Abstract and Introduction
Abstract
The focus of this article is to provide information for palliative care nurses to use in their practice. The underlying study explored ongoing symptoms in breast cancer survivors. The design was a cross-sectional electronic survey. The survey included the Therapy-Related Symptom Checklist (TRSC), Daily Activities Rating Scale, Health-Related Quality of Life–Linear Analog Self-assessment, and a Subject Characteristics and Health Form. Data were analyzed by Fisher exact test and regression, as well as descriptive analyses. The main research variables were symptom occurrence and severity, daily activities, health-related quality of life, age, education, treatment type, and time since treatment completion. The findings of the study included the following: time following the treatment's completion did not affect TRSC scores; high total scores on the TRSC related to high scores on the Daily Activities Rating Scale and to low scores on the Health-Related Quality of Life–Linear Analog Self-assessment. The odds of a low TRSC score increased with both a higher education level and increased age; however, the odds score diminished if treatment included chemotherapy. Skilled palliative nurses should be aware of the occurrence and severity of ongoing symptoms among breast cancer survivors in order to improve patient screening and tailor interventions for palliation of those symptoms.
Introduction
Palliative nurses face symptom management challenges daily, and because breast cancer is the second leading cause of cancer death in women in the United States, a patient with breast cancer often presents with these challenges. One of 8 women will be diagnosed with breast cancer in her lifetime; estimates indicate that 2.6 million women live with this disease and the sequelae of treatment. This study considered how breast cancer survivors might provide evidence to inform nursing practice about symptom management. Nurses play a key role in developing a model of survivorship care planning for patients with breast cancer. The 2013 National Consensus Project guideline 2.2 recommends "the assessment and management of symptoms and side effects contextualized to the disease state."
Although advances in detection and treatment of breast cancer have increased the survival rate for women over the past several years, many of these survivors continue to suffer from physiological and psychological late effects from their treatment. Throughout the entire continuum of one's life as a survivor, situations occur that can cause psychosocial distress that can seriously affect their quality of life (QOL), as well as their morbidity and mortality. QOL has been the subject of at least 606 studies in breast cancer patients from 1974 to 2007.
Medical professionals might inadvertently minimize the toll patients experience from specific, ongoing symptoms. For example, Rossman indicated that the onset of hair loss is the second most traumatic event after initial communication of the diagnosis of cancer. Unfortunately, health care providers often minimize the importance of alopecia, as it is temporary and easy to remedy. One of the survivors wrote a comment on her survey: "One of my biggest concerns associated with my cancer and its treatment was the loss of my hair. Even though now, over 5 years later, I do have a full head of hair, it still causes me grief. My hair is much different. The medical staff has used the word petty when I have complained about this when I was looking for comfort and understanding. It is still a big issue for me."
Another ongoing symptom that is troublesome for survivors is a change in sexual activity or interest. Several studies indicated that pain, change of body image, and fear resulted in lower frequency of sexual relations and even celibacy because couples were neither informed of what to expect nor supported in their efforts to cope with their sexual problems.
Fatigue is often described in the literature as one of the most common and distressing of the ongoing symptoms experienced by cancer survivors. An estimated 80% to 100% of people with cancer experience fatigue. Many other symptoms also have a significant impact on QOL such as pain and mood disturbances, insomnia, depression, and anxiety. Experiencing multiple symptoms causes a synergistic effect among symptoms that result in reduced QOL. Symptoms interfere with many functions in daily life, resulting in frustration and depression because of a need to give up enjoyable activities that result in decreased QOL.
Many studies have demonstrated that demographics have an important impact on symptoms, and other studies have verified that the type of treatment affects symptoms such as fatigue. Using subject characteristics to focus nursing assessments and target interventions is an important step in the improvement of survivorship care.