Christopher Pirschel

A CANCER DIAGNOSIS COMES with a laundry list of physical and emotional side effects, and a variety of resources can help patients deal with them.

Unfortunately, those resources don’t offer quick fixes for problems including mental fogginess, short-term memory trouble, multitasking difficulties and slower mental acuity compared with before diagnosis. Often referred to as chemo brain, these cognitive changes are a common side effect of many types of cancer treatments — not just chemotherapies, as the term suggests.

Although strategies for improving mental sharpness after cancer treatment already exist, new and more effective techniques are being sought. In a study funded by the Oncology Nursing Society Foundation, one nurse researcher determined that adding a mindfulness aspect to post-treatment exercise can help ease chemo brain.

To explore this avenue, Oncology Nursing Society member Jamie Myers, Ph.D., RN, AOCNS, a research assistant professor at the University of Kansas Medical Center School of Nursing in Kansas City, measured the effectiveness of using qi gong, a mindfulnessbased exercise, to mitigate the effects of chemo brain in patients with breast cancer.

Myers’ study, which is being reviewed pending publication, recruited women with breast cancer who received chemotherapy and finished their treatment at least two months prior to enrollment. Qi gong, a low-intensity exercise, combines physical activity (slow, flowing movement) with mindfulness techniques (deep breathing and meditation). It was selected for study because it can be done standing or sitting and regardless of fitness level.

“Our participants had concerns about their mental abilities and difficulties they were experiencing with memory and multitasking,” Myers said. “We randomized participants to one of three groups that met once a week for eight weeks. The first group met and practiced qi gong, the second engaged in gentle exercise with no mindfulness element, and the third attended a support group tailored to the needs of women with the breast cancer experience.”

Participants rated their own mental abilities using a validated questionnaire, and Myers’ team also tested their cognitive function. “At baseline and a month after the groups ended, we had participants complete a short series of cognitive tests that went along with how they were reporting their own mental abilities,” Myers said. “We wanted to have both subjective and objective results that we could compare pre- and post-study.”

After eight weeks and continued follow-up, Myers’ team noted that, of all three groups, the patients who engaged in qi gong experienced the most improvement in self-reported memory, multitasking and other mental abilities. “We saw significant improvement for the women in the qi gong group,” Myers said. “Also, when we initially assessed for their baseline abilities, we asked them about stress levels, fatigue and sleep habits. The qi gong group reported the biggest reduction of stress levels compared with all other groups.”

Myers and her team recognized the time commitment involved with following a program an hour a week for eight weeks. Some patients left the study as a result, she said, but those who remained were enthusiastic and engaged. Classes in qi gong and other mindfulness-based exercises could be offered online using services such as Skype, according to Myers. However, practicing qi gong is not appropriate for everyone, she said, so patients should consult their health care providers for more information.

“We have to be careful not to overstate the study,” Myers said, “but we were excited to see that our small study indicated that adding a mindfulness component to exercise could enhance the benefits for patients. Mindfulness-based exercise can be added as a piece of a patient’s arsenal, but it depends on the individual patient’s condition.”

With support from the Oncology Nursing Society Foundation and its donors, Myers and many other oncology nurse scientists continue to drive patient-centered research, leading to practice change and improved quality of life for patients with cancer.

“We were thrilled when we heard our grant application was approved,” Myers said. “It’s the only way we could’ve done this work. Whether it’s as researchers conducting the studies, as oncology nurses supporting patients or as patients journeying through a cancer diagnosis, the support the Oncology Nursing Society Foundation provides is critical to laying the groundwork for future studies.”

The ONS Foundation is the only entity that directly supports the projects of oncology nurses like Jamie Myers. For more information about the ONS Foundation and ways to give, visit ONSFoundation.org.

Articles

To ease ‘chemo brain,’ a nurse researcher combined mindfulness with physical exercise.

