Family History of Colorectal Cancer May Make African Americans Less Likely to get Screened The Next Research Generation: Managing Uncertainty, Improving the Quality of Life Living with Cancer: Mind Does Matter Each year, as many as 2,000 children become long-term cancer survivors thanks to a powerful treatment tool: bone marrow transplantation, or BMT. However, this aggressive treatment, when successful in defeating the cancer, is known to come with potential long-term damage to a child's bones. Without intervention, the damage can lead to considerable pain and disability later in life. Writing in the Journal of Pediatric Oncology Nursing, Johns Hopkins University School of Nursing clinical instructor and PhD candidate Kathy Ruble, MSN, RN, describes the incidence, risks for occurrence, and symptoms of three of the most salient bone problems that occur in the decades following successful bone marrow transplantation among young cancer patients. They include bony lesions on the skeleton called osteochondromas that can cause pain or restrict movement; thinning bones that can lead to fractures; and avascular necrosis, the death of bone tissue that leads to bone collapse, most often in the knee, shoulder, or hip. "Oncology nurses are leading the way in the care of cancer survivors and play a critical role in ensuring the best possible outcomes for these individuals," Ruble observes. She recommends the steps oncology nurses can play in the early identification and treatment of these potentially disabling conditions during routine care of long-term survivors of childhood cancer. Careful review of each patient's individual risks for these BMT complications, coupled with ongoing monitoring, diagnosis and treatment (including behavioral, pharmacological and physiological interventions) can help promote healthier lives for thousands of young cancer survivors.
-Teddi Fine Regular colorectal cancer screening is one of the most powerful weapons in preventing colorectal cancer. It can, in many cases, prevent the cancer altogether. Yet Johns Hopkins University School of Nursing researcher Kathleen Griffith, PhD, CRNP, has discovered that African-Americans with a family history of colorectal cancer are less likely to be screened than those at average risk for the disease. Findings also suggest that African-Americans with a family history are also less likely to be screened than their white counterparts. "African-Americans have the highest colorectal cancer incidence and death rates-and the lowest screening rates-of all racial groups in the United States," says Griffith. "It is difficult to explain why African-Americans who perceive an increased risk for developing cancer, particularly those with a family history of colorectal cancer, are less likely to get screened. Our results suggest that there are some other factors, which we haven't included in this study, that affect their screening decision."
Griffith and her colleagues from the University of Maryland, Baltimore, analyzed data from the 2002 Maryland Cancer Survey, a telephone survey of more than 5,000 Maryland residents, to look for predictors of screening among African-Americans. Analyses revealed that, regardless of family history, individuals who are physically active or who receive a health care provider's recommendation for colorectal cancer screening are more likely to obtain risk-appropriate screening. With additional research, Griffith hopes to develop culturally tailored interventions to increase screening rates, which in turn could ultimately improve early detection and reduce colorectal cancer deaths in African Americans. The study is published in the July 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.
Adapted from CANCER press release Nursing research has helped extend the lives of people diagnosed with cancer by promoting adoption of a team approach to care. Today's young nurse researchers, such as Johns Hopkins University School of Nursing post-doctoral fellow Maya Shaha, PhD, RN, are going one step further, focusing on improving the quality of life and not just extending the life for cancer patients. Following a cancer diagnosis, patient uncertainty, stress and anxiety often remain pervasive, affecting the quality of life for both patient and family. Little is known about factors that contribute to this uncertainty or how those factors can be managed. Shaha and colleagues conducted a literature review of over 40 articles that included the issue of uncertainty among breast, colon and prostate cancer patients. The review yielded three sources of patient uncertainty: post-diagnosis information needs; decisions about treatment; and impact on home and family. The review also confirmed that patient uncertainty ebbs and flows with the course of the illness and treatment. Shaha posited that assessment and management of patient uncertainty should be a routine part of comprehensive cancer care.
-TF  The connection between mind and body is not lost on researcher and Director of the Office for Teaching Excellence Anne Belcher, PhD, RN, AOCN, FAAN, and Professor Fannie Gaston-Johansson, PhD, RN, FAAN. They are two of a growing number of faculty and researchers at the Johns Hopkins University School of Nursing who are integrating patient self-care, from visualization to meditation and from spirituality to laughter and exercise, into comprehensive treatments for cancer.
Gaston-Johansson and colleagues compared two groups of breast cancer patients who were undergoing chemotherapy, one of which had been trained in specific strategies to foster relaxation and positive thinking. The women who used their newly minted coping strategies experienced less depression and anxiety as well as less nausea and fatigue during their bouts with chemotherapy. As Director of the JHUSON Center on Health Disparities Research, Gaston-Johansson is also working to level the health care playing field for underserved populations, including African-American women with breast cancer. In a recent study, she found that the same spirituality and faith that influence African Americans' general health practices, beliefs, and outcomes also have a positive influence on physical and emotional wellbeing during breast cancer treatment. Gaston-Johansson's suggestion that nurses can help make spiritual and faith-oriented coping strategies part of comprehensive breast cancer treatment plans for women of diverse ethnic and racial backgrounds resonates with Belcher, who has suggested in Oncology Nursing Society News that nurses should add expertise at the interface of clinical and spiritual issues as part of the skills they bring to the cancer treatment team. Belcher also adds a somewhat different take on the power of the mind-body connection. She prescribes humor in liberal quantities, which she says, "stimulates the release of endorphins that can help control pain and help people sleep better. There's some evidence it boosts our immune system and, of course, it helps psychologically."
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