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Cancer survivors’ well-being is threatened by the risk of cancer recurrence and the increased risk of chronic diseases resulting from cancer treatments. Improving lifestyle behaviors attenuates these risks. Traditional approaches to lifestyle modification (i.e., counseling) are expensive, require significant human resources, and are difficult to scale. Mobile health interventions offer a novel alternative to traditional approaches. However, to date, systematic reviews have yet to examine the use of mobile health interventions for lifestyle behavior improvement among cancer survivors. The objectives of this integrative review were to synthesize research findings, critically appraise the scientific literature; examine the use of theory in intervention design; and identify survivors’ preferences in using mobile health interventions for lifestyle improvement. Nineteen articles met eligibility requirements. Only two studies used quantitative methods (no RCTs). Study quality was low and only one study reported the use of theory in app design. Unfortunately, the evidence has not yet sufficiently matured, in quality or in rigor, to make recommendations on how to improve health behaviors or outcomes. However, six themes emerged as important considerations for intervention development for cancer survivors (app features/functionality, social relationships/support, provider relationships/support, app content, app acceptability, and barriers to use). These findings underscored the need for rigorous, efficacy studies before the use of mobile health interventions can be safely recommended for cancer survivors.

Survivors of advanced breast cancer (ABC), also known as metavivors, are often left with fewer treatment options in the landscape of a cure culture. Metavivors have unique psychosocial and physical needs distinct from patients with early-stage breast cancer. This analysis delves into side effects commonly experienced by patients with ABC, such as fatigue, anxiety, and cardiotoxicity; how these side effects impact caregiver support, financial toxicity, emotional strain, and spiritual and emotional distress; as well as current strategies for mitigation, including nutrition, exercise, and participation in clinical research. Overall, this analysis is a mandate for additional research to explore novel treatments and implement strategies to maintain and improve patients’ quality of life.

Medicare's new focus on end-of-life care has driven nurses and other clinicians to re-examine when advanced care planning should begin, and serious illness discussions should be conducted. This article will address barriers to, cultural influences on, framing of, and documentation of serious illness discussions using a case study approach.

Upper extremity limb precautions are recommended for patients who undergo axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) to lower the risk of lymphedema. Limb precautions involve avoiding use of the affected arm for point-of-care testing, venipuncture, and blood pressure measurement, all of which can affect quality of life and create delays in care.This review provides a summary of the evidence regarding limb precautions and evidence-based interventions to lower the risk of lymphedema after ALND or SLNB.A literature search was conducted using CINAHL®; PubMed®; Education Resources Information Center; History of Science, Technology, and Medicine; Cochrane Library; and Joanna Briggs Institute databases.Evidence supports exercising the affected limb, maintaining a body mass index of less than 25, and massaging to lower the risk of lymphedema. There is limited evidence for avoiding IV catheter placement and venipuncture in the affected arm following ALND and SLNB. Best practice is to assess the patient for risk factors of lymphedema before recommending selected evidence-based limb precautions.

Enhanced recovery programs are multimodal, evidence-based perioperative programs designed to improve a patient’s functional recovery after surgery. Enhanced recovery programs promote standardized, multidisciplinary care throughout the perioperative course to improve patient outcomes, rather than focusing on surgical technique. It is important for nurses working in acute and critical care to be aware of the paradigm shift created by the trend toward the enhanced recovery approach. By learning more about facets of the approach, the nurse will be better prepared to adopt whatever aspects of enhanced recovery their institution implements for the surgical oncology population. An overview is provided of the potential components of enhanced recovery.

