Course Of Cancer Treatment Research Articles

The Relationship between Pain Experience and Roy Adaption Model : Application of Theoretical Framework

Roy Adaptation Model (RAM) provides knowledge and broad understanding of the person as both a physiological being in a physical world and thinking. According to RAM, the overall goal of nursing is to focus on promoting health of the individual and group by promoting adaptation in each of four adaptive modes: physiological-physical, selfconcept, role function, and interdependence. It could foster nursing knowledge through organized research and it could provide a more organized curriculum. The cancer patients who are under treatment with chemotherapy and radiotherapy may experience a physical selfdisruption such as fatigue, altered skin integrity, fluid and electrolyte imbalances and physical changes (hair loss). This experience in physiological changes may influence the role function of the patient (social interaction with peers) and changes in the interdependence mode (family); if the families understand how to support the patient, the patient may have an integrated adaptation level. By understanding the relationships among selfconcept, family functioning, functional status, and psychological adaptation, the nurse can identify the factors that lead to mal adaptation, and supportive services can be implemented during the course of cancer treatment. Research that studied the experience of cancer-related pain confirmed that pain is a multidimensional symptom that consists of feelings of hopelessness, helplessness, emotional distress, and has a negative impact on coping mechanism. Also, cancer pain was confirmed by researchers as a complex phenomenon associated with adverse physiologic, psychosocial consequences, (depression, anxiety), cognitive, behavioral, and socio-cultural dimensions. There are many factors associated with cancer related pain such as type of cancer, stage of disease, type of treatment received and location of cancer. Such findings have raised the importance for researchers to study the experience of cancer related-pain in a comprehensive approach using the multidimensional aspects of cancer pain experience.

Construções de significados acerca do adoecimento e morte nas narrativas de crianças com câncer

As narrativas surgem para ordenar a experiência humana alterada pela ruptura no seu estado canônico. Nesse sentido, uma doença como o câncer pode ser considerada uma experiência excepcional, que requer a narrativa para significá-la. Esse estudo investigou a construção de significados acerca do adoecimento e da morte nas narrativas de crianças com câncer em etapas distintas do tratamento. Para tanto, foram realizadas seis sessões de brincadeira com cada participante. A análise dos dados demonstrou que crianças com mais tempo de tratamento tendem a finalizar suas narrativas com a morte dos personagens e que crianças com menos tempo de tratamento apresentam narrativas relacionadas ao desconforto físico que o tratamento ocasiona e aos impedimentos que a doença acarreta em suas vidas. Esses resultados apontam para a necessidade de uma maior atenção à forma como as crianças falam do seu adoecimento e da subsequente possibilidade de morte no decorrer do tratamento oncológico, a fim de que possamos atentar para a diversidade dos momentos de tratamento, compreendendo que esses configuram diferentes relações subjetivas da criança para com sua doença e a morte.

The impact of comorbidity on cancer survival: a review

BackgroundA number of studies have shown poorer survival among cancer patients with comorbidity. Several mechanisms may underlie this finding. In this review we summarize the current literature on the association between patient comorbidity and cancer prognosis. Prognostic factors examined include tumor biology, diagnosis, treatment, clinical quality, and adherence.MethodsAll English-language articles published during 2002–2012 on the association between comorbidity and survival among patients with colon cancer, breast cancer, and lung cancer were identified from PubMed, MEDLINE and Embase. Titles and abstracts were reviewed to identify eligible studies and their main results were then extracted.ResultsOur search yielded more than 2,500 articles related to comorbidity and cancer, but few investigated the prognostic impact of comorbidity as a primary aim. Most studies found that cancer patients with comorbidity had poorer survival than those without comorbidity, with 5-year mortality hazard ratios ranging from 1.1 to 5.8. Few studies examined the influence of specific chronic conditions. In general, comorbidity does not appear to be associated with more aggressive types of cancer or other differences in tumor biology. Presence of specific severe comorbidities or psychiatric disorders were found to be associated with delayed cancer diagnosis in some studies, while chronic diseases requiring regular medical visits were associated with earlier cancer detection in others. Another finding was that patients with comorbidity do not receive standard cancer treatments such as surgery, chemotherapy, and radiation therapy as often as patients without comorbidity, and their chance of completing a course of cancer treatment is lower. Postoperative complications and mortality are higher in patients with comorbidity. It is unclear from the literature whether the apparent undertreatment reflects appropriate consideration of greater toxicity risk, poorer clinical quality, patient preferences, or poor adherence among patients with comorbidity.ConclusionDespite increasing recognition of the importance of comorbid illnesses among cancer patients, major challenges remain. Both treatment effectiveness and compliance appear compromised among cancer patients with comorbidity. Data on clinical quality is limited.