Presence of Mind: Tips for Combatting Chemo Brain

With every cancer diagnosis comes a detailed treatment plan that usually includes a seemingly endless list of multisyllabic medications. Remembering what to take, and when, can be a challenge for anyone, but evidence shows that it’s especially difficult for adolescents and young adults (AYAs) who have cancer. These patients, ages 15 to 39, are particularly susceptible to missing medications, mainly due to lifestyle issues, and this has been associated with poorer outcomes and the potential for relapse.

A solution might lie in the palms of their hands, according to a team of nurse researchers at Huntsman Cancer Institute at the University of Utah in Salt Lake City. They theorized that a medication-reminder smartphone app would improve adherence rates. 

“Studies of children and adolescents with acute lymphoblastic leukemia indicate that less than 95 percent adherence to their cancerrelated medications is associated with a 2 ½ times increased risk of relapse,” says nurse researcher Lauri Linder, Ph.D., APRN, CPON, an Oncology Nursing Society (ONS) member. “Patients who experience relapses of their disease are then at risk for decreased long-term survival. This age group is at greater risk for poor adherence, and the AYA population’s cancer-related outcomes have not improved at the same rates as younger children.”

AYA patients face unique challenges, according to Linder.“This population is a distinct developmental group. They are gaining independence from their families and are assuming greater responsibility for their own medication adherence,” she says. “Their schedules also tend to be complex — many are attempting to balance work, school, social activities and family life. Complex personal schedules make remembering to take medications more difficult.” Is there an app for that? Linder and her colleagues sought to find out.

TRACKING ADHERENCE THROUGH MEDICATION REMINDERS

The prevalence of AYAs’ smartphone use, coupled with their need for improved medication adherence, presented an opportunity to understand whether  technology could make a difference. With funding from the ONS Foundation, the team reached out to software developers.

“For our study, we used a commercially available app, Dosecast, developed by Montuno Software,” Linder says. “Montuno supported our team by providing participants with a code to allow them to access the Dosecast Pro edition for one year at no cost. They also provided our team with app usage data for each participant.”

After downloading the app, participants entered information, including medications and desired reminders. When it was time for a dose, the app would send a reminder that prompted the patient to select from three options: take now, postpone or skip.

The study results showed that patients who scored highly for adherence at baseline usually continued to take their medications in a timely manner — but with less variation in their schedules, which Linder considers encouraging. Using the app had less impact on those with low baseline adherence, but, according to Linder, a small third subset across both groups showed clearly improved adherence. Most participants reported that they found the app helpful and easy to use and would recommend it to others. 

“Smartphone-based apps are just one resource that addresses one aspect of promoting oral medication adherence,” Linder says. “Reasons for nonadherence are as diverse as our patients themselves. Although forgetfulness is a frequently cited reason for nonadherence, the reasons for forgetfulness vary greatly. Future studies can help us better understand how technology-based interventions, such as smartphone apps, can help in practice.” 

MOVING THE NEEDLE ON PATIENT-CENTERED RESEARCH

Oncology nurse researchers like Linder strive to make advancements in cancer care research that improve experience, outcomes and quality of life for their patients. “The ONS Foundation has a very important role in oncology nursing research,” Linder says. “Having access to funding resources is essential to developing nurse scientist ideas. The funding support that we received from the ONS Foundation was essential to our being able to conduct this study.”

Individuals seeking to support patient-centered cancer research can invest in the work of oncology nurse scientists through the ONS Foundation, which is dedicated to supporting the nurses who care for patients with cancer.

Mobile apps may help teens and young adults stick with their medication schedules, a nurse scientist finds.

Hold the Phone

A CANCER DIAGNOSIS IS one of the most stressful, lifechanging experiences a human being might face. Between countless trips to the infusion center, other medical appointments, mounting health worries, financial strain and concern about the effects on loved ones and caregivers, stress may seem like the one constant of the experience.

Unfortunately, stress affects not just psychological health but also a patient’s overall well-being, potentially worsening symptoms.

