All head and neck cancer (HNC) patients receiving radiotherapy should have access to Speech and Language Therapy (SLT) for management of speech and swallowing(1).
A pilot SLT education group ...programme, was delivered over a 10-week-period in a radiation-oncology (RO) service in 2023 as part of a waiting-list initiative. The purpose was to increase timely access to SLT for HNC patients.
We aimed to evaluate the SLT pilot education group and make recommendations for future service delivery models.
HNC patients receiving radical radiotherapy (n=22) prioritised as low-risk SLT patients, attending for RO, were identified and invited to attend an SLT education session. High-risk patients requiring intensive SLT intervention e.g. hypo-pharyngeal cancer, advanced laryngeal cancer and T4 tumours were excluded.
Topics covered included an introduction to eating, drinking and swallow (ED&S) mechanisms, side-effects of radiotherapy and potential impact on ED&S, management strategies and prophylactic swallowing exercises. Sessions were interactive and patient information leaflets were provided. Invitations to attend additional sessions were extended; individual appointments were available on patient request.
Swallowing outcomes (The MDADI global score, EAT-10) and patient satisfaction levels were completed at the time of attendance.
Data was collected on patient demographics, treatment plans, attendance rates, admissions, patient self-report of dysphagia and impact on quality of life. Waiting-list times and cost savings were calculated.
The results demonstrated that 14 patients attended (64%) the offered education session (9 males; mean age 66.5, range 46-84 years)
The majority of patients had disease staging as ≤T2 (57%; 8/14). Attendees were heterogeneous with regard to tumour location (Table 1).
No patients requested individual appointments.
Of 14 attendees, 5 required inpatient admission (36%), compared to 6 (75%) patients who were invited and did-not-attend the education session.
Reason for admission analysis revealed all 5 attendees required admission for symptom control, chiefly pain management, nausea, constipation and weight loss. Requirement for NG feeding was stated in 3/5 (60%) cases. Inpatient NG insertion requirement in the non-attender cohort was 67% (4/6).
Treatment for pneumonia was required in 0% of cases.
Attendees were admitted later into their treatment (mean fraction at time of admission 32; range 28-35) when compared to non-attendees (mean fraction at time of admission 23.5; range 13-35).
The presence of oropharyngeal dysphagia as per self-report was identified in 8 (57%; EAT-10 score ≥3) attendees. However, the majority of attendees did not consider dysphagia as affecting quality-of-life (Mean MDADI global-question score of 3).
All attendees reported the education session as helpful, they planned to implement advice given and would recommend attendance to fellow-patients.
Seven patients received SLT input within local departmental standards (KPI of by 5 fractions). An additional 7 patients accessed SLT who would not have been seen due to service constraints. A further 8 patients would have received SLT guidance if they had attended the education session offered.
When comparing costings for individual versus group interventions, a saving of €482.46 could be made per group programme for a similar patient cohort(2). Display omitted
This waiting-list group initiative provided access to SLT for a cohort of low-risk HNC patients who would not have received guidance due to departmental service constraints.
This pilot study has shown that group interventions can be an effective way to introduce the role of SLT, deliver general patient education and introduce swallowing rehabilitation to this specific client group.
Preliminary findings suggest that this pilot waiting-list initiative was an effective medium to enhance patient experience and encourage patient autonomy and empowerment for HNC patients during their radiation-oncology journey.
However, this pilot programme was delivered to a low-risk HNC patient cohort and a similar approach may not be appropriate for HNC patients with more extensive disease where an individualised treatment programme is the gold-standard (3).
Group intervention can be a necessary solution to address service delivery demands in the existence of resource constraints. Nevertheless, the value, impact and effectiveness of tailored face-to-face SLT interventions with HNC patients who present with acute, chronic and complex ED&S needs cannot be underestimated(4, 5).
This initiative will continue and facilitate further analysis regarding admission avoidance, alternative feeding requirement and swallow function outcomes. Further analysis exploring rationale for nonattendance will assist with future programme design.
Data will also be used to assist with future service development, resource allocation and staff planning.
Introduction: Care for patients with oncology diseases is a specific area of competence in nursing. The nurse, as part of an interdisciplinary team, has an essential role in organizing, planning, ...implementing and evaluating the results of patient clinical care. The study aimed to investigate patients' and nurses' opinions on the role of the nurse-patient relationship in improving the quality of care. Material and methods: Data were collected by direct individual self-administered questionnaire among 49 nurses and a "face to face" semi-structured interviewwith 67 patients in five departments. Data were processed with the statistical program Microsoft Office Excel 2015 и SPSS v.21. Results: The idea of the therapeutic relationship "nurse-patient" was examined from the view point of both patients and nurses. More than half of the patients (53,7%) arrange as particularly important nurse skills to relieve physical pain, followed by 40,3% to inspire confidence and hope and 35,8% - the ability to listen and give advice. One in 10 patients expects to be included as a decision-making partner in planning care; every fifth patient expects information from the nurse according to her competence. Professional ethics and the relationship "nurse-patient" was evaluated by 55,2% of patients as excellent. All nurses (100%) underlie the principles of the therapeutic relationship, regardless of the length of the contact are respect, genuineness, empathy, active listening, trust, and confidentiality. Conclusion: The nurse-patient relationship is a common responsibility of both: nurses and patients. Both groups evaluated the importance of its components for mutual satisfaction in such communication.
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that is best treated in a multidisciplinary fashion using surgery, chemotherapy, and radiation. Adjuvant chemotherapy has shown to ...have a significant survival benefit in patients with resected PDAC. However, up to 50% of patients fail to receive adjuvant chemotherapy due to postoperative complications, poor patient performance status or early disease progression. In order to ensure the delivery of chemotherapy, an alternative strategy is to administer systemic treatment prior to surgery. Precision oncology refers to the application of diverse strategies to target therapies specific to characteristics of a patient’s cancer. While traditionally emphasized in selecting targeted therapies based on molecular, genetic, and radiographic biomarkers for patients with metastatic disease, the neoadjuvant setting is a prime opportunity to utilize personalized approaches. In this article, we describe the current evidence for the use of neoadjuvant therapy (NT) and highlight unique opportunities for personalized care in patients with PDAC undergoing NT.
Abstract
To examine the current situation of patient delay and to identify factors associated with patient delay among women with breast cancer in China.
A total of 283 women, aged 23 to 83 years old ...and with histologically confirmed breast cancer, were investigated in this cross-sectional study. The women were recruited from seven selected hospitals in Sichuan Province, China. Face-to-face interviews using a structured questionnaire were performed.
Among the 283 participants, the range of patient delay was 0.2 to 900 days with a median patient delay of 50 days. A total of 35.8% of patients waited ≥90 days to access medical treatment after symptom onset. Binary logistic regression analysis showed that the main predictors of patient delay were knowledge of breast cancer symptoms (OR = 0.716, 95%CI:0.637–0.804,
P
= .000), external health locus of control (OR = 1.173, 95%CI:1.087–1.266,
P
= .000), breast self-examination/physical examination (OR = 0.065, 95%CI: 0.007–0.590,
P
= .015), perceived health competence (OR = 0.873, 95%CI:0.808–0.944,
P
= .000), family support (OR = 0.911,95%CI:0.847–0.981,
P
= .013), pain stimulation (OR = 0.191, 95%CI:0.046–0.792,
P
= .023) and age (OR = 1.028, 95%CI:1.000–1.058,
P
= .049).
These factors explained 41.0% of the variance.
Information on the current situation and predictors of patient delay in Chinese women with breast cancer might provide meaning insights into the early diagnosis of breast cancer. The results of this study may help health professionals develop specific clinical practice strategies to reduce patient delay of initial treatment as a way to improve outcomes for women with breast cancer.
Oncology Patient Navigation Overview Gentry, Sharon
Journal of radiology nursing,
September 2023, 2023-09-00, Volume:
42, Issue:
3
Journal Article
Peer reviewed
Oncology navigation is defined as individualized assistance offered to patients, families, and caregivers to help overcome healthcare system barriers and facilitate timely access to quality health ...and psychosocial care from prediagnosis through all phases of the cancer experience. With the evolution of innovations in screening services, precision medicine in diagnostics, and advanced developments in cancer treatment, oncology patient navigation is a solution to this complexity as a health delivery support strategy that expands across the cancer care continuum to address fragmentation and assist in explaining the maze of information by enhancing patient shared decision making. Navigators are members of the oncology interdisciplinary team to help address oncology care fragmentation and promote delivery of a coordinated and seamless experience across the care continuum for patients. This personalized care strategy can be applied and impact all geographies where oncology care is provided and be a solution for the increasing health equity concerns among cancer patients. With ongoing evidence on positive patient experience, clinical outcomes and return on investment, navigation will continue to fit in with the quality value of future oncology as well as other chronic diseases.
