Research Working Group - Updates from 2017
October 2017: Metaphors in palliative cancer care
Here, Ulrika Östlund of the EONS Research Working Group introduces a project that she believes is both interesting and important. Charlotte Hommerberg, the project leader, explains the study below and shares some preliminary results.
Metaphors are so common in every-day language that we do not even notice when they are being used. Yet, metaphors can have powerful effects on our way of understanding and experiencing life, particularly in the kind of emotionally and psychologically challenging situation that confronts patients with chronic cancer and their family members. In today’s Swedish palliative cancer care, there is wide-spread awareness of the importance of good communication for patients as well as those close to them. This type of communication involves particular challenges because of extensive differences in involvement, power and expertise between different groups, patients, family members and health professionals. The project ‘Metaphors in palliative cancer care’ aims to raise awareness among health professionals working in palliative cancer care about the complex forms and functions of metaphors. In addition, results are also communicated directly to stakeholder groups through outreach activities, for instance a module in a university course designed specifically for patients and family members.
The project is an interdisciplinary collaboration between linguistics and health sciences: https://lnu.se/en/research/searchresearch/metaphors-in-palliative-cancer-care/. The data consist of blogs written by patients and family members as well as interviews with patients, family members and health professionals, in total approximately three million words. This text database, or corpus, is processed using both quantitative and qualitative linguistics methods in order to reveal how the stakeholders themselves use metaphors when capturing their experiences in words. The study uses a design that has been developed for a comparable investigation, Metaphor in end-of-life care, which has previously been completed in the UK: http://ucrel.lancs.ac.uk/melc/.
The preliminary results reveal a number of different metaphorical domains which recur across several language users. For instance, the experience of living with chronic cancer is described in terms of a detour on the journey of life, as being trapped in an undesirable place or as carrying something heavy. Particularly for the patient group, fight and battle metaphors have a strong foothold, reproducing a metaphorical framing that has become commonplace in Western culture, not least in the media. While this way of framing the cancer experience has been criticized for having potential negative consequences, assigning responsibility and possibly also guilt to the patient who cannot be cured by the treatment, battle, fight and struggle metaphors nonetheless seem to also have important enabling functions for the users.
The project ‘Metaphor in palliative cancer care’ is a three-year study, which runs from 2015 to 2018. The study is founded by the Kamprad Family Foundation.
Charlotte Hommerberg, Project leader
September 2017: Maintaining hope
By Wendy Oldenmenger
Oncology nursing research could have an added value to medical studies, even in phase 1 oncology trials. A nice example of this is the recent article of Diane van der Biessen, a nurse practitioner oncology of the Erasmus MC Cancer Institute in the Netherlands.
Understanding how coping strategies and quality of life maintain hope in patients deliberating phase I trial participation.
van der Biessen DA, et al. Psycho-oncology. 2017 Jun 30. doi: 10.1002/pon.4487.
OBJECTIVE: This study aimed to understand how hope and motivation of patients considering phase I trial participation are affected by psychological factors such as coping strategies and locus of control (LoC) and general well-being as measured by the quality of life (QoL).
METHODS: An exploratory cross-sectional study was performed in patients with incurable cancer (N = 135) referred to our phase I unit for the first time. Patients were potentially eligible for phase I trial participation and participated in our study while deliberating phase I trial participation. We used questionnaires on hope, motivation to participate, coping, LoC, and QoL. To investigate the nature and magnitude of the relationships between the scales, a structural equation modeling (SEM) was fitted to the data.
RESULTS: Hope significantly predicted the motivation to participate in phase I trials. Predictors of hope were a combination of flexible and tenacious goal pursuit (both P < .01), internal LoC (P < .01), and QoL (P < .01). The SEM showed an exact fit to the data, using a null hypothesis significance test: chi-square (8) = 9.30, P = .32.
CONCLUSIONS: Patients considering phase I trial participation seem to use a pact of tenacious and flexible coping and control to stay hopeful. Furthermore, hope and QoL positively affected each other. The psychological pact may promote an adaptation enabling them to adjust to difficult circumstances by unconsciously ignoring information, called dissonance reduction. This mechanism may impair their ability to provide a valid informed consent. We suggest including a systematic exploration of patients’ social context and values before proposing a phase I trial.
Summary of the motivation model of patients with cancer during phase I trial deliberation:
August 2017: Summer time and self-care
By Iveta Nohavova
When I was contemplating what topic I would focus on this month, I kept thinking about summer days calling us outside to relax, move, do fun activities, travel, or simply smell, listen and observe nature around us. This is also the time of summer vacations during which we aim to step away from our daily routines and perhaps even forget for a moment our duties or worries.
