Cancer Nursing

Prevalence and Risk Factors of Urinary Retention in Patients With Cervical Cancer

Background The literature is inconsistent on the prevalence and risk factors of urinary retention in patients with cervical cancer. Objective The aim of this study was to review the literature on the prevalence of urinary retention in patients with cervical cancer and consolidate the risk factors. Methods For this meta-analysis, eligible articles published in English or Chinese by December 10, 2021, were systematically searched for and retrieved from PubMed, Cochrane Library, Ovid-Embase Medline, Web of Science, PsycINFO, CINAHL, and Scopus. Prevalence, odds ratios (ORs), and 95% confidence intervals (CIs) were used for meta-analysis. Results Twenty-five studies were included in the analysis. The pooled overall prevalence was 0.26 (95% CI, 0.21-0.30, I 2 = 95.0%). The identified risk factors were age (OR, 1.13; 95% CI, 1.08-1.19), urinary tract infection (UTI) (OR, 3.33; 95% CI, 1.48-7.49), surgical extent (OR, 2.95; 95% CI, 1.27-6.85), and catheter indwelling time (OR, 3.44; 95% CI, 2.43-3.87). Conclusions The prevalence of urinary retention in patients with cervical cancer is 0.26. Older age, UTI, longer catheter indwelling time, and a larger surgical extent may increase the risk of urinary retention. Clinicians should identify patients at risk and adopt interventions such as individualized catheter care. Implications for Practice Nursing staff should assess the risk of urinary retention in a patient with cervical cancer according to her age, presence of UTI, surgical extent, and catheterization time. A carefully chosen surgical procedure and interventions such as individualized education, timely catheter removal, treatment of UTI, and rehabilitation should be offered.

The Impact of Frailty on the Toxic Reaction of Chemotherapy in Patients With Cervical Cancer

Background Longitudinal research on the impact of frailty on chemotherapy toxicity in patients with cervical cancer is limited. Objectives To explore the impact of frailty on chemotherapy toxicity in patients with cervical cancer. Methods Two hundred fifty-nine postoperative cervical cancer patients from a hospital located in Northwest China were enrolled between July 2020 and December 2021. Participating patients were followed up for 4 chemotherapy cycles after surgery. Frailty was measured using the Tilburg Frailty Indicator. Chemotherapy toxic reactions were evaluated using the Common Terminology Criteria for Adverse Events 4.0. Repeated-measures analysis of variance and Cox regression analysis were used to analyze the effect of frailty on chemotherapy toxicity. Results Cox regression analysis showed that frailty could serve as an independent risk factor for total toxicity (hazard ratio [HR], 5.423; 95% confidence interval [CI], 3.260-9.023; P < .001), nausea (HR, 3.967; 95% CI, 2.446-6.433; P < .001), and vomiting (HR, 3.081; 95% CI, 1.921-4.942; P < .001). Repeated-measures analysis of variance showed that the white blood cell values of the frail group were lower than those of the nonfrail group ( F group effect = 4.172, P = .043), and the hemoglobin values of the frail group were lower than those of the nonfrail group ( F group effect = 6.589, P = .012). Conclusions Frailty can increase the risk of total chemotherapy toxicity, nausea, and vomiting. Frailty can reduce the white blood cell and hemoglobin values of postoperative adjuvant chemotherapy cervical cancer patients. Implications for Practice Findings may assist healthcare providers in taking effective measures to reduce the toxicity of chemotherapy.

