The development and application of an oncology Therapy-Related Symptom Checklist for Adults (TRSC) and Children (TRSC-C) and e-health applications.

BACKGROUND: Studies found that treatment symptoms of concern to oncology/hematology patients were greatly under-identified in medical records. On average, 11.0 symptoms were reported of concern to patients compared to 1.5 symptoms identified in their medical records. A solution to this problem is use of an electronic symptom checklist that can be easily accessed by patients prior to clinical consultations. PURPOSE: Describe the oncology Therapy-Related Symptom Checklists for Adults (TRSC) and Children (TRSC-C), which are validated bases for e-Health symptom documentation and management. The TRSC has 25 items/symptoms; the TRSC-C has 30 items/symptoms. These items capture up to 80% of the variance of patient symptoms. Measurement properties and applications with outpatients are presented. E-Health applications are indicated. METHODS: The TRSC was developed for adults (N = 282) then modified for children (N = 385). Statistical analyses have been done using correlational, epidemiologic, and qualitative methods. Extensive validation of measurement properties has been reported. RESULTS: Research has found high levels of patient/clinician satisfaction, no increase in clinic costs, and strong correlations of TRSC/TRSC-C with medical outcomes. A recently published sequential cohort trial with adult outpatients at a Mayo Clinic community cancer center found TRSC use produced a 7.2% higher patient quality of life, 116% more symptoms identified/managed, and higher functional status. DISCUSSION, IMPLICATIONS, AND FOLLOW-UP: An electronic system has been built to collect TRSC symptoms, reassure patients, and enhance patient-clinician communications. This report discusses system design and efforts made to provide an electronic system comfortable to patients. Methods used by clinicians to promote comfort and patient engagement were examined and incorporated into system design. These methods included (a) conversational data collection as opposed to survey style or standardized questionnaires, (b) short response phrases indicating understanding of the reported symptom, (c) use of open-ended questions to reduce long lists of symptoms, (d) directed questions that ask for confirmation of expected symptoms, (e) review of symptoms at designated stages, and (d) alerting patients when the computer has informed clinicians about patient-reported symptoms. CONCLUSIONS: An e-Health symptom checklist (TRSC/TRSC-C) can facilitate identification, monitoring, and management of symptoms; enhance patient-clinician communications; and contribute to improved patient outcomes

The development and application of an oncology Therapy-Related Symptom Checklist for Adults (TRSC) and Children (TRSC-C) and e-health applications

BACKGROUND: Studies found that treatment symptoms of concern to oncology/hematology patients were greatly under-identified in medical records. On average, 11.0 symptoms were reported of concern to patients compared to 1.5 symptoms identified in their medical records. A solution to this problem is use of an electronic symptom checklist that can be easily accessed by patients prior to clinical consultations. PURPOSE: Describe the oncology Therapy-Related Symptom Checklists for Adults (TRSC) and Children (TRSC-C), which are validated bases for e-Health symptom documentation and management. The TRSC has 25 items/symptoms; the TRSC-C has 30 items/symptoms. These items capture up to 80% of the variance of patient symptoms. Measurement properties and applications with outpatients are presented. E-Health applications are indicated. METHODS: The TRSC was developed for adults (N = 282) then modified for children (N = 385). Statistical analyses have been done using correlational, epidemiologic, and qualitative methods. Extensive validation of measurement properties has been reported. RESULTS: Research has found high levels of patient/clinician satisfaction, no increase in clinic costs, and strong correlations of TRSC/TRSC-C with medical outcomes. A recently published sequential cohort trial with adult outpatients at a Mayo Clinic community cancer center found TRSC use produced a 7.2% higher patient quality of life, 116% more symptoms identified/managed, and higher functional status. DISCUSSION, IMPLICATIONS, AND FOLLOW-UP: An electronic system has been built to collect TRSC symptoms, reassure patients, and enhance patient-clinician communications. This report discusses system design and efforts made to provide an electronic system comfortable to patients. Methods used by clinicians to promote comfort and patient engagement were examined and incorporated into system design. These methods included (a) conversational data collection as opposed to survey style or standardized questionnaires, (b) short response phrases indicating understanding of the reported symptom, (c) use of open-ended questions to reduce long lists of symptoms, (d) directed questions that ask for confirmation of expected symptoms, (e) review of symptoms at designated stages, and (d) alerting patients when the computer has informed clinicians about patient-reported symptoms. CONCLUSIONS: An e-Health symptom checklist (TRSC/TRSC-C) can facilitate identification, monitoring, and management of symptoms; enhance patient-clinician communications; and contribute to improved patient outcomes

