Faculty Bibliography

OBJECTIVES: To explore factors influencing functional status over time after cancer surgery in adults aged 65 and older. DESIGN: Secondary data analysis of combined data subsets. SETTING: Five prospective, longitudinal oncology nurse-directed clinical studies conducted at three academic centers in the northwest and northeast United States. PARTICIPANTS: Three hundred sixteen community-residing patients diagnosed with digestive system, thoracic, genitourinary, and gynecological cancers treated primarily with surgery. MEASUREMENTS: Functional status, defined as performance of current life roles, was measured using the Enforced Social Dependency Scale and the Medical Outcomes Study 36-item Short-Form Survey (using physical component summary measures) after surgery (baseline) and again at 3 and 6 months. Number of symptoms, measured using the Symptom Distress Scale, quantified the effect of each additional common cancer symptom on functional status. RESULTS: After controlling for cancer site and stage, comorbidities, symptoms, psychological status, treatment, and demographic variables, functional status was found to be significantly better at 3 and 6 months after surgery than at baseline. Factors associated with better functional status included higher income and better mental health. Factors associated with poorer average functional status were a greater number of symptoms and comorbidities. Persons reporting three or more symptoms experienced statistically significant and clinically meaningful poorer functional status than those without symptoms. Persons reporting three or more comorbidities were also found to have poorer functional status than those without comorbidities. No significant relationship existed between age and functional status in patients aged 65 and older. CONCLUSION: Factors other than age affect recovery of functional status in older adults after cancer surgery.

Combining extant datasets with differing outcome measures, an economical method to generate evidence guiding older adults' cancer care, may introduce heterogeneity leading to invalid study results. We recently conducted a study combining extant datasets from five oncology nurse-directed clinical trials (parent studies) using norm-based scoring to standardize the differing outcome measures. The purpose of this article is to describe and analyze our methods in the recently completed study. Despite addressing and controlling for heterogeneity, our analysis found statistically significant heterogeneity (p < 0.0001) in temporal trends among the five parent studies. We concluded that assessing heterogeneity in combined extant datasets with differing outcome measures is important to ensure similar magnitude and direction of findings across parent studies. Future research should include investigating reasons for heterogeneity to generate hypotheses about subgroup differences or differing measurement domains that may have an impact on outcomes.

OBJECTIVES: To review the available scientific literature on cancer care in nursing homes and recommendations for clinical practice and further research are offered. DATA SOURCES: Research studies and review articles. CONCLUSION: Overlooked issues for older adults with cancer in nursing homes include screening, treatment, and symptom management. Cancer care and survivorship in nursing homes receives little direct attention. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can improve cancer care and survivorship in nursing homes by considering nursing homes as a practice venue.

OBJECTIVES: Multidisciplinary care of cancer patients in varied settings is well described in the literature, but there is little specifically describing the multidisciplinary care of the patient with hepatocellular carcinoma (HCC). The purpose of this article is to describe HCC and the multidisciplinary approach at the Philadelphia Veterans Affairs Medical Center (PVAMC). MATERIALS AND METHODS: HCC is one of the most common solid tumors in the world, but it is rare in North America. It is associated with environmental carcinogens identified in animal studies, hepatitis B and C, cirrhosis of any etiology, and various metabolic diseases. No reliable therapy has been established for HCC. Surgical resection is the best treatment, but it is possible only in the patient with adequate hepatic reserve and limited-stage cancer. From January 1995 to May 1998, 22 patients at PVAMC received a diagnosis of primary HCC. One patient was a candidate for surgery, two patients received radiation therapy, and one patient underwent chemoembolization. Eighteen patients presented with an advanced-stage disease and comorbidities. RESULTS: Therapy goals in these 18 patients were limited to supportive care and enhancement of quality of life. A multidisciplinary team provided care to this challenging patient population. The multidisciplinary team treating HCC at PVAMC consisted of physicians, nurses, pharmacists, social workers, and a chaplain. Most care occurred in the outpatient setting. Supportive therapy included the controlling of ascites and abdominal discomfort, hepatic encephalopathy, and pruritus. Opioids relieved abdominal pain. Psychiatric support and counseling helped patients and families cope with the poor prognosis. CONCLUSIONS: A multidisciplinary team approach helped provide care for this challenging population. Through anecdotal reports, patients and family expressed satisfaction with their care. Research is needed to systematically test interventions designed to enhance quality of life in patients with HCC.