The Effect of Decision Aid on Satisfaction With Decision and Anxiety Among Women With Abnormal Cervical Screening Results

Background Most women in the face of stressful situations such as risk of a cancer diagnosis (abnormal Papanicolaou smear results) need guidance to choose the appropriate method to follow the diagnosis process, but few studies have identified appropriate interventions to support these women. Objective To determine the effect of decision aid on anxiety and satisfaction with decisions (SWD) regarding the type of follow-up method after receiving an abnormal Papanicolaou smear result. Methods This interventional study was conducted on women referred to the oncology clinic in Tabriz, Iran. Women were assigned to the intervention (n = 27) and control groups (n = 27) in a ratio of 1:1 using blocked randomization. The intervention group received a decision aid booklet. Participants in both groups completed questionnaires assessing demographic and obstetric characteristics, anxiety, SWD, and shared decision-making before and after the intervention. Results The mean score for SWD in the intervention group was significantly higher than that in the control group after the intervention (median, 6.43 with 95% confidence interval of 3.11–7.76; P = .03). There was no significant difference between groups in the mean score of anxiety after intervention (median, 1.14; 95% confidence interval, −0.5 to 2.70; P = .19). Conclusion A decision aid can increase SWD among women with abnormal results in their cervical cancer screening. Implications for Practice It is recommended that healthcare providers use decision aid tools to support and guide patients.

From Probands to Relatives

Background The genetic risk communication from proband to relatives varies from family to family, and patients often need support with the communication of genetic test results and making decisions to manage hereditary cancer risks. Objective The aim of this study was to characterize the communication of BRCA1 or BRCA2 (BRCA1/2) genetic risk from proband to first-degree relatives (FDRs) using a social network framework. Methods We characterized network and nonnetwork factors to explore their association with which FDRs were told about the genetic risk and whether or not relatives underwent genetic testing. Ninety-two female probands with hereditary breast and ovarian cancer who have confirmed BRCA1/2 mutations participated in the study. Communication of hereditary breast and ovarian cancer risk was assessed between 92 probands and their 417 FDRs. Results Of 92 probands, 94.5% (n = 87) communicated their genetic test result to at least one of their FDRs. Of FDRs older than 18 years, 19.9% (n = 72) have genetic testing. Emotional closeness, educational level of the proband, and relative's age were significantly associated with communicating test results with FDRs. Conclusion Communication of genetic risk with the FDRs after having a BRCA1/2 gene-mutation–positive test result was high in this group of cancer patients. However, the rate of genetic testing among FDRs was low. Implications for Practice Probands' educational level and age of relatives for cascade genetic screening should be considered during counseling. Interventions to support women with BRCA1/2 mutations during the communication process and their family members' engagement in testing and risk-reducing strategies are needed.

What Can Social Media Tell Us About Patient Symptoms

Background Ovarian cancer (OvCa) patients suffer from symptoms that severely affect quality of life. To optimally manage these symptoms, their symptom experiences must be better understood. Social media have emerged as a data source to understand these experiences. Objective The objective of this study was to use topic modeling (ie, latent Dirichlet allocation [LDA]) to understand the symptom experience of OvCa patients through analysis of online forum posts from OvCa patients and their caregivers. Interventions/Methods Ovarian cancer patient/caregiver posts (n = 50 626) were collected from an online OvCa forum. We developed a symptom dictionary to identify symptoms described therein, selected the top 5 most frequently discussed symptoms, extracted posts that mentioned at least one of those symptoms, and conducted LDA on those extracted posts. Results Pain, nausea, anxiety, fatigue, and skin rash were the top 5 most frequently discussed symptoms (n = 4536, 1296, 967, 878, and 657, respectively). Using LDA, we identified 11 topic categories, which differed across symptoms. For example, chemotherapy-related adverse effects likely reflected fatigue, nausea, and rash; social and spiritual support likely reflected anxiety; and diagnosis and treatment often reflected pain. Conclusion The frequency of a symptom discussed on a social media platform may not include all symptom experience and their severity. Indeed, users, who are experiencing different symptoms, mentioned different topics on the forum. Subsequent studies should consider the influence of additional factors (eg, cancer stage) from discussions. Implications for Practice Social media have the potential to prioritize and answer the questions about clinical care that are frequently asked by cancer patients and their caregivers.

