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HIV self-testing is an important strategy in the US Ending the HIV Epidemic initiative. To facilitate uptake of self-testing, we developed the mLab app, which complements existing self-test options to support the potential for higher uptake of the HIV self-test. Syphilis, a sexually transmitted infection with currently rising prevalence and overlap in risk profiles with HIV, could similarly benefit from the advantages of companion diagnostic mobile apps such as mLab. Due to the success of the mLab app in promoting HIV self-testing during a randomized controlled trial and the scientific evidence of need for at-home syphilis testing, our team developed the mLab+ app, which supports both HIV and syphilis testing through an image processing algorithm that incorporates a duplex HIV and syphilis point-of-care test. We conducted a pilot study to assess the feasibility and usability of the mLab+ app for HIV and syphilis testing. We recruited participants who were assigned male sex at birth and reported sex with another man. Participants came to the Nurse Practitioner Group clinic for baseline and follow-up visits. Participants rated the usability of the app using the Health Information Technology Usability Evaluation Scale and the Post-Study System Usability Questionnaire at their 3-month follow-up visit. The primary outcome was the number of participants who were able to self-administer the DPP HIV-Syphilis test with the assistance of the mLab+ app. Feasibility was measured through recruitment pace, retention over 3 months, app usability, and paradata. Of the 20 participants, 19 identified as male and 1 identified as nonbinary. Most participants (n=16) were able to complete the DPP HIV-Syphilis test with facilitation support from the mLab+ app. The average duration of an app session, from after authentication until log-out or abandonment, was 30 minutes and 33 seconds (SD 21 minutes and 40 seconds). Apart from the 27% (13/48) of sessions that were 5 minutes or less, the distribution of session durations was approximately normal. Users spent the longest time viewing testing screens (ie, timer screens, initial testing screen, test guided walkthroughs, test results, and picture and result upload). The overall mean scores on the Post-Study System Usability Questionnaire (2.65, SD 1.06) and Health Information Technology Usability Evaluation Scale (3.62, SD 1.07) indicated medium to high usability. The retention rate for the 3-month trial was 80% (16/20). The findings support the use of the mLab+ app as a tool for assisting consumers in self-testing for HIV and syphilis. The limitations of the study design warrant further examination outside of clinic settings to better understand the utility of these tools for improving consumer health outcomes.

An evaluation of symptom clusters provides information on stable groups of symptoms that are relatively independent from other clusters. No studies were identified that evaluated for symptom clusters in patients with cancer during the COVID-19 pandemic. The purpose was to describe the occurrence, severity, and distress of the five most common symptoms reported by patients during the COVID-19 pandemic and identify symptom clusters during the COVID-19 pandemic. Data were collected from 1144 patients from May 2020 and February 2021 via an online survey. Patients completed an online questionnaire that obtained information on demographic and clinical characteristics and a revised version of the Memorial Symptom Assessment Scale (MSAS) with 44 symptoms. Descriptive statistics were used to evaluate sample and symptom characteristics. Exploratory factor analysis (EFA) with goemin rotation was used to identify the symptom clusters using symptom occurrence ratings. Of the 1144 patients, 83.9% were female, 84.9% self-reported their race and ethnicity as white, 46.2% had an advanced degree, 67.5% were married/ partnered, 43.7% were employed, and 43.9% were receiving active treatment. Sample's mean age was 62.3 (+11.3) years, time since diagnosis was 8.6 (+7.9) years and number of MSAS symptoms was 10.0 (+5.8). The five most common symptoms were: pain (63.7%), difficulty sleeping (58.4%), lack of energy (57.1%), worrying (50.7%), and joint pain (47.7%). The most severe symptoms were: difficulty sleeping, problems with sexual interest/activity, I don't look like myself, difficulty swallowing, and change in sense of smell. The most distressing symptoms were: difficulty sleeping, problems with sexual interest/activity, weight gain, I don't look like myself, and hair loss. Six symptom clusters were identified and named: psychological, respiratory, chemotherapy-related, pain, weight loss, and epithelial. As noted previously, the most common symptoms are not always the symptoms that are the most severe and/or distressing. While psychological, respiratory, and epithelial clusters were identified in previous studies, the pain cluster that included pain, joint pain, and muscle aches and pain is cluster that warrants additional evaluation. It is possible that the symptoms of joint pain and muscle aches that were added to the revised MSAS contributed to the identification of this cluster.

