Nursing interventions for newly diagnosed older cancer patients facing terminal illness.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
R McCorkle
Publications and source records attributed to R McCorkle.
Providing accurate information to women about tamoxifen therapy for breast cancer: current indications, effects, and controversies.
PURPOSE/OBJECTIVES: To address the uses of and current controversies surrounding tamoxifen therapy for the treatment and possible prevention of breast cancer so nurses may provide patients with accurate information. Factors that may hinder assimilation of information and strategies to enhance patient understanding are discussed. DATA SOURCES: Published, data-based articles and texts. DATA SYNTHESIS: The role of tamoxifen in controlling breast cancer includes adjuvant treatment for early stage breast cancer and palliative treatment of advanced disease. Investigational uses of tamoxifen include breast cancer prevention in women at high risk for the disease. Although tamoxifen has its proven benefits, confusion regarding who should take it still exists. CONCLUSIONS: Medical information as it relates to life-threatening disease often is transmitted to the public in an alarmist manner. While women still have legitimate concerns about tamoxifen use (e.g., increased risk of endometrial cancer and thromboembolic events), the benefits of this treatment for breast cancer (e.g., increased disease-free and overall survival, reduction in contralateral breast cancer) appear to far outweigh the risks. IMPLICATIONS FOR NURSING PRACTICE: Nurses should be cognizant of issues related to tamoxifen therapy so they can assist women in making informed decisions. Unbiased communication of the facts with attention to each woman's situation can facilitate individual consideration of options in an informed manner.
Antineoplastic Agents, Hormonal↗
A test of the fit between the Corbin and Strauss Trajectory Model and care provided to older patients after cancer surgery.
The Corbin and Strauss Trajectory Model proposed that nursing care should differ along a trajectory of eight phases to meet patients' and families' needs. Seventy-nine patients with breast, prostate, or gastrointestinal cancer were determined to be in either the stable or the unstable phase of their illness. Contrary to expectations, documented nursing interventions did not significantly differ between stable and unstable trajectory phases, although significant differences were found when comparisons were made across cancer sites. These findings suggest that the trajectory framework may require modification for use with oncology patients.
Aged↗
Nutritional adaptation of women living with HIV: a pilot study.
The incidence of human immunodeficiency virus (HIV) infection in women worldwide is increasing rapidly. Assumptions about HIV-related immunologic and nutritional changes are primarily based on data derived from men infected with HIV. The article reports a pilot study designed to examine the immunologic and nutritional responses of a small group of women with HIV infection and to suggest the Roy adaptation model as a framework for understanding HIV-related changes in women. A cross-sectional descriptive design was used to study physiologic mode responses in women seropositive for HIV. Results indicated that the subjects had lower than normal total CD4+ counts. The mean body mass index and midarm muscle area of this cohort of women fell between the 50th and 75th percentiles, and the triceps skinfold thickness was slightly below the 50th percentile, compared with age-matched norms derived from NHANES II data. Although wasting and nutritional problems are common in men with HIV disease the results suggest that women at the midlevel of the disease may not yet have major problems with nutritional adaptation to HIV. Future studies using the Roy adaptation model with larger samples of women who are followed over time are needed to determine whether the decline in physiologic mode adaptation level noted in men infected with HIV is also experienced by women infected with HIV.
Adaptation, Physiological↗
Development of two instruments examining stress and adjustment in children with cancer.
Explore the source record for details and available documents.
Adaptation, Psychological↗
Nursing intervention intensity and focus: indicators of process for outcomes studies.
Outcomes research has become increasingly important in the current health care environment and for informatics research efforts. Recent efforts in automating clinical data for use in outcomes studies has focused attention on the need to represent the processes of care in the classic structure-process-outcome models of care. This paper reports on use of the Nursing Intervention Lexicon and Taxonomy for classifying interventions to characterize two process of care variables: intervention intensity and intervention focus. Study results demonstrate that these variables are descriptive and provide promise for describing processes of nursing care for describing clinical care.
Breast Neoplasms↗
Explaining reduced cancer survival among the disadvantaged.
The fact that socially disadvantaged cancer patients face a greater risk of mortality than the advantaged is well recognized but poorly understood. Existing research and a newly completed 10-year survival study suggest that complex interrelations among biological factors, medical interventions, and specific dimensions of social differentiation determine survival differences. Patterns of interrelations among determinants of survival appear compatible with an "economic" model in some forms of cancer and a "cognitive-behavioral" model in others. Findings presented here suggest that improved access to health care will reduce mortality risk among the disadvantaged in at least some malignancies, but will not alone make their survival chances equal to those of the advantaged.
Adult↗
Oncology nursing--a challenge not to be taken lightly. 1977.
Explore the source record for details and available documents.
History, 20th Century↗
A cancer nursing curriculum guide for baccalaureate nursing education.