Changes in Depression and Sleep Quality and Associated Factors in Women Receiving Chemotherapy for Ovarian Cancer

Background Although women with ovarian cancer experience depression and poor sleep quality, little is known about how various factors, particularly self-efficacy, might be associated with these conditions. Objectives The aim of this study was to examine the prevalence of and changes in depression and sleep quality and the factors associated with these conditions in a cohort of women with ovarian cancer before, during, and after chemotherapy. Methods A prospective repeated-measures design was adopted in this study. Participants were women with ovarian cancer who were expected to receive 4 to 6 cycles of chemotherapy and were recruited at a medical center in Taiwan. The participants were asked to complete a questionnaire that included the Symptom Distress Scale, Center for Epidemiologic Studies Depression Scale, General Self-efficacy Scale, and Pittsburgh Sleep Quality Index. The data were collected before, during, and after the course of chemotherapy. Results Overall, 24.6% to 36.9% of women were at risk for depression; 75.4% to 80.0% of women had poor sleep quality. There were no significant changes in depressive symptoms and sleep quality throughout the course of chemotherapy. More severe depressive symptoms were associated with higher levels of symptom distress and lower self-efficacy. Poorer sleep quality was associated with higher levels of symptom distress. Conclusions Among participants, more depressive symptoms and poorer sleep quality were associated with higher levels of symptom distress or lower self-efficacy. Implications for Practice Healthcare providers should continuously assess depression and sleep quality in women with ovarian cancer. These symptoms may be improved by strengthening self-efficacy and relieving symptom distress.

Concomitant Benefits of an Auricular Acupressure Intervention for Women With Cancer on Family Caregiver Sleep Quality

Background Sleep disturbance is a frequent and significant problem challenge for family caregivers of patients with cancer. A previously tested 6-week auricular acupressure intervention was found to reduce symptom burden in women with cancer. It is possible that such an intervention has a concomitant benefit for family caregivers. Objectives The aim of this study was to explore if the effects of an auricular acupressure intervention on major symptoms experienced by women with ovarian cancer improves the sleep quality of family caregivers. Methods A quasi-randomized controlled trial with a repeated-measures design was used. Family caregivers (n = 68) of cancer patients were recruited and completed the Pittsburgh Sleep Quality Index on 4 occasions. Demographic information included age, sex, duration of caring role, and relationship to the patient. Results Family members with a longer duration of caregiving reported more sleep disturbance at baseline. As the symptom burden of treated women decreased, their family caregivers reported improved Pittsburgh Sleep Quality Index scores at 4 weeks (time 2; Cohen d = 1.075) and 6 weeks (time 3; Cohen d = 1.022). Conclusions Reducing the symptom burden of patients with cancer can improve the sleep quality of family caregivers. Implications for Practice Auricular acupressure is a noninvasive and easy-to-apply intervention that can be applied by caregivers to assist their family member. Nursing staff can implement and test the acupressure intervention into their clinical practice and better support family-based strategies and interventions. Further studies with larger samples are needed to confirm our findings.

Experiences of BRCA1/2 Gene Mutation–Positive Women With Cancer in Communicating Genetic Risk to Their Relatives

Background When a woman is diagnosed with hereditary breast or ovarian cancer, family members may be at high risk of cancers associated with BRCA1/2 gene mutation and benefit from disclosure of the genetic test result. This duty of informing relatives may be distressing, or relatives may not be properly informed. Objective To qualitatively describe breast cancer patients’ experiences communicating genetic risk of cancer to their relatives. Methods Probands with BRCA1/2 gene mutations were recruited from an oncology institute in Istanbul, Turkey, and interviewed by telephone. Qualitative content analysis was conducted to derive central elements of the 30 women’s experiences communicating genetic risk to their relatives. Results Six themes were identified: response to genetic test results, reason for communication, feelings about communication, reflection after communication, results of communication, and needs. Conclusion Women with cancer found to have BRCA1/2 gene mutations tended to share their genetic test results within the family. The main motives for sharing test results were the desire to encourage relatives to get tested and moral and ethical convictions. Women needed explicit information regarding cancer risk and risk-reducing strategies to act upon. Implications for Practice The women’s feelings and reflections about the communication process were varied and suggest that personalized genetic risk communication interventions may better support women with BRCA1/2 gene mutations during and after communication with relatives. Long-term follow-up of those women is essential because of the need for informed decision on risk-reducing strategies.