Although many reports have already shown RSV outbreaks among hemato‐oncology patients, genomic studies detecting similar RSV strains prior to an outbreak in the hospital are rare. In 2014, the ...University of the Ryukyus hospital hemato‐oncology unit experienced, and successfully managed, a respiratory syncytial virus (RSV) nosocomial outbreak. During the outbreak investigation, genotyping and phylogenetic analysis was used to identify a potential source for the outbreak. Nasopharyngeal swabs were tested for RSV using three tests: (1) rapid antigen test (RAT); (2) reverse transcriptase polymerase chain reaction (PCR); or (3) quantitative PCR (RT‐qPCR); a positive PCR reaction was considered a confirmed case of RSV. Phylogenetic analysis of the G protein was performed for outbreak and reference samples from non‐outbreak periods of the same year. In total, 12 confirmed cases were identified, including 8 hemato‐oncology patients. Patient samples were collected weekly, until all confirmed RSV cases returned RSV negative test results. Median time of suspected viral shedding was 16 days (n = 5, range: 8‐37 days). Sensitivity and specificity of the RAT compared with RT‐qPCR were 30% and 91% (n = 42). Phylogenetic analysis revealed nine genetically identical strains; eight occurring during the outbreak time period and one strain was detected 1 month prior. A genetically similar RSV detected 1 month before is considered one potential source of this outbreak. As such, healthcare providers should always enforce standard precautions, especially in the hemato‐oncology unit.
Cancer is a leading cause of death worldwide, and most patients with cancer in South Korea die in hospitals. Oncology nurses experience physical, emotional, and occupational challenges associated ...with the psychological burden of caring for dying patients.
This study explored the coping strategies used by oncology nurses to deal with the psychological burden of patient deaths.
In this descriptive qualitative study, 10 oncology nurses who had recently experienced a patient's death were recruited via snowball sampling. All were female, with a mean age of 32.9 years (range, 27-44 years), and their mean working duration was 9.9 (range, 3-23) years. Participants were interviewed individually face-to-face 3 times, with each interview lasting 1 to 1.5 hours.
Oncology nurses coped with the psychological burden of a patient's death in the following 4 ways: ( a ) avoiding patient deaths to the extent possible, ( b ) reflecting upon the meaning of life and death, ( c ) suppressing their emotional distress over the patient's death, and ( d ) becoming kinder and more caring toward people around them.
The findings suggest that oncology nurses struggle to cope with the psychological burden of patient deaths. Oncology nurses are affected both negatively and positively by experiencing death as they provide end-of-life care.
Oncology nurses need education or counseling to reduce the psychological burden of caring for dying patients with cancer. Hospital administrators need to continuously identify ways to reduce the psychological burden of oncology nurses providing end-of-life care.
Abstract
Purpose
Initial experience with use of a smartphone application to enhance communication with and home monitoring of hematology/oncology patients under treatment with oral antineoplastic ...agents (OAAs) is described.
Summary
Broad use of OAAs is changing the landscape of hematology/oncology patient care, with this form of therapy giving patients greater autonomy but also raising concerns about correct OAA administration and management of adverse effects (AEs) or interactions. Information and communication technologies, specifically mobile health technologies, are ideal tools in this new environment. A multidisciplinary team at a large hospital in Spain developed a smartphone application for patients receiving OAA therapy that consists of 5 modules or functionalities: (1) a treatment agenda, or electronic journal of patient activity, including medication use; (2) a treatment record; (3) continuous recording of vital signs (blood pressure and temperature), health-related quality of life, and AEs, with management of AEs based on an algorithm that displays different recommendations according to AE severity; (4) 2-way messaging capability; and (5) information and links to websites of interest. From June through November 2017, 37 patients downloaded and used the application. About two-thirds (68%) of the patients sent a total of 182 messages to the pharmacist on duty; 58% of the patients registered at least 1 AE. The mean time of registration of the first AE after initiation of OAA therapy was 8 days. As a result of patient use of the application, 2 emergency room visits were avoided and 3 patients were referred to a general practitioner.
Conclusion
The application has allowed real-time monitoring of patients treated with OAAs. This new patient-pharmacist communication channel has facilitated the early detection of AEs, contributing to the safety of treatment and patient satisfaction with healthcare.
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