[Purpose] The purpose of this study is to clarify information and support needs regarding sexuality during the post-diagnosis and treatment period of young patients diagnosed with breast cancer and those with experience in treatment.

[Method] This descriptive study conducted qualitative and inductive analyses of the information obtained from interviews of nine patients from three hospitals that specialize in breast cancer surgery. All patients provided written informed consent for participation.

[Results] Information and support needs for sexuality in young breast cancer patients after diagnosis and during treatment were categorized into eight periods from notification to end of treatment, including: perioperative, chemotherapy, hormone therapy, radiation therapy and end of treatment. These comprised 135 codes, 40 subcategories, and 19 categories.

[Discussion] Patients’ physical, psychological, social, and spiritual needs change in response to treatment. Medical professionals need to provide information and support while taking into consideration the different stages of a patient's treatment.

[Conclusion] The sexuality-related information and needs of young women with breast cancer from diagnosis to the end of their treatment period were categorized into eight periods. This revealed the patients’ needs specific to each treatment period and the general needs recognized during all periods.

Aim: The aim of this study was to clarify the characteristics by age group of difficult cases as perceived by nurses in the care of adolescents and young adults (AYA) with cancer.

Methods: A cross-sectional study was conducted among nurses at Japanese designated cancer hospitals in 2016. We conducted a questionnaire survey about the most difficult cases as perceived by nurses in caring for AYA cancer patients. The study sample included nurses who had been working for more than 1 year in a department that treats or continuously observes 15- to 39-year-old cancer patients.

Results: Participants comprised 1,627 nurses. Difficulties were characterized as “notification of poor prognosis”, “support for patient decision-making” and “assurance of patient’s opportunities for education” for 15- to 19-year-olds, “refusal/drop-out of treatment” and “support for employment” for 20- to 24-year-olds, and “family relationships/family issues” for 25- to 39-year-olds.

Conclusion: The results of this study revealed that the types of difficulties recognized by nurses vary between age groups. Particularly in the terminal period, parental intentions might be prioritized in the case of 15-19 AYA cancer patients.

Hand-foot skin reaction (HFSR) is one adverse event that can occur following the use of tyrosine kinase inhibitor (TKI) for unresectable hepatocellular carcinoma. The HFSR incidence in each of the hands and feet is unclear. Therefore, the purpose of this study was to compare the incidence, symptoms, and time of HFSR occurrence between the hands and feet. This study aimed to provide evidence to support patients treated using TKI.

A cohort study was conducted with the approval of the Ethical Review Committee of the Graduate School of Nursing, Chiba University including patients to be treated with lenvatinib, sorafenib, and regorafenib for unresectable hepatocellular carcinoma. The patients were tracked for 2 months, and the skin symptoms on their hands and feet were surveyed. During the entire study period, the patients were asked about their subjective symptoms, and photographs of their hands and feet were taken at each hospital visit. Photographs of the hands and feet were checked for skin symptoms by three people, including a footcare expert nurse. The date of HFSR occurrence in each hand and foot was described using the Kaplan-Meier curve and analyzed using the log-rank test.

The HFSR incidence was 84% out of 58 patients who provided consent to this study conducted between September 2018 and March 2020. The most common symptom was skin peeling of the hands and feet, which was observed in 23% and 39% of patients, respectively. The median HFSR occurrence dates were 21 days for the hands (95% CI 17.6-24.3 days) and 13 days for the feet (95% CI 11.6-14.3 days), indicating that the feet had earlier HFSR (log-rank test p < 0.01).

This study indicated that observation of patients’ feet as well as hands is important for early detection of HFSR. Nurses are expected to check the patient's hands and feet from before the start of TKI treatment and then during every hospital visit, so that even small skin changes are not missed and patients are supported to receive appropriate treatment.

Purpose: Fear of cancer recurrence is common among survivors after treatment, and higher fear of cancer recurrence affects quality of life and well-being. However effective nursing interventions have not been identified. This study aimed to develop a complex nursing intervention for managing fear of cancer recurrence among breast cancer survivors and to investigate its effectiveness.

Methods: In this single-arm study, the breast cancer survivors attended a five-week program to promote stress management and symptom management and to adopt healthy behaviors. This comprised three support-group sessions and two one-to-one counseling sessions. The primary outcome was fear of cancer recurrence; secondary outcomes included quality of life and coping. Participants’ status was examined pre-intervention (T1), immediately post-intervention (T2), and three months post-intervention (T3).

