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A little bit of heaven
Marley is a young, beautiful, and funny, but she's afraid of opening herself up to true love. A life-changing visit to her doctor sends both of them on an eye-opening adventure of mutual discovery, leading to revelations neither thought possible.
DVD
Impact of advance care planning and end‐of‐life conversations on patients with cancer: An integrative review of literature
Purpose The purpose was to review published articles to examine the impact of advance care planning (ACP) and end‐of‐life (EOL) conversations on patients with cancer, and aimed to compare the findings for congruency with the goals of ACP. Design and Method The study was guided by Whittemore and Knafl's integrative review methodology. Articles published between 2015 to 2020 were identified through electronic databases. The search included: Cumulative Index for Nursing Allied Health Literature (CINAHL), PubMed, MEDLINE‐Ovid, and MEDLINE full text, and using the MeSH terms. Two hundred and five (205) articles were identified and screened for eligibility, and 15 articles were appraised. Findings The fifteen (15) articles that met the inclusion criteria included five (5) qualitative, eight (8) quantitative, and two (2) mixed methods. The review analysis revealed six themes emerged in three categories: cancer patients' experience with advance care planning (1) patients' prognostic awareness, (2) decision making; cancer patients' perceived outcomes with advance care planning (3) patient‐provider relationship, (4) concordance in care based on goals, and cancer patients' propositions related to advance care planning, (5) timings of advance care planning discussions, and (6) support during ACP and/or EOL conversations. Conclusion ACP and EOL conversations play a critical role in cancer patients' awareness of their disease and prognosis and help them in making end‐of‐life care decisions. Clinical relevance There exists a need for earlier ACP and EOL conversations with cancer patients with emotional support during these conversations.
Journal Article
Nutritional interventions in elderly gastrointestinal cancer patients: the evidence from randomized controlled trials
Literature concerning nutritional interventions in elderly patients with gastrointestinal cancer, with special reference to randomized clinical trials, has been critically reviewed. This segment of oncologic population was found to be penalized by a high prevalence of malnutrition and sarcopenia which translated in an increased rate of toxicity from chemotherapy, poor compliance with oncologic treatments, and, finally, with a poor prognosis. Attempts to reverse this condition included a potentiation of nutrients intake which should sequentially proceed through the use of dietary counseling and administration of standard or ω-3 fatty acid–enriched oral supplements to finally come to enteral or parenteral nutrition. Randomized clinical trials investigating the effects of simple dietary advice and use of standard oral supplements were disappointing as regards long-term compliance and results. Nutritional and clinical benefits were reported with the use of ω-3 fatty acid–enriched oral supplements and especially with long-term supplemental parenteral nutrition. Despite the general recommendation of the scientific community that emphasizes the use of the enteral route, whenever possible, for delivering the nutritional support, it appears from the literature that more consistent benefits can be achieved, especially in the long-term nutritional support, when an insufficient oral nutrition is partnered with intravenous nutrition.
Journal Article
Health Advocacy, Inc. : how pharmaceutical funding changed the breast cancer movement
\"Today, most patient groups in Canada are funded by the pharmaceutical industry, raising an important ethical question: Do alliances between patient organizations and corporate sponsors ultimately lead to policies that are counter to the public interest? In this examination of Canada's breast cancer movement from 1990 to 2010, health activist, scholar, and cancer survivor Sharon Batt investigates the relationship between patient advocacy groups and the pharmaceutical industry--and the hidden implications of pharma funding for health policy. Health Advocacy, Inc. dissects the alliances between the companies that sell pharmaceuticals and the individuals who use them, drawing links between neoliberalism and corporate financing, and the ensuing threat to the public health care system. Batt combines archival analysis, interviews with advocacy and industry representatives, and personal observation to reveal how a reduction in state funding drove patient groups to form partnerships with the private sector. The resulting power imbalance continues to challenge the groups' ability to put patients' interests ahead of those of the industry. Batt's conclusion is unsettling: a once-vibrant movement that encouraged democratic participation in the development of health policy now eerily echoes the demands of the pharmaceutical industry. This thorough account of the shift from grassroots advocacy to Big Pharma partnership defines the struggles and stakes of activism in public health today.\"-- Provided by publisher.
Book
Effects of the teach-back method among cancer patients: a systematic review of the literature
PurposeThis study aimed to systematically review published research on the use of the teach-back method among cancer patients and provide basic data for developing effective nursing interventions.MethodsUsing a PICOS (Population, Intervention, Comparisons, Outcomes, Study Designs) framework, we reviewed 246 studies from selected electronic databases—CINAHL, EMBASE, PubMed, PsycInfo, RISS, KISS, DBpia, NDSL, and KCI—and selected five studies for further analysis. We evaluated the reference quality using Cochrane’s risk of bias and risk of bias assessment tool for non-randomized studies, following which we performed reviews and analyses.ResultsFive studies were selected for the final analysis, including four quasi-experimental studies and one randomized controlled experimental study. The intervention programs were provided mostly by outpatient clinics. The cancer types of the subjects were breast cancer and gastrointestinal cancer in four and one study, respectively. The number and duration of the interventions varied depending on the content. The number of outcome variables ranged from 1 to 5, depending on the study; among these, self-efficacy, symptom experience, and distress were used. Teach-back intervention programs significantly affected happiness, health literacy, anxiety about death, symptom experience, distress, and self-efficacy.ConclusionThis study found that teach-back interventions have positive health outcomes including happiness, uncertainty, self-efficacy, self-management behavior, symptom experience, distress, anxiety, and health literacy among cancer patients. However, it found no effects with regard to drug administration, functional measurements, or satisfaction. Future research should continuously examine the teach-back approach and assess its positive health outcomes for cancer patients.
Journal Article
Peer support interventions for breast cancer patients: a systematic review
PurposeDue to the clear efficacy of peer support as a means of improving emotional well-being and healthy behaviors in a highly cost-effective manner, this program is widely used. Controversy remains, however, with regard to its efficacy in breast cancer patients. Given the heterogeneity of peer support interventions, this review aimed to categorize, assess, and synthesize the existing evidence from randomized controlled trials (RCTs) to clarify the effects of different types of peer support on breast cancer patients.MethodsWe searched Pubmed, EMBase, CENTRAL, CINAHL, PsychINFO, Chinese National Knowledge Infrastructure (CNKI) and Wanfang Data for English and Chinese language RCTs. The Cochrane Collaboration ‘risk of bias’ tool for systematic reviews was used to assess the methodological quality of each RCT.ResultsOf the 1494 studies screened, 15 studies met eligibility criteria for inclusion, comprising 1695 breast cancer patients. Overall, there were more positive effects than invalid or negative effects across peer interventions, with notable exceptions: unmoderated and unstructured group peer support interventions as well as Internet-based models without peer training had no effect or adverse effects on proximal and distal outcomes. However, adding other peer roles to the peer support structure or using one-on-one models could significantly improve the patients’ negative emotions. Peer education showed promising effects on stress management, quality of life, and healthy behaviors.ConclusionsThis systematic review found that different types of peer support have different effects on outcomes for breast cancer patients. Web-based group peer support without peer training must be avoided or used with caution in the future. Peer education is recommended for breast cancer patient support models, given its excellent results and cost-effectiveness.
Journal Article
Chemical features of blood-borne TRG CDR3s associated with an increased overall survival in breast cancer
PurposeImmunogenomics and earlier, pioneering studies, particularly by Whiteside and colleagues, have indicated a positive role for B-cells in breast cancer, as well as a positive role for gamma-delta T-cells. However, these studies have been completely limited to assessing breast cancer tumor tissue.Methods and ResultsOur analyses here has shown that blood-borne T-cell receptor gamma (TRG) chain sequences were associated with greater overall survival, of particular note due to the comparative longevity of primary breast cancer patients, whereby assessments of disease-free, but rarely overall survival parameters are possible. Additional immunogenomics approaches narrowed the overall survival correlations to specific, TRG complementarity determining region-3, amino acid (AA) sequence chemical features, independently of many common, confounding variables in the breast cancer setting, such as estrogen or progesterone receptor status.ConclusionsThese results are discussed in the context of patient age and with regard to potential antigenic targets, based on the chemistry of the TRG CDR3 AA sequences associated with the higher survival rates.
Journal Article
The perceived cancer-related financial hardship among patients and their families: a systematic review
Purpose
The escalating health-care spending for cancer management has caused cancer patients to struggle further as a result of financial burden. This systematic review was carried out to investigate the prevalence of perceived financial hardship and associated factors among cancer patients and their families.
Methods
A systematic search for studies concerning the perception of financial burden among cancer patients and their families was conducted. Several electronic resources such as Medline, Elsevier (Science Direct), Web of Science, Embase, PubMed, CINAHL and Scopus (SciVerse) were searched. Additionally, manual search through indices citation was also thoroughly utilized. The main outcome of interest was the prevalence of perceived financial hardship among cancer patients and their families. Studies reported only the cost of cancer treatment and qualitative studies were excluded. Our search was limited to articles that were published from 2003 to 2013.
Result
Ten studies were included in this review and with a majority originating from high-income countries. The prevalence of the financial burden perception was reported between 14.8 and 78.8 %. The most frequent and significant risk factor reported associated with the perception of financial difficulty was the households with low income. Discontinuation of treatment and poverty were conversely the important consequences of financial burden in cancer patients and their families.
Conclusion
Evidently, cancer is a long-term illness that requires a high financial cost, and a significant number of cancer patients and families struggle with financial difficulty. Identifying such groups with a high risk of facing financial difficulty is a crucial measure to ensure safety nets are readily available for these targeted population.
Journal Article
The Age-Adjusted Charlson Comorbidity Index Predicts Prognosis in Elderly Cancer Patients
The age-adjusted Charlson comorbidity index (ACCI) is a useful measure of comorbidity to standardize the evaluation of elderly patients and has been reported to predict mortality in various cancers. To our best knowledge, no studies have examined the relationship between the ACCI and survival of elderly patients with cancer. Therefore, the primary objective of this study was to investigate the relationship between the ACCI and survival of elderly patients with cancer.
A total of 64 elderly patients (>80 years) with cancer between 2011 and 2021 were enrolled in this study. According to the ACCI, the age-adjusted comorbidity index was calculated by weighting individual comorbidities; patients with ACCI<11 were considered the low-ACCI group, whereas those with ACCI≥11 were considered the high-ACCI group. The correlations between the ACCI score and survival outcomes were statistically analyzed.
There was a significant difference in overall survival (OS) and progression-free survival (PFS) between the high-ACCI group and the low-ACCI group (P<0.001). The median OS time of the high-ACCI group and the low-ACCI group were 13.9 (10.5-22.0) months and 51.9 (34.1-84.0) months, respectively. The 2-, 3-, and 5-year survival rates of the high-ACCI group were 28.1%, 18.8%, and 4.2%, respectively, whereas the 2-, 3-, and 5-year survival rates of the low-ACCI group were 77.3%, 66.4%, and 39.1%, respectively. Multivariate analysis showed that ACCI was independently associated with OS (HR=1.402, 95% CI: 1.226-1.604, P < 0.05) and PFS (HR=1.353, 95% CI: 1.085-1.688, P = 0.0073).
The ACCI score is a significant independent predictor of prognosis in elderly patients with cancer.
Journal Article