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  • November 21, 2022 3:17 PM | Anonymous

    Authors:
    Ya-Ting GAO RN, MN 1,2 ; Yan LOU PhD, Associate Professor 1 ; Ying LIN RN, MN 1 ; Shuai-Ni LI RN, MN 1,3 ; Mei-Rong HONG RN, BN 1 ; Yu-Lu XU RN, BN 1 ; Wei YU RN, BN 1
    1.  School of Nursing, Department of Medicine, Hangzhou Normal University
    2.  Sir Run Run Shaw Hospital (SRRSH), School of Medicine, Zhejiang University
    3.  The Children's Hospital, School of Medicine, Zhejiang University


    Cancer-related fatigue is a long-lasting and distressing symptom for CRC patients, and it would exhibit a detrimental effect on their quality of life. Physical activity could relieve fatigue, and aerobic exercise combined with resistance training can maximize the fatigue-relieving effect. Nevertheless, it has been challenging in promoting combined aerobic exercise and resistance training among CRC patients, especially training for improving lower limb flexibility, muscular strength, and endurance.1 Novel strategies are needed to enable these individuals to monitor their physical activity levels, encouraging them to set goals to achieve adequate physical activity levels for themselves. Mobile-health was suggested to be a desirable platform to administer physical activity program for this purpose.2

    We conducted a study that aimed to design and implement a combined aerobic exercise and resistance training program for CRC patients with fatigue via a mobile-health platform. Overall, our twelve-week exercise program involved a combination of aerobic exercise and resistance training, and it was supplemented with flexibility exercises. Progressive increase in the frequency, intensity, duration and volume of the exercise have been introduced as the participants progressed through the program. The core elements of personalized intervention included an individualized goal setting, autonomous habit training, staged professional guidance and targeted interactive encouragement. The feasibility and applicability of the mobile-health-based personalized exercise management program for CRC patients with fatigue were also evaluated.

    This study was conducted using a multi-step approach.

    Step 1:  Development of the exercise movement library
    Four exercise guidance movement libraries were established . Specific movements included: (i) the dynamic stretching movement library; (ii) the aerobic exercise movement library; (iii) the resistance training movement library (iv) the static stretching movement library. The combination of these movements forms three progressive aerobic exercise and resistance training sets.

    Step 2:  Digitization of intervention program
    We used multi-media technology including audio, video, and motion graphics to present the program and make it adaptable to the mobile-health platform.

    Step 3: Evaluation of intervention program
    Face-to-face or virtual expert consultation method were used to evaluate the feasibility and applicability of the program. Seven experts with a professional background of human kinesiology or nursing care for CRC patients validated the applicability of the exercise management program, and the suitability of movement library for CRC patients. These experts provided feedback and comments on the ways to improve the program.

    Step 4: Design of the mobile-health platform
    WeChat Mini Program was selected as the mobile-health platform for the presentation of the exercise management program. An iterative interactive process was used. The research team and the software designers held six rounds of face-to-face interviews, and online communications were also established with them, where the technical aspects of presenting the program via the mobile-health platform were discussed and sorted.  

    Step 5: Preliminary test
    Twenty CRC inpatients and their families were invited using a purposive sampling method to evaluate the WeChat Mini Program. Face-to-face semi-structured interviews were used to collect the qualitative data on the patients’ experience and feedback in using the WeChat Mini program. The thematic analysis method was used to extract themes from the data.

    Overall, the development and implementation of the personalized exercise management program for colorectal cancer patients with fatigue appeared to be feasible. CRC patients and their families who participated in this program perceived that the WeChat Mini Program, “Huì Dòng” (Smart Exercise), was easy to use. Program content was suitable and beneficial for them to do exercises, and almost all of participants expressed willingness to continue using it, although two were concerned about the low potential of long-term adherence to the program. The WeChat Mini Program could be improved from the perspective of optimized format design, such as the use of light color background in the video, the incorporation of oral interpretation into the motion graph, and enhancement of cognition education on exercise. Further cohort studies should be conducted to evaluate its effect on the level of physical activity, the relief on CRF, self-efficacy in exercise and quality of life.



    Figure: The Resistance Training Program-Beginning Level.

    References

    1. Nakagawa H, Sasai H, Tanaka K. Physical Fitness Levels among Colon Cancer Survivors with a Stoma: A Preliminary Study. Medicina (Kaunas). 2020 Nov 10;56(11):601. doi: 10.3390/medicina56110601.

