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Hui-Lin C, Ting G. The experiences, perceptions, and support needs among family caregivers of patients with advanced cancer and eating problems: An integrative review. Palliat Med 2022; 36:219-236. [PMID: 35188004 DOI: 10.1177/02692163211058598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Advanced cancer patients often present with numerous eating problems, posing a significant challenge for family caregivers during the provision of nutritional care. AIM To systematically identify and synthesize empirical literature on the experiences, perceptions, and support needs of family caregivers of patients with advanced cancer and eating problems to ascertain directions for future research. DESIGN Integrative review guided by Whittemore and Knafl's methodological framework. DATA SOURCES Five electronic databases were searched from their inception to April 2021. Studies were eligible if they examined family caregivers' perspectives and experiences when caring for their relatives with advanced cancer and eating problems and were primary quantitative, qualitative, and mixed-methods studies published in English-language peer-reviewed journals. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. RESULTS Twenty-seven papers from 21 studies met the eligibility criteria and were included in this review. The included papers were mostly qualitative studies and were of moderate to high methodological quality. Three themes were identified: (a) multiple negative effects of advanced cancer patients' eating problems; (b) coping responses in managing advanced cancer patients' eating problems; and (c) unmet support needs in the provision of nutritional care. CONCLUSIONS Research on the studied topic was descriptive and predominantly qualitative in nature. Quantitative research examining the impact of caregiving experiences in relation to food and eating in the context of advanced cancer patients is the first important step moving this research area forward.
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Affiliation(s)
- Cheng Hui-Lin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Gan Ting
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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Sato R, Naito T, Hayashi N. Barriers in Nursing Practice in Cancer Cachexia: A Scoping Review. Asia Pac J Oncol Nurs 2021; 8:498-507. [PMID: 34527779 PMCID: PMC8420920 DOI: 10.4103/apjon.apjon-2152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 01/06/2023] Open
Abstract
This scoping review aims to identify the barriers in practice and clinical trials for oncology nurses in cancer cachexia. We used the framework proposed by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Studies written in English and published between 2008 and 2021 were retrieved from five databases: MEDLINE, Cochrane Library, CINAHL, PsycINFO, and EMBASE. A total of 1075 studies were identified, and 34 full-text studies were assessed for eligibility by three researchers. Seventeen studies met the inclusion criteria. This review revealed several barriers to nursing practice and clinical trials in cancer cachexia. First, health-care professionals, including nurses, faced individual barriers (insufficient understanding and skills for diagnosis and management) and environmental barriers (lack of standardized screening tools or treatment options, difficulties in collaboration with other professions, and limited human resources) in practice. Second, studies on nurse-led interventions for cancer cachexia were relatively few and different in objectives, making it challenging to integrate the outcomes. Finally, there were no established educational programs for nurses that explicitly focused on cancer cachexia. This scoping review revealed individual and environmental barriers in nursing practice. In addition, there have relatively few clinical trials involving oncology nurses in cancer cachexia. Continuing education for nurses should cover cancer cachexia to improve the quality of oncology care in the future. It is also necessary to standardize practical assessment tools that are easy to assess daily and lead to interventions and develop nurse-led multidisciplinary care.
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Affiliation(s)
- Rika Sato
- Division of Nursing, Shizuoka Cancer Center, Shizuoka, Japan.,Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naoko Hayashi
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
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Zhao Y, Pang D, Lu Y. The Role of Nurse in the Multidisciplinary Management of Cancer Cachexia. Asia Pac J Oncol Nurs 2021; 8:487-497. [PMID: 34527778 PMCID: PMC8420922 DOI: 10.4103/apjon.apjon-2123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
Cancer cachexia is a complex syndrome for which multidisciplinary management through collaboration has the potential to improve patient outcomes and efficiency of care, through the integration of nursing into practice. These authors conducted a literature review of PubMed, EBSCO, OVID, and ProQuest for publications on the roles and responsibilities of nurses who are working in multidisciplinary teams for the management of cancer cachexia. We limited our search parameters for the literature review such that: (1) the included papers were published in the English language from January 2000 to February 2021 and (2) the included papers featured an adult patient population. Based on this review, cancer cachexia can be characterized as an involuntary loss of body weight that is combined with a dysregulation in the control of energy homeostasis and protein loss, which leads to poor clinical outcomes in patients. Cancer cachexia has been recognized as having multidimensional etiologies that are related to the nutritional and metabolic systems, as well as other physical and physiological systems, and to symptoms that manifest concurrently to the cachexia. While the clinical identification and taxonomic classification of cancer cachexia are usually associated with an observable degree of weight loss and muscular atrophy in a patient, clinical evidence of inflammation and related symptoms should be considered (in addition to the weight loss and muscular atrophy) in the diagnosis and evaluation of cancer cachexia, as will be argued in this paper. Early diagnosis, appropriate clinical assessment, and evaluation of cancer cachexia are crucial to predicting the onset of the condition and managing its symptoms when it occurs. Various tools have been developed for the clinical evaluation and diagnosis of cancer cachexia which reflect the multitudinous manifestations of the condition. Due to the diversity of its manifestations, multimodal therapy has gained popularity for the management of cancer cachexia. Multimodal therapy includes combined pharmacologic intervention, nutrition supplements, nutritional consultation, physical exercise, and symptom control. As these authors will demonstrate in this paper, this mode of multidisciplinary team management is increasingly supported by scientific evidence and as such, can be seen as essential for high-quality cancer cachexia management. Nursing plays an important role in the multidisciplinary care team model for cancer cachexia management, as nurses are well situated to perform screening, referral, coordination, nutritional consultation, physical exercise consultation, direct nutritional nursing, psychosocial support, symptom control, and hospice care. However, an increased focus on education, skills training, and tool development (as well as adoption of tools) on the part of nurses and other multidisciplinary team members is required to meet the goal of efficient care and improved outcomes for patients with cancer cachexia. These authors demonstrate that increasing roles and responsibilities for nurses in the management of cancer cachexia is a valuable area to explore in the literature and to implement in clinical practice. Our review aims to summarize the etiology and epidemiology, mechanisms-of-action, and multitudinous manifestations of cancer cachexia, the therapies that are used in cancer cachexia care and the management approaches by which this care is organized. Finally, these authors emphasize nurses' responsibilities in this mode of cancer cachexia multidisciplinary team management, which represents a fruitful benefit both in the research literature and in clinical settings.
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Affiliation(s)
- Yiyuan Zhao
- Department of Head and Neck, Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Dong Pang
- Peking University School of Nursing, Beijing, China
| | - Yuhan Lu
- Department of Nursing, Key Laboratory of Carcinogenesis and Translation Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
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Molassiotis A, Brown T, Cheng HL, Byrnes A, Chan RJ, Wyld D, Eastgate M, Yates P, Marshall AP, Fichera R, Isenring L, To KF, Ko PS, Lam W, Lam YF, Au LF, Lo RSK. The effects of a family-centered psychosocial-based nutrition intervention in patients with advanced cancer: the PiCNIC2 pilot randomised controlled trial. Nutr J 2021; 20:2. [PMID: 33388075 PMCID: PMC7778804 DOI: 10.1186/s12937-020-00657-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/06/2020] [Indexed: 02/07/2023] Open
Abstract
Background Malnutrition in advanced cancer patients is common but limited and inconclusive data exists on the effectiveness of nutrition interventions. Feasibility and acceptability of a novel family-based nutritional psychosocial intervention were established recently. The aims of this present study were to assess the feasibility of undertaking a randomised controlled trial of the latter intervention, to pilot test outcome measures and to explore preliminary outcomes. Methods Pilot randomised controlled trial recruiting advanced cancer patients and family caregivers in Australia and Hong Kong. Participants were randomised and assigned to one of two groups, either a family-centered nutritional intervention or the control group receiving usual care only. The intervention provided 2–3 h of direct dietitian contact time with patients and family members over a 4–6-week period. During the intervention, issues with nutrition impact symptoms and food or eating-related psychosocial concerns were addressed through nutrition counselling, with a focus on improving nutrition-related communication between the dyads and setting nutritional goals. Feasibility assessment included recruitment, consent rate, retention rate, and acceptability of assessment tools. Validated nutritional and quality of life self-reported measures were used to collect patient and caregiver outcome data, including the 3-day food diary, the Patient-Generated Subjective Global Assessment Short Form, the Functional Assessment Anorexia/Cachexia scale, Eating-related Distress or Enjoyment, and measures of self-efficacy, carers’ distress, anxiety and depression. Results Seventy-four patients and 54 family caregivers participated in the study. Recruitment was challenging, and for every patient agreeing to participate, 14–31 patients had to be screened. The consent rate was 44% in patients and 55% in caregivers. Only half the participants completed the trial’s final assessment. The data showed promise for some patient outcomes in the intervention group, particularly with improvements in eating-related distress (p = 0.046 in the Australian data; p = 0.07 in the Hong Kong data), eating-related enjoyment (p = 0.024, Hong Kong data) and quality of life (p = 0.045, Australian data). Energy and protein intake also increased in a clinically meaningful way. Caregiver data on eating-related distress, anxiety, depression and caregiving burden, however, showed little or no change. Conclusions Despite challenges with participant recruitment, the intervention demonstrates good potential to have positive effects on patients’ nutritional status and eating-related distress. The results of this trial warrant a larger and fully-powered trial to ascertain the effectiveness of this intervention. Trial registration The trial was registered with the Australian & New Zealand Clinical Trials Registry, registration number ACTRN12618001352291.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Teresa Brown
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Hui Lin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Angela Byrnes
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Raymond Javan Chan
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - David Wyld
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Melissa Eastgate
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Patsy Yates
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia.,Gold Coast University Hospital, Southport, Australia
| | | | - Liz Isenring
- Nutrition & Dietetics, Bond University, Gold Coast, Australia
| | - Ki Fung To
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Po Shan Ko
- Kowloon East Cluster, Hospital Authority, Kowloon, Hong Kong
| | - Wang Lam
- Haven of Hope Hospital, Tseung Kwan O, Hong Kong
| | - Yuk Fong Lam
- Haven of Hope Hospital, Tseung Kwan O, Hong Kong
| | - Lai Fan Au
- Shatin Hospital, Ma On Shan, New Territories, Hong Kong
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Wilson CM, Mooney K. Advancing Oncology Nursing Practice Through the Adoption of Patient Monitoring Digital Tools. Semin Oncol Nurs 2020; 36:151087. [PMID: 33218884 DOI: 10.1016/j.soncn.2020.151087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this paper is to describe the use of oncology digital symptom monitoring and patient self-management coaching tools, how nurses and nurse practitioners (NPs) can optimize their use as an adjunct in improving oncology care and discuss issues and strategies needed for adoption within a variety of clinical settings. DATA SOURCES A review of the research literature regarding digital health in oncology symptom management in PubMed provided the foundation for this paper. CONCLUSION Digital symptom monitoring technology provides a variety of opportunities for oncology nurses and NPs to efficiently extend and improve symptom management in multiple settings including cancer patients at home between clinic visits, at clinic visits, and during inpatient stays. Digital monitoring and patient engagement make possible frequent symptom assessments, just-in-time personalized self-management reinforcement, and judiciously alert nurses and NPs about key times for follow-up with patients supported with evidenced-based guidelines. Oncology nurses at all levels have the opportunity to be leaders in the adoption and expansion of digital tools to enhance their practice. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses and NPs can lead practice changes that improve patient outcomes through understanding and shaping the use of digital tools.
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Affiliation(s)
| | - Kathi Mooney
- University of Utah College of Nursing, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
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