Oncology Nursing Forum

Distinct Morning and Evening Fatigue Profiles in Patients With Gynecologic Cancers Receiving Chemotherapy

To identify distinct morning and evening fatigue profiles in patients with gynecologic cancers and evaluate for differences in demographic and clinical characteristics, common symptoms, and quality-of-life outcomes. Outpatients with gynecologic cancers (N = 233) were recruited before their second or third cycles of chemotherapy at four cancer centers in San Francisco Bay and New York. The Lee Fatigue Scale was completed six times over two cycles of chemotherapy in the morning and in the evening. Latent profile analysis was used to identify distinct morning and evening fatigue profiles. Four distinct morning and two distinct evening fatigue classes were identified. Common risk factors for morning and evening fatigue included younger age, higher body mass index, lower functional status, and higher comorbidity burden. Patients in the worst morning and evening fatigue classes reported higher levels of anxiety, depression, and sleep disturbance; lower levels of energy and cognitive function; and poorer quality of life. Clinicians can use this information to identify higher-risk patients and develop individualized interventions for morning and evening fatigue.

Factors Associated With African American Mothers’ Perceptions of Human Papillomavirus Vaccination of Their Daughters: An Integrated Literature Review

African American (AA) women have a higher mortality rate for cervical and other cancers and are less likely to have received the human papillomavirus (HPV) vaccine than White women. Mothers play a significant family role and have a unique relationship with their daughters. Mothers' positive views on HPV vaccination may enhance the HPV vaccination rate among their daughters. The review was conducted by searching literature in PubMed®, CINAHL®, ScienceDirect, Ovid MEDLINE®, and ProQuest databases. The search was limited to studies conducted in the United States and published since the inception of the HPV vaccine in 2006. Of 10,566 publications retrieved, 28 articles were included in the final sample. Factors associated with HPV vaccination were approval and disapproval of HPV vaccination from physicians, family, and friends; HPV knowledge; attitude and belief about HPV vaccination; benefits of vaccination; and challenges of and barriers to HPV vaccination. Understanding factors related to HPV vaccination decisions among AA mothers will inform healthcare providers of the best approach to improving vaccination rates among this high-risk population.

Exploring the Emotional Effects of Reproductive Decision-Making in Women With a BRCA Pathogenic Variant

To evaluate how reproductive decision-making in women with a known BRCA pathogenic variant is influenced by emotional states and individual factors. 85 women with a BRCA pathogenic variant from a familial cancer registry at a local university hospital system in Pennsylvania. This exploratory, descriptive study used the validated Appraisal of Life Events Scale to measure emotional states. Binary logistic regression was used to analyze the relationships among emotional states, BRCA pathogenic variant status, and individual factors in reproductive decision-making. Age at genetic testing and number of children significantly predicted decisions about having more children. Among women with family history of ovarian cancer, perceived loss/benefit was significantly associated with reproductive decision-making. Loss/benefit was significantly related to reproductive decision-making among women with family history of ovarian cancer. Recognizing the emotional impact of reproductive decision-making in women at risk for hereditary cancer could aid in improving their overall health and psychosocial outcomes.

Low-Cost Interventions to Improve Cervical Cancer Screening: An Integrative Review

Cervical cancer (CC) is a major public health problem in low- and middle-income countries. Although screening can reduce CC incidence, screening programs are difficult to implement in resource-limited countries, making innovative interventions necessary. PubMed®, MEDLINE®, CINAHL®, LILACS, and SciELO databases were searched for studies published within the past five years that explored interventions to improve CC screening. Of the 486 articles identified, 35 were included in the review. The evidence was summarized, analyzed, and organized by theme. Several low-cost interventions improved aspects of CC screening, most of which were associated with a significant increase in adherence and uptake. Other interventions led to better baseline knowledge and involvement among patients and healthcare providers and a higher proportion of patients receiving treatment. Screening programs can use single or multiple approaches and match them to the local conditions and available resources. By understanding the various interventions that can mitigate CC incidence, healthcare providers can select the best approach to reach women eligible for CC screening.

Consideration for Multigene Panel Testing Outside of Cancer-Specific Genetic Testing

Familiarity and Perceptions of Ovarian Cancer Biomarker Testing and Targeted Therapy: A Survey of Oncology Nurses in the United States

To assess oncology nurses' awareness of biomarker testing and targeted therapy for ovarian cancer. 100 oncology nurses completed an online survey in June 2022. A cross-sectional survey was used to examine nurses' understanding of ovarian cancer testing and treatments, assess barriers, and identify opportunities for further education. Almost all respondents believed biomarker testing and targeted therapy were very/extremely important in diagnosing and supporting treatment of patients with ovarian cancer. Nurses were very/extremely familiar with cancer antigen 125 and germline testing, but fewer reported the same familiarity with somatic testing. Most nurses were familiar with targeted therapy for ovarian cancer, but only about half were very/extremely familiar with poly(ADP-ribose) polymerase (PARP) inhibitors. Less than half felt highly knowledgeable about PARP inhibitors. It is important that oncology nurses understand biomarker testing and targeted therapy. There is an opportunity to provide resources to nurses to help them become more comfortable with PARP inhibitors in particular.