Recognizing this risk, John Merriman, Ph.D., RN, a member of the Oncology Nursing Society (ONS), an oncology nurse scientist and assistant professor at New York University Rory Meyers College of Nursing, in New York City, decided to research the way stress affects patients with cancer and how they can use mindfulness-based stress reduction (MBSR) techniques to mitigate that burden.

“MBSR has been around for a few decades now outside of oncology,” Merriman says. “There are courses and sessions you can attend to learn MBSR practices. But mindfulness techniques for most people are simply defined as a way of learning to be present in the moment. It’s about not being lost in your thoughts. Mindfulness has been shown to improve issues related to anxiety and high stress. It allows patients to learn how to take things as they come and not have to react to everything.”

Patients can incorporate a number of these techniques into their daily routines to help mitigate stress. “Yoga can be a great mindfulness technique because it’s not always physical. Most yoga has some aspect of mindfulness of the body and your movements,” Merriman says. “Those not interested in yoga can use very simple forms of meditation, such as sitting meditation, which is something patients can do for 10 minutes at a time. There are plenty of practical ways patients can use MBSR.”

Through rigorous investigation, oncology professionals have quantified the benefits of MBSR. Merriman’s focus is on the body’s response to the techniques and how the strategies can help patients with cancer. His research examines how stress affects the cognitive function of patients with cancer. Typically, patients find it difficult to focus or accomplish tasks, and they feel that they’ve slowed down since they were diagnosed.

“One of the possible reasons for these cognitive changes is stress,” Merriman says. “It could be stress related to the diagnosis itself — psychological stress &mdash; or it could be physical stress related to the cancer and treatment. My research is starting to look at how MBSR techniques can help patients improve their cognitive functioning. We’re looking at brain imaging, alongside self-reporting and neuropsychological assessments, to really understand how MBSR practices impact the brain and overall outcomes for patients.”

Getting his research funded was no easy task. Merriman’s grant proposal underwent intense critical review to ensure that it addressed the requirements needed to receive funding.

For many, this is a daunting, difficult path. To make sure his proposal was ready to submit, Merriman looked to his experienced colleagues and participated in the ONS Foundation Oncology Nurse Scientist Intensive, a program that brings together accomplished nurse scientists to review grant proposals from novice researchers.

Merriman recalls his time at the intensive: “It’s a really unique opportunity to get good, critical feedback on the grant proposal you’re working on. The scientists who gave me feedback were experienced and had good track records of receiving funding themselves, most having been funded through the National Institutes of Health.”

With his colleagues’ help, Merriman revised, adjusted and focused his grant proposal. His project received the funding it needed from the National Institute of Nursing Research, enabling him to pursue his research into the ways MBSR techniques can help patients cope with cognitive changes.

An oncology nurse scientist is studying whether stress can harm cognitive functioning &mdash; and how practicing mindfulness might help.

Mind, Body and Spirit: How Mindfulness Can Help

That’s the phrase Oncology Nursing Society (ONS) member Patricia Jakel, RN, M.N., AOCN, uses to describe her breast cancer diagnosis in the winter of 2016. Jakel, a clinical nurse specialist at UCLA, discovered a lump in her breast on that year’s Super Bowl Sunday and knew she had to have it examined.

“I first found it by looking in the mirror, which, at 55, is not something I do very often,” Jakel jokes. “It was only five months after a negative mammogram. Because of some insurance complications at the time, I could get an MRI (magnetic resonance imaging test) only if a surgeon ordered it. So I had to have a surgeon friend of mine examine me in my office to make sure. After he saw me, he ordered the MRI.”

By chance, the MRI results came back to Jakel during an appointment with her gastroenterologist. She was there for a routine colonoscopy when the doctor mentioned that the MRI results were in. Both being part of the medical community, Jakel and her doctor decided to just read the results together.

“I’d had this appointment for months,” Jakel remembers, “and I’d told my doctor about the lump. She said she’d gone through a similar situation with a scare, and everything had worked out fine.” But that wasn’t the case this time. Jakel recalls watching her doctor’s face change after seeing the results.