Resveratrol enhances ionizing radiation-induced premature senescence in lung cancer cells

Radiotherapy is used in >50% of patients during the course of cancer treatment both as a curative modality and for palliation. However, radioresistance is a major obstacle to the success of radiation therapy and contributes significantly to tumor recurrence and treatment failure, highlighting the need for the development of novel radiosensitizers that can be used to overcome tumor radioresistance and, thus, improve the efficacy of radiotherapy. Previous studies indicated that resveratrol (RV) may sensitize tumor cells to chemotherapy and ionizing radiation (IR). However, the mechanisms by which RV increases the radiation sensitivity of cancer cells have not been well characterized. Here, we show that RV treatment enhances IR-induced cell killing in non-small cell lung cancer (NSCLC) cells through an apoptosis-independent mechanism. Further studies revealed that the percentage of senescence-associated β-galactosidase (SA-β-gal)-positive senescent cells was markedly higher in cells treated with IR in combination with RV compared with cells treated either with IR or RV alone, suggesting that RV treatment enhances IR-induced premature senescence in lung cancer cells. Comet assays demonstrate that RV and IR combined treatment causes more DNA double-strand breaks (DSBs) than IR or RV treatment alone. DCF-DA staining and flow cytometric analyses demonstrate that RV and IR combined treatment leads to a significant increase in ROS production in irradiated NSCLC cells. Furthermore, our investigation show that inhibition of ROS production by N-acetyl-cysteine attenuates RV-induced radiosensitization in lung cancer cells. Collectively, these results demonstrate that RV-induced radiosensitization is associated with significant increase of ROS production, DNA-DSBs and senescence induction in irradiated NSCLC cells, suggesting that RV treatment may sensitize lung cancer cells to radiotherapy via enhancing IR-induced premature senescence.

Predictors of falls among community-dwelling older adults with cancer: results from the health and retirement study

Cancer symptoms and the side effects of its treatment can increase the risk of falling among older adults with cancer. This study aimed to identify predictors of falling and recurrent falls among community-dwelling older adults with cancer over a 2-year period. Data from the Health and Retirement Study were used (N = 1,630) in this study. The sample had a mean age of 75 years and was mostly female (53 %) and white (89 %). Descriptive analyses, correlation analyses, and logistic regressions were used to analyze the data. The results showed that functional limitations (OR = 1.13, 95 % CI = 1.03-1.24), the full-tandem stance (OR = 1.48, 95 % CI = 1.01-2.16), and self-reported difficulties with balance (OR = 1.50, 95 % CI = 1.23-1.83) at time 1 were significant predictors of falling at time 2. Only difficulties with self-reported balance (OR = 1.84, 95 % CI = 1.44-2.36) at time 1 were found to be a predictor of recurrent falls at time 2. The consequences of falling can complicate the course of cancer treatment. Measures of functional limitations and balance have the potential to be quick and useful clinical tools to detect falling among seniors with cancer living in communities.

Relationships Among Therapy-Related Symptoms, Depressive Symptoms, and Quality of Life in Chinese Children Hospitalized With Cancer

Recent advances in cancer screening and treatment have resulted in a decrease in mortality rates in children and adolescents. However, despite the improved prognosis, the course of cancer treatment continues to be a very stressful experience in the life of a child. The objectives of the study were to assess the occurrence and severity of treatment-related symptoms manifested by children and adolescents undergoing active cancer treatment and to examine the relationships between therapy-related symptoms, depressive symptoms, and quality of life of these pediatric patients. A cross-sectional study design was used, and 135 Hong Kong Chinese children (9- to 16-year-olds) who were admitted for treatment of cancer in a pediatric oncology unit were invited to participate in the study. Results indicated that children and adolescents receiving combined cancer treatment generally experienced greater symptom occurrence and severity. In addition, children reporting greater symptom occurrence and severity experienced higher levels of depression and a lower level of quality of life. The study revealed that therapy-related symptoms are a strong predictor of quality of life of children and adolescents hospitalized for cancer treatment. Cancer and its treatments significantly affect the psychosocial well-being and quality of life of children and adolescent hospitalized for cancer care. Therapy-related symptoms can be a useful indicator for screening those pediatric patients who are likely to exhibit psychosocial distress or are at high risk of depression. It is essential for nurses to be sensitive and knowledgeable about the therapy-related symptoms of cancer treatment and their effects on children and adolescents to promote the psychosocial well-being of these patients and enhance their quality of life.