Results: Twenty-two breast cancer survivors with fear of cancer recurrence from two outpatient facilities participated in the study. Fear of cancer recurrence significantly improved at T3 compared to T1; quality of life significantly improved at T2 and T3. No significant improvement was observed in coping scores.

Conclusions: The study showed positive results in breast cancer survivors' fear of recurrence and quality of life, suggesting that the complex nursing intervention program developed in this study may be useful in helping breast cancer survivors manage their fear of recurrence. Further studies are required to verify the intervention’s effectiveness.

To clarify cancer patients’ experience of dealing with reality after being notified of their cancer genomic profiling results which did not lead to new treatments, a qualitative descriptive study was performed. Semi-structured interviews were conducted with 10 cancer patients who had received cancer genomic profiling and had been notified that their results did not lead to new treatments. Their experience of dealing with reality after being notified of such results was summarized into the following 5 categories: accepting the results in a constructive manner by deeming that genetic information paves the way for future treatments, finding the situation acceptable because of one’s stable condition even without new treatments, controlling one’s emotional ups and downs by not clinging to something as a ray of hope, believing in oneself for having survived until now, and having people understand oneself as someone with no way out. Cancer patients’ experience of dealing with reality after being notified of their cancer genomic profiling results which did not lead to new treatments were characterized by “having fewer options, but feeling that one can live a little more” and “using one’s strength of fully understanding one's present self for emotional control”. The results suggest that these patients need to find circumstances that allow them to think about their future even in a severe situation, and medical staff need to promote their understanding of the characteristics of genomic profiling, understand their emotions, and continuously support them to help them deal with reality.

Purpose: The purpose of this study is to examine the reliability and validity of a scale that was created in the process of studying the sense of meaningful experiences by nurses in end-of-life care for cancer patients.

Methods: In the first study, the 37-item SMEEN, which had five factors, was developed based on a previous qualitative study. Then, in the second study, a self-administered questionnaire was sent to 1,304 nurses at 170 hospitals randomly selected from among the designated prefectural cancer treatment centers throughout Japan.

Result: The factor analysis confirmed, as did the first study, the 5-factor structure: realization of the meaning and role of care focusing on being together; learning and impressions of knowing various views of life; feeling of cohesiveness between the patient's family and the medical team; realization that they contributed to reduce total pain; and pursuit of care that better understands the client. The overall Cronbach's α was 0.95, and each sub-scale was 0.80 to 0.92, showing sufficient internal consistency. As a result of multi-trait scaling analysis, the validity of the construct was confirmed. A positive correlation with the satisfaction scale of nurses involved in end-of-life care and vigor in terms of the shortened version of POMS were observed. In addition, as a known population validity, nurses with experience in palliative care units and on palliative care teams scored significantly higher than the inexperienced.

Discussion: Adequate reliability and validity of the 37-item SMEEN was confirmed. By using this scale, it will be possible to grasp the actual situation and evaluate educational support that focuses on the positive aspects of the end-of-life nursing experience.

The objective of this study is to clarify the difficulties and coping strategies of premenopausal breast cancer patients undergoing endocrine therapy as well as their support during treatment. Semi-structured interviews were conducted with 14 outpatient premenopausal breast cancer patients who were undergoing endocrine therapy, and the results were qualitatively and inductively analyzed.

Six categories were derived as difficulties faced by premenopausal breast cancer patients who were undergoing endocrine therapy, including: physical symptoms that cause various types of pain resulting from endocrine therapy, suffering from an inability to control oneself, and an inability to fulfill the role of wife/daughter/mother. Four categories were derived as coping strategies for those difficulties, including: trying to positively apply meaning to and accept one’s situation and trying to endure loss, change, and suffering. Three categories were derived as support during endocrine therapy: feeling the presence of someone who has an interest in them, the desire to survive endocrine therapy, and the confidence that endocrine therapy can be continued]. Premenopausal breast cancer patients were able to continue treatment by devising ways to cope with difficulties whenever they emerged. Through their supporters, the patients developed the desire to survive and the confidence that endocrine therapy can be continued. It was shown that employing endocrine therapy for breast cancer over a long period of 10 years requires accurately assessing the patient’s condition in a short period of time, increasing the patient’s sense of self-efficacy for continuing treatment, and providing nursing assistance that actively engages with the patient’s difficulties that are hard to express.

Purpose: To explore how home-visit nurses support the administration of medication in older adult cancer patients undergoing oral chemotherapy.

Methods: Qualitative and descriptive research was conducted using semi-structured interviews with 14 home-visit nurses who had experience in providing home nursing care to older adult cancer patients undergoing oral chemotherapy in their own homes. A thematic analysis was used to analyze the interview data.

Results: Three themes were identified in this study: medication assistance as a secondary purpose, exploring the meaning of treatment for patients, and doing the best within set limits.

Conclusions: Home-visit nurses prioritized relationship-building with older adult cancer patients, emphasized respect for the patients’ autonomy and maintaining their lives at home, and gave support for medication administration, which was regarded as a secondary matter. Additionally, home-visit nurses maintained their stance of searching for the underlying intentions of the patients and exploring the meaning of treatment for patients, even while facing conflicts with applying treatment for older adult cancer patients. They tried their best within set limits by incorporating medication into the patients’ lives, building a network for risk, and taking action to defend the patients.

The purpose of this study was to clarify elements of nurses’ sense of difficulty when caring for patients with malignant fungating wounds (MFWs).

We previously asked 14 nurses with experience of MFW care to recall the settings of such care, and describe them in a survey form. Then, we conducted semi-structured interviews with these nurses using an interview guide, and qualitatively and inductively analyzed the obtained data. Elements of nurses’ sense of difficulty when caring for patients with MFWs were classified into 41 codes, 15 sub-categories, and the following 6 categories: “being threatened by the visualized cancer destroying the human body”, “facing the limitations of measures to reduce the uncontrollable odor of MFWs”, “being fearful of the possibility of hurting patients’ self-esteem”, “finding the hardships patients are facing due to MFWs unimaginable and heart-wrenching”, “hesitating to adopt psychological approaches for patients who are in dire straits struggling to be freed from MFWs”, and “feeling pressured by wound care, where errors are not allowed, as they directly lead to mental anguish”.

These elements of nurses’ sense of difficulty were characterized by their perception that MFWs, which destroy the human body, are shocking and threatening to themselves. The nurses were fearful of the possibility of their statements and behaviors hurting patients, who desperately struggle to be freed from MFWs and survive. Although they desired to help patients suffering from such a condition feel relieved in daily life, they faced difficulty due to specialization needed, and such distress was suggested to be an element of their sense of difficulty.

This study aimed to identify the experiences of patients with cancer with permanent gastrointestinal stomas regarding their employment in each period of time from before stoma creation to after the resumption of employment and examine the nursing support for their employment for each time period.

Interviews with 11 subjects were analyzed qualitatively and descriptively to extract the codes, subcategories, and categories for before the stoma creation and before and after resumption of employment.

Regarding the work-related experiences of patients with cancer with permanent gastrointestinal stomas, five categories were identified for before stoma creation, which included “judged whether to continue working based on the image and values of the cancer and stoma.” For before resumption of employment, there were seven categories, including “judged whether to resume work based on the current situation,” and “unable to imagine how the cancer treatment and stoma would affect employment and anxiety.” For after the resumption of employment, seven categories were obtained, which included “constant anxiety and tension at work due to concerns regarding fecal leakage and odor.” In addition, the respondents underwent cancer treatment while taking care not to inconvenience those involved at their work during the entire treatment period. Further, they communicated about their cancer and stoma to those involved at work from time to time and received support regarding their resumption of work.

Based on these findings, we believe that working patients with cancer with permanent gastrointestinal stomas require support for providing information on their cancer treatment and the impact of the stomas on employment before stoma creation. In addition, support should also be provided for establishing self-care measures for the side effects of their cancer treatment and stoma management at work before resumption, and for reducing anxiety and tension regarding fecal leakage and odor after resumption.

Purpose: To clarify the actual consultation support provided by oncology certified nurse specialists at cancer counseling support centers to advanced cancer patients and their families when choosing the place of end of life care at the time of treatment discontinuation.

Method: Semi-structured interviews were conducted with 10 specialist cancer nurses with more than five years of experience as specialist nurses and more than one year of consultation support experience, and the data were qualitatively analyzed.

Results: The actual consultation support provided by specialist cancer nurses consisted of the following: Inferring the complex nature of and true feelings of patients and their families regarding the discontinuation of cancer treatment; predicting possible future symptoms and time remaining from pathological conditions and ADL; helping patients and their families understand the current situation; bridging perception divides between the people involved with the patient; accepting feelings and prioritizing psychological well-being over providing information; respecting the patient’s way of life and strength, and confirming their intentions about how to spend the time available to them; formulating strategies while considering the effects of consultation support for patients and families and the maximum functionality of team medical care; and supporting patients and families based on the beliefs and ethical values of a specialist cancer nurse.