SYMPTOM OCCURRENCE AND SEVERITY AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH BREAST OR GYNECOLOGIC CANCER RECEIVING MATCHED CANCER THERAPY

Background: Scientific advancements in oncology allow routine patient cancer genomic profiling, which may guide the choice of novel therapies to match genomic alterations for the treatment of cancer. Potential differences in cancer therapy-related symptom severity and occurrence as well as health-related quality of life (HRQOL) between patients who receive matched therapy and those who do not have not been previously explored. Purposes: The purpose of this study was to describe the characteristics of patients with breast or gynecologic cancer who were receiving matched therapy or not matched therapy, as well as to describe their cancer therapy-related symptom occurrence and severity, and overall HRQOL. Methods: Existing data from the records of 129 patients receiving care at a cancer center in the upper Midwest were used for this descriptive correlational research study. Descriptive statistics and multiple linear regression analyses were performed to address the study purpose and aims. Results: This study found that patients receiving matched therapy had lower mean therapy-related symptom checklist (TRSC) scores (M = 14.7) than patients receiving not matched therapy (M = 16.1). Compared to prior studies, a higher percentage of patients (29%) added symptoms to the TRSC. TRSC scores for individual symptoms were similar across groups, except pain, which was higher in patients receiving matched therapy, and hair loss, which was higher in patients receiving not matched therapy. Patients receiving matched therapy had higher mean Health-Related Quality of Life – Linear Analogue Self Assessment (HRQOL-LASA) scores (M = 48.1), than patients receiving not matched therapy (M = 45.4). Patients who had prior therapy less than three months prior to the onset of the current therapy had significantly higher TRSC total scores than patients with no prior therapy (B = 6.2, p = 0.045). Patients who had a higher number of prior lines of therapy had significantly higher HRQOL-LASA scores (B = 0.56, p = 0.05). Patients with higher TRSC scores had significantly lower HRQOL-LASA (B = -0.36, p < 0.001). Conclusions: Patients receiving matched therapy did not have worse therapy-related symptoms or HRQOL. Findings provide initial information about the symptom experience and HRQOL for patients receiving matched therapy

The Journal of BSN Honors Research, Volume 5, Issue 1, Summer 2012

University of Kansas School of Nursing. Bachelor of Science in Nursing Honors ProgramExploration Of Health Care Needs Among Sudanese Refugee Women - Albin, J M, Domian, E. Is There An App For That? Developing An Evaluation Rubric For Apps For Use With Adults With Special Needs - Buckler, T, Peterson, M. The Relationship Between Nursing Characteristics And Pain Care Quality - Davis, E, Dunton, N. The Relationship Between Sleep And Night Eating On Weight Loss In Individuals With Severe Mental Illness - Huynh, Thu Nhi, Hamera, E. Examining Nurse Leader/Manager-Physician Communication Strategies: A Pilot Study - Jantzen, M, Ford, D J. Comparison Of Personal, Health And Family Characteristic Of Children With And Without Autism - Martin, A, Bott, M J. Association Between Obstructive Sleep Apnea And Postoperative Adverse Events - Nielsenshultz, Y, Smith, C, Bott, M, Schultz, M P, Cole, C. Challenges Associated With Partnering With Sudanese Refugee Women In Addressing Their Health Issues - Pauls, K L, Baird, M B. Complementary Therapy To Relieve Pediatric Cancer Therapy-Related Symptoms In The Usa - Slaven, A, Williams, P D

Improving Communication Between Cancer Patients and Providers During a 15-Minute Office Visit: A Systematic Review of the Literature