Beyond the stress of a cancer diagnosis, stressors associated with a global pandemic (loneliness, social isolation, financial toxicity) may exacerbate patients' symptom experiences. No studies have examined these relationships using a comprehensive symptom inventory and measures of four different types of stress. The purpose was to identify distinct symptom profiles and evaluate for differences among the profiles in demographic and clinical characteristics and stress. Data were collected from 1144 patients from May 2020 and February 2021 via an online survey. Patients completed an online questionnaire that included: revised Memorial Symptom Assessment Scale (37 symptoms), Impact of Event Scale-Revised (GOVID-19 and cancer-specific stress), Perceived Stress Scale (global stress), Social Isolation Scale, UCLA Loneliness Scale, and Comprehensive Score for Financial Toxicity. Using symptom occurrence rates, latent class analysis was done to identify distinct symptom profiles. Differences among the profiles were evaluated using parametric and non-parametric tests. Four distinct profiles were identified (Le., Low (28.2%), Moderate Physical and Lower Psychological (22.7%), Moderate Physical and Higher Psychological (31.6%), and High (17.4%); Figure 1). Mean number of symptoms was 3.5 (+2.0) and 19.0 (+3.5) in Low and High classes, respectively. Compared to the Low class, patients in the High class were younger, more likely to be female, had a lower level of education, and a lower annual income. In addition, patients in the High class had a higher body mass index, a worse comorbidity profile, a lower functional status, and were more likely to be receiving active treatment. As the symptom profiles worsened, levels of global stress, COVID-19 and cancer-specific stress, loneliness, and financial toxicity increased in a dose response fashion (i.e., Low < Moderate Physical and Lower Psychological < Moderate Physical and Higher Psychological < High). Patients in the High class had stress scores suggestive of post-traumatic stress disorder, moderate to moderately high level of loneliness, and significant financial toxicity. Distinct symptom profiles identified in this study are consistent with a previous report of patients receiving chemotherapy. While recovery from the GOVID-19 pandemic is occurring, these findings provide \"baseline\" data to use for comparative purposes. These findings provide strong support for an association between increasing symptom burden and higher levels of multiple types of stress. Clinicians need to perform comprehensive assessments of both symptom burden and stress to provide tailored interventions.

Patients with myelodysplastic syndrome (MDS) require expert, consistent monitoring and management of their blood counts, disease status, and treatment regimens. Understanding how MDS presents and progresses as well as understanding treatment options and how to implement them on an individualized patient basis is essential for patients to receive optimal care. Nurse practitioners play a central role in the care of MDS patients. They have an opportunity to develop trusting relationships with their patients and are crucial parts of the health care team in helping to coordinate care, facilitate treatment, improve quality of life, and avoid life-threatening complications of the disease. •Myelodysplastic syndrome is a hematopoietic stem cell disorder that causes peripheral blood cytopenias.•Patients need consistent monitoring of laboratory work and symptoms for disease management.•There is large variability in disease progression, requiring individualized care.•Nurse practitioners are influential in proper disease management as oncology health care providers.

Conflicting literature exists regarding the relationship of combined oral contraceptives (COCs) and breast cancer risk. Although earlier studies demonstrated an association between the use of COCs and overall breast cancer risk in previous and current users, more recent research exhibits a small increased risk in current users only, with risk declining within 5 years after discontinuation. Furthermore, recent research demonstrates that COCs may protect against ovarian, endometrial, and colorectal cancer. This report reviews literature from 2010 to current on breast cancer incidence among average- and high-risk women who ever used COCs as well as protective benefits they may provide. •Combined oral contraceptives (COCs) may cause a small increase in breast cancer risk in current users; however, the risk after discontinuation disappears within 5 years.•The level of risk for breast cancer associated with COC use in women at high risk for developing breast cancer, such as those with BRCA1/2 mutations, is equivalent to that in the general population.•COCs may provide a significant reduction in the risk for ovarian cancer among both average-risk and high-risk women.•Further protective benefits may exist in reducing endometrial cancer, and some data suggest a reduction in colorectal cancer.•Overall, although some risk exists, use is permissible in average- and high-risk women.

OBJECTIVES: To identify subgroups of patients with distinct psychological profiles at the beginning of the COVID-19 pandemic and evaluate for differences. SAMPLE & SETTING: Online survey of patients with cancer during the COVID-19 pandemic. METHODS & VARIABLES: Patients completed measures of demographic and clinical characteristics, as well as cancer- and COVID-19-related stress, global stress, social isolation, loneliness, financial toxicity, and common symptoms. Latent profile analysis was used to identify distinct psychological profiles. RESULTS: Among 1,145 patients, three subgroups were identified (i.e., no anxiety or depression and normative level of resilience; high depression, high anxiety, and low resilience; and very high depression, very high anxiety, and very low resilience). Patients with the two worst psychological profiles were younger, more likely to be female, more recently diagnosed with cancer, and more likely to have breast cancer. IMPLICATIONS FOR NURSING: Findings may assist clinicians to identify patients at increased risk for significant psychological morbidity and provide more timely, targeted, and cost-effective interventions.