    2. Cheong IY, An SY, Cha WC, et al. Efficacy of Mobile Health Care Application and Wearable Device in Improvement of Physical Performance in Colorectal Cancer Patients Undergoing Chemotherapy. Clin Colorectal Cancer. Jun 2018;17(2):e353-e362.

  • November 14, 2022 3:14 PM | Anonymous

    Haiqin Hu, MMed, Department of Thyroid Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences

    Oral cancer is a malignant tumor occurring in the oral cavity. Currently, surgical resection is still the major treatment strategy for oral cancer, but undergoing such treatment may lead to a repertoire of postoperative conditions such as bacterial imbalance, a condition that involves an imbalance of health-promoting and pathogenic bacteria in the gastrointestinal tract. This may have an adverse effect on the prognosis and quality of life of patients after surgery. The perioperative care requirements of oral cancer patients are different from those of patients of other diseases, which demands proficiency of the nurses in their professional practice. At present, there is still a lack of corresponding evidence-based practice of oral care in China. To enhance the quality of life of people with oral cancer, a set of care standards for oral cancer management needs to be developed. To facilitate this, we conducted a review on the evidence-based practice of oral care for oral cancer patients, with the aim to develop, based on the JBI evidence-based health care model, a set of scientific and standardized evidence-based oral care practice program that can guide clinical nursing staff for increasing the efficacy of oral cancer care that they can deliver. This may help provide a more scientific and effective decision-making basis for clinical nursing practice in oral care.

    To start off, we first established a research team, consisting of nursing professors, medical specialists in head and neck, clinical psychologist, dietician rehabilitation nurse specialist. The team members conducted a review in order to summarize and evaluate the literature that reports oral care programs currently practiced worldwide. PubMed, Cochrane Library ,Web of Science , the National Comprehensive Cancer Network (NCCN) and the Oncology Nursing Society (ONS) were used in the literature search, using a combination of keywords including oral cancer, oral care and perioperative. In our search, we retrieved four articles for inclusion in this review, including three practice guideline papers and one systematic review paper (Adelstein et al., 2017; Cervenka et al., 2019; Dort et al., 2017; Joo et al., 2019). Upon the retrieval of these articles, we conducted a summary of the evidence presented in these articles, and an evaluation on their suitability in clinical practice. The collected evidence was then summarized narratively in our review, presenting the latest evidence-based practice for perioperative oral care of patients with oral cancer. Recommendations on the care practice were classified into six major themes, including perioperative oral care rehabilitation, behavioral habits, psychology, flap care, nutrition, and pain.

    According to the included evidence and the preliminary investigation, the possible obstacles in the implementation of oral care practice were also analyzed. We finally established the final draft of perioperative oral care practice plan for oral cancer patients, including an action plan and a flow chart of this plan (Figure 1).

    In order to scientifically and effectively establish an evidence-based practice plan for perioperative oral care for patients with oral cancer, we also carried out a survey among current oral cancer patients. After review of the survey data, we found that current oral care practice does not involve the medical staff to evaluate the oral function of patients before surgery, to guide patients to quit smoking, nor to use skin temperature detectors to monitor the oral flap temperature of patients after surgery.

    Overall, our review and survey have highlighted the importance of the evaluation of preoperative and postoperative oral function, nutrition, pain and psychological status among patients, the provision of rehabilitation training to patients, as well as the guidance for them to quit smoking and excessive alcohol consumption.


    References
    Adelstein D, Gillison ML, Pfister DG, Spencer S, Adkins D, Brizel DM, Burtness B, Busse PM, Caudell JJ, Cmelak AJ, et al. NCCN Guidelines Insights: Head and Neck Cancers, Version 2.2017. J Natl Compr Canc Netw. 2017; 15(6): 761-770.

    Cervenka B, Pipkorn P, Fagan J, Zafereo M, Aswani J, Macharia C, Kundiona I, Mashamba V, Zender C, Moore M. Oral cavity cancer management guidelines for low-resource regions. Head Neck. 2019; 41(3): 799-812.

    Dort JC, Farwell DG, Findlay M, Huber GF, Kerr P, Shea-Budgell MA, Simon C, Uppington J, Zygun D, Ljungqvist O, et al. Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society. JAMA Otolaryngol Head Neck Surg. 2017; 143(3): 292-303.

    Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, et al. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol. 2019; 12(2): 107-144.


    Figure 1. Flowchart of perioperative oral care plan for patients with oral cancer.                             

  • November 07, 2022 3:10 PM | Anonymous

    Author: Huiting Zhang, MSN., RN; Case Manager, Head Nurse, Department of Breast Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China


    Breast cancer patients having undergone curative treatment, including surgery, chemotherapy and radiation therapy, often face problems upon returning to work .after completion of such treatments. For example, the function of the affected limbs may not have fully recovered after surgery, while nausea and vomiting caused by chemotherapy may affect the patients’ adaptability to work. In addition, hair loss as a result of chemotherapy may lead to a tendency of the patients to avoid facing their colleagues. These patients would also face a repertoire of psychological issues as a result of the treatment, which may potentially have negative effect on their attitudes towards returning to work. A better understanding on the factors that would hamper and facilitate the patients to return to work after cancer treatment is needed, in order to address the psychological issues that contribute to the patients’ reluctance to return to work. Therefore, we conducted a qualitative study that explores the psychological changes and influencing factors of breast cancer patients having completed their curative treatment and were returning to work during the rehabilitation period. Study findings may provide a basis for constructing individualized interventions that facilitate patients to return to work.

    We used a phenomenological approach to conduct this study. Ten breast cancer patients who were either receiving endocrine therapy or having completed all curative treatments, who have returned to work or were planning to return to work, were recruited. Semi-structured interviews were conducted with the patients to explore their views upon returning to work, and the factors that may encourage or hamper them from doing so.

    Two themes were generated from the interview data. The first theme pertains to the journey of the breast cancer patients in promoting their mental health when they returned to work. The journey has three phases. First, ‘Avoid and surround themselves’, where the patients showed a low willingness to return to work when they were still at the early stage of treatment. Second, ‘Forget the past, set sail again, when they would try to let go of their pain and illness, accept the reality and resume their work, after a period of recovery at post-treatment. Finally, ‘grasp today and harvest the future’, where the patients who had returned to work, after a period of adjustment, could work as normal, believing that their illness had brought unexpected benefits, while feeling satisfied with their job, and being hopeful and optimistic for their future. The second theme involves the factors affecting breast cancer patients' return to their work after completing their treatment. Economic pressure, work ability and experience, the correct mentality in the face of the illness, the pursuit of social values, and social support were identified to be the stimulating factors for patients to return to work, while work pressure was found to be a hindering factor.

    Indeed, the process for patients to return to work is dynamic, where the patients’ feelings would change over the course of rehabilitation from their illness. They will have different attitudes towards returning to work at different times. Returning to work can help to forget the pain of their illness, improve their self-value, and return to a normal life. In the future, medical staff should carry out relevant interventions that address the influencing factors of patients returning to work. For example, rehabilitation volunteer groups may be set up, where the patients can receive social support from the medical staff, enabling the patients to maintain positivity and optimism during their rehabilitation.


  • October 31, 2022 2:58 PM | Anonymous

    Authors:

    Liyan Zhang (Registered Nurse) 1; Jieyuan Cai (Master Student) 1; Hong Sun (Doctor of Medication) 2; Lin Shen (Doctor of Medication) 1
    1 The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Medical Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China 2 Department of Intergrative Medicine & Geriatric Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China;
    *Corresponding author: Hong Sun

    Regorafenib is a novel, oral anticancer agent used in cancer treatment. Despite its known benefit in improving survival among cancer patients, it was reported to induce hand–foot skin reaction (HFSR) in patients . HFSR is characterised by numbness, tingling sensation, swelling, desquamation, ulceration, hyperkeratinized or pain in hands and feet. It significantly affects the quality of life (QOL) of patients, even upon dose reductions or treatment discontinuation. Currently, the methods for managing HFSR include moisturization, avoiding friction or chemical injury, or drug dose adjustment, although these treatments have limited efficacy. Traditional Chinese medicine (TCM) is useful in skin-related symptoms by regulating internal imbalance, promoting skin wound healing, relieving pain, anti-inflammatory. However, there is no clinical studies to confirm the effect of TCM in alleviating HSFR.

