Scalp Cooling: The Prevention of Chemotherapy-Induced Alopecia

Hair loss (alopecia) from chemotherapy is one of the most feared side effects of many patients, particularly women. Many patients and their healthcare providers believe that cryotherapy can help prevent or mitigate these changes. Scalp cooling has been used for more than 30 years to prevent alopecia caused by chemotherapy, particularly taxanes and anthracyclines. This article presents an overview of the evidence for this strategy, as well as its impact on nursing care provision.

Team Science and Big Brains

Recently, I was honored with the task of moderating a session at the Oncology Nursing Society's 42nd Annual Congress in Denver, Colorado. The panel discussion, "Team Science: A Discussion With the Experts," was described as an opportunity to learn about team science implementation in the conduct of cancer research. The panel members were leaders in oncology research. As the session was about to begin, I looked over at the panelists and decided that this session should have been called "The Big Brains Session" because the panelists are giants in the field. And yes, I was just a little intimidated to be posing questions to the panel, not to mention moderating their discussion.
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Interventions to address sexual problems in people with cancer

BACKGROUND

Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer.

METHODS

This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer Expert Panel, a group organized by the Program in Evidence-Based Care (pebc). Consistent with the pebc standardized approach, a systematic search was conducted for existing guidelines, and the literature in medline and embase for the years 2003-2015 was systematically searched for both systematic reviews and primary literature. Evidence found for men and for women was evaluated separately, and no restrictions were placed on cancer type or study design. Content and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users.

RESULTS

The search identified 4 existing guidelines, 13 systematic reviews, and 103 studies with relevance to the topic. The present guideline provides one overarching recommendation concerning the discussion of sexual health and dysfunction, which is aimed at all people with cancer. Eleven additional recommendations made separately for men and women deal with issues such as sexual response, body image, intimacy and relationships, overall sexual functioning and satisfaction, and vasomotor and genital symptoms.

CONCLUSIONS

To our knowledge this clinical practice guideline is the first to comprehensively evaluate interventions for the improvement of sexual problems in people with cancer. The guideline will be a valuable resource to support practitioners and clinics in addressing sexuality in cancer survivors.

Religiosity: Its Impact on Coping Styles Among Women Undergoing Fertility Treatment

The Israeli worldview places great significance on childbearing. This could create emotional and ethical difficulties for women coping with fertility issues in addition to their treatments. This study examined the relations between coping strategies and level of religiosity in 159 women undergoing infertility treatment. Statistically significant relations were found between the problem-solving coping style and religious observance (p < 0.01) and religious beliefs (p < 0.05). An inverse correlation was found between the emotional coping style and religious beliefs (p < 0.001). Health professionals should recognize the patient's coping styles and understand the patient's religious belief system as part of an ongoing fertility treatment.

Psychiatric and behavioral side effects of anti-epileptic drugs in adolescents and children with epilepsy

PURPOSE

The objective of the study was to compare the psychiatric and behavioral side effect (PBSE) profiles of both older and newer antiepileptic drugs (AEDs) in children and adolescent patients with epilepsy.

METHOD

We used logistic regression analysis to test the correlation between 83 non-AED/patient related potential predictor variables and the rate of PBSE. We then compared for each AED the rate of PBSEs and the rate of PBSEs that led to intolerability (IPBSE) while controlling for non-AED predictors of PBSEs.

RESULTS

922 patients (≤18 years old) were included in our study. PBSEs and IPBSEs occurred in 13.8% and 11.2% of patients, respectively. Overall, a history of psychiatric condition, absence seizures, intractable epilepsy, and frontal lobe epilepsy were significantly associated with increased PBSE rates. Levetiracetam (LEV) had the greatest PBSE rate (16.2%). This was significantly higher compared to other AEDs. LEV was also significantly associated with a high rate of IPBSEs (13.4%) and dose-decrease rates due to IPBSE (6.7%). Zonisamide (ZNS) was associated with significantly higher cessation rate due to IPBSE (9.1%) compared to other AEDs.

CONCLUSION

Patients with a history of psychiatric condition, absence seizures, intractable epilepsy, or frontal lobe epilepsy are more likely to develop PBSE. PBSEs appear to occur more frequently in adolescent and children patients taking LEV compared to other AEDs. LEV-attributed PBSEs are more likely to be associated with intolerability and subsequent decrease in dose. The rate of ZNS-attributed IPBSEs is more likely to be associated with complete cessation of AED.