Cervical Cancer Screening Among Women in Malawi: An Integrative Literature Review

In Malawi, the cervical cancer death rate is eight times that of the global rate. Cervical cancer is preventable by vaccination, screening, and early treatment. The purpose of this study was to identify the prevalence of cervical cancer screening and factors associated with screening uptake among women in Malawi using Whittemore and Knafl's integrative methodologic review framework. A comprehensive literature search was conducted in MEDLINE®, Scopus®, Academic Search Complete, CINAHL®, and Google Scholar™ databases. 12 studies met the inclusion criteria, and quality was assessed using the Mixed-Methods Appraisal Tool, version 2018. Themes were categorized within the situation-specific theory components. The screening rate ranged from 1.74% to 47%. Access to healthcare services factors and individual, sociocultural, and sociodemographic factors were associated with screening uptake. The identified gaps in cervical cancer prevention in Malawi can serve as evidence to develop nursing intervention strategies to promote screening and treatment uptake in the country.

Cervical Cancer Screening Beliefs and Practices Among Black Immigrant Women From Africa and the Caribbean Living in Massachusetts

To examine the cervical cancer screening beliefs and practices of Black immigrant women from sub-Saharan African or Caribbean countries living in Massachusetts. 19 women who self-identified as being sub-Saharan African or Caribbean, spoke English, were foreign-born, were aged 25-65 years, and had been living in the United States for at least six months were included. A qualitative descriptive design and thematic analysis were used. A semistructured interview guide was developed based on the PEN-3 cultural model. Facilitators of cervical cancer screening included a sense of personal responsibility to maintain one's health, cultivating trust within the healthcare system, and cultivating community support. Barriers included pain and fear, navigating a new identity as a Black immigrant, a lack of formal education on sexual health, and challenges accessing the healthcare system. Culturally tailored resources and community partnerships may be useful in promoting cervical cancer screening in Black immigrant women.

Adverse Childhood Experiences and Preventive Cervical Cancer Screening Behavior

To examine associations between a history of adverse childhood experiences (ACEs) and receiving preventive cervical cancer screening and to investigate whether number and type of ACE exposures were predictive of cervical cancer screening uptake. Data were from 11,042 adults who completed the 2020 Texas Behavioral Risk Factor Surveillance System survey. The U.S. Preventive Services Task Force guidelines were used to indicate whether individuals had received cervical cancer screening at recommended intervals. Multiple logistic regression analysis was used to predict the likelihood of not having received the recommended preventive cancer screening by number and type of ACE exposures. Chi-square analysis was used to determine associations among demographic characteristics, cancer screening uptake, and ACE number and type. Individuals with one to three ACEs and those with six or more ACEs were statistically more likely not to have received the recommended cervical cancer screenings compared to those with zero ACEs. A history of physical ACEs was associated with 3.88 times the likelihood of not having received the recommended cervical cancer screening. To promote timely cervical cancer screening and prevent retraumatization of patients with a history of ACEs, providers should implement trauma-informed care principles in their healthcare settings.

Barriers and Facilitators to Breast and Cervical Cancer Screening in Somali Immigrant Women: An Integrative Review

Somali immigrant women access breast and cervical cancer screenings at a significantly lower rate than other women in the United States and face unique barriers and facilitators to cancer screening. A literature search was performed using CINAHL®, PubMed®, EBSCOhost, PsycINFO®, MEDLINE®, and Google ScholarTM. Articles included qualitative studies that explored the barriers and facilitators to breast and cervical cancer screening in Somali immigrant women. 10 articles were summarized using a standardized data matrix. Evidence was integrated into a synthesis of evidence and organized by theme. According to the literature reviewed, Somali immigrant women face knowledge, cultural, and healthcare system barriers to screening for breast and cervical cancer. Recommendations to increase screening included providing culturally tailored education, increasing community involvement, and improving provider education. Understanding the barriers and facilitators that are unique to Somali immigrant women can assist nurse researchers and practitioners in developing evidence-based interventions that will provide support to this underserved population.

Effect of Foot Reflexology and Aromatherapy on Anxiety and Pain During Brachytherapy for Cervical Cancer

To determine if the addition of aromatherapy and foot reflexology to the standard of care improves pain and anxiety in patients receiving brachytherapy for cervical cancer. 41 women with locally advanced cervical cancer who received intracavitary brachytherapy as part of their treatment. Participants were randomized to either the control group, which received the standard-of-care management during brachytherapy, or the intervention group, which received the addition of aromatherapy and foot reflexology to standard of care. Participants rated their pain on a numeric rating scale and anxiety on the State-Trait Anxiety Inventory (STAI) and a numeric rating scale at five different time points. All average pain and anxiety scores were equal or lower at each key time point for the intervention group. Statistically significant differences were found for the intervention group for anxiety on the numeric rating scale and on the STAI, but only post-reflexology. Nurses and other healthcare providers can be trained to provide reflexology during painful, anxiety-producing procedures to increase patient tolerance of these treatments and overall quality of life.