    In view of this, we conducted a study that aimed to investigate whether a compound traditional Chinese medicine (CTCM) oil would alleviate HFSR induced by regorafenib, in order to enhance the physical function and quality of life of cancer patients on a regorafenib treatment regime.

    The study involved 85 patients with metastatic colorectal cancer presenting with HFSR. These patients were divided into the control group (n = 42) and the intervention group (n = 43). The HFSR among the control participants was managed as keeping skin moisture, avoiding friction or chemical injury and using pain killers or other medication following doctors’ order. The intervention participants was treated with a CTCM oil comprising five selected herbs which can alleviate skin swelling, pain, injury anti-inflammatory, eventually promoting skin repair and wound healing . This oil generally works by regulating immune functions and the molecular pathways leading to inflammation. The oil was given to the intervention participants for external application twice daily for two weeks. To evaluate the effect of the application of this CTCM oil, we compared the HFSR remission rate and quality of life (QOL) between the two groups of participants at post-intervention (two weeks after the start of intervention).

    Our data support that CTCM oil application is effective in the treatment of HSFR and improving the well-being of the patients. Notably, the post-intervention HFSR remission rate was significantly higher among participants in the intervention group than those in the control group (65.1% vs 16.7%; p < 0.01) indicating that the use of the CTCM oil can alleviate the severity of HFSR among the patients. Consistent with this, participants in the intervention group also experienced lower levels of pain caused by the inflammatory events associated with HFSR (p < 0.01). Besides, the oil significantly improved patients’ physical function such as walking and grabbing stuffs, emotional function as depression and the social function as social activities. (p < 0.05). Overall, our data demonstrated that the CTCM oil can effectively alleviate HFSR and improve the QOL of patients using regorafenib.

    The findings suggest the CTCM oil can be considered as an optional management of patients undergoing therapy with regorafenib. Future research may explore the efficacy of CTCM oil in reliving other skin conditions.

    Before CTCM oil application             After CTCM oil application

    Before CTCM oil application              After CTCM oil application

    Figure 1. HRSR before and after intervention
    Note: Before treatment, both patients’ feet occur HFSR, presenting as skin hyperkeratinized (as yellow part shown), swelling and severe pain, affect their walking badly. After treatment, the symptoms significantly relieved.

    This study was presented at ICCN2022 virtual conference.
    Registration for ICCN2022 virtual library now open. For more information, please access https://www.iccn2022.com/registration/

  • October 26, 2022 5:20 PM | Leya Duigu (Administrator)


    Present your research to an international audience of best-in-class supportive cancer care professionals.

    Abstracts on a wide range of supportive care topics are welcome, particularly those relating to our 2023 meeting themes:

    • Overall Theme: Interdisciplinary Nature of Supportive Cancer Care
    • Robotics and Digital Medicine
    • Disparities in the Availability of Supportive Care
    • When Evidence-Based Medicine Meets Traditional Medicine
    • Sessions on the Various MASCC/JASCC/ISOO Study Group Topics

    We encourage submissions from both new and experienced researchers. A number of awards and scholarships are available to qualifying first authors.

    Deadlines:

    December 21, 2022 3pm EST (for submissions which include a Conference Scholarship application)

    January 11, 2023 3pm EST (for all other submissions, including all other awards and scholarships)

    Learn more here: mascc.org/annualmeeting2023/abstracts/


  • October 24, 2022 2:57 PM | Anonymous

    Authors: Jia Hui Liu, MS, RN, Hunan Cancer Hospital; Xu Ying Li, PhD, RN, Hunan Cancer Hospital

    Background

    Breast cancer(BC)is a common cancer type in women, ranking the first in in the incidence, and the fourth in the mortality, among female cancers in China. Treatment of BC was reported to lead to a repertoire of psychological symptoms and health problems, such as depression, anxiety and fatigue (de Ligt et al., 2019; Götze et al., 2020), and the psychological symptoms were suggested to be caused by psychological distress among patients receiving treatment. (Loewenstein 2018). Such psychological distress may hinder treatment compliance, increase the risk of suicide and mortality, and affect the prognosis of the disease. In light of the detrimental effect of cancer treatment on the psychological well-being on patients, a better understanding on the factors that may increase their risk of experiencing psychological distress is needed. Therefore, we conducted a systematic review that aims to provide an overview on the prevalence of psychological distress with breast cancer patients in China, and the factors that may affect their experience of psychological distress. These identified factors may help provide useful clues in the identification of patients at higher risk of psychological distress, where additional psychological interventions may be given to these patients to facilitate personalized care.