Impact of palliative care on end-of-life management of cancer patients dying in the hospital.

e20613 Background: A substantial number of cancer patients receive inpatient care at the end-of-life (EoL). Involvement of palliative care teams during the course of cancer treatment has been shown to improve quality of life (QoL) in cancer patients. In this study, we compare the EoL care of cancer patients dying in the hospital under medical oncology (MO) and palliative care (PC) services. Methods: A retrospective review of medical records of adult cancer patients who received chemotherapy during their illness and died in our hospital between January 2010 and January 2012 was conducted. The quality metrics measured as endpoints were: chemotherapy given within 21 days of death, death in the ICU, CPR at time of death, and time from last chemotherapy to death (TLCD). These endpoints were compared between patients who died under the MO service (cohort A) and those dying under PC service (cohort B). Chi-square test and T-test were used to compare the endpoints between the two cohorts. Results: Of the 106 cancer patients who died in the hospital, 40 and 66 were in cohorts A and B respectively. 30% of all patients were 65 years of age or older, and were equally distributed between the two cohorts. Patients in cohort A were more likely to receive chemotherapy within last 3 weeks of life (27.5% versus 7.5%, p=0.012, 95% CI 4.16-37.15), to have CPR at time of death (15% versus 0%, p=0.005, 95% CI 4.2-29.8) and to die in the ICU (52.5% versus 1.5%, p=<0.001, 95% CI 33.3-67.1) as compared to patients in cohort B. The average time from last chemotherapy to death was significantly longer (221 days) for cohort B patients as compared to cohort A patients (96 days), p=0.01. Patients in cohort A who had PC consultation during their hospitalization had no differences in the measured endpoints when compared to patients in cohort B. Conclusions: Cancer patients who die in the hospital while under MO service without PC involvement tend to have more aggressive EoL care. This may impact negatively on some QoL features. Early referral to palliative care services may facilitate better understanding and fulfillment of the needs of cancer patients and their caregivers by the healthcare-providers.

Prospective Evaluation of Patients with Early-/Intermediate-stage Hepatocellular Carcinoma with Disease Progression Following Arterial Locoregional Therapy: Candidacy for Systemic Treatment or Clinical Trials

PurposeDuring the course of cancer treatment, patients whose disease progresses despite therapy are offered alternative options. Similarly, patients with hepatocellular carcinoma (HCC) whose disease progresses following arterial locoregional therapies (LRTs) cross over to undergo systemic therapies or participate in clinical trials. Per current guidelines, patients must meet inclusion criteria (most importantly Child–Pugh class A status) to qualify for systemic options. The present study analyzed the candidacy for systemic agents or clinical trials of patients whose disease progresses despite LRTs. Materials and MethodsA total of 245 patients with HCC were treated with LRTs (chemoembolization, n = 123; yttrium-90 [90Y] radioembolization, n = 122) as part of a previously published comparative effectiveness study; 96 patients exhibiting disease progression were followed prospectively. Modes of progression (cancer stage, Child–Pugh class) were analyzed to determine candidacy for systemic therapy or clinical trials, as well as assess ultimate treatment(s) received. ResultsAmong the 96 patients with disease progression, 52% and 48% had Child–Pugh class A and class B/C disease, respectively, thereby substantially limiting the latter group’s eligibility for systemic therapy and/or clinical trials. Of those whose disease progressed who had advanced-stage HCC, 63% had Child–Pugh class B/C disease. By size and necrosis criteria, the local disease progression rate was higher with chemoembolization than with 90Y radioembolization (P = .006 and P = .016, respectively). Of the 96 patients with disease progression, only 13 (13%) ultimately received systemic agents or entered clinical trials. ConclusionsMost patients with advanced HCC that progresses following LRTs were not candidates for clinical trials or systemic agents. There is a need for future research efforts directed at treatment options or novel trial designs that will permit inclusion of patients with progressive liver disease and suboptimal liver function.