Our Responsibility to Our Research Participants

As the readers of this journal know all too well, conducting a study takes a lot of time, energy, commitment, and, most of all, work. I do not have to list the myriad steps that need to be taken, often with delays in between, to take a study from good idea to analysis. There are often sweat and tears, if not blood, and, at the end of the process, there may be exhaustion. Then the piles of paper and data-rich files languish on a desk or computer, never to see the light of day. Or, perhaps, a manuscript is written and submitted and then rejected or needs extensive revision. And it languishes again. Many of us have been in this position and remember what that rejection felt like and how hard it was to revise and submit again, or not.
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Some Things Must Not Change

The past three months have been a season of tremendous change, and many of us have been surprised by the political events that have taken place. January heralds a change in administration for the United States, and the future seems uncertain. I sense that change is going to be the new normal, and we have to be able to cope with it-and with each other-for a long time. What I want to talk about is those things that do not change and how we, as nurses and scientists, must remain true to our roots.
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Upon Further Review: Peer Process Vital to Publishing

Peer review is one of the hallmarks of professional publishing and one that I appreciate every day in my work as editor of this journal. I simply could not do this work without reviewers, and all of my editor colleagues across the globe would agree. I have been a reviewer for various journals for many years, and now, as editor of the Oncology Nursing Forum, I am even more aware of how important my reviews are for others. Just this morning, I reviewed a manuscript-for a noncompeting journal, of course-and as I entered my comments, I thought about what I, as editor, would find useful.
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Clear as Glass

Beginning with the first issue of 2016, the Oncology Nursing Forum (ONF) will join many other journals in publishing the contribution of each of the listed authors to the article. Why has this taken us so long? In part, this is an editorial decision, and I have always thought that nurses are honest and would not include anyone on a manuscript who had not contributed in a meaningful way to the writing of the manuscript. That belief has not changed.

Sexuality After Cancer: A Model for Male Survivors

INTRODUCTION

For men with cancer, sexual dysfunction is a common issue and has a negative impact on quality of life, regardless of whether he has a partner. In general, sexuality encompasses much more than intercourse; it involves body image, identity, romantic and sexual attraction, and sexual thoughts and fantasies.

AIM

Acknowledging that cancer affects multiple physical and psychosocial domains in patients, the authors propose that such changes also inform sexual function for the male survivor.

METHODS

An in-depth review of the literature describing alterations to sexual functioning in men with cancer was undertaken. Based on this and the clinical expertise of the authors, a new model was created and is presented.

RESULTS

This biopsychosocial model is intended to expand the understanding of male sexuality beyond a purely biomedical model that addresses dysfunction as distinct from the context of a man's life and sexual identity.

CONCLUSION

Most data on sexual dysfunction in men with cancer are derived from those with a history of prostate cancer, although other data suggest that men with other types of malignancies are similarly affected. Unfortunately, male sexuality is often reduced to aspects of erection and performance. Acknowledging that cancer affects multiple physical and psychosocial domains in patients, the authors propose that such changes also inform sexual function for the male survivor. This biopsychosocial model might form the basis for interventions for sexual problems after cancer that includes a man and his partner as a complex whole.

Issues Critical to the Successful Application of Cryosurgical Ablation of the Prostate

The techniques of present-day cryosurgery performed with multiprobe freezing apparatus and advanced imaging techniques yield predictable and encouraging results in the treatment of prostatic and renal cancers. Nevertheless, and not unique to cryosurgical treatment, the rates of persistent disease demonstrate the need for improvement in technique and emphasize the need for proper management of the therapeutic margin. The causes of persistent disease often relate to a range of factors including selection of patients, understanding of the extent of the tumor, limitations of the imaging techniques, and failure to freeze the tumor periphery in an efficacious manner. Of these diverse factors, the one most readily managed, but subject to therapeutic error, is the technique of freezing the tumor and appropriate margin to a lethal temperature [Baust, J. G., Gage, A. A. The Molecular Basis of Cryosurgery. BJU Int 95, 1187–1191 (2005)]. This article describes the recent experiments that examine the molecular basis of cryosurgery, clarifies the actions of the components of the freeze-thaw cycle, and defines the resultant effect on the cryogenic lesion from a clinical perspective. Further, this review addresses the important issue of management of the margin of the tumor through adjunctive therapy. Accordingly, a goal of this review is to identify the technical and future adjunctive therapeutic practices that should improve the efficacy of cryoablative techniques for the treatment of malignant lesions.

Moving the Science Forward

This edition of the Oncology Nursing Forum (ONF) is the "research issue" in my mind. That might sound strange, given that ONF is the research journal of the Oncology Nursing Society (ONS) and, other than the featured columns that we publish, all other articles are reports of research. This issue is special for three reasons.

The Circle of Female Sexual Desire-Have We Come a Long Way?

Ever since the release of sildenafil (Viagra) two decades ago to treat erectile dysfunction in men, there has been a conversation around whether there is a need for a "female Viagra." Last year's release of flibanserin (Addyi) was hailed by some as an achievement in women's sexual health. But how effective is this drug in affecting women's sexual desire? And are the things being labeled as women's sexual desire problems really problems to be fixed with a drug?