“She’s one of those doctors who always has the computer turned to face you while she’s talking. I saw this horrified look on her face,” Jakel remembers. “She said, ‘I’m so sorry to be the one to tell you, but you have cancer.’”

The office started spinning. Jakel remembers being in a daze as she left. By the time she’d made it to the elevator, she was in tears. An older woman said, “Honey, don’t worry. It’s going to get better.” Jakel was stunned. Was she now the one being comforted? She’d woken up that morning on one side of the cancer experience and now found herself on the other.

After beginning treatment, Jakel continued to work. She elected not to disclose her diagnosis to her patients, and her colleagues and hospital administrators worked hard to fulfill her wishes.

She started working with a new patient, Nicole, who’d received a diagnosis of lymphoma around the same time Jakel had learned about her breast cancer. Nicole lived more than 100 miles from the hospital, was a young mother with two kids at home and found herself alone a lot. Jakel visited Nicole often during downtime and between patients.

“I used to go sit with her when I had time,” Jakel remembers. “She had bad mucositis, so I’d bring her Slurpees from 7-Eleven, and we really got to know each other. One day, we started talking about her diagnosis, and she told me, ‘It isn’t fear. It isn’t anxiety. It’s all-out terror.’ I hadn’t told her about me, but we’d have these deep conversations about fear and terror. That’s how we bonded.”

It was from those conversations that Jakel’s perspective changed. She learned about unsupportive social interactions and how often they occur after a cancer diagnosis. Jakel noted many well-meaning comments from her own friends, family and co-workers that missed the mark. She suddenly understood the gap in understanding that can exist between patients and oncology professionals.

“I thought of all the stupid things I’d said to patients over the years,” Jakel says. “Stuff like, ‘Oh, come on, you got this! You’re going to be a fighter.’ In fact, I’d had instances in the past where certain patients would blow up at me over saying things like that, and I never really got it — until now.”

BRINGING THE PATIENT EXPERIENCE INTO PRACTICE

“I’ve learned not to gloss over things,” she adds. “Not to just tell a patient, ‘Honey, don’t worry. Everything’s going to get better.’ It’s about listening, reacting and addressing individual needs in a supportive way that’s right for them.”

Since her diagnosis, Jakel has worked to improve the care she and her colleagues provide, specifically when it comes to social interactions.

As part of the ONS Foundation’s Mara Mogensen Flaherty Memorial Lectureship series, Jakel was given the opportunity to share her story, and dual perspectives, at the 2017 ONS Congress in Denver, a national conference for oncology nurses.

Jakel, now in remission, discussed her experiences and touched on unsupportive social interactions between patients and nurses. She explained ways to close the gaps in understanding and encouraged her colleagues to pursue further research in the area. She wants patients to feel supported and understood from initial diagnosis through treatment and into survivorship.

It was through donations and support from the ONS Foundation that Jakel was able to share her story. The lectureship is possible through contributions to the ONS Foundation, and it provided Jakel with the platform to educate her colleagues. For more information about the ONS Foundation, visit ONSFoundation.org.

The ONS Foundation is the only entity in the world that directly supports the projects of oncology nurses like Patricia Jakel. For more information about the ONS Foundation and ways to give, visit onsfoundation.org.

An oncology nurse learns what it’s like to have cancer &mdash; and uses the experience to improve the way patients are treated.

Nurse Uses Her Cancer to Improve Treatment of Others

New technologies can often seem like futuristic pipe dreams. Flying cars, cities on the moon or whole meals shrunk to fit inside a little pill are typically the trappings of science fiction. But consider the immense technological advancements and their societal impacts in just the past 25 years. We have smart devices in our pockets capable of allowing us to see and talk with loved ones across the world in real time. There are watches that read our emails, track our heartbeats and measure the distance we’ve walked in a day. We might not have communities on the moon, but technology has certainly come a long way.

For oncology nurses and nurse researchers, evolving technology is one avenue that is helping to improve the quality of care for patients with cancer. Recently at the Oncology Nursing Society’s (ONS) 42nd Annual Congress — an oncology nurse-focused conference in Denver, Colorado &mdash; researchers presented new information about using health trackers, like Fitbits, in patient care.