    Our findings showed that breast cancer patients in China had a high prevalence of psychological distress of 55.4%. We also found that patients with moderate distress, those who were about to receive chemotherapy, those living in western regions in China, and those whose cancer was at the pathological stages Ⅱ to Ⅲ had a higher prevalence of psychological distress.

    With our data showing the relatively high prevalence of psychological distress among breast cancer patients in China, more resources should be allocated in the implementation of psychological interventions shown to be effective in alleviating psychological issues, such as training more psychological care professionals, and constructing psychological intervention plans based on the level of psychological distress. Psychological interventions of potential for implementation among the patients include relaxation training, physical activity, and couples therapy. Patients at stages II or III of Cancer who have their chemotherapy scheduled to start and those living in western China are in higher need of these interventions. Meanwhile, there is a great need to further improve the ability of healthcare professionals to screen for or detect psychological distress in cancer patients, where those having psychological distress can be identified for referrals to receive the psychological interventions. The Government may consider the allocation of more resources for training healthcare professionals to implement these interventions.

    References:

    de Ligt, K. M., Heins, M., Verloop, J., Smorenburg, C. H., Korevaar, J. C., Siesling, S. (2019). Patient-reported health problems and healthcare use after treatment for early-stage  breast cancer. Breast, 46, 4-11. doi: 10.1016/j.breast.2019.03.010

    Götze, H., Friedrich, M., Taubenheim, S., Dietz, A., Lordick, F., Mehnert, A. (2020). Depression and anxiety in long-term survivors 5 and 10 years after cancer diagnosis. Support Care Cancer, 28(1), 211-220. doi: 10.1007/s00520-019-04805-1

    Loewenstein, K. (2018). Parent Psychological Distress in the Neonatal Intensive Care Unit Within the Context  of the Social Ecological Model: A Scoping Review. J Am Psychiatr Nurses Assoc, 24(6), 495-509. doi: 10.1177/1078390318765205

    This study was presented at ICCN2022 virtual conference.
    Registration for ICCN2022 virtual library now open. For more information, please access https://www.iccn2022.com/registration/

  • October 20, 2022 9:34 PM | Leya Duigu (Administrator)


    Invited by City Cancer Challenge, Prof Patsy Yates, past president of ISNCC, represented ISNCC to be one of the ASCO-C/Can Global External Panel of Experts for the implementation of the ASCO Multidisciplinary Cancer Management Course (MCMC) in Greater Petaling, Malaysia. The course focused on using multidisciplinary team care and guidelines for breast cancer to help healthcare professionals in Greater Petaling to address local gaps in cancer care. The course was successfully conducted on 17th to 19th September 2022. 

  • October 17, 2022 2:56 PM | Anonymous

    Authors:

    • Winnie K.W. So, RN, PhD, FAAN; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
    • Dorothy N.S. Chan, RN, PhD; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
    • Bernard M.H. Law, PhD; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
    • Kai Chow Choi, PhD; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
    • Meinir Krishnasamy, RGN, PhD; Peter MacCallum Cancer Centre, Victoria, Australia;
    • Carmen W.H. Chan, RN, PhD, FAAN; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;


    Submission topic:
    A Family-based Multimedia Intervention: A Potential Strategy to Promoting Colorectal Cancer Screening Utilisation among South Asian Ethnic Minorities

    Colorectal cancer (CRC) is one of the most common cancers in Hong Kong. In view of the benefit of cancer screening utilisation in reducing CRC prevalence, the local government had started implementing a CRC screening programme that enable the public to undergo screening tests (faecal immunohistochemical test – FIT) at a reduced cost. Nevertheless, South Asian (SA) ethnic minorities, one of the disadvantaged populations in Hong Kong, were known to exhibit a low CRC screening rates.1 They face multiple barriers in utilising the available CRC screening services, including the language barrier, and limited knowledge on CRC prevention and screening.2,3 SA older adults are particularly affected by these barriers, yet these individuals are those who require CRC screening most, due to the increased CRC risks among older individuals. These older adults are in need of effective educational interventions to increase their knowledge on CRC screening, its benefits and how screening services can be accessed.