Cancer is a leading cause of morbidity and mortality in the United States, affecting one of four Americans. Many nurses without specialized oncology preparation will provide counsel and care for people at risk for or with cancer. In recognition of the cancer-related educational needs for all nurses in the wide variety of health care settings, the American Cancer Society Professors of Oncology Nursing provide a curriculum guide for core cancer nursing content in undergraduate education for baccalaureate students. It is intended to assist educators to define expectations for clinical competencies in cancer care for preparing graduates at the baccalaureate level. A variety of educational strategies and resources for the educator are suggested to facilitate integration of cancer content within existing programs.
American Cancer Society↗
A prospective longitudinal investigation of spousal bereavement examining Parkes and Weiss' Bereavement Risk Index.
The purpose of this study was (a) to describe spousal bereavement both prospectively and longitudinally and (b) to examine the validity of the Bereavement Risk Index (BRI) published by Parkes and Weiss (1). Psychological distress was measured in 46 subjects across five time intervals beginning prior to a spousal death from lung cancer and ending 25 months after the death using the Brief Symptom Inventory (BSI) (2). The hypothesis that the BRI discriminates between bereaved spouses at high and low risk for psychological distress was supported by measurements taken within two months of the patient's diagnosis (prior to death), at 6 weeks following the death, and at 6 and 13 months thereafter. These findings support the need for early identification of individuals at high risk for negative bereavement outcomes even prior to the spousal death.
Adolescent↗
The impact of posthospital home care on patients with cancer.
Symptom distress, mental health status, enforced social dependency and health perceptions were measured in two groups of cancer patients, one receiving home care services (n = 49) and the other receiving no such services (n = 11). Data were obtained at hospital discharge and 3 months later. Patients receiving home care demonstrated statistically significant improvement on mental health and social dependency; patients not receiving home care did not improve on any variable. After controlling for baseline scores, the home care group had significantly higher mental health status at the second interview than the no home care group.
Aftercare↗
Weight change and lung cancer: relationships with symptom distress, functional status, and smoking.
The pattern of weight change (at five 6-week intervals beginning 2 months after diagnosis of advanced disease) is described in adults with progressive lung cancer (N = 60). Weight loss of 10% or more at study entry occurred in 35% of subjects; 37% lost weight at three or more intervals; and 25% lost weight at only one interval. Pre-illness weight loss was moderately correlated with subsequent decreased functional status (Enforced Social Dependency Scale) at Times 1, 2, and 3 (r = -.49, r = -.43, r = -.48, p < .001). Weight loss correlated with subsequent increased symptom distress (Symptom Distress Scale, SDS) at three times (Times 2, 4, and 5: r = -.34, r = -.30, r = -.43, p < .05). Chemotherapy (50% of subjects) and smoking (25% at study entry) predicted weight loss from Time 1 to 5, explaining 28% of the variance.
Adenocarcinoma↗
Psychological distress in survivors of residential fires.
This paper presents preliminary findings from an ongoing study of survivors of residential fires. The purpose of this study was to examine psychological distress and extent of loss in order to provide a psychological profile of survivors overtime. The sample (N = 69) was drawn consecutively from the database of residential fires available through the Philadelphia Fire Department. Levels of psychological distress were measured as well as reports of symptoms consistent with the diagnostic criteria for Post-traumatic Stress Disorder. The major findings indicate that residential fires caused significant and sustained distress. An agenda for further research and for services to survivors of these fires is presented.
Adolescent↗
Detecting survival effects of socioeconomic status: problems in the use of aggregate measures.
Direct measures of SES are seldom included in medical records or large databases on disease incidence or survival, forcing researchers to infer the SES characteristics of individuals from aggregate data (e.g. census tract-level income, education, etc.). This paper assesses the degree of error that results from such inference and the impact this error may have on reported relationships between SES and survival. The authors obtained both individual and census tract-level data on 536 persons diagnosed with cancer between 1980 and 1982 and monitored their survival through 1992. Pearson correlations between individual-level and census tract-level SES variables ranged between 0.2 and 0.4. Statistically significant relationships between SES and survival were observed in the models based on individual-level but not census tract-level SES data. The authors computed the degree to which inference of individual-level from census tract-level SES reduces estimates of risk ratios across SES. It appears likely that much larger numbers of observations than have been used in published studies will be needed to better understand the relationship of SES to survival and other disease outcomes.
Age Factors↗
Production of bioactive and immunoreactive interleukin-6 (IL-6) and expression of IL-6 messenger ribonucleic acid by human pituitary adenomas.
Preliminary studies have demonstrated that some pituitary adenomas secrete immunoreactive interleukin-6 (irIL-6) when cultured in vitro. We have extended these studies by investigating 100 pituitary adenomas of different types measuring immunoreactive and bioactive IL-6. Tumors were cultured either as explants without fetal calf serum or as dispersed cells with 10% total calf serum. Fifty-three of the 100 (53%) pituitary cultures were found to release irIL-6 and in 44 adenomas examined, 32 (72.7%) secreted bioactive IL-6. In 61 explant cultures, 30 adenomas released IL-6, indicating autonomous secretion. The amount of IL-6 released by adenomas in cell culture was generally higher, although the incidence was similar to explant cultures. IrIL-6 was released by 7 of 14 prolactinomas, 15 of 27 somatotrophinomas, 5 of 7 corticotrophinomas (including 2 Nelson's adenomas), 1 of 1 thyrotrophinomas, 2 of 2 gonadotrophinomas, and 23 of 49 clinically non-functioning adenomas. Periadenomatous tissue removed from a patient with a corticotrophinoma was found to secrete IL-6 but in much lower concentration than from the adenoma tissue. Tumor necrosis factor-alpha and -gamma-interferon were not detected in the conditioned media. Four IL-6-secreting adenomas were examined by in situ hybridization for IL-6 messenger RNA, and three of these were positive with fluorescence present throughout the tissue examined. We have provided evidence that over half of pituitary adenomas secrete IL-6 which is bioactive and that IL-6 is synthesized within the tumor by the adenoma cells.
Adenoma↗
A descriptive study of immune status in patients undergoing colorectal surgery: lymphocyte phenotypes.
PURPOSE/OBJECTIVES: To describe immune status in patients prior to colorectal surgery for cancer, to establish values to serve as a baseline for subsequent analyses, and to describe a procedure for studying phenotypes of the immune system, elucidating its advantages. DESIGN: One component of a larger longitudinal survey. SETTING: Two large, inner-city university hospitals and two of their affiliated hospitals in the northeastern United States. SAMPLE: Patients undergoing surgery for colorectal cancer (N = 94). Subjects were primarily male (n = 57) and Caucasian (n = 85) and ranged in age from 26-88 years (mean = 63). Seventy-seven percent (n = 73) had cancer, 23% (n = 21) had benign diseases or conditions. METHODS: Flow cytometry analysis of lymphocyte phenotypes was performed on blood samples drawn from patients before they underwent surgery for colorectal cancer. MAIN OUTCOME MEASURES: The average absolute lymphocyte subset levels and the average relative lymphocyte subset levels of blood samples taken from patients undergoing surgery for colorectal cancer were compared (using t-tests) with the subset levels of two normal reference samples. FINDINGS: The average absolute lymphocyte subset levels and average relative lymphocyte subset levels of patients undergoing surgery for colorectal cancer fell within normal ranges. CONCLUSIONS: These findings suggest that this sample of patients undergoing surgery has one essential element of an intact immune system--normal levels of lymphocyte subsets. IMPLICATIONS FOR NURSING PRACTICE: There is no indication preoperatively that this population is at a higher risk for infection or delayed wound healing. However, there may be other times in the illness trajectory when the immune system does become compromised, and these values prior to surgery will serve as a baseline to identify changes in patients' immune status over time. Further longitudinal studies are necessary.
Adult↗
Determinants of subsequent home health care nursing service use by hospitalized patients with cancer.
BACKGROUND: The authors examined the extent to which specific patient characteristics and length of hospital stay were capable of independently explaining the use of home health care nursing services by hospitalized patients with cancer after discharge. METHODS: The current study represents a secondary analysis of a data set originally gathered to identify the home health care needs of patients with cancer. The sample involved 87 patients with cancer who received home health care after hospitalization and 43 patients who did not receive such services. RESULTS: A logistic regression analysis indicated that home health care use was related to patient age, length of hospital stay, and level of symptom distress. Specifically, the likelihood of home health care use was found to increase among subjects older than 50 years of age, subjects with hospital stays of more than 7 days (apparently related to surgery), and those who experienced moderate to high levels of symptom distress. CONCLUSIONS: The results indicate a need for home health care nurses to be skilled in the management of cancer symptoms and in the complex problems commonly experienced by the postsurgical patient with cancer.
Activities of Daily Living↗
A shortened version of an instrument measuring bereavement.
The purpose of the study was to develop a tool to measure the grief experience. The Grief Experience Inventory (GEI) [Sanders et al., A Manual for the Grief Experience Inventory. C. M. Sanders, Charlotte, NC (1979)] was revised according to the Parkes [Bereavement: Studies of Grief in Adult Life. International Universities Press, New York (1972)] framework. Four hundred and eighteen subjects who had been primary care givers for significant others prior to the loss of the person through death completed Revised Grief Experience (RGEI) questionnaires. The internal consistency reliability (coefficient alpha) for the RGEI was 0.93. A principal components factor rotation was performed yielding a four factor solution consistent with the theoretical structure (Parkes, 1972). Results demonstrated that the RGEI is a concise, valid, and reliable measure sensitive to the grief experience.
Adaptation, Psychological↗