Patients undergoing chemotherapy treatments for cancer often experience adverse side effects, including cognitive deficits. These deficits impact the patient\u27s ability to communicate effectively with their oncology provider. Ineffective communication can adversely affect patient outcomes and decrease patient-provider satisfaction. The resulting poor communication can contribute to poor patient outcomes. This systematic literature review focused on assistive communication tools that could be used in an outpatient oncology setting to improve patient-provider communication. The literature review findings led to the development of a resource for providers that includes 15 communication tools that can be used to assess and improve communication in cancer care. Initially 4, 533 articles were identified using the search terms; cancer patient/providers, communication tools, chemo brain, and improving/ineffective communications. Articles were selected for inclusion that included communication tools, which assisted oncology providers in improving cancer care. Articles were excluded if they were not specific to cancer patients and did not contain communication tools. Analysis of the systematic review of the literature utilized Bandolier\u27s hierarchy levels of evidence. The Health Promotion Model serves as the theoretical framework to guide the project. Oncology providers that utilized communication tools with patients found an 116% improvement in documentation of symptoms, adverse effects, and corresponding medical management compared to providers who did not use communication tools. Implementation of communication tools in outpatient oncology settings can result in a positive social change in the patient-provider relationship during cancer treatment

Digital health for optimal supportive care in oncology: benefits, limits, and future perspectives

Background Digital health provides solutions that capture patient-reported outcomes (PROs) and allows symptom monitoring and patient management. Digital therapeutics is the provision to patients of evidence-based therapeutic interventions through software applications aimed at prevention, monitoring, management, and treatment of symptoms and diseases or for treatment optimization. The digital health solutions collecting PROs address many unmet needs, including access to care and reassurance, increase in adherence and treatment efficacy, and decrease in hospitalizations. With current developments in oncology including increased availability of oral drugs and reduced availability of healthcare professionals, these solutions offer an innovative approach to optimize healthcare resource utilization. Design This scoping review clarifies the role and impact of the digital health solutions in oncology supportive care, with a view of the current segmentation according to their technical features (connection to sensors, PRO collection, remote monitoring, self-management in real time…), and identifies evidence from clinical studies published about their benefits and limitations and drivers and barriers to adoption. A qualitative summary is presented. Results Sixty-six studies were identified and included in the qualitative synthesis. Studies supported the use of 38 digital health solutions collecting ePROs and allowing remote monitoring, with benefits to patients regarding symptom reporting and management, reduction in symptom distress, decrease in unplanned hospitalizations and related costs and improved quality of life and survival. Among those 38 solutions 21 provided patient self-management with impactful symptom support, improvement of QoL, usefulness and reassurance. Principal challenges are in developing and implementing digital solutions to suit most patients, while ensuring patient compliance and adaptability for use in different healthcare systems and living environments. Conclusions There is growing evidence that digital health collecting ePROs provide benefits to patients related to clinical and health economic endpoints. These digital solutions can be integrated into routine supportive care in oncology practice to provide improved patient-centered care

Nutritional Status, Eating Behaviors, and Gastrointestinal Symptom Cluster among Thai Children Receiving Cancer Chemotherapy

This dissertation examines how gastrointestinal (GI) symptoms influence eating and nutritional status for Thai children receiving cancer chemotherapy. The research is guided by Step 1: a tentative logic model of the problem of Intervention Mapping (6-step process for multi-level intervention development).The scoping review encompassed a comprehensive analysis of previous research studies (n=8) investigating symptom clusters in children undergoing cancer treatments. We identified the 12 most commonly reported GI and associated non-GI symptoms. These symptoms then were the main focus during data collection with Thai participants.Participants (n=54) in data-collected research included child-parent dyads (n=16), pediatric oncology clinicians (n=2 physicians, n=9 registered nurses), and 11 other key personnel identified by clinicians. Child’s diagnosis and nutritional status were abstracted from medical record. Parents and children completed a survey with items about (a) child and parent demographics, (b) child’s GI symptoms, and (c) child’s quality of life (QOL). Children, parents, and clinicians participated in semi-structured interviews about child's nutritional status and contributing factors. Most children (62.5%) were male, with an average age of 11.28 years. Most of parents and clinicians (respectively, 93.75% and 95.4%) were female. Clinicians had an average 15.55 years of experience caring for Thai children with cancer. Identified influential factors at the child (individual level) included non-modifiable (cancer, treatment) and modifiable (symptoms, lack of knowledge) factors. These factors affected children’s eating, specifically eating less, preferring fried meats and spicy soups, and self-managing symptoms by waiting it out rather than telling a clinician. Changes in nutrition status included weight loss and gain. Parent strategies to optimize children’s nutrition included symptom management and maintaining food intake. Clinical practices influencing children’s nutrition included recommending the low bacterial diet, which was challenging for children and parents to enact. Modifiable clinician factors included reliance on pharmacologic approaches to symptom management and focus on cure vs. nutrition. Hospital factors included unpleasant food offerings, sights and odors, and lack of guidelines and resources for nutrition management.Multi-level interventions are necessary to optimize eating and nutritional status of Thai children during chemotherapy by addressing GI symptoms, stakeholders' knowledge and role norms, and improving the hospital environment.Doctor of Philosoph

Cancer Rehabilitation Publications (2008–2018) With a Focus on Physical Function: A Scoping Review

Background: Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. Purpose: This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. Data Sources: PubMed and CINAHL were searched up to September 2018. Study Selection: Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. Data Extraction: Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. Data Synthesis: Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). Limitations: Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. Conclusions: This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function

Gene Expression and Fatigue in Puerto Rican Men

Background: Prostate cancer is the most frequently diagnosed cancer in men (40.6% in 2010) in Puerto Rico and external beam radiation therapy (EBRT) is the preferred form of treatment for one third of newly diagnosed prostate cancer patients in Puerto Rico. Puerto Ricans often experience ethnic disparities in cancer treatments and in their symptom experience. Purpose: This study will: (a) describe the trajectory of fatigue among Hispanic Puerto Rican men over the course of receiving EBRT for non-metastatic prostate cancer and compare these findings with historical data of fatigue symptoms of Caucasian men with prostate cancer during EBRT; (b) assess gene expression changes from baseline to midpoint of EBRT using microarray technology; and (c) determine the association between changes in genes expression and changes in fatigue score from baseline to midpoint of EBRT using an unbiased, hypothesis-generating approach. Methods: As a prospective exploratory and comparative design study, fatigue was measured using the Functional Assessment of Cancer-Therapy –fatigue from 26 Hispanic Puerto Rican men who were newly diagnosed with non-metastatic prostate cancer at three time points (baseline [prior to EBRT], midpoint [days 19-21], and end of EBRT [days 38-42]). Whole-blood samples also were collected at baseline and at midpoint of EBRT to explore the differential expression of genes using microarray. Functional networks of the differentially expressed genes were examined. Descriptive data were analyzed using t-test, Wilcoxon, and Friedman test for repeated measures. Gene expression data were analyzed using the LIMMA package in R and the functional network analysis was conducted using Ingenuity Pathway analysis. Findings: Subjects were ages 52-81 with fatigue scores that were unchanged during EBRT (baseline= 42.38, SD= 9.34; mid-point=42.11, SD= 8.93, endpoint= 43.04, SD= 8.62); Friedman's test: χ21.20[df, 2], p=.55). Three hundred seventy-three genes (130 up regulated and 243 down regulated) were differentially expressed from baseline to mid-point of EBRT (FDR<0.01). The top distinct canonical pathways of the differentially expressed probesets (p< 0.0001) were: Phospholipase C Signaling, Role of NFAT in Regulation of the Immune Response, and Gαq Signaling. Conclusions: There were no changes in fatigue scores among Puerto Rican men during EBRT for prostate cancer. However, differentially expressed genes during EBRT suggest activation of immune response, which is a mechanism proposed to explain cancer-related fatigue. Further investigation is warranted to explain the disparity in fatigue symptoms reporting of Puerto Rican men from other ethnicities receiving the same treatment