    To educate SA effectively, we developed and implemented a family-based multimedia educational intervention, and assessed its effectiveness in promoting FIT utilisation among SA older adults in a cluster-randomised controlled trial. The intervention not only provides education on FIT to the SA older adults, but also highlights the importance of support from younger family members in enhancing cancer screening utilisation among these adults. It involved a multimedia health talk by trained instructors and navigational assistance by site coordinators, where they accompanied the older adults to attend medical appointment with a family doctor for FIT. Dyad participants, comprising an older adult and one of their younger family members, were recruited among SA communities through our partnerships with non-governmental organisations (NGOs).

    The intervention appeared effective in enhancing FIT utilisation among SA older adults, as the proportion of intervention participants having undergone FIT was 10 times higher than that among control participants. Among the younger family members, the intervention may have promoted their level of willingness and readiness to encourage and assist their older family members to undergo FIT, where such levels had remained high at post-intervention among the dyads in the intervention group only. Moreover, the participants were satisfied with the intervention, expressing that they would promote it to their peers. Over 80% of our partnering NGOs were impressed with the intervention and would continue implementing it at their centres provided they have the manpower and resources. Overall, our findings demonstrated the acceptability and effectiveness of our family-based multimedia intervention, and the potential feasibility of its implementation in local SA communities.

    Given the demonstrated effectiveness of the intervention in promoting CRC screening utilisation among local SA, we suggest that the intervention should be implemented regularly within SA communities worldwide, via NGOs serving local SA. Governments worldwide may allocate more resources for training the staff at these NGOs, enhancing their competence in delivering the intervention to their community peers. With enhanced awareness of SA on the importance of CRC screening and prevention, it is of potential that the CRC prevalence among this disadvantaged population group in regions worldwide can be reduced.

    Detailed report of this study can be found in the published article in the International Journal of Nursing Studies.4


    References

    1.    Choi KC, So WK, Chen JM, Lau GC, Lee PC, Chan CW. Comparison Study of Uptake of Colorectal Cancer Testing between Ethnic Minorities and the General Population in Hong Kong. Asian Pac J Cancer Prev. 2015; 16(17): 7713-7720. http://dx.doi.org/10.7314/apjcp.2015.16.17.7713.

    2.    Campbell C, Douglas A, Williams L, Cezard G, Brewster DH, Buchanan D, Robb K, Stanners G, Weller D, Steele RJ, Steiner M, Bhopal R. Are there ethnic and religious variations in uptake of bowel cancer screening? A retrospective cohort study among 1.7 million people in Scotland. BMJ Open. 2020; 10(10): e037011. http://dx.doi.org/10.1136/bmjopen-2020-037011.

    3.    Wyatt LC, Patel S, Kranick JA, Raveis VH, Ravenell JE, Yi SS, Kwon SC, Islam NS. Disparities in colorectal cancer screening among South Asians in New York City: a cross-sectional study. J Cancer Educ. 2021: http://dx.doi.org/10.1007/s13187-021-01991-7.

    4.    So WKW, Chan DNS, Law BMH, Choi KC, Krishnasamy M, Chan CWH. Effect of a family-based multimedia intervention on the uptake of faecal immunohistochemical test among South Asian older adults: A cluster-randomised controlled trial. Int J Nurs Stud. 2022; 132: 104254. https://doi.org/10.1016/j.ijnurstu.2022.104254



    The flow of the family-based multimedia intervention project. In this project, we first recruited a number of South Asian instructors who will take part in delivering the educational intervention to their community peers. They were trained on their presentation skills and educated on various aspects of colorectal cancer and its prevention. They were also given training on how stool sample is collected for faecal immunohistochemical test (FIT). They were given a competence assessment at the end of the training. Upon passing the assessment, they will be engaged in delivering the family-based multimedia intervention. The intervention involved a health talk on colorectal cancer, colorectal cancer screening and how it can be accessed. During the talk, a video clip was shown, with its content highlighting the importance of support from younger family members in modifying cancer screening behaviours of the older participants. A demonstration on how stool sample is collected for FIT was also given by the instructor during the talk. Finally, each participant received a health information booklets at the end of the talk, with the contents aiming to reinforce the knowledge gained by the participants during the educational intervention.

  • October 10, 2022 2:11 PM | Anonymous

    Author: LING Wai Man (MScN, RN, FHKAN), Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong

    Metastatic spinal cord compression (MSCC) is an oncological emergency which can cause severe debilitation and adverse impacts on patient’s quality of life. A preliminary review conducted between January 2018 and June 2019 in our oncology wards on 6 MSCC patients revealed that there were delayed initiation of multidisciplinary supportive care and a paucity of routine psychosocial assessment. The lack of a systematic and timely multidisciplinary MSCC care plan was evident. Therefore, we decided to initiate a quality improvement project to enhance the MSCC care by establishing and implementing a systematic multidisciplinary care pathway.

    Based on the gaps identified from the aforesaid review and current international guidelines like the Christie NHS Guideline and NICE Pathway, a departmental integrated care pathway (ICP) for MSCC was developed. Emphasis was placed on the multidisciplinary input for timely therapeutic interventions, pain management, psychosocial care and supportive measures so as to maximize rehabilitation, prevent complications and aid discharge planning. To facilitate the systematic care delivery, a clinical practice checklist was designed and used since September 2019. A clinical audit was then conducted in late 2020 to evaluate the effectiveness of the project, including the (i) compliance to the ICP, (ii) effectiveness in multidisciplinary communication and service coordination, and (iii) effectiveness of the enhancement in clinical care.

    A retrospective approach with the pre and post historical comparison design was adopted. Twenty-one MSCC patients from September 2018 to August 2019 (pre cohort) and 40 from September 2019 to August 2020 (post cohort) were recruited. Their median age was 71 with the range of 41 to 100. Thirty-eight (62.3%) of them were male. The top 5 cancer diseases were lung, prostate, colorectal, breast and lymphoma. The most common site of MSCC was thoracic spine (86.7%), followed by cervical (18.3%) and lumbar (15%). Ratio of single to multiple levels of MSCC was half to half. Radiotherapy (85.2%) was the most common primary treatment for the MSCC, whereas surgery (4.9%) and supportive management (9.8%) were the minority. Their median survival time was 3.2 months only.

    The overall compliance to ICP was good. All the post cohort patients were under its care with 85% initiated within 1 day. All had a clear documentation of the spinal stability. Use of anti-embolism stockings rose from 19% to 75% (p<0.001). There was a statistically significant increase in the referral to physiotherapist (81% vs 100%; p<0.5), occupational therapist (72.6% vs 95%; P<0.5) and social worker (42.9% vs 75%; P<0.5). Although it was not statistically significant yet, there was a trend of improvement in pain control, prevention of constipation and discharge planning. The median length of stay was shortened from 13 to 10 days with over three-fourths back to home or elderly home.

    Our audit results support the use of ICP, which can promote systematic, timely and holistic MSCC care, and is worthwhile to adopt in routine practice. Improvement actions (like a stepwise remobilization protocol and a more convenient multidisciplinary referral system) have been identified afterwards to strive for a continuous quality enhancement in our MSCC care.

    References
    Christie Hospital NHS Foundation Trust. (2020a). Overview of the Management of Metastatic Spinal Cord Compression due to Cancer (Version: V6). Retrieved from https://www.christie.nhs.uk/media/9329/overview-of-the-management-of-mscc-due-to-cancer-sept-2020-final.pdf
    Christie Hospital NHS Foundation Trust. (2020b). Protocol for Mobilisation and Rehabilitation (Version: V6). Retrieved from https://www.christie.nhs.uk/media/9321/guidelines-on-mobilisation-and-rehabilitation-sept-2020-final.pdf
    Laufer, I., Bilsky, M., Schiff, D., & Brown, P. (2021). Treatment and prognosis of neoplastic epidural spinal cord compression (Topic 2820 Version 42.0). Retrieved from https://www.uptodate.com/contents/treatment-and-prognosis-of-neoplastic-epidural-spinal-cord-compression?search=malignant%20spinal%20cord%20compression&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
    National Institute for Health and Clinical Excellence. (2008). Metastatic spinal cord compression in adults: risk assessment, diagnosis and management (CG75). Retrieved from https://www.nice.org.uk/guidance/cg75
    Vogel, W. (2020). Structural Emergencies. In J. M. Brant, D. G. Cope, & M. G. Saria. (Eds.), Core Curriculum for Oncology Nursing (6th ed.) (pp. 470-486). St. Louis, Missouri: Elsevier.

    Oncology nurses are practicing the essential skills in MSCC care: the application of orthotics and log rolling.