Barriers to cancer screening among Orthodox Jewish women

The increased risk of genetic cancer mutations for Ashkenazi Jews is well known. However, little is known about the cancer-related health behaviors of a subset of Ashkenazi Jews, Orthodox Jews, who are a very religious and insular group. This study partnered with Rabbinical leadership and community members in an Orthodox Jewish community to investigate barriers to cancer screening in this community. Orthodox Jewish women were recruited to participate in focus groups designed to elicit their perspectives on barriers to cancer screening. A total of five focus groups were conducted, consisting of 3-5 members per group, stratified by age and family history of cancer. Focus groups were audio recorded and transcribed. Transcripts were coded using conventional content analysis. The resulting themes identified as barriers to cancer screening were: preservation of hidden miracles, fate, cost, competing priorities, lack of culturally relevant programming, lack of information, and fear. These results provide a unique perspective on barriers to cancer screening in a high risk but understudied population. Findings from this study may serve to inform culturally appropriate cancer education programs to overcome barriers to screening in this and other similar communities.

Following the Rules

I am getting better at following the rules as I grow older, although I still bristle at many of them. I was a typical rebellious teenager; no one understood me, David Bowie was my idol, and, one day, my generation was going to change the world. Now I really want people to understand me: David Bowie remains one of my favorite singers and, yes, my generation has changed the world, and not necessarily for the better. Growing up means that you have to make the rules, not just follow those set by others, and, at times, having rules makes a lot of sense.
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Abstract A19: A mixed methods approach to assessing ehealth activity among African American cancer survivors

The research literature on eHealth activity across different patient populations is rapidly expanding, yet little is known about eHealth among diverse cancer survivors. Most existing measures of such activity are quantitative (QUAN). Compared to qualitative (QUAL) methods, QUAN methods are limited in capturing in-depth information regarding eHealth experiences that can inform user-centered design of technologies optimized for survivors' use. The goal of the pilot project reported here was to develop a mixed methods approach to assessing the full scope of eHealth activity among African American cancer survivors.

Based on a literature review, study investigators created a measure that included 27 eHealth activities across 5 domains: informational, communal, self-care/management, expert care, and transactional. An embedded mixed methods design was used in which QUAN items represented the “primary strand” of data and QUAL probes represented the “secondary strand.” Within each domain, participants responded to QUAN items regarding each activity that asked if they were aware the activity was possible; if they had ever engaged in the activity personally; whether someone else (surrogate) had engaged in the activity on their behalf; the recency of the eHealth activity; how often the activity was related to their cancer; and their interest in engaging in the activity in the future. Then, QUAL probes were presented asking about the reasons they had participated in domain-specific activities and general problems or challenges within activities, or what had kept them from engaging in the activities and the support/resources needed to do so in the future.

Participants were 23 African American breast, prostate, and colorectal (CRC) cancer survivors (12 breast; 7 prostate; 2 female CRC; 1 male CRC) identified through the Metropolitan Detroit Cancer Surveillance System, a member of NCI's SEER program. The mean age among participants was 60 years and time since end of primary treatment ranged from 13-46 months. In this pilot sample, 78% reported using the internet. Personal engagement in eHealth activities was highest in the informational domain (range: 9-72% across items) and the most reported activity was searching online for information about specific symptoms or problems. Personal engagement was lowest in the transactional domain. Across both personal and surrogate engagement, eHealth activities most often reported as related to cancer most or all of the time were searching online for information about how to reduce healthcare costs (60%), searching online for information about a hospital or healthcare facility (62.5%), and using technology to track medical symptoms (100%). Across all participants, interest in future engagement was greatest in the informational domain, including searching online for information about specific symptoms (86%), medical treatments or procedures (78%), and signing up to receive online, email or mobile updates on medical issues (74%). Interest in the future engagement was lowest for the communal domain. QUAL probes revealed several challenges within eHealth activities including difficulties in identifying credible health-related online resources; verifying the credibility of online health information; determining effective search terms to find relevant information; managing different policies across healthcare providers related to the electronic exchange of information; and technical problems with devices.

Findings led to the revision of this mixed methods approach such that additional QUAN items and QUAL probes were added, with QUAL probes specific to eHealth activities rather than eHealth domains . The revised measure is currently being administered as part of an AHRQ-funded R01 study of eHealth activity among 1200 African American and white cancer survivors in the metropolitan Detroit area.

Citation Format: Hayley S. Thompson, Anne Katz, Charity Barnes, Mary Smith, Tara Eaton. A mixed methods approach to assessing ehealth activity among African American cancer survivors. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A19.