived as helpful in planning interventions. The setting was a Children's Oncology Group-affiliated hospital in the Intermountain West of the United States. Twenty-two pediatric oncology health care providers (95% female; 68% nurses) participated in one of four focus group sessions. Sessions were facilitated by two individuals and included six open-ended questions addressing participants' perspectives of cancer-related symptoms, approaches to symptom assessment, challenges and frustrations encountered when assessing symptoms, and information needed to plan interventions. Participants identified 75 physical and psychosocial responses that included both subjectively experienced symptoms and other consequences of the cancer experience. Qualitative content analysis procedures organized other responses into categories and subcategories. Participants most frequently reported using observational approaches including physical assessment findings and observation of the child's behavior to identify symptoms. Strategies that sought the child's input such as the use of a rating scale or seeking the child's verbal description were less frequently named. Participants related discerning and interpreting the child's behaviors as a challenge to symptom assessment. They also reported attention to symptom characteristics as important to planning interventions. Future directions include building capacity to support child-centric symptom assessment. Development of reliable and valid resources for use in clinical settings may support a more child-centric approach to symptom assessment.

Respiratory depression is a complication that often follows cancer-related surgery and can result in life-threatening consequences. Oncology nurses caring for postoperative patients must monitor for respiratory complications and implement measures to prevent respiratory depression. A review of postoperative respiratory depression risk factors, clinical findings, and monitoring will be presented in this article using a case study.

The care of pediatric patients with cancer and their families is complex and rapidly evolving. Despite significant advances in outcomes, symptoms of the disease and complications of therapy continue to cause suffering that may improve with the involvement of pediatric palliative care (PPC) services. This descriptive study responds to the observation of great variability in PPC utilization within pediatric oncology. Data collected from 156 health care professionals (nurses, advanced practice professionals, and physicians) from a statewide hematology alliance evaluates the knowledge, beliefs, and perceived barriers to PPC involvement. Data analysis reveals significant variability when comparing respondents from professional roles and practice environments. Despite progress in PPC availability, care delivery remains incongruent with current recommendations. Knowledge gained from this study emphasizes the important role for all health care providers in advocating for support of PPC programs, educating the public, and committing to intentional involvement of PPC services while caring for pediatric oncology patients.

Aim: The primary objective of this study was to describe demographics and end-of-life treatments of children with cancer at a government tertiary cancer center in India., Methods: A retrospective review was undertaken of medical charts of all children younger than 18 years, who died as inpatients while undergoing treatment at the pediatric oncology department between April and September 2016. Data were collected on demographics, diagnosis, treatments, survival, palliative care involvement, and symptoms at end of life., Results: There were 44 pediatric oncology patients who died in the hospital during the study period. The most frequent diagnoses were hematological malignancies (n = 29). Tumor-specific treatment was given to 38/44 (86%) patients in the last 30 days of life, and 13 patients in the last day of life or 1 day before. Of all deaths, 23/44 (52%) occurred within 30 days of admission to the pediatric ward and 34/44 (77%) within 90 days. Of the 44 patients, 25 (57%) were referred to palliative care. The median number of days between referral and death was 14 (0-78) days. Frequent symptoms documented were bleeding (11/44), dyspnea (10/44), pain (7/44), seizures (7/44), and delirium (5/44), with each patient having one or more of these symptoms. Only patients with a palliative care referral received opioid analgesics or benzodiazepines at the end of life., Conclusions: This study highlights the demographics of suffering, death, and end-of-life care in children with cancer at a government tertiary cancer center in India.

Objectives: The aim of this study was to assess the degree of compassion satisfaction and compassion fatigue (CF) among critical care, oncology and charge nurses., Background: Cumulative grief resulting from caring for critically/terminally ill patients may result in CF, leading to lower quality care and higher nurse attrition., Method: Data were collected from 38 direct care nurses and 10 charge nurses, using the Professional Quality of Life., Results: Charge nurses had higher secondary traumatic stress (STS) than direct care nurses. Nurses with less than 10 years of experience had lower CS than experienced nurses. Higher levels of burnout (BO) and STS were reported among charge nurses, whereas less direct care nurses had average to high BO and STS ratings., Conclusions: Previous studies focused on direct care nurses; our findings suggest that CF is prevalent among charge nurses as well. Interventions should be considered for clinical providers and charge nurses including debriefing, stress reduction, peer support, and team building.

Background: Geriatric oncology incorporates comprehensive geriatric assessment (CGA) and traditional oncology care., Objectives: The aims are to identify limitations reflected by mean scores on the CGA instruments and describe the CGA recommendations documented in the medical record., Methods: CGA was administered and consisted of the Timed Up and Go Test, the Activities of Daily Living Scale, the Instrumental Activities of Daily Living Scale, grip strength, falls, pain, the Brief Fatigue Inventory, the Pittsburgh Sleep Quality Index, the Geriatric Depression Scale, the Mini-Cog, and the Mini Nutritional Assessment. CGA recommendations were obtained from the medical record. Descriptive statistics were used to analyze the data., Findings: Most recommendations were for general cancer treatment, followed by fall referral/education.

Background: Psychosocial distress screening is a quality care standard in cancer care. Screening implementation may be facilitated by an educational program that uses goals to evaluate progress over time., Objectives: This article describes the content and design of the Screening for Psychosocial Distress Program (SPDP), reports on its delivery to 36 paired participants, and evaluates its effects on distress screening activities and goals., Methods: The SPDP used a one-group pre-/post-test design. It was delivered at 2 workshops and 10 conference calls during a two-year period. Data on screening and goal achievement were collected at 6, 12, and 24 months. Data on the quality of dyads' relationships were collected at 24 months., Findings: At 24 months, all 18 dyads had begun screening. Dyads reported working effectively together and being supportive of the other member of the dyad while achieving their goals for implementing psychosocial distress screening.

Healthcare providers often do not have the time to counsel patients on how to quit smoking. Consequently, little emphasis is placed on this pursuit, and no behavioral counseling is done. Using medications approved by the U.S. Food and Drug Administration in combination with behavioral counseling has been shown to be effective in smoking cessation programs. Oncology nurses, and advanced practice nurses in particular, can play a significant role in helping patients to quit smoking. This article details how one oncology clinical nurse specialist created a smoking cessation program at her institution.

Knowledge of genetic mutations and how these affect patient outcomes is rapidly expanding in the care of individuals diagnosed with multiple myeloma (MM). Genetic analysis of bone marrow biopsies now provides information about diagnosis,response to treatment, and prognosis. Oncology nurses need to understand the science and meaning of bone marrow biopsy reports, including the implications of genetic alterations and minimal residual disease. This will allow them to provide care, support, and education related to MM and its treatment to patients and their families.