Background: Research has consistently demonstrated the benefits of exercise in the oncology patient (Blaney et al, Psychooncology 2013; Garcia and Thomson, Nutr Clin Pract 2014; Rock et al, CA Cancer J Clin 2012). Despite the benefits of exercise for cancer survivors, only 20%–30% of them will be active after cancer treatment (Rock et al, CA Cancer J Clin 2012). The known barriers to exercise in oncology are lack of patient education, lack of knowledge, fatigue, decreased motivation, and comorbidities (Blaney et al, Psychooncology 2013). Objectives: This quality initiative program between oncology rehabilitation physical therapy department and surgical oncology nursing aims to improve the quality of care provided to our patients by reducing the barriers to exercise. One main barrier for the patients is their lack of knowledge of how to begin an exercise program. This is overcome by prescribing physical therapy and designing an individualized exercise program that can be performed in their home. Secondary objectives are to determine a change in fatigue, compliance, and/or any barriers after physical therapy. Methods: Patients are identified by the breast surgical oncology team, and a referral for physical therapy is placed. A comprehensive evaluation is completed, including: past exercise preferences, 2-minute walk test, a fatigue questionnaire, and a 30-second sit to stand test, with these same outcome measures obtained at discharge. The James Exercise Program is provided via 4 1-hour sessions. A nurse from surgical oncology calls the patient, administers the fatigue questionnaire, and determines any barriers to exercise that the patient is facing at the 8- and 12-week mark. Results: The preliminary results of the program demonstrate compliance with exercise, reduction in fatigue, improvement in endurance and strength. Conclusion: This innovative quality initiative between physical therapy and surgical oncology nursing has benefitted our patients. We leverage the expertise of the physical therapists to provide personalized exercise regimens and the professional clearance/recommendation for physical therapy from oncology team, to minimize barriers to exercise in the oncology population. Limitations to this program are that some participants fail to arrive at the initial session, lack of support and resources in the participants hometown to allow adherence to the exercise program (despite all efforts to encourage the fact that the program can be completed in their own home), and the low number of participants.

BACKGROUND In 2016, there were 15.5 million cancer survivors in the United States. Survivors’ mortality and well-being are threatened by the risk of cancer recurrence and the prevalence of chronic diseases resulting from cancer treatments. Improving lifestyle behaviors attenuates these risks. Traditional approaches to lifestyle modification (i.e., counseling), are expensive, require significant human resources, and are difficult to scale. Mobile health (mHealth) interventions offer a novel alternative to traditional approaches. Although mHealth interventions are a relatively new phenomenon (c. 2010), their presence and use have increased exponentially in the last few years. However, to date, systematic reviews have failed to examine the use of mHealth interventions in lifestyle behavior change among cancer survivors. OBJECTIVE : The specific objectives of this integrative review were to (1) identify and synthesize the research in the use of mHealth apps for lifestyle behavior modification among cancer survivors; (2) critically appraise the scientific literature; (3) examine the use of theory in mHealth app design, development and testing; and (4) identify cancer survivors’ preferences in using mHealth apps for lifestyle behavior change. METHODS The review process was guided by Whittemore and Knafl’s framework and the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. We searched 8 databases and 3 journals for studies reported between January 1, 2007, and April 15, 2019, using concepts associated with mobile health, cancer, and lifestyle behaviors. The inclusion of studies and study quality were assessed by at least two research team members, using pre-established criteria and validated tools. We assessed theory use with a coding scheme developed by Michie and Prestwich. RESULTS Of the 1,351 manuscripts retrieved, 19 articles (17 studies) met eligibility requirements. Ten articles reported on the use of mHealth interventions while 9 described mHealth features and functions important to survivors. No RCTs were identified and only 2 quasi-experimental studies were included. Breast cancer survivors were over-represented in the studies as was the lifestyle behavior of physical activity (PA) (n=15). The 2 non-PA studies included in this review focused on stress. Survivors’ perceptions about using mHealth were synthesized into 6 common themes: App Functionality & Features, Social Relationships & Support, Provider Relationships, Support & Communications, Content, Acceptability, and Barriers to Use. The overall quality of the studies was low, except for 3 pilot studies (2 moderate, 1 strong). Only 1 study reported the use of theory in the design, development, or testing of the mHealth intervention. CONCLUSIONS Overall, the low-quality of studies included in this review validated a need for rigorous, theory-based pilot and efficacy studies before use of mHealth interventions can be safely and effectively recommended and used to improve lifestyle behaviors in cancer survivors.

CASE STUDY Ms. X is a 23-year-old female who presented to clinic with stage 2A endometrial cancer of the ovary. At her first visit, Ms. X was prescribed paclitaxel and carboplatin on day 1 for 6 cycles. During the visit, the nurse noted Ms. X could not keep her hands out of her hair; she continually played with it. The nurse, judging by Ms. X’s body language, suspected she valued her hair. Ms. X revealed she had been doing some research and wanted to use a cold cap to try and prevent alopecia during her treatment. On the first day of chemotherapy, Ms. X came to the clinic with her mother. They brought a manual cap for scalp cooling and a cooler of dry ice. Her mother was to serve as a "capper" and change the cap at 20- to 30-minute intervals during treatment to keep her scalp cool. Ms. X was made comfortable in an infusion bed, and the cap was applied 30 minutes prior to the start of therapy. Ms. X’s mother changed the dry ice caps every 20 minutes throughout the infusion. Ms. X then left it on for 90 minutes following her chemotherapy. After 6 cycles of chemotherapy, Ms. X still had all her hair. She appeared to have retained 100% of her hair, although she estimates that she lost about 5% of her hair. During therapy, she followed the instructions outlined in Table 1. Ms. X reported that she rented the cap for $500 per month and paid $45 per week for the dry ice. Her mother also had to miss work to be the "capper," and this added to the out-of-pocket costs of scalp cooling.