Discussion and Conclusions: Specialist cancer nurses helped cancer patients face their prognosis and make decisions about how to spend the time available to them while predicting their remaining time. Based on the best possible QOL of the patient and family, it was suggested that the final medical treatment support system should be adjusted in a way which respects the patient's decision-making from the projected time remaining as a means of support for the patient to live their remaining days with a sense of conviction.

The purpose of this study was to elucidate the nature of the intentional involvement of oncology nurse specialists with end-of-life cancer patients who are aware of dying. We conducted semi-structured interviews with 10 oncology nurse specialists and analyzed the data obtained by qualitative induction. As a result, “Commit myself to the patient,” “Always face the patient with an unwavering resolve,” “Sharpen awareness and sense the patient’s messages,” “Accompany the patient on the journey to the end of life,” “Protect the things that are important to the patient until the end,” “Guide the patient in a way that enables the patient to proceed on his/her own,” “Strengthen cooperation with people who support the patient,” and “Provide underlying care,” were concluded to be intentional involvements of oncology nurse specialists with end-of-life cancer patients who have become aware of dying. The characteristics of the involvement of the oncology nurse specialists were concluded to be: (1) a constant unwavering attitude and resolve, while committing oneself to patients who are aware of dying, (2) an awareness of playing the role of a companion on the patient’s journey to the end of his/her life, (3) support that leads to the completion of the patient’s life in the patient’s own way, and (4) involvement built on underlying care. In addition, the results suggested that opportunities for education by oncology nurse specialists and developing and strengthening the surrounding support system are needed to train nurses who are capable of staying involved with their patient until the end of the patient’s life.

This study aimed to clarify advanced hepatobiliary pancreatic cancer patients’ experiences during the chemotherapy treatment and recuperation processes when a cure is unlikely to be achieved.

Eighteen patients with primary hepatobiliary pancreatic cancer at the Department of Oncology of a metropolitan university hospital were included in the study. Interviews were conducted, and data were analyzed using a grounded theory approach. From the 31 total categories, five core categories were extracted: being caught in an unusual situation, receiving multiple announcements in addition to the name of the disease, continuing to search for a satisfactory conclusion while ill, continuing to move forward following a guiding light called chemotherapy and painfully realizing that one is on the borderline between life and death.

The results revealed that patients receive severe cancer announcements and are looking for a specialized hospital that can provide a satisfactory diagnosis and treatment without support from medical professionals. Furthermore, the analysis revealed that patients are deeply distressed amidst the ups and downs of treatment effectiveness. The treatment and recuperation process changed over time, with these phases: the period before cancer detection, the period of diagnosis and notification, the period of seeking treatment, the treatment period, and the treatment modification period —each corresponding to the five core categories.

Regarding nursing support, a system should be established that enables patients to receive a prompt and accurate diagnosis. In addition, when there are fluctuations in treatment efficacy, nurses must listen to the patient's thoughts, support continued treatment, and remain actively involved to ensure that treatment does not end abruptly.

This study aims to elucidate the process of women undergoing areola and nipple reconstruction after a mastectomy. Semi-structured interviews were conducted with seven subjects who underwent nipple-areola reconstruction, which were then analyzed qualitatively and descriptively. The core category of identity as women with breast cancer reconstituted by areola reconstruction was extracted from the experience of women who underwent mastectomies. First, they were “disappointed about having mastectomies at an early stage of the disease”, but “decided to have a total mastectomy to prevent metastasis and recurrence.” Further, they had a “feeling of loss and discomfort,” and felt “they can’t show their breasts” at public baths or during hobbies. They engaged in self-exploration and oriented themselves. Those who had undergone nipple and areola reconstruction have a sense of value in having breasts with nipples and areolas. “It gave them support after the physical, mental, and economic burden of breast cancer treatment.” They underwent areola and papilla reconstruction to repair and maintain themself as a woman through habits and the continuation of their social life. After the areola and papilla reconstruction, “they didn’t have to worry about the scars from the mastectomy,” and “when viewed from a distance, their breasts looked natural.” As a result, they could live their lives without a sense of awareness of what other people think or that they had lost their breast due to cancer.