ONS member Jennifer Briden, B.S.N., RN, of Parkland Medical Center in Salem, New Hampshire, attended with the help of the ONS Foundation’s Congress Scholarship, and attended an educational session about the use of health trackers in practice.

“In many health tracker apps, you can not only track steps, stairs, sleep and workouts, but also fluid and food intake,” Briden says. “The goal-setting application would assist practitioners with getting patients to gradually increase their steps, hydration levels and nutrition goals with each visit. I could see many of my patients who are combatting fatigue from their chemotherapy finding benefit from slowly increasing their step goals every week.”

Jinbing Bai, Ph.D., M.S.N., RN, a postdoctoral researcher at Emory University who is also an ONS member and ONS Foundation Congress Scholarship recipient, sees the value in the personalized data collected from health tracking devices. “Health care providers or practitioners can use the real-time data collected to modify or strengthen interventions for individual patients, like increasing or decreasing physical activities based on their reported fatigue scores,” she says.

The session Briden attended touched on the need to address obesity in the cancer survivor population. According to information gathered by the National Cancer Institute, more than 31 percent of cancer survivors older than 20 were considered obese in 2015. It’s an issue that’s prevalent in the survivorship community, and one that Briden says could benefit from the use of health trackers.

“One of my patients is a breast cancer survivor who is two years post-chemotherapy and radiation treatment, and could not lose the 20 pounds she had gained during her treatment,” she says. The patient decided to buy a Fitbit “and discovered she walked well over 10 flights of stairs a day, so she increased her goal to 20 flights of stairs a day. She reported that, by increasing her stair goal, she found that her daily steps also gradually increased. Soon after, she began to drop some of the weight that she had gained. The last time she came into my office, she’d joined her local YMCA, was walking over 10,000 steps a day and had lost 15 of the 20 pounds she needed to lose.”

Health trackers could allow practitioners and patients to monitor and address sleep issues and review nutritional data, paving the way for helpful interventions, Bai notes.

Looking to the Future of Health Tracker Technology

As a researcher, Bai is interested in the future potential benefits of health trackers. “These health trackers can potentially provide innovative, efficient, convenient and cost-effective ways to monitor the progression of patient-reported outcomes and symptoms,” she says. “Technologyrelated health trackers could provide new ways to for us to monitor a patient’s status remotely and allow us to act immediately. This could help nurses intervene with patients more efficiently, addressing their symptoms when they occur. On a global scale, we would be able to monitor patients no matter where they go, aiding them when they need it.”

Bai acknowledges that more in-depth study will be needed before we fully understand the impact and validity of health trackers on cancer care. The ONS Foundation agrees, and has committed its support to funding health tracker research through grants to oncology nurse scientists.

“Trackers still need to be tested for use in terms of reliability and validity,” Bai says. “Oncology nurses need to be able to provide patients with additional education and training about how to correctly use the devices, what the parameters mean and how to evaluate the devices’ function.”

More than just wristwatches, wearable fitness trackers can help assess patients’ health, and the ONS Foundation plans to fund research into the devices.

Keeping a Close Watch on Patients' Fitness

WHEN IT COMES TO the cancer journey, it’s almost impossible not to have a tale to tell. In some instances, you may be the protagonist, overcoming insurmountable odds and waking each day to slay the dragon. Sometimes you are a companion on the adventure, supporting and lifting up the hero when times are tough. Some individuals may play the wise sage who offers guidance and instruction to intrepid adventurers. And others may find themselves all three.

There are stories everywhere, and as examples, two oncology nurses have shared their experiences of inspiration and commitment to cancer care. With support from their patients, colleagues and professional organizations, these nurses have grown and evolved in order to provide the best possible care. Thanks to the Oncology Nursing Society (ONS) Foundation, each was given an opportunity to attend the annual ONS Congress, a conference that brings together oncology nurses from across the country and world to further their education so they can continue to provide high-quality, cutting-edge care. With help from donations, the foundation provides such opportunities and others through awards, grants and scholarships.