Receptor type and function of bradykinin (BK) receptors on human synovial fibroblasts (HSF) was determined. Scatchard analysis of [3H]BK saturation binding to intact synovial cells revealed a single binding site, with a Kd of 3.8 +/- 0.6 nM. HSF express approximately 50,000 BK sites/cell. Specificity of [3H]BK binding was confirmed by the ability of several BK peptide agonists and antagonists to inhibit binding in a dose dependent manner. The rank order of potency for agonist inhibition of [3H]BK and the inability of selective antagonists of the B1-type to displace binding suggest that the BK receptor on HSF is a B2 subtype receptor. The addition of BK to HSF caused a time and concentration dependent increase in PGE2 production. This BK induced PGE2 production was blocked by specific B2 type BK antagonists and not by B1 antagonists. The results of this study identify B2 type BK receptors on synovial fibroblasts and suggest that BK may be a primary mediator in inflammatory arthritis.

Recent studies have demonstrated that phagocytosis of colloidal particles by the mononuclear phagocytes of the liver and spleen can be controlled by either coating or stabilizing particulate carriers with the amphipathic polymeric surfactants, F108 and T908. These surfactants consist of copolymers of polypropylene oxide (PPO) and polyethylene oxide (PEO) and, when adsorbed to particulate surfaces, significantly decrease sequestration of particulates by the mononuclear phagocytes (MPS) of the liver. To evaluate these observations further, murine peritoneal macrophages were incubated for varying periods with surfactant-coated and noncoated polystyrene particles (PSPs). Phagocytosis was monitored using gamma counting and quantitative fluorescence microscopy. The data show that phagocytosis is decreased when PSPs are coated with F108 and T908. In addition, suppression of phagocytic activity was observed when cells were pretreated with the surfactant and then challenged with noncoated particles. The data confirm previous observations that polymeric surfactants consisting of PEO and PPO protect particulate carriers from rapid uptake by the MPS of the liver. Further, F108 and T908 suppress phagocytosis directly without affecting the integrity, viability, or functional state of the cell.__________

Formation of phosphatidylcholine from phosphatidylethanolamine via the S-adenosylmethionine (AdoMet) pathway has been shown to be required for signal transduction of receptor–ligand interactions in a variety of cells. These interactions result in the remodeling of phospholipid pools and phospholipase activation. To extend these observations and to explore the role of the phosphatidylcholine synthesis pathway in transduction of the leukotriene B4 (LTB4) receptor–ligand response, we examined phospholipid methylation in human polymorphonuclear leukocytes (PMN) following stimulation by LTB4, a potent chemotactic agent that is a metabolite of arachidonic acid. At early time points (~3–10 min), formation of methylated phospholipids was enhanced following LTB4 stimulation. The LTB4 analogs 6-trans LTB4 as well as LTB4 epimers induced less methylation compared with LTB4, and the potencies of these analogs in inducing methylation correlated with their diminished ability to induce chemotaxis. Furthermore, the ability of these agonists to induce methylation also correlated with the binding affinity of these agents to the LTB4 receptors on these cells. Synthesis of phosphatidylcholine by the choline transferase pathway was not affected by LTB4. Inhibition of the AdoMet reaction with 3- deazaadenosine, L-homocysteine homolactone, or erythro-9-[2-hydroxy-3-nonyl] adenine (EHNA) abrogated LTB4-induced phospholipid methylation and the chemotactic response. The potencies of these inhibitors in blocking phospholipid methylation also correlated with their ability to abrogate the LTB4-induced chemotactic response. These data suggest that phospholipid methylation and phospholipase activation play an important role in transduction of the LTB4 receptor–ligand interaction in PMN, which results in chemotaxis.