The Relationship Between Sexual Satisfaction and Marital Satisfaction in Women With Ovarian Cancer and Their Spouses

Background Ovarian cancer can have long-term physical and psychosexual effects on survivors. The post–ovarian cancer sexuality concerns of women can cause sadness and anxiety and negatively impact sexual and marital satisfaction in these women and their spouses. Objective The aim of this study was to investigate the relationship between sexual satisfaction and marital satisfaction of women with ovarian cancer and their spouses. Methods This study was designed retrospectively. This study was conducted with 172 participants: 86 women with ovarian cancer and 86 spouses. Data were collected over 6 months from July 2019 to December 2019. Sexual satisfaction levels were assessed using the Golombok Rust Inventory of Sexual Satisfaction. Marital satisfaction levels were assessed using the Golombok Rust Inventory of Marital State. Results Spouses’ sexual satisfaction (mean, 8.10) was worse than that of the women (mean, 5.60). The women’s marital satisfaction (mean, 47.39) was worse than that of their spouses (mean, 40.75). Conclusions As the sexual satisfaction of the women increased, the marital satisfaction of the women (r = 0.346, P = .001) and spouses (r = 0.308, P = .001) increased. As the sexual satisfaction of the spouses increased, the marital satisfaction of the women (r = 0.512, P = .001) and spouses (r = 0.409, P = .001) increased. Implications for Practice Nurses and healthcare teams need to be aware of post–ovarian cancer sexual and marital satisfaction problems of women and their spouses and organize activities at education and couple counseling on these problems.

The Experiences of Women Living With Cervical Cancer in Africa

Background Cervical cancer is the fourth most common cancer in women worldwide. However, developing countries bear 85% of the burden, with Africa sharing the highest incidence with Melanesia. Objectives The aims of this study were to explore the experiences of women living with cervical cancer in Africa and to inform others of the extent of the work done in this field of study by synthesizing the findings of qualitative research. Methods The work of Sandelowski and Barroso guided the study, and 6 databases were searched to identify relevant studies using the key words Africa, cervical cancer, and experiences. Results A total of 13 studies (n = 13) met the inclusion criteria, and their findings were synthesized. The studies originated primarily from South Africa and focused on the period from diagnosis to 1 year after completing curative treatment. One overarching core theme living a life of suffering, 2 main themes, architects of suffering and mediators of suffering, and 9 subthemes were identified. Conclusion Women living with cervical cancer in Africa live a life of suffering, which starts when they experience the first symptom of cervical cancer and continues well after completing treatment. The facilitators of suffering outweighed the mediators and could not be guaranteed, as it did not relieve the suffering of all. Implications for practice Nurses practicing in Africa should be acutely aware of cervical cancer and do their utmost within their limited resources to prevent and detect the disease in its earliest stage. Religious and support interventions could be used to lessen the suffering of these women.

Improving Cervical Screening in Trans and Gender-Diverse People

Background Trans and gender-diverse people with a cervix experience difficulties accessing cervical cancer screening because of structural, interpersonal, and individual barriers. Objective The aim of this study was to explore issues with cervical cancer screening participation, awareness, and healthcare provider recommendation for trans and gender-diverse people. Methods A national Australian survey was conducted in 2018 to 2019. Participants included 196 trans and gender-diverse people with a cervix. Data were analyzed using descriptive and multiple regression analyses. Two awareness items related to cervical cancer screening, healthcare provider recommendation, and cervical cancer screening participation were assessed. Four variables associated with cervical cancer screening were included in the regression: age, healthcare provider recommendation, like for body, and gender. Results The sample was young; half (52.6%) were aged 20 to 24 years. Almost half (44.6%) had never had a healthcare provider recommend cervical cancer screening to them. Around half (48.0%) had never participated, with 21.9% reporting that they are regular screeners. More than a quarter (27.5%) of people who had screening had an abnormal result. The most common reasons for not participating in screening were that it is emotionally traumatic for them (55.3%) and inability to find a healthcare provider with whom they are comfortable (38.3%). Conclusions Trans and gender-diverse Australians with a cervix are unlikely to be regular participants in cervical cancer screening. To continue reducing cervical cancer rates, healthcare providers must address underscreening in this community. Implications for Practice Gender diversity training needs to be provided to healthcare providers. In addition, healthcare providers need to promote participation in cervical screening in this trans and gender-diverse community.