Prevention of Depression Using Escitalopram in Patients Undergoing Treatment for Head and Neck Cancer

Major depressive disorder develops in up to half of patients undergoing treatment for head and neck cancer resulting in significant morbidity. Preventing depression during the course of cancer treatment may, thus, be of great benefit. To determine whether prophylactic use of the antidepressant escitalopram would decrease the incidence of depression in subjects receiving primary therapy for head and neck cancer.

The Influence of Radiation Therapy on Dental Implantology

Patients with a history of head and neck cancer resection require extensive prosthodontic rehabilitation following cancer treatment. The oral anatomy drastically changes from ablative therapy, and the oral tissue response becomes altered as a consequence of radiation and chemotherapy. Successful restoration of oral function in this specific patient population was increasingly difficult before the widespread use of dental implants. Implant-borne prosthetics are now often used. However, surgical guidelines remain unclear with regard to oncology-related parameters. In this article, guidelines are introduced for implant therapy in the cancer patients according to radiation dosage and timing. Indications for hyperbaric oxygen treatment are highlighted along with risk assessment associated with implant placement. These guidelines are intended to augment knowledge obtained through oncology consultation; moreover, provide a rationale for implant therapy within the course of cancer treatment.

Abstract P1-07-12: Using Natural Language Processing to Identify and Extract HER2 Value from a large EMR system

Abstract Background: HER2 status is important in breast cancer prognosis but has not been well collected in NCI-SEER affiliated cancer registries until recent years. For example, in a cohort of 2,846 women who were diagnosed with breast cancer from 1997 to 2011 in a large health plan, only 49% of these patients had known HER2 status. However, many of these with missing HER2 status were documented in clinical notes. This study used Natural Language Processing (NLP) technology to identify and extract HER2 status. NLP results were validated by comparison with cancer registry data and any discrepancies were manually reviewed. Method: We assembled a cohort of 2,846 breast cancer patients from the membership of a health plan based in southern California, Kaiser Permanente. All free text notes including pathology reports, progress notes, and discharge summaries were extracted from our electronic medical record (EMR) system. A window of 9 months before and after the diagnosis date was applied to restrict the number of notes needed to be processed. Overall, 513,903 clinical notes were processed and indexed, which averages to 180 notes per patient. Separate ontologies were created for the HER2 terminology and HER2 status. HER2 status values included positive, negative, borderline, test performed and test not performed. The NLP system employed additional components such as spelling correction, acronym recognition and negation identification. The output from the NLP system was further processed in three steps: Identification of the HER2 concept, followed by extraction of the most likely HER2 value, and lastly, a decision module to select the most likely HER2 value if there were conflicting values. Results: Use the cancer registry data as the gold standard, for positive and negative HER2 values, the sensitivity and specificity of the NLP algorithm were 94.7% and 93.3%, respectively, including the cases where NLP did not select either positive or negative values. A manual chart review was performed on the discrepant cases. We found that the NLP were correct for many of these cases. For example, out of the 39 NLP positive but registry negative cases, 4 were false positives and 35 were true positives. Compared to the cancer registry data, NLP increased capture of positive and negative HER2 cases from 49% to 73% of the cohort population. Discussion: NLP provides the opportunity to process clinical notes which are added to the EMR after the cancer registry has completed documenting the patients' initial course of cancer treatment. On the other hand, NLP was not able to access some of the HER2 related clinical notes. For example, according to our chart review, some notes were stored as scanned images and not retrievable. In addition, clinical notes with incorrect filing dates so patients without any diagnosis date were not processed. We also identified key challenges in determining HER2 results using NLP in this study. First, non-standard terminology for the HER2 receptor in the clinical notes hampered the NLP effectiveness. Second, clinicians described HER2 results in many different ways. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-07-12.

Abstract No. 240: Assessing clinical and imaging patterns of progression following locoregional therapy for hepatocellular carcinoma: candidature for systemic therapy or clinical trials

