Nurse-reported vs. Patient-reported Symptom Occurrence, Severity, And Agreement Using The Therapy-related Symptoms Checklist (TRSC) In Cancer Patients

PURPOSE: Developments in cancer treatments have resulted in increased survival of patients, but side effects/symptoms continue to be a concern. The Therapy-Related Symptoms Checklist (TRSC) has been used with adults undergoing cancer treatments. Study purposes were to examine among patients who completed the TRSC: (a) patient-reported symptom occurrence and severity; (b) nurse-reported symptom occurrence and severity; and (c) inter-rater agreement between patient-reported and nurse-reported symptoms. No study on this last question has been reported. Theoretical Framework: Orem’s Self-Care Deficit Theory focuses on individuals unable to meet their own self-care requirements. The TRSC is a tool that assists nurses in identifying these deficits, better facilitates supportive interventions to alleviate the symptoms, and promotes the patient’s/caregiver’s ability to enhance self-care. DESIGN: This is a cross-sectional study using primary data collection and analysis. Setting: The study was conducted on patients at a single outpatient cancer center in a rural community of the Midwestern United States. Participants: A convenience sample (N=22) of adult outpatients undergoing cancer therapy. METHODS: All patients and their nurse completed the TRSC, a 25-item checklist, with response choices ranging from “0” (none) to “4” (very severe). Descriptive statistics were used to address Purposes A and B, and a Pearson product-moment correlation analysis for Purpose C. RESULTS: All symptoms on the TRSC were reported in varying degrees. Regarding Purpose A, 40% or more of the patients reported 14 symptoms. Regarding Purpose B, 40% or more of nurse respondents reported 8 symptoms. In addition to higher symptom occurrence, greater symptom severity also was reported by patients compared to nurses. Regarding Purpose C, the percentage agreement between patient-reported and nurse identified symptoms was 77%, and the Pearson product-moment correlation coefficient was r =.77, indicating moderate agreement. CONCLUSIONS: Use of patient self-report of symptoms is a preferred approach. A standardized tool (the TRSC) can guide nurses in providing a more complete, symptom-focused care. This may then enhance treatment compliance and improved outcomes

Complementary Therapy to Relieve Pediatric Cancer Therapy-Related Symptoms in the USA

Children undergoing treatment for cancer often receive chemotherapy or radiation therapy and may experience many symptoms linked to these treatments. This study examined complementary therapies and self-care or dependent-care methods used by pediatric patients and parents to alleviate symptoms during cancer treatments. The specific purposes of this study were to assess symptoms and the complementary therapies and self-care or dependent-care methods used by pediatric patients and parents during cancer treatments. Orem’s self-care/dependent-care concept was used to guide the analysis of the care pediatric patients received. Secondary analysis was done on data collected from a cross-sectional, multi-site study in the Midwestern and Southwestern USA. The sample included 92 parents/children ages 1-17 years old; 52% were females; 16 were less than 5 years old; 53 were 5-11 years old, and 23 were 12-17 years old. Of the cancer diagnoses reported, 56% had leukemia and 44% had other cancer types. The 30-item Therapy-Related Symptom Checklist for Children (TRSC-C) was used to record patients’ symptom occurrence and severity on a 5-pt scale (0, no symptom; 4, “A whole lot”). The Symptom Alleviation: Self-Care Methods (SA:SCM) tool was used to identify methods parents used to alleviate therapy-related symptoms. To address the study purposes, descriptive data and content analyses were conducted. Symptom occurrences of 19 symptoms were reported by 40% or more of the patients and had a mean severity of “2” or “Quite a bit.” The top five symptoms included nausea, feeling sluggish, hair loss, loss of appetite and vomiting. Of the six categories of self-care or dependent-care methods and complementary therapies, four were found useful; herbal treatments were not mentioned. The two categories most utilized were Prescribed Medications and Mind Body Control. Assessing patient-reported and parent-reported symptoms and the use of self-care and dependent-care methods and complementary therapies help parents cope and help their children.University of Kansas School of Nursing. Bachelor of Science in Nursing Honors Progra

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

Complementary therapy and care to relieve pediatric cancer therapy-related symptoms in Thailand