Social Support and Life Satisfaction in Women With Cervical Cancer

Background Although the number of studies focusing on life satisfaction in women with cervical cancer is increasing, there are limited studies on the pathway between social support and life satisfaction in this population. Objective This study explored the pathway between social support and life satisfaction in women with cervical cancer by examining the serial mediating effects of self-care self-efficacy, coping strategies, and depressive symptoms. Methods In this cross-sectional study, a total of 292 women with cervical cancer completed a questionnaire for assessing social support, self-efficacy, coping strategies, depressive symptoms, and life satisfaction. Structural equation modeling was used to test the direct and/or indirect effects of the variables on life satisfaction. Results Structural equation modeling analysis indicated that self-efficacy, coping strategies, and depressive symptoms mediates the effect of social support on life satisfaction. Direct paths from social support to life satisfaction, social support to self-efficacy, self-efficacy to coping strategies, coping strategies to depressive symptoms, and depressive symptoms to life satisfaction were significant (P < .05). Moreover, indirect paths from social support to life satisfaction, self-efficacy to life satisfaction, and coping strategies to life satisfaction were also significant (P < .05). Conclusions Self-care self-efficacy, coping strategies, and depressive symptoms are potential pathways through which social support may affect life satisfaction in women with cervical cancer. Implication Healthcare providers, family, and friends should offer more social support to the patients and make efforts to strengthen their self-care self-efficacy, facilitate active coping, and alleviate depressive symptoms to improve women’s life satisfaction.

The Effect of Face-to-Face and Phone Call Motivational Interviewing on Cervical Cancer Screening

Background Having regular screening tests largely depends on motivational factors. Motivational interviewing (MI) facilitates the movement through the stages of the transtheoretical model of change. Objective The aim of this study was to compare the effect of face-to-face and phone call MI on cervical cancer screening. Methods This experimental study was conducted on 150 eligible women referred to health centers in Tabriz, Iran. The women were assigned into 3 groups (face-to-face MI, phone MI, or control) using blocked randomization. The face-to-face MI group participated in 3 weekly group counseling sessions, and the motivational phone call group received 3 weekly phone calls. The participants completed the demographic and obstetric questionnaire and stages of change checklist. Adherence to Pap smear was checked, according to the health profile, 6 months after the intervention. The data were analyzed using SPSS24 software. Chi-square, homogeneity test, and sequential logistic regression by the generalized estimating equations were used. Results After the intervention, about 32% women from the face-to-face MI group, 22% from the motivational phone call group, and 4% from the control group underwent Pap smear screening (P = .002). There was no significant difference between the 2 interventional groups in Pap smear frequency (P = .36). Conclusion The study results indicated that both face-to-face and phone call MI are effective in motivating women to have a Pap smear. Further studies are recommended to consider long-term follow-up (3–5 years). Implications for Practice It is recommended that healthcare providers use motivational phone call to encourage cancer screening behaviors.