During the course of cancer treatment, patients who progress on a therapy are offered alternative options. Similarly, patients with hepatocellular carcinoma (HCC) who progress following transarterial locoregional therapies (LRTs) cross over to systemic therapies or clinical trials. Per current guidelines, patients must meet inclusion criteria (most importantly Child-Pugh A status) to qualify for these options. We analyzed the candidacy of patients progressing on LRTs for systemic agents or clinical trials. 245 HCC patients were treated with LRTs (chemoembolization: N=123, 90Y: N=122) as part of a previously published comparative study; (1) 96 patients progressed (chemoembolization N=54, 90Y N=42). Modes of progression, cancer stage, Child-Pugh class at the time of progression and clinical follow up were analyzed to determine candidacy for systemic therapy or clinical trials and to study the effect of LRTs on liver function. Of 96 progressing patients, 52% were Child-Pugh A and 48% were B/C, thereby excluding the latter group from systemic therapy and/or clinical trials. 63% of patients with advanced HCC (metastases, vascular invasion) at progression were Child-Pugh B/C. By size and necrosis criteria, the rate of local disease progression was higher with chemoembolization than Y-90 (p=0.006 and 0.016, respectively). Following LRTs, 81% of patients maintained or improved their Child-Pugh class at progression when compared with baseline. The majority of patients with advanced HCC are not candidates for clinical trials and systemic agents at the time of progression. 90Y leads to higher rate of local disease control and limits progression. LRTs do not affect liver function significantly as Child-Pugh class is maintained or improves in majority after treatment. Further research should be directed at finding new therapeutic strategies for patients who have progressive disease and suboptimal liver function.

Sexuality in patients undergoing haematopoietic stem cell transplantation

McKee and Schover have suggested that sexuality is an aspect of intimacy that is frequently compromised by cancer and its treatments. Cancer, both in terms of diagnosis and treatments, may have a dramatic impact on both intimacy and sexuality. There is a body of published research addressing sexual concerns among patients with prostatic, testicular, breast, and rectal cancers. This issue seems to be less well documented in patients who have undergone haematopoietic stem cell transplantation (HSCT). In this review, we seek to elaborate different points regarding sexuality and how it is affected in patients undergoing HSCT, with the aim of identifying optimum solutions for such patients in confronting such problems in the course of cancer treatment.

Abstract 4667: Prediagnosis body mass index and smoking in relation to colon cancer survival: The NIH-AARP Diet and Health Study

Abstract Modifiable lifestyle factors such as body mass index (BMI) and smoking have been related to risk of colon cancer incidence, but little is known the roles of these factors in colon cancer survival. Therefore, we examined associations between prediagnosis BMI and smoking and mortality among colon cancer survivors in the NIH-AARP Diet and Health Study, a prospective cohort study. Colon cancer cases were indentified through linkage of the cohort to state cancer registries which reported cancer diagnosis date, morphologic characteristic of cancer, and the initial course of cancer treatment. A questionnaire was administered to collect information about demographics, anthropometrics, diet, and lifestyle including smoking at study baseline (1995-96). Cox proportional hazard regression was used to estimate relative risks (RR) and 95% confidence intervals (CI). Multivariate models controlled for age at cancer diagnosis, calendar year of cancer diagnosis, sex, race, education, physical activity, self-rated health condition, personal history of diabetes and heart disease, diet quality, stage of cancer, and the initial cancer treatments. From 1995 to 2005, we identified a total of 4,675 incidence colon cancer cases (3,131 men and 1,544 women) among 497,557 men and women who were free of cancer and 50-71 years old at baseline. Mean age at colon cancer diagnosis was 68.7 years. Mean time from baseline to colon cancer diagnosis was 4.8 years. During follow-up of colon cancer cases up to 10 years (mean =3.7 years), 1,275 people died: 911 people died of colon cancer (mean age at death = 72.4 years). Most colon cancer cases were localized (n=1,118) or regional (n=1,189) and had surgery as the first treatment: 2,705 cases had surgery only and 1,127 cases had surgery with other treatments. We found that prediagnosis BMI was not associated with total and colorectal cancer mortality in colon cancer survivors. Compared to BMI 18.5-<25, relative risk (95% CI) of total mortality was 1.30 (0.73-2.33) for BMI <18.5, 1.03 (0.89-1.18) for BMI 25-<30, and 1.03 (0.88-1.21) for BMI≥30. On the other hand, prediagnosis smoking was related to a significantly higher risk of total and colon cancer death. Compared to never smokers, former smokers had a 17% increased risk of total mortality (RR=1.17, 95% CI:1.02-1.33) and current smokers had a 85% increased risk of total mortality (RR=1.85, 95% CI:1.54-2.23). Similar results were observed for colon cancer death. In addition, the results were similar across categories of cancer stage, initial treatments, age at cancer diagnosis (<60, 60-<70 and 70+ yrs), and time from the study entry to colon cancer diagnosis (2-<5, 5-<8 and 8+ yrs). In conclusion, pre-cancer BMI was not related to colon cancer survival, but pre-cancer smoking was associated with a significantly higher risk of total and colon cancer mortality among colon cancer survivors. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4667. doi:10.1158/1538-7445.AM2011-4667