When ONS member Maggie Smith, D.N.P., M.S.N., RN, OCN, was a child, she was good with numbers and wanted to be an accountant. For her, the thought of poring over ledgers or balancing the books seemed like a golden dream. But her father saw something different.

“It was actually my dad who encouraged me to go into nursing,” Smith remembers. “I went into oncology because I saw great opportunities, my friends were encouraging me and I always enjoyed a challenge.

Oncology was all new to me, and I was intrigued by it. I’ve been here for 17 years, and I can tell you honestly that there’s nothing else like it.” Smith had no idea that, one day, she would accompany her father on his own journey with non-small cell lung cancer. “I went from being a nurse on the outside to a daughter who had to care for her father with this terminal disease,” Smith remembers. “It brought my dad and I even closer together — and we were already close. Unfortunately, he succumbed to his battle. But it was an entirely different perspective for me, and through it all I gained an even greater appreciation for patients and their families.” Smith takes inspiration from her experiences and continually seeks new opportunities to grow as an oncology nurse, including through her foundation-sponsored attendance at the ONS Congress.

“I was able to use the educational sessions to become aware of the latest and greatest advancements in terms of diagnostics and medicine,” Smith notes. “It helped me become more aware of side-effect management and preventive care for my patients. My time at congress even helped me develop my own evidence-based research, where I learned about train-the-trainer programs that could help educate my colleagues.”

 Smith has embraced her experiences in oncology. She makes a point of celebrating victories with her patients, and she strives to learn and listen as they progress through treatment and into survivorship. Even then, she and her patients exchange updates about major life events such as birth announcements and anniversaries.

Oncology nurse and ONS member Donna Clark, RN, B.S.N., OCN, always knew she wanted to help people. Growing up, she figured she was destined to become a nurse. Her experiences and personal triumphs have only further confirmed that dedication.

“I truly believe God placed, deep in my heart, the desire to be an oncology nurse,” Clark says. During her nursing years, she says, “I lost my father to lung cancer, my mother to gastric cancer, and I was diagnosed with advanced endometrial cancer in 2014. I had to take a year off from working as a clinical oncology nurse to do all the radiation, chemotherapy and surgeries necessary for a successful remission. I think of myself as dual citizen, as both nurse and patient.” While Clark was away from her job, many new treatments, medications and therapies were approved. She wanted to close the educational gap that had opened during her absence, and she looked to the ONS Foundation for help.

“I couldn’t afford to attend ONS’s annual congress. The 2016 ONS Foundation Congress scholarship helped me get there,” Clark notes. “The scholarship netted me invaluable opportunities to connect with my fellow nurses and to bring evidence-based practices back home to educate patients and colleagues at my institution.”

Clark has a special connection to her patients. During her own cancer treatment, some of them reached out to Clark’s supervisor. “They sent me music, flowers and encouraging notes,” she remembers. “One of the best parts of nursing is just that — the relationships with those we care for return it to us when it’s most needed. That makes me want to strive to become a better nurse for them and my future patients.”

With help from the ONS Foundation, oncology nurses provide care that merges education with inspiration.

By Your Side: Oncology Nurses Provide Care, Inspiration

Cancer treatments are unlike any other medical procedures. For many, they can cause an overwhelming sense of drowsiness, exhaustion and weakness — despite plenty of rest. Cancer treatment-related fatigue is unlike normal, everyday fatigue, the wear and tear that comes after a long day at the office or a hard workout at the gym. Cancer-related fatigue can feel like being stuck in a car that won’t shift out of first gear. Patients with cancer are likely all too familiar with this. Estimates suggest that nearly 90 percent of patients undergoing radiation therapy and 80 percent treated with chemotherapy experience cancer-related fatigue.

For more than 20 years, the Oncology Nursing Society (ONS) Foundation has worked to provide nurse scientists with funding and support as they conduct research related to fatigue symptoms. Through this area of study, new, evidence-based practices are being incorporated into treatment plans throughout the country.

Cancer-related fatigue symptoms are often pervasive, disruptive and difficult to understand, which is why, in 1995, the ONS Foundation created the Fatigue Initiative through Research and Education® program, awarding grants to oncology nurse scientists seeking ways to treat these symptoms. From 1995—2000, the Foundation awarded more than $1 million to help understand, investigate and ameliorate symptoms associated with cancer-related fatigue.

ONS member Anna Schwartz, Ph.D., FNP, FAAN, was one of the recipients of an early FIRE grant. Her focus was to create a clinically effective scale to assess and monitor fatigue associated with cancer treatment, since previous measurements of fatigue were not designed specifically for people with cancer. She developed the Schwartz Cancer Fatigue Scale, a validated questionnaire that measures fatigue based on physical and perceptual dimensions. In another Foundation-funded study from 2013, ONS member Margaret McCabe, Ph.D., R.N., PNP, studied fatigue in pediatric patients and its association with their hospital environments, accounting for light, sound, temperature, humidity and room entries.

“We documented that reduced sleep impacts fatigue in less well-functioning patients,” McCabe said. “We were able to see that patients who were more ill were more impacted by less sleep — they reported higher levels of fatigue.” McCabe and her colleagues also noticed a relationship between fatigue and factors that can affect sleep quality. “Less fatigue and better sleep quality were associated with less light in the environment,” McCabe said. “We also noticed that elevated sound levels, despite efforts to keep noise at a low level in the hospital, was impacting sleep quality, too.”

For many patients, cancer-related fatigue is thought to stem solely from treatment regimens such as radiation and chemotherapy. However, McCabe was quick to note that the reasons for fatigue in patients go beyond treatment.

“What we’re learning in the science of fatigue is that there are so many variables that have the potential to impact symptoms,” McCabe noted. “We have the environment, everything related to the disease process itself, treatment, and there may be underlying genetic implications for how you experience symptoms, as well.”

Challenging Fatigue Symptoms Through Physical Activity

In the past, most oncology professionals would recommend extended rest for patients with cancer suffering from fatigue. However, evidence and ongoing research show the importance of physical activity to help with managing fatigue.

Through an intense review of the research and associated literature, ONS has developed recommendations for practice that incorporate physical activity into treatment, as tolerated by the patient and approved by the physician. ONS champions this through its Get Up, Get Moving campaign, which encourages oncology nurses to work with their patients and oncologists to create individualized physical activity plans.

For some patients, physical activity may mean simply walking to the mailbox at the end of the driveway or taking a stroll outside. For other patients, jogging, biking and weight training may be encouraged. The most important thing is to consult with nurses and physicians first.

Exciting possibilities are on the horizon for fatigue management. From the incorporation of physical activity into treatment plans to digital monitoring devices to computer-aided programs that track fatigue levels in relation to activity, future strategies could provide great relief to patients suffering from cancer-related fatigue.

In 2017 and beyond, the ONS Foundation has committed to funding several fatigue-related research projects. By supporting oncology nurse scientists, the ONS Foundation hopes to discover novel, evidence-based interventions that decrease symptoms, lessen the negative impacts of treatment and increase quality of life for all patients with cancer.

The ONS Foundation (onsfoundation.org) is the only entity in the world that directly supports the projects of oncology nurses like Anna Schwartz and Margaret McCabe. Gifts to the foundation provide these nurses with access to education, research and professional development, ultimately improving patient care and advancing the oncology nursing profession.

The reasons for fatigue in patients go beyond treatment.

Developing Methods to Fight Cancer-Related Fatigue

Virginia's humid, subtropical climate makes for beautiful weather and plenty of days to spend outside in the sun. As a result, however, Oncology Nursing Society (ONS) member Adrienne Banavage, a registered nurse and nursing education coordinator at the Emily Couric Cancer Center at the University of Virginia Health Systems in Charlottesville, noticed a serious need for skin cancer education among those in her community.