The Symptom Experience and Self-management Strategies of Women Undergoing Cervical Cancer Treatment

Background Cervical cancer treatment modalities, such as surgery, chemotherapy, radiation, and brachytherapy, often result in short- and long-term adverse effects such as nausea, fatigue, and sexual dysfunction. Chemotherapy and radiation are typically provided on an outpatient basis, requiring women to be more active in self-managing their symptoms at home. Objective The aim of this study was to explore how women with cervical cancer experience symptoms and manage daily life during treatment. Methods Individual interviews with 10 women diagnosed with cervical cancer and undergoing curative concurrent chemotherapy and radiation were carried out. Data analysis was conducted using a phenomenological-hermeneutic perspective, inspired by Ricoeur. Results Three themes were identified based on the interviews: (1) new life perspectives, (2) suffering in silence, and (3) enhanced symptom self-management strategies. Conclusion Diagnosis and treatment create an opportunity for the women to critically reflect on their lives and to develop new life perspectives. During treatment, a mental transformation involving the use of various individual social, mental, and physical coping strategies allowed the women to manage their daily lives. This enabled self-management strategies, resulting in maintaining a sense of normalcy, trying to defy the adverse effects, and prioritizing themselves, their families, and the treatment. Implications for Practice Women with cervical cancer undergoing oncological treatment need more specific and detailed information about the course of treatment, symptom management, adverse effects, and psychological reactions to better manage their daily lives. Healthcare professionals play a crucial role in supporting and guiding the women and in ensuring optimal symptom management.

Identifying Language Features Associated With Needs of Ovarian Cancer Patients and Caregivers Using Social Media

Background Online health communities (OHCs) can be a source for clinicians to learn the needs of cancer patients and caregivers. Ovarian cancer (OvCa) patients and caregivers deal with a wide range of unmet needs, many of which are expressed in OHCs. An automated need classification model could help clinicians more easily understand and prioritize information available in the OHCs. Objective The aim of this study was to use initial OHC postings to develop an automated model for the classification of OvCa patient and caregiver needs. Methods We collected data from the OvCa OHC and analyzed the initial postings of patients and caregivers (n = 853). Two annotators coded each posting with 12 types of needs. Then, we applied the machine learning approach with bag-of-words features to build a model to classify needs. F1 score, an indicator of model accuracy, was used to evaluate the model. Results The most reported needs were information, social, psychological/emotional, and physical. Thirty-nine percent of postings described information and social needs in the same posting. Our model reported a high level of accuracy for classifying those top needs. Psychological terms were important for classifying psychological/emotional and social needs. Medical terms were important for physical and information needs. Conclusions We demonstrate the potential of using OHCs to supplement traditional needs assessment. Further research would incorporate additional information (eg, trajectory, stage) for more sophisticated models. Implications for Practice This study shows the potential of automated classification to leverage OHCs for needs assessment. Our approach can be applied to different types of cancer and enhanced by using domain-specific information.

The Level of Psychological Distress Is Associated With Circadian Rhythm, Sleep Quality, and Inflammatory Markers in Adolescent and Young Adults With Gynecological Cancer

Background Adolescent and young adult (AYA) patients with cancer commonly experience psychological distress, with female patients experiencing higher levels of psychological distress. Objective The aim of this study was to investigate the relationships among circadian rhythm, sleep quality, inflammatory markers, and psychological distress in AYA patients with gynecological cancer in China. Methods This cross-sectional study enrolled 75 AYA patients in treatment for gynecological cancer, 64 of whom completed the Chinese version of the Morningness-Eveningness Questionnaire and the Distress Thermometer. Actigraphy was used to measure their objective sleep parameters: total sleep time, sleep onset latency, and sleep efficiency. Blood samples collected 3 times across 1 day were used to measure the average levels of interleukin 6, C-reactive protein, and tumor necrosis factor α. Results The mean score on the Distress Thermometer among respondents was 4.23, which was above the cutoff value for clinically significant psychological distress. High levels of psychological distress may be associated with circadian disturbances, poor sleep quality, and elevated inflammatory markers. In addition, total sleep time, sleep onset latency, and tumor necrosis factor α averages were the dominant predictors of these AYA patients’ psychological distress. Conclusion Improving sleep quality and reducing the levels of inflammatory markers may relieve psychological distress among AYA patients with gynecological cancer. Implications for Practice Healthcare professionals need to actively focus on circadian rhythm, inflammatory markers, sleep quality, and mental health status in AYA cancer patients to better meet their therapeutic and psychological needs.