Quality of life during the course of cancer treatment in older newly diagnosed patients. Results of a prospective pilot study

BackgroundThe aim of this prospective study was to report the quality of life (QoL) of older cancer patients during the first year after diagnosis and factors influencing QoL. Patients and methodsNewly diagnosed patients aged ≥65 years were recruited for a pilot prospective cohort study at the Jewish General Hospital, Montreal, Canada. Participants were interviewed at baseline, and at 1.5, 3, 4.5, 6, and 12 months. QoL was assessed at each interview using the European Organization for the Research and Treatment of Cancer Quality of Life Core Questionnaire with 30 items. Logistic regression was conducted to determine which sociodemographic, health, and functional status characteristics were associated with decline in global health status/QoL between baseline and 12-month follow-up. ResultsThere were 112 participants at baseline (response rate 72%), median age of 74.1, and 70% were women. Between baseline and 12-month follow-up (n = 78), 18 participants (23.1%) declined ≥10 points in global health status/QoL, while 34 participants (43.6%) remained stable and 23 participants (33.3%) improved ≥10 points. None of the sociodemographic, health, and functional status variables were associated with decline in logistic regression analyses. ConclusionAlmost 25% of older adults experienced clinically relevant decline in their QoL. Further research is needed on which factors influence decline in QoL in older adults.

Editor’s Choice

Fatigue is such a widespread experience of both ill and otherwise well people that it is becoming known as the sixth vital sign. Indeed, virtually every woman who gives birth experiences some degree of postpartum fatigue, which has the potential to interfere with her and her family members’activities of daily living and the quality of the life of the expanding family. The study by Song et al. (2010) in this issue of JAN contributes substantially to understanding postpartum fatigue. Overall, their findings are generalizable to women worldwide, and the inclusion of satisfaction with Sanjujori–a form of postpartum care provided by non-professional caregivers in Korea–sensitizes us to the cultural context of postpartum fatigue. Researchers who are interested in postpartum fatigue might want to test Song et al.’s theory in other cultures to determine if concepts specific to those cultures are associated with postpartum fatigue. Researchers who are interested in fatigue experienced by people with diverse health conditions may want to use the Song et al.’s theory as a starting point for development and testing of fatigue theories that are specific to those health conditions. Inasmuch as cancer-related fatigue is arguably as intense as postpartum fatigue and may last much longer due to the prolonged course of cancer treatment, I encourage oncology nurse researchers to follow the theoretical lead provided by Song et al. Song et al.’s study joins a growing number of other explicit theory-generating and theory-testing studies that collectively represent the evidence needed to advance evidence-based nursing practice (see for example, Tsai et al. 2003, Sheehan et al. 2010). Descriptive theory-generating and theory-testing studies yield descriptive theories, which provide evidence for assessments of people’s health-related experiences. Correlational theory-testing studies yield explanatory theories, which provide evidence for more comprehensive assessments of people’s health-related experiences. Experimental theory-testing studies yield predictive theories, which provide evidence for nursing interventions directed toward improving people’s well-being. Hallmarks of Song et al.’s correlational explanatory theory-testing research are the careful explanation of the relation of each concept of their theory to other concepts and a sophisticated analysis of data using structural equation modelling that accounted for some concepts acting as mediators. Their findings revealed a more parsimonious theory than initially proposed, with some relations between some concepts found to be non-significant. It is, I believe, important to not leap to recommendations for experimental studies to test predictive theories of nursing interventions on the basis of the findings of correlational studies of explanatory theories. Instead, the logical recommendation stemming from any correlational study designed to test an explanatory theory should be comprehensive patient assessment. Accordingly, Song et al.’s study findings provide the evidence needed for comprehensive assessment of women during the postpartum to determine their level of fatigue and concepts that are associated with fatigue, especially postpartum depression and quality of sleep during the postpartum. Furthermore, inasmuch as Song et al. found that childcare stress, unsatisfactory infant feeding, infant difficulty, satisfaction with Sanjujor and social support were indirectly related to postpartum fatigue, a comprehensive assessment might also include those concepts. The instruments used by Song et al. to measure the theory concepts encompassed 61 items, which may be considered excessive for use in practice. Therefore, if clinicians find that so many items impose undue respondent burden in everyday practice, shorter forms of the instruments or other measures of the theory concepts could be developed. For example, a comprehensive assessment form could be made up of a one-item numerical rating scale or a visual analogue scale for each theory concept.