PurposeNo information is available on cancer patients’ knowledge of and experiences with COVID-19. We undertook an evaluation of differences in COVID-19 symptom occurrence rates, COVID-19 testing rates, clinical care activities, knowledge of COVID-19, and use of mitigation procedures between patients who were and were not receiving active cancer treatment.MethodsPatients enrolled were > 18 years of age; had a diagnosis of cancer; and were able to complete the emailed study survey online.ResultsOf the 174 patients who participated, 27.6% (n = 48) were receiving active treatment, 13.6% were unemployed because of COVID-19, 12.2% had been tested for COVID-19, and 0.6% had been hospitalized for COVID-19. Patients who were not on active treatment reported a higher mean number of COVID-19 symptoms (3.1 (± 4.2) versus 1.9 (± 2.6)), and patients who reported a higher number of COVID-19 symptoms were more likely to be tested. Over 55% of the patients were confident that their primary care provider could diagnose COVID-19, and the majority of the patients had high levels of adherence with the use of precautionary measures (e.g., social distancing, use of face coverings).ConclusionThe high level of COVID-19 symptoms and the significant overlap of COVID-19 and cancer-related symptoms pose challenges for clinicians who are assessing and triaging oncology patients for COVID-19 testing. For patients on active treatment, clinicians face challenges with how to assess and manage symptoms that, prior to COVID-19, would be ascribed to acute toxicities associated with cancer treatments or persistent symptoms in cancer survivors.

To identify subgroups of patients with distinct psychological profiles at the beginning of the COVID-19 pandemic and evaluate for differences. Online survey of patients with cancer during the COVID-19 pandemic. Patients completed measures of demographic and clinical characteristics, as well as cancer- and COVID-19-related stress, global stress, social isolation, loneliness, financial toxicity, and common symptoms. Latent profile analysis was used to identify distinct psychological profiles. Among 1,145 patients, three subgroups were identified (i.e., no anxiety or depression and normative level of resilience; high depression, high anxiety, and low resilience; and very high depression, very high anxiety, and very low resilience). Patients with the two worst psychological profiles were younger, more likely to be female, more recently diagnosed with cancer, and more likely to have breast cancer. Findings may assist clinicians to identify patients at increased risk for significant psychological morbidity and provide more timely, targeted, and cost-effective interventions.

OBJECTIVES: To evaluate forsubgroups of patients with distinct symptom profiles and differences in demographic and clinical characteristics and stress and resilience among these subgroups. SAMPLE & SETTING: 1,145 patients with cancer aged 18 years or older completed a survey online. Data were collected between May 2020 and February 2021. METHODS & VARIABLES: Patients completed measures for depression, state anxiety, cognitive function, morning fatigue, evening fatigue, morning energy, evening energy, sleep disturbance, pain, stress, and resilience. Latent class profile analysis was used to identify subgroups of patients with distinct symptom profiles. Differences among the subgroups on study measures were evaluated using parametric and nonparametric tests. RESULTS: Four distinct profiles were identified (none, low, high, and very high). Patients in the high and very high classes reported clinically meaningful levels of all nine symptoms. Differences among the four profiles for stress and resilience exhibited a dose-response effect. IMPLICATIONS FOR NURSING: Findings can serve as benchmark data of the symptom burden of patients with cancer following the COVID-19 pandemic. KEYWORDS COVID-19; anxiety; depression; fatigue; loneliness; social isolation

OBJECTIVES: To evaluate for subgroups of patients with distinct symptom profiles and differences in demographic and clinical characteristics and stress and resilience among these subgroups. SAMPLE & SETTING: 1,145 patients with cancer aged 18 years or older completed a survey online. Data were collected between May 2020 and February 2021. METHODS & VARIABLES: Patients completed measures for depression, state anxiety, cognitive function, morning fatigue, evening fatigue, morning energy, evening energy, sleep disturbance, pain, stress, and resilience. Latent class profile analysis was used to identify subgroups of patients with distinct symptom profiles. Differences among the subgroups on study measures were evaluated using parametric and nonparametric tests. RESULTS: Four distinct profiles were identified (none, low, high, and very high). Patients in the high and very high classes reported clinically meaningful levels of all nine symptoms. Differences among the four profiles for stress and resilience exhibited a dose-response effect. IMPLICATIONS FOR NURSING: Findings can serve as benchmark data of the symptom burden of patients with cancer following the COVID-19 pandemic.