Patients undergoing treatment for cancer, whether it includes chemotherapy and/or radiation, experience many side effects that are linked to the treatment. The specific purposes of this study were to examine (a) what Thai parents report they do to help alleviate symptoms that the child experiences during cancer therapy; and (b) what categories of dependent care and/or complementary therapies were those methods reported. Orem’s self-care/dependent-care concept was used to guide the analysis of the care pediatric patients received. Secondary analysis was done of data collected from a larger study at the National Children’s Hospital in Thailand. The sample included children ages 5-17 years (N=100). Of the 100 patients, 71 were male and 29 female; while 75 patients were 5-11 years old, and 25 patients 12-17 years old. Cancer diagnoses can be divided into the following: 63% leukemia, 12% nervous system tumors, 10% solid tumors, 6% lymphoma, and 9% Other. The 34-item Therapy-Related Symptom Checklist for Children (TRSC-C) was used to record patients’ symptom occurrence/severity (0, no symptom; 4, “A whole lot”); and the Symptom Alleviation: Self-Care Methods (SA:SCM) tool was used to identify methods parents used to alleviate chemotherapy-related symptoms. To address the study purposes, descriptive data and content analyses were done. Symptom occurrence of 16 symptoms were reported by 45% or more of patients; and mean severity “2”, or “Quite a bit” of the top five reported symptoms included hair loss, nausea, vomiting, fever, loss of appetite. Of the six categories of self/dependent-care methods/complementary therapies, all were found useful; and, Diet/nutrition/life-style and Mind/Body Control were the most utilized. Assessing patient/parent-reported symptoms and use of self/dependent care and complementary therapies help Thai families cope during pediatric cancer treatments.UNIVERSITY OF KANSAS SCHOOL OF NURSING BACHELOR OF SCIENCE IN NURSING HONORS PROGRAMSELF REPORTED HEALTH PROMOTION BEHAVIORS OF INDIVIDUALS WITH PSYCHIATRIC DISABILITIES IN A WEIGHT LOSS INTERVENTION Biethman, E Hamera, E PATIENT SATISFACTION FOR THE ADULTS WITH DOWN SYNDROME SPECIALTY CLINIC Bowman, S Peterson, M BUILDING STUDENT RESOURCES FOR THE KANSAS CENTER FOR NURSING SCHOLARSHIP & LEADERSHIP Feighny, M Teel, C EXPLORING BARRIERS TO EXCLUSIVE BREASTFEEDING AMONG ADOLESCENT LATINA WOMEN Hansen, L L Wambach, K FAMILY CAREGIVER STRAIN AND RESIDENT DISTRESS IN THE DEMENTIA POPULATION OF NURSING HOME FACILITIES Harris, B Bott, M J COMPLEMENTARY THERAPY/CARE TO RELIEVE PEDIATRIC CANCER-THERAPY RELATED SYMPTOMS IN THAILAND Shanberg, R Williams, P D Piamjariyakul,

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 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

Expanding ART for Treatment and Prevention of HIV in South Africa: Estimated Cost and Cost-Effectiveness 2011-2050

Background: Antiretroviral Treatment (ART) significantly reduces HIV transmission. We conducted a cost-effectiveness analysis of the impact of expanded ART in South Africa. Methods: We model a best case scenario of 90% annual HIV testing coverage in adults 15-49 years old and four ART eligibility scenarios: CD4 count <200 cells/mm3(current practice), CD4 count <350, CD4 count <500, all CD4 levels. 2011-2050 outcomes include deaths, disability adjusted life years (DALYs), HIV infections, cost, and cost per DALY averted. Service and ART costs reflect South African data and international generic prices. ART reduces transmission by 92%. We conducted sensitivity analyses. Results: Expanding ART to CD4 count <350 cells/mm3prevents an estimated 265,000 (17%) and 1.3 million (15%) new HIV infections over 5 and 40 years, respectively. Cumulative deaths decline 15%, from 12.5 to 10.6 million; DALYs by 14% from 109 to 93 million over 40 years. Costs drop $504 million over 5 years and$3.9 billion over 40 years with breakeven by 2013. Compared with the current scenario, expanding to <500 prevents an additional 585,000 and 3 million new HIV infections over 5 and 40 years, respectively. Expanding to all CD4 levels decreases HIV infections by 3.3 million (45%) and costs by $10 billion over 40 years, with breakeven by 2023. By 2050, using higher ART and monitoring costs, all CD4 levels saves$0.6 billion versus current; other ART scenarios cost $9-194 per DALY averted. If ART reduces transmission by 99$17.5 billion. Sensitivity analyses suggest that poor retention and predominant acute phase transmission reduce DALYs averted by 26% and savings by 7%. Conclusion: Increasing the provision of ART to <350 cells/mm3 may significantly reduce costs while reducing the HIV burden. Feasibility including HIV testing and ART uptake, retention, and adherence should be evaluated

ROR1 and ROR2 expression in pancreatic cancer

Background: The Wnt receptors ROR1 and ROR2 are generating increased interest as cancer therapeutic targets but remain understudied in pancreatic ductal adenocarcinoma (PDAC). Compared to canonical Wnt/ β-catenin signalling, the role of noncanonical Wnt signalling in PDAC remains largely unknown. Only one study has investigated the prognostic significance of the noncanonical Wnt signalling receptor, ROR2 in PDAC. No studies have investigated the prognostic role of ROR1 in PDAC. Methods: Here, we performed analysis of ROR1 and ROR2 mRNA expression in three publicly available datasets ICGC-PACA-AU (n = 81), TCGA-PAAD (n = 150) and CPTAC-PDAC (n = 137). ROR1 and ROR2 protein expression from the CPTAC-PDAC discovery cohort were also analysed. Immunohistochemistry (IHC) using the validated anti ROR1 monoclonal antibody (4A5) was performed on the Australian Pancreatic Cancer Genome Initiative (APGI) cohort of PDAC samples (n = 152). Association between ROR1 cytoplasmic staining intensity and clinicopathological parameters including stage, grade and overall survival (OS) was investigated. Results: High ROR1 mRNA expression levels correlated with a favourable OS outcome in all of the ICGC-PACA-AU, TCGA-PAAD and CPTAC-PDAC cohorts. ROR1 protein expression was not associated with stage, grade or OS in the APGI cohort. Conclusion: ROR1 and ROR2 have potential as prognostic markers when measured at the mRNA level in PDAC. Our IHC cohort did not support ROR1 protein expression in predicting OS, and highlighted the discrepancy of prognostic biomarkers when measured by MS, IHC and RNAseq

Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis.

INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from 7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood