Trajectories of fear of progression in nasopharyngeal carcinoma patients receiving proton and heavy ion therapy

OBJECTIVE

The study examined the growth trajectory of fear of progression(FOP) in nasopharyngeal carcinoma (NPC) patients. In addition, sociodemographic and clinical variables of each trajectory class were analyzed.

METHOD

Two hundred sixteen NPC patients undergoing proton and heavy ion therapy were measured beginning (T0) and end of a 4-week proton and heavy ion therapy (T1), 3 months (T2) and 6 months (T3) after discharge. And data from the final 197 NPC patients were analyzed. NPC patients' FOP was investigated by the Fear of Progression Questionnaire-Short Form (FOP-Q-SF) form T0 to T3. SPSS and Mplus were used for statistical analysis. The LGMM was used to analyze the trajectory of FOP followed up over 6 months after proton and heavy ion therapy. The logistic regression was utilized to compare the differences in sociodemographic and clinical characteristics of patients in different trajectory groups of FOP.

RESULTS

One hundred ninety-seven NPC patients were analyzed. LGMM analysis showed that three-group trajectory solution was the best fitting (low-fear decline FOP (14.21%), the moderate-fear stable FOP(43.15%), and high-fear rising FOP (42.64%). Significant positive associations were found between age < 30 years (β = 3.399, p = 0.023), with or without children (β = 3.1, p = 0.002), primary/recurrence (β = -6.196, p < 0.001), diagnosis < 3 months (β = 4.435, p = 0.031), high school education (β = 2.98, p = 0.048), and high fear rising FOP. Patients who had moderate financial stress (β = 2.51, p = 0.041), with or without children (β = 1.564, p = 0.003), primary/recurrence (β = -2.578, p = 0.005), less than 30 radiotherapy times (β = 0.979, p = 0.046) tended to report significant moderate-fear stable FOP over time.

CONCLUSION

42.64% of the NPC patients showed high-fear rising FOP over the 6 months after treatment. Age 18-30 years, with or without children, relapsed, diagnosis < 3 months, and high school education and reporting being a pessimist predicts higher FOP scores. Early identification of age 18-30 years, with or without children, relapsed, diagnosis < 3 months, and high school education might help to identify populations experiencing long-term FOP. Clinical teams responsible to develop the target interventions for management of FCR in clinical practice.

How Advanced Practice Nurses Can Be Better Managed in Hospitals: A Multi-Case Study

The labor markets for care professionals are a perennial topic of discussion. Advanced practice nurses (APN), as an advanced role in nursing, arose to solve the shortage of primary health care professionals. Prior research has advanced several areas of exploration for APNs' training or employing methods in Chinese hospitals. However, this leaves a key imperative unexplored: the management strategy of APNs in hospitals. The present study seeks to explore the management strategy of APNs in Chinese hospitals. The resource orchestration theory served as the guide as the multi-case study method investigated 18 case hospitals, gathered information from a variety of case data sources, and summarized the management strategies for hospitals' advanced practice nurses. Four types of APN management strategies-expert customized type, hierarchical linkage type, multidisciplinary benefit type, and professional penetration type-have been identified through resource orchestration. Hospitals can utilize the APN management strategy model as a guide to manage APNs in accordance with the unique characteristics of APN resources.