Abstract

The purpose of this study was to clarify the experiences of elderly patients receiving stereotactic radiotherapy for lung cancer without operative indication and review the necessary nursing practices.

Semi-structured interviews of 9 elderly patients receiving stereotactic radiotherapy for lung cancer without operative indication and an analysis using Krippendorff’s method for content analysis revealed that the experiences of elderly patients receiving stereotactic radiotherapy for lung cancer without operative indication could be classified under 6 main headings: “cannot entirely give up the hope to have surgery,” “appreciating the availability of a therapy that replaces surgery despite old age,” “counting on stereotactic radiotherapy, which replaces surgery, believing in a cure,” “prepared to gratefully accept undesired effects, posttreatment complications and discomfort during treatment if there is no other treatment option but stereotactic radiotherapy,” “afraid that even healthy cells might be destroyed by radiation,” and “cannot fully trust the effects of stereotactic radiotherapy.”

The first step as a nursing practice for the elderly patients receiving stereotactic radiotherapy for lung cancer without operative indication is to support the completion of treatment for the patients who are counting on stereotactic radiotherapy although they are unable to give up their desire and hope for surgery. However, when a patient is unable to achieve the desired therapeutic effect or pneumonitis develops after treatment, the latent, lingering desire and hope for surgery may trigger their resentment for being judged to have no operative indication to manifest. Then support would be needed in order to encourage reassure of their abilities by having them review their own lives in which they have overcome many hardships, allowing them to overcome this situation. In addition, the necessity of support for dispelling the fear of radiation, and of continuing nursing care during office visits and by telephone was suggested.

Abstract

The purpose of this study was to clarify the coping processes for psychosomatic tension and tension alleviation of cancer patients undergoing ambulatory chemotherapy, and to obtain suggestions for nursing practices that promote tension alleviation. The subjects were eight cancer patients undergoing ambulatory chemotherapy. Data was collected through participant observation and semi-structured interviews. The data was then analyzed using a modified grounded theory approach.

As a result, the coping processes for psychosomatic tension and tension alleviation of cancer patients undergoing ambulatory chemotherapy could be divided into two core categories: “becoming aware of psychosomatic tension while conscious of various somatic sensations” and “being subjected to psychosomatic tension alleviation strategies while heading towards tension alleviation.” In this process, if patients had “large-amplitude, repeated somatic sensations that cannot be explained by a single cause and effect,” some of them experienced an “emergence of psychosomatic tension” due to “being aware of changes in somatic sensation and behavior,” “changes in everyday life taking place,” and “being informed by others of changes in behavior and appearances” while others would “live without being aware of psychosomatic tension.” In both cases, the patients experienced alleviation of psychosomatic tension through “repeated evaluation while feeling alleviation.” This was made possible by using the following somatic sensation coping strategies: “perform the same alleviation methods used before the beginning of ambulatory chemotherapy”; “use the passive methods selected without resistance”; “control speech and behavior so the patient remains unstimulated”; “create time and space for shifting their interest outward”; “utilize connections with people with the same experiences”; “prepare to face the next treatment.”

Based on these results, a need has been suggested for a nursing practice that helps patients become aware of their psychosomatic tension at an early stage.

Abstract

Pre- or postmenopausal women with breast cancer completed a self-administered questionnaire to observe changes in menopausal symptoms and quality of life （QOL） in the early phase of hormonal therapy. Data on menopausal symptoms and QOL were collected by mail at the start of hormonal therapy and at 1 and 3 months after starting therapy.

Of 41 eligible patients, 31 patients responded for all 3 questionnaires （response rate 75.6 ％）．A total of 30（73.2 ％） valid responses were obtained. The sample consisted of 15 premenopausal patients taking tamoxifen and 15 postmenopausal patients taking aromatase inhibitors. Two-way ANOVA followed by Dunnett’s test revealed that menopausal symptoms and QOL significantly worsened at 3 months （p ＜ 0.05 and p ＜ 0.01, respectively）． However, at this time, few patients experienced severe menopausal symptoms and no significant correlation was observed between menopausal symptoms and QOL（p = 0.054）．

The results of this study suggest that patients experience a deterioration of menopausal symptoms early after starting hormonal therapy. In addition, menopausal symptoms may deteriorate further in the following months during long-term therapy. QOL may correspond to these changes in menopausal symptoms. It is therefore crucial to assess patients’ symptoms at around 3 months. Nurses have an important role to play in preventing menopausal symptoms from deteriorating and in minimizing their impact.

Abstract

Objective：The present study aimed to investigate the effects of psychological nursing intervention for patients undergoing initial non-small cell lung cancer treatment.

Methods：A total of 18 men with stage III or IV non-small cell lung cancer were assigned to either the control or intervention group by stratified randomization using age and cancer stage. The intervention group received cognitive and emotional support from a certified palliative care nurse. The effects of intervention were measured using a cognitive appraisal scale, the mental adjustment to cancer scale, and the 30-item cancer quality of life questionnaire (QLQ―C30).

Results：The control group (n=10) comprised four stage III and six stage IV patients while the intervention group (n=8) comprised three stage III and five stage IV patients. While mean scores for “threat” and “anxious preoccupation” 1 month after the start of treatment increased in the control group, scores decreased in the intervention group (effect size per category, 0.62 and 0.64, respectively; both p＜0.05). Various items in “role functioning” observed on the QLQ―C30 improved in the intervention group (effect size, 0.59：p＜0.05).

Conclusion：The present findings suggest that psychological nursing intervention alters non-small cell lung cancer patients’ appraisals of their situation and is effective for promoting illness acceptance and treatment initiatives.

Abstract

This study implemented nursing interventions based on the Purpose in Life (PIL) test for outpatients with cancer undergoing radiation therapy, and examined their effects on quality of life (QOL) and psychological adjustment.

Outpatients with cancer undergoing radiation therapy were randomly assigned to a control group (20 patients) or to an intervention group (19 patients) as study participants. The PIL test was distributed to the intervention group at the start of radiation therapy and there was a dialogue between the researcher and the patient based on the results. The effects were examined at three stages (at the start of radiation therapy, at the end of therapy, and three months after the end of the therapy) with the Japanese versions of the Quality of Life Radiation Therapy Instrument (QOL―RTI) and Mental Adjustment to Cancer (MAC) questionnaires. The two-way mixed analysis of variance (ANOVA) was performed between the presence or absence of intervention (unpaired) and at certain times during the treatment process at the start of radiation therapy, the end of treatment, or three months after the end of treatment (paired). The results suggesed interaction had a significant effect on helpless/hopeless , a subscale of MAC, in all participants (p＜0.10). In the intervention group, helpless/hopeless tended to decrease with the beginning of radiation therapy. There were no significant effects of interaction in QOL―RTI. However, in patients with breast cancer, who accounted for 60％ of this study, significant differences were found regarding the interaction effects in the total QOL and spiritual/mental scores (p＜0.05). The intervention group showed improvement in QOL and mental and spiritual aspects after radiation therapy started. These findings suggest that the experience of mutually interactive dialogue between outpatients undergoing radiation therapy and researchers regarding their views on life, disease, or death helped decrease the helpless/hopeless feelings in patients. Furthermore, it demonstrated remedial effects on QOL and its mental and spiritual aspects in patients with breast cancer.

Abstract

The purpose of this study is to clarify the thoughts of families of patients undergoing extended radical surgery for cancer of the head and neck followed by reconstruction using free-tissue transfer. The close families of the head and neck cancer patients in postoperative acute phase, who face more problems associated with deterioration in communication competence and change of facial appearance compared to other cancer patients. Semi-structured interviews were conducted to collect the thoughts of the family dealing with surgery, which were analyzed using KJ method. The results from the interviews were labeled and coded. Consequently, five subcategories; “Peace”, “Relief”, “Joy”, “Gratitude” and “Sense of accomplishment” were summarized in positive thoughts. Similarly, seven subcategories; “Fear”, “Sadness”, “Sympathy”, “Confusion”, “Anxiety” and “Desire for empathy” in negative thoughts. From this study, it was found that the close families have many feelings they usually do not express, and they support the patients going through the high risk treatment with great efforts and self-control. The information gained in this study could be used to further develop appropriate help and support for both patients and their families.

Abstract

The purpose of this study was to explore patients’ experiences of hope in cases where multidisciplinary treatment of their cancer had not been effective. The study sought to describe the meaning of hope as a resource sustaining such patients.

Four patients aged from their 50’s to 60’s who were palliative care outpatients participated in this study and underwent semistructured interviews using open-ended questions. Data were then analyzed using the phenomenological method devised by Giorgi with the aim of extracting realistic comments regarding specific experiences.

From the data, the following picture emerged: Patients for whom multidisciplinary cancer treatment was no longer appropriate were equally aware of themselves as having ‘limited time’. The hope spoken of by subjects who were confronted by their ‘unique self-existence’ while knowing that they were drawing closer to their own death was meaningful in several ways, including ‘affirming being themselves’, making it possible for them to continue to be themselves; ‘attaching meaning to relationships’, which clarified the meaning of their own existence via others; and ‘expectations for a new future’ that were not affected by biological death. Hope with such meaning did not let patients lose sight of their own existence, while experiencing the loss and pain specific to cancer; this hope sustained them, allowing them to cope until the end of their life.

The above results suggest that when investigating nursing techniques to support hope in cancer patients, attention should be first paid to the ability to interact with self-existence, that is, ‘myself’ in such patients, rather than focusing on the hope expressed by patients themselves. Increasing this ability may open up the possibility of acquiring hope that will help patients live while facing inevitable death.

Abstract

The purpose of this study is to evaluate the protocol for acute adverse events associated with the radiation therapy of head and neck cancer patients.

This protocol was created to treat the patient according to the severity of acute adverse events including dermatitis through the assessment of the periodic oral cavity according to Eilers Oral Assessment Guide.

Subjects consisted of patients undergoing chemoradiotherapy for head and neck cancer.There were 24 patients in total, 12 before introduction of the protocol and 12 after the introduction. The average age was 66.8 years. After the protocol was introduced, water for gargling containing lidocaine started to be used 6.9 days earlier (p＜0.05) and meal type was modified 3.2 days earlier. On the other hand, the use of non-steroidal anti-inflammatory drugs (NSAIDs) for oral pain and sore throat began 2.0 days later (p=0.68). The rate of weight loss was 8.1% for the pre-protocol group and 6.5% for the post-protocol group (p=0.54). Ointments to treat dermatitis were used 6.6 days earlier in the post-protocol group (p＜0.05). The percentage of patients with Grade 3 dermatitis with 30 fractions of radiation decreased to 33% in the post-protocol group, compared to 66% for the pre-protocol group (p=0.16).

After the introduction of the protocol, regular observation and scoring of acute adverse events were performed, which led to earlier interventions. Consequently, we could complete radiotherapy with an interval of four days or less.

Abstract

Objective：The purpose of this study was to investigate the current situation of nursing care regarding depression in cancer patients, and to address issues related to nursing care.

Methods：The study was approved by the ethics board of the affiliated university．Data were collected by mail．We sent a questionnaire survey of 435 palliative care unit nurses in Japan．The questionnaire comprised the following：objective items related to depression (35 items)；subjective items related to depression (37 items)；communication skill (22 items)；balancing factors such as realistic perception of the event, adequate situation support, and adequate coping mechanisms (total 38 items)；years of nursing experience；years of palliative care practice, etc.

Results：Valid responses were obtained from 250 nurses (57.5％)．

1) More than 70％ of the nurses were aged 30～49．Their average number of years of nursing experience was 16.6 (SD ± 7.5), and their average number of years of palliative care experience was 5.1 (SD ± 2.8)．

2) More than 75％ of respondents answered “always” and “sometimes” to 32/35 objective items related to depression and 10/37 subjective items related to depression．

3) More than 75％ of respondents answered “always” and “sometimes” to 19/22 items regarding communication skill and “always” to 20/38 items regarding balancing factors.

4) Multiple regression analysis indicated that objective and subjective items related to depression were significantly associated with communication skill (β=0.247～0.414, p＜0.001).

Conclusion：These findings indicate that improvement of communication skills for listening to patients’ subjective views based on observation and sufficient objective observation are required for early detection of depression in cancer patients.