Knowing that many there are at risk, and having firsthand experience treating patients with skin cancer, Banavage and her colleagues decided to take action, and set to work creating a public education program to support those in their community.

“We have a fairly significant rate of skin cancer in central Virginia,” Banavage said. “There’s a moderate to high amount of agriculture here, so lots of people are outside all day.” Banavage also noted that, because Charlottesville is a college town, the message was in a prime space to impact the health of a younger generation by creating awareness around skin cancer.

In fact, skin cancer awareness is an important issue across the country for people of all ages. Basal and squamous cell skin cancers account for more than 5.4 million diagnoses each year, and the more potentially deadly melanoma accounts for more than 76,000, according to the American Cancer Society.

Thanks to help from the ONS Foundation and its Cancer Public Education Award, Banavage was able to lead a team of oncology nurses to create the campaign UVigilant: Illuminating Skin Cancer Prevention at the City Market. Their project was focused on creating awareness about the dangers of skin cancer and the importance of protection from ultraviolet (UV) light generated by the sun and other sources. Working with the Virginia Cancer Network (VCN), Banavage gathered a team of oncology nurses to set up a booth at the farmer’s market in Charlottesville, Virginia, and engage with local patrons over eight months.

Their partnership with VCN gave the nurses access to a UV exposure camera and printer. This gave participants a look at their own skin damage caused by UV rays. The camera, designed to be used by health care professionals to highlight skin damage, used side-by-side images of a person’s face under a regular camera lens and a UV camera lens. Photos were taken of the participants and printed out to use in consultation with their primary-care physicians.

“People were really enticed to participate when they learned about the UV camera,” Banavage said. “They were fascinated by the idea that they could get immediate feedback on what their skin damage was.”

Once the participants received their pictures, they were provided with educational materials that highlighted the proper ways to stay safe in the sun.

“Many were surprised that they had any skin damage at all, especially the younger people,” Banavage noted. Participants who said they regularly wore sunscreen and participated in behaviors to reduce skin damage were also surprised to see that they might not have been as thorough with their sunscreen as they had originally thought. “Typically, people don’t apply sunscreen as effectively as they could,” Banavage said. “That was a good talking point, as well.”

According to Banavage, the UVigilant program reached 344 participants (74 percent female and 26 percent male). Half of the participants were 18 to 35 years old, including some college students. Banavage reported that 41 percent of participants, prior to talking with her and her colleagues, stated that they always or nearly always used sun protection. After participants saw their pictures from the UV camera and were educated about the dangers of skin damage, 72 percent reported that they intended to increase their use of sun protection. Moreover, two-thirds of participants said that they would follow up with their family doctors regarding their risk for skin cancer; 58 percent said that they planned to have a skin cancer screening done by their doctor.

While screening for skin cancer is not needed by everyone with UV damage, there are signs that can indicate that a check by a doctor is a good idea. Signs and symptoms of skin cancers can include changes in the size or color of moles, growths or spots; the appearance of new skin growths; the presence of rough, scaly or oozing skin; one or more sores that won’t heal; coloring that spreads beyond the edge of a mole; or skin tenderness, pain or itchiness.

The team’s work didn’t stop with the UVigilant project: Banavage noted that she and her colleagues continue to host skin cancer-related educational events in the Charlottesville community. Hopefully, she added, other communities will take up this call to arms against skin cancer and provide their residents with opportunities to better understand skin cancer prevention.

Those who want to learn more about their risk for skin cancer can ask an oncology nurse or a dermatologist how to protect against UV damage, and for information about screening.

 The Oncology Nursing Society Foundation is the only entity in the world that directly supports the projects of oncology nurses like Adrienne Banavage. Gifts to the foundation provide nurses who specialize in cancer care with access to education, research and professional development, ultimately improving patient care and advancing the oncology nursing profession. For more information about the foundation and ways to give, visit 

 

 

 Virginia nurses raised awareness about skin cancer risk by evaluating people’s faces for sun damage. 
