The Challenges of Oral Agents as Antineoplastic Treatments

OBJECTIVE: Given the increasing use of oral antineoplastic agents in cancer management, patient adherence is critical to successful treatment outcomes. This article reviews the scope of the problem and issues of adherence to oral antineoplastic agents. DATA SOURCES: Research based and other articles, newsletters, and conference presentations. CONCLUSION: Suboptimal adherence to oral antineoplastic agents is a significant clinical problem that may result in disease or treatment complications, adjustment in treatment regimen, disease progression, and premature death. IMPLICATIONS FOR NURSING PRACTICE: Healthcare providers need to monitor and facilitate adherence by identifying barriers and implementing strategies to assure adherence, and therefore, improve clinical outcomes

Policy Implications of Oral Agents

OBJECTIVE: With the increasing use of oral antineoplastic agents in cancer management, patients and family members need to understand of how to obtain, safely handle, and store the medication, how and when the medications should be taken, and when to report toxic side effects to accomplish efficacious treatment. DATA SOURCES: Research based articles and conference presentations. CONCLUSION: Cancer centers to modify policies, protocols, or practices to assure safe and proper administration of oral antineoplastic agents. IMPLICATIONS FOR NURSING PRACTICE: Clinicians need to monitor and facilitate administration of oral antineoplastic agents, and ultimately improve clinical outcomes

Examination of the Role of Religious and Psychosocial Factors in HIV Medication Adherence Rates

Optimal adherence to antiretroviral therapy (ART) is associated with favorable HIV outcomes, including higher CD4 cell counts, HIV virus suppression and a lower risk of HIV transmission. However, only 25% of people living with HIV/AIDS (PLWH) in the USA are virally suppressed. Sub-optimal adherence (p\u3c 0.05). Social support satisfaction was also significantly associated with ART adherence (OR = 1.52, 95% CI [1.11–2.08], p \u3c 0.05) and energy/fatigue/vitality (OR = 1.03, 95% CI [1.00–1.05], p \u3c 0.05)

An Intervention to Improve Adherence and Management of Symptoms for Patients Prescribed Oral Chemotherapy Agents: An Exploratory Study

Background: The use of oral chemotherapy agents to treat cancer has increased. Patients are responsible for adhering to complex dosing regimens, while monitoring and managing symptoms from side effects of the chemotherapy at home. Objective: This study examined an intervention to manage symptoms and promote adherence to oral chemotherapy agents. Intervention and Methods: A 3 group exploratory pilot study determined how an Automated Voice Response (AVR) system alone (N=40), or the AVR with strategies to manage symptoms and adherence (N=40), or the AVR with strategies to manage adherence (N=39) reduced symptom severity and improved adherence. Participants received a Symptom Management Toolkit, completed a baseline interview, and were randomized to receive 8 weekly AVR calls. The AVR directed patients to the toolkit for high symptoms and nurse calls occurred for management of severe symptoms or non-adherence. An exit interview occurred at 10 weeks. Results: Mean age was 59.6, with 70% female and 76% Caucasian. Overall, 42% of patients were non-adherent, with missed doses increasing with regimen complexity. Symptom severity declined over time in all groups. No difference was found in adherence rates among intervention groups. Higher adherence rates were related with lower levels of symptom severity across groups. Conclusions: Adherence is a significant clinical problem, which can affect efficacy of the cancer treatment. The AVR intervention alone was just as effective as the AVR plus the nurse intervention at promoting adherence and managing symptoms from side effects. Implications for Practice: Nurses need to focus on patient education by assuring patient understanding of oral agent regimen, and the need to adhere to the oral agent for efficacious cancer treatment. Nurses can promote the use of medication reminders and self- management of symptoms from side effects, to support adherence to the oral agent

Sixty Years of CA: A Cancer Journal for Clinicians

The first issue of CA: A Cancer Journal for Clinicians was published in November of 1950. On the 60th anniversary of that date, we briefly review several seminal contributions to oncology and cancer control published in our journal during its first decade. CA Cancer J Clin 2010. © 2010 American Cancer Society, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78301/1/20088_ftp.pd

Discovery of a Large ~200 kpc Gaseous Nebula at z=2.7 with the Spitzer Space Telescope

We report the discovery of a very large, spatially extended Ly alpha -emitting nebula at z=2.656 associated with a luminous mid-infrared source. The bright mid-infrared source (F(24um)=0.86 mJy) was first detected in observations made using the Spitzer Space Telescope. Existing broad-band imaging data from the NOAO Deep Wide-Field Survey revealed the mid-infrared source to be associated with a diffuse, spatially extended, optical counterpart in the Bw band. Spectroscopy and further imaging of this target reveals that the optical source is an almost purely line-emitting nebula with little, if any, detectable diffuse continuum emission. The Lya nebula has a luminosity of L[Lya] ~ 1.7e44 erg/s and an extent of at least 20 arcsec (160 kpc). Its central ~8 arcsec shows an ordered, monotonic velocity profile; interpreted as rotation, this region encloses a mass M = 6e12 Msun. Several sources lie within the nebula. The central region of the nebula shows narrow (~365 km/s) emission lines of CIV and HeII. The mid-infrared source is a compact object lying within the nebula, but offset from the center by a projected distance of ~2.5 arcsec (20 kpc), and likely to be an enshrouded AGN. A young star-forming galaxy lies near the northern end of the nebula. We suggest that the nebula is a site of recent multiple galaxy and AGN formation, with the spatial distribution of galaxies within the nebula perhaps tracking the formation history of the system.Comment: 37 pages (includes 11 figures). Accepted to Ap

Exploring individual differences in online addictions: the role of identity and attachment

Research examining the development of online addictions has grown greatly over the last decade with many studies suggesting both risk factors and protective factors. In an attempt to integrate the theories of attachment and identity formation, the present study investigated the extent to which identity styles and attachment orientations account for three types of online addiction (i.e., internet addiction, online gaming addiction, and social media addiction). The sample comprised 712 Italian students (381 males and 331 females) recruited from schools and universities who completed an offline self-report questionnaire. The findings showed that addictions to the internet, online gaming, and social media were interrelated and were predicted by common underlying risk and protective factors. Among identity styles, 'informational' and 'diffuse-avoidant' styles were risk factors, whereas 'normative' style was a protective factor. Among attachment dimensions, the 'secure' attachment orientation negatively predicted the three online addictions, and a different pattern of causal relationships were observed between the styles underlying 'anxious’ and 'avoidant' attachment orientations. Hierarchical multiple regressions demonstrated that identity styles explained between 21.2 and 30% of the variance in online addictions, whereas attachment styles incrementally explained between 9.2 and 14% of the variance in the scores on the three addiction scales. These findings highlight the important role played by identity formation in the development of online addictions

Beverage specific alcohol intake in a population-based study: Evidence for a positive association between pulmonary function and wine intake

BACKGROUND: Lung function is a strong predictor of cardiovascular and all-cause mortality. Previous studies suggest that alcohol exposure may be linked to impaired pulmonary function through oxidant-antioxidant mechanisms. Alcohol may be an important source of oxidants; however, wine contains several antioxidants. In this study we analyzed the relation of beverage specific alcohol intake with forced expiratory volume in one second (FEV(1)) and forced vital capacity (FVC) in a random sample of 1555 residents of Western New York, USA. METHODS: We expressed pulmonary function as percent of predicted normal FEV(1) (FEV(1)%) and FVC (FVC%) after adjustment for height, age, gender and race. To obtain information on alcohol intake we used a questionnaire that reliably queries total alcohol and beverage specific recent (past 30 days) and lifetime alcohol consumption. Results: Using multiple linear regression analysis after adjustment for covariates (pack-years of smoking, weight, smoking status, education, nutritional factors and for FEV(1)%, in addition, eosinophil count), we observed no significant correlation between total alcohol intake and lung function. However, we found positive associations of recent and lifetime wine intake with FEV(1)% and FVC%. When we analyzed white and red wine intake separately, the association of lung function with red wine was weaker than for white wine. CONCLUSION: While total alcohol intake was not related to lung function, wine intake showed a positive association with lung function. Although we cannot exclude residual confounding by healthier lifestyle in wine drinkers, differential effects of alcoholic beverages on lung health may exist

Subjective Distresses of Nasogastric Tube Feeding

Health care professionals assume that tube feeding is an unpleasant, distressing experience for patients, which is only partially substantiated by experience. Thirty patients were interviewed via a tube feeding and hospital experience checklist (a 47–item interview schedule). Common experiences were operationally defined as those felt by at least 50%; subjectively distressful experiences were those identified by patients as causing distress. The most common and most distressful experiences of nasogastric tube feeding were: sensory irritations and sensory deprivation. The psychosensory irritation experiences were: thirst, sore nose or throat, dry mouth, runny nose, a tube in the nose, taking food through a tube, breathing through the mouth, breathing with a tube in the nose, taking food in a treatment type container, and taking food with a different texture and smell than usual. The psychosensory deprivation experiences were: an unsatisfied appetite for certain foods, deprivation of tasting, chewing, swallowing food, and drinking liquids, limited mobility, and deprivation of regular food. Except for burping, gastrointestinal symptoms were not common though they were usually distressful. This information has been used to develop teaching programs which are being tested for effectiveness in reducing distress associated with nasogastric tube feeding.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68702/2/10.1177_014860717900300204.pd