  • October 03, 2022 2:05 PM | Anonymous

    Authors

    • Dorothy N.S. Chan, RN, PhD; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
    • Bernard M.H. Law, PhD; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
    • Winnie K.W. So, RN, PhD, FAAN; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
    • Ning Fan, MBBS; Yan Chai Hospital, Hospital Authority, Hong Kong SAR, China
    Cervical cancer screening utilisation is known to be of benefit to reduce the prevalence of cervical cancer,1 one of the most common cancers among women. However, individuals with physical disabilities, including those having impairments in mobility, vision and hearing, were reported to exhibit low cervical cancer screening utilisation rate.2,3 This renders them more likely to have missed the opportunities to detect any precancerous lesions early for a timely treatment that prevents these lesions to develop into cancer. Therefore, strategies need to be developed to increase the screening rates of individuals with physical disabilities. To do so, we need to have a better understanding on the factors that hamper and facilitate these individuals to undergo cervical cancer screening.

    To this end, our team had previously conducted a systematic review exploring the barriers and facilitators of cervical cancer screening utilisation among individuals with mobility, visual and hearing impairments. Based on these identified barriers and facilitators, we aim to make recommendations on the potential strategies that help increase the screening rates of these disadvantaged individuals.

    Overall, people with physical disabilities, especially those with mobility disabilities, are hampered to undergo cervical cancer screening by three major factors:
    •    They possess limited knowledge, and even misconceptions, on the need for screening – they believe that screening is not needed if they feel healthy or are not sexually active.
    •    They perceive that undergoing screening is an unpleasant experience, as they have been informed on the poor screening experience of their peers, potentially due to the lack of knowledge of healthcare professionals to work with people with disabilities.
    •    They experience difficulties in accessing screening providers, especially owing to the hassle in making transportation arrangements and the lack of ramps for wheelchairs within the premises of screening providers.

    On the other hand, individuals with physical disabilities would be more likely to undergo cervical cancer screening if an attendant is on hand to help these individuals throughout the screening procedures, and that the duration of screening appointments can be lengthened so that they can feel less rushed during the screening process.

    The review findings enable the suggestion of several strategies for enhancing the cervical cancer screening utilisation rate of individuals with physical disabilities. First, public education on cervical cancer screening should be enhanced within communities, through the implementation of educational programmes that help clarify certain misconceptions on cervical cancer screening possessed by the public. Second, more resources may be allocated to train healthcare professionals to work with people with disabilities, enabling these healthcare professionals to be more patient with these disabled individuals. This may provide a more pleasant and relaxing experience for these individuals to undergo screening. Third, screening providers may also consider allocating resources to employ helpers assisting individuals with physical disabilities to get into position for the screening procedures, install disability-friendly facilities at their premises and provide transportation services for these individuals, offering them a greater level of convenience for them to attend screening appointments. All these may enhance the intention and capability of these individuals to undergo screening.

    The article reporting the methodologies and findings of this review was recently published in Health Policy.4

    References

    1.    Landy R, Sasieni PD, Mathews C, Wiggins CL, Robertson M, McDonald YJ, Goldberg DW, Scarinci IC, Cuzick J, Wheeler CM; New Mexico HPV Pap Registry Steering Committee. Impact of screening on cervical cancer incidence: A population-based case-control study in the United States. Int J Cancer. 2020; 147(3): 887-896. http://dx.doi.org/10.1002/ijc.32826.

    2.    Lofters A, Guilcher S, Glazier RH, Jaglal S, Voth J, Bayoumi AM. Screening for cervical cancer in women with disability and multimorbidity: a retrospective cohort study in Ontario, Canada. CMAJ Open. 2014; 2(4): E240-E247. http://dx.doi.org/10.9778/cmajo.20140003.

    3.    Kellen E, Nuyens C, Molleman C, Hoeck S. Uptake of cancer screening among adults with disabilities in Flanders (Belgium). J Med Screen. 2020; 27(1): 48-51. http://dx.doi.org/10.1177/0969141319870221.

    4.    Chan DNS, Law BMH, So WKW, Fan N. Factors associated with cervical cancer screening utilisation by people with physical disabilities: A systematic review. Health Policy. 2022: (in press). doi: 10.1016/j.healthpol.2022.08.003.


    A schematic diagram depicting the identified barriers and facilitators of cervical cancer screening utilisation among people with physical disabilities.

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