A qualitative comparison of how older breast cancer survivors process treatment information regarding endocrine therapy.

BACKGROUND:It remains unclear how information about aromatase inhibitors (AI) impacts women's decision-making about persistence with endocrine therapy. PURPOSE:To describe and compare how women treated for primary early stage breast cancer either persisting or not persisting with an AI received, interpreted, and acted upon AI-related information. DESIGN:Thematic analysis was used to sort and compare the data into the most salient themes. PARTICIPANTS:Women (N = 54; 27 persisting, 27 not persisting with an AI) aged 65-93 years took part in qualitative interviews. RESULTS:Women in both subgroups described information similarly in terms of its value, volume, type, and source. Aspects of AI-related information that either differed between the subgroups or were misunderstood by one or both subgroups included: (1) knowledge of AI or tamoxifen prior to cancer diagnosis, (2) use of online resources, (3) misconceptions about estrogen, hormone replacement therapies and AI-related symptoms, and (4) risk perception and the meaning and use of recurrence statistics such as Oncotype DX. CONCLUSIONS:Persisters and nonpersisters were similar in their desire for more information about potential side effects and symptom management at AI prescription and subsequent appointments. Differences included how information was obtained and interpreted. Interactive discussion questions are shared that can incorporate these findings into clinical settings

Supportive Care in Older Adults with Cancer: Across the Continuum

Supportive care is an essential component of anti-cancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anti-cancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent

Persoonlikheids- en biochemiese kriteria vir neurosielkundige disfunksie by alkoholiste

Proefskrif (D.Phil.) -- Universiteit van Stellenbosch, 1986.Full text to be digitised and attached to bibliographic record

"Winging It": How Older Breast Cancer Survivors Persist With Aromatase Inhibitor Treatment.

PurposeAromatase inhibitors (AIs) are an important and effective hormonal adjuvant treatment for early-stage breast cancer. Up to 50% of women stop AIs prematurely, missing a valuable therapeutic intervention.Patients and methodsWe used grounded theory methodology to conduct in-depth, semistructured interviews and analyze data among patients with breast cancer diagnosed at age 65 years or older who were receiving an AI. The goal of the interviews was to understand decision making regarding persisting with AIs. Interview transcripts were systematically analyzed to identify emergent categories and relationships.ResultsInterviews were conducted with 27 women. After completion of primary treatment, women in our sample found themselves "winging it" as they faced substantial struggles with infrequent support during this new phase of the cancer trajectory. Self-management of AI adverse effects occurred in the contexts of older age and early survivorship. "Bearing it" emerged as another important management process regarding the impact of AIs on quality of everyday life. The complex decision to persist with the AI involved weighing the possibility of a cancer-free future against the burden of adverse effects. Women relied on informal networks for support, rather than oncology providers, highlighting the need for practical self-management strategies. The notion of a tipping point in persistence revealed their susceptibility to early discontinuation.ConclusionThis study provides insight into potential decisional pathways leading to early discontinuation of AIs among older women with breast cancer. Better support is needed for these women

Reflections of Low-Income, Second-Generation Latinas About Experiences in Depression Therapy

Depression is higher among second-generation Latinas compared with immigrants, but mental health treatment is stigmatized. Therefore, second-generation Latinas were interviewed after completing an eight-session depression treatment program to gain insight on what they found valuable about their therapy experiences. Constructivist grounded theory guided data collection and analysis which showed that women valued treatment more when they recognized their needs were being met, the therapist was a worthy copilot, and the program's structure had flexibility. Four processes were considered important to their work in therapy: understanding feelings about past events, seeing patterns, accepting self, and changing family patterns but still being "family." Post therapy, women valued their enhanced confidence and a "toolbelt" of techniques they gained for self-treatment. These findings have implications for designing future depression treatment programs that are more likely to be desirable and effective for the growing subgroup of underserved second-generation Latinas in the United States

Perceptions of Support Groups Among Older Breast Cancer Survivors: "I've Heard of Them, but I've Never Felt the Need to Go".

BackgroundCancer survivors transitioning from active treatment to posttreatment may lack critical support and information about their posttreatment care. Support groups have the potential to address this gap.ObjectiveThe aim of this study was to describe how breast cancer survivors 65 years and older perceived professionally led, in-person support groups.MethodsIndividual interviews with 54 women were analyzed using grounded theory informed by constructivism.ResultsStrong negative assumptions about cancer support groups were described. Tension existed between two opposing categories: participants' preconceptions of support groups and characterizations of their members and the women's perceptions of their own informational and emotional needs. Participants also described what sources of support they used in lieu of professionally led support groups.ConclusionsDespite awareness and availability, most participants did not use support groups as a resource during their primary or post-cancer treatment.Implications for practiceStructural changes can benefit existing models of support groups including how and when support needs and services are discussed with survivors and a shift toward the inclusion of practical information

Perceptions of Support Groups Among Older Breast Cancer Survivors: "I've Heard of Them, but I've Never Felt the Need to Go".

BackgroundCancer survivors transitioning from active treatment to posttreatment may lack critical support and information about their posttreatment care. Support groups have the potential to address this gap.ObjectiveThe aim of this study was to describe how breast cancer survivors 65 years and older perceived professionally led, in-person support groups.MethodsIndividual interviews with 54 women were analyzed using grounded theory informed by constructivism.ResultsStrong negative assumptions about cancer support groups were described. Tension existed between two opposing categories: participants' preconceptions of support groups and characterizations of their members and the women's perceptions of their own informational and emotional needs. Participants also described what sources of support they used in lieu of professionally led support groups.ConclusionsDespite awareness and availability, most participants did not use support groups as a resource during their primary or post-cancer treatment.Implications for practiceStructural changes can benefit existing models of support groups including how and when support needs and services are discussed with survivors and a shift toward the inclusion of practical information

Coming of Age With Cancer: Physical, Social, and Financial Barriers to Independence Among Emerging Adult Survivors

PURPOSE:To explore the transition to self-care among a sample of emerging adult cancer survivors after hematopoietic cell transplantation (HCT). 
. PARTICIPANTS & SETTING:18 HCT survivors who were aged 18-29 years at the time of HCT for a primary hematologic malignancy and were 8-60 months post-HCT participated in the study. The study took place in the hematology outpatient setting at City of Hope National Medical Center.
. METHODOLOGIC APPROACH:The authors conducted in-depth semistructured interviews and analyzed interview transcripts using grounded theory methodology.
. FINDINGS:Health-related setbacks following HCT disrupted not only participants' journey toward self-care, but also their overarching developmental trajectory toward adulthood. Physically, participants struggled with lack of personal space around caregivers, but felt unready to live on their own. Socially, they relied on multiple caregivers to avoid relying too much on any one person. Financially, participants worried about prolonged dependence and increased needs in the future.
. IMPLICATIONS FOR NURSING:Nurses can support the transition to self-care among emerging adults after HCT by recognizing the broader developmental impact of their cancer experience