Blowing in the Wind: Unanchored Patient Information Work during Cancer Care.

Patients do considerable information work. Technologies that help patients manage health information so they can play active roles in their health-care, such as personal health records, provide patients with effective support for focused and sustained personal health tasks. Yet, little attention has been paid to patients' needs for information management support while on the go and away from their personal health information collections. Through a qualitative field study, we investigated the information work that breast cancer patients do in such 'unanchored settings'. We report on the types of unanchored information work that patients do over the course of cancer treatment, reasons this work is challenging, and strategies used by patients to overcome those challenges. Our description of unanchored patient information work expands our understanding of patients' information practices and points to valuable design directions for supporting critical but unmet needs.

The Impact of Cancer on Children's Physical, Emotional, and Psychosocial Well-being

The diagnosis and treatment of cancer are a stressful and threatening experience, which can be emotionally devastating to children. Despite the improved prognosis, the course of cancer treatment has tremendous impact on children. This article aims to examine the impact of cancer on physical, emotional, and psychosocial well-being of Hong Kong Chinese children, an area of research that has been underrepresented in the literature. Ninety-eight Hong Kong Chinese children aged 7 to 15 years, admitted for treatment of cancer in 2 pediatric oncology units of 2 different hospitals, were invited to participate in the study. Findings from this study indicated that the children scored considerably high state anxiety on admission, and more than half of the participants presented some depressive symptoms during their stay in the hospital. Moreover, semistructured interviews indicated that nearly all children expressed different degrees of sadness and worry. The findings suggested that there is a room for improvement in existing nursing intervention regarding preparing children for hospitalization and treatment of cancer. There is an imperative need for nurses to evaluate appropriate nursing interventions that can help children resume their normal growth and development, in particular, to help them ease the physical, emotional, and psychological burden of life-threatening disease.

Salvage of infected tumor prostheses

Limb salvage in oncologic surgery with endoprosthetic reconstruction results in infection in 5.7–15% of patients. These infections result in subsequent amputation in 46–87% of patients. Through literature review, we evaluated the statistically associated factors, treatments, outcomes and future trends regarding endoprosthetic infection. Infection was more prevalent in periacetabular and proximal tibial reconstructions. Coagulase-negative Staphylococcus was the most common pathogen in seven of eight case series. Factors associated with increased initial and persistent infection included myeloma, radiation therapy, poor soft-tissue condition, revision surgeries, and cementless fixation. Infection was noted to significantly increase 10-year survival in osteosarcoma patients. Recommendations on treatment were mixed, the only significant association with cure was early surgical intervention, and increased salvage rates were seen with both limited one-stage and extensive two-stage procedures. All studies agreed that clinicians and researchers should direct intensive efforts toward the prevention of infection. A number of recent studies showed promising in vitro and in vivo effects of antimicrobial implant surfaces, specifically silver and vancomycin, in retarding the establishment of periprosthetic infection. Infections of oncologic endoprostheses remain challenging problems, with no recent advances in the treatment of established infections. Associated factors have been established, although most are unavoidable in the course of cancer treatment. Most promise comes with the ongoing development of antimicrobial implant surfaces that aim to prevent the establishment and persistence of these difficult infections.

BRCA-FA Pathway as a Target for Anti-Tumor Drugs

Promising research on DNA repair signaling pathways predicts a new age of anti-tumor drugs. This research was initiated through the discovery and characterization of proteins that functioned together in signaling pathways to sense, respond, and repair DNA damage. It was realized that tumor cells often lacked distinct DNA repair pathways, but simultaneously relied heavily on compensating pathways. More recently, researchers have begun to manipulate these compensating pathways to reign in and kill tumor cells. In a striking example it was shown that tumors derived from mutations in the DNA repair genes, of BRCA-FA pathway, were selectively sensitive to inhibition of the base excision repair pathway. These findings suggest that tumors derived from defects in DNA repair genes will be easier to treat clinically, providing a streamlined and targeted therapy that spares healthy cells. In the future, identifying patients with susceptible tumors and discovering additional DNA repair targets amenable to anti-tumor drugs will have a major impact on the course of cancer treatment.