Have you already thanked yourself today for being the person you are?
Well, why not use this month to reflect on how important it is for we nurses to take good care of our bodies and minds because, undoubtedly, our profession demands a lot of empathy and care for others. And, over time, this can be exhausting, especially if we do not take care to replenish both our inner and our physical strength.
Have you taken 15 minutes today, just for you?
I want to invite you to:
- sing for joy
- dance with your eyes closed
- draw a picture
- take a walk in the woods
- take a nap
- enjoy a cup of tea with your friend
- meditate about things you are thankful for
- write an entry in your journal
- compose a poem/
In other words, simply do whatever makes you happy! And, if possible, do this every day.
Happy, healthy and content nurses provide the best nursing care and create a healthy work environment. Self-care is an essential instrument to prevent the burnout, moral distress and compassion fatigue of which we are at daily risk in our profession. So, do not forget to take care of yourselves. Summer is the ideal time to restore and replenish our reserves.
I would like to close with the following quote from Ovid:
“Take rest. The field that has rested gives a beautiful crop.”
July 2017: EONS research support helps cancer nurse gain PhD
EONS research support has helped Dr Ylva Hellstadius, an EONS nurse and PhD student at the Karolinska Institutet in Stockholm, Sweden, on her way to being an accomplished researcher and making a real difference to patient care.
EONS Research Working Group Co-chair Mary Wells, played a key part in this major achievement as one of her PhD examiners. Paying tribute to Ylva’s work, she commented: “Finishing a PhD is a major achievement in any nurse researcher’s life and it is quite right that it should be marked in a formal way. Having been a PhD examiner for a number of theses in the UK, I was excited to be asked, for the first time, to be an ‘opponent’ for a PhD student at the Karolinska Institutet in Stockholm, Sweden. I was particularly looking forward to it as the student was Ylva, who took part in our second EONS Research Workshop in Stockholm in 2012, when she was just embarking on her doctoral studies.
“Ylva was also a deserving winner of an EONS Research Travel Grant a few years later, and this grant enabled her to spend some time at St Thomas’ Hospital in London, where she conducted two of her research studies. Ylva’s thesis explored psychological distress in patients with oesophageal cancer. Her work included three published quantitative studies illustrating significant levels of anxiety and depression in patients before surgery, at sixth months and also at five years after surgery. She also conducted an in-depth qualitative study (to be published) which revealed important insights into the often hidden distress reactions experienced by patients who have had treatment for this devastating disease.”
Ylva Hellstadius receives her 2013 Research Travel Grant from EONS Board member and Advocacy Working Group chair Patrick Crombez.
Explaining her role, Mary continued: “As the opponent, I was required to ask Ylva a range of searching questions about her work in front of an audience of family, friends, supervisors and colleagues, and in the presence of an examining committee. This is very different from the PhD viva voce examination which takes place in the UK, as this involves only the examiners and student discussing the work in a private room.
“There is something much more ceremonial about the system in Sweden and it was a really interesting experience for me, as well as being quite a demanding one! But the best thing about it was seeing Dr Ylva Hellstadius, an EONS nurse, achieve her PhD. It’s fantastic to see that EONS research support has helped her on her way to being an accomplished researcher whose work will make a real difference to patient care.”
Find out more about how EONS grants and awards could help you build your research skills.
March 2017: Unleashing the power of nature in advanced symptom management: the case of thyme honey in xerostomia
By Andreas Charalambous, Assistant Professor of Oncology Nursing and Palliative Care, Nursing Faculty, Cyprus University of Technology and Docent at University of Turku, Finland.
Cancer treatments including immunotherapy have all been associated with numerous adverse effects of varying levels of severity, including oral toxicities and cutaneous toxicities, to name a few. One of the most prominent and persistent side effects for patients with malignancy undergoing chemotherapy and/or radiotherapy is xerostomia. These adverse effects, when severe, can cause dose limitation, interruption of treatment, difficulties in performing the activities of daily living and subsequently increasing the negative impact on the patient’s overall Health-Related Quality of Life (Charalambous, 2014).
Xerostomia is the abnormal dryness in the mouth characterized by a marked decrease and/or thickening of saliva, resulting from the reduction or absence of sufficient quantity of salivary production. For example, radiation therapy as monotherapy (worse effects observed when radiotherapy is combined with chemotherapy such as increased duration of xerostomia) can reduce the salivary flow rate by up to 80% by the 7th week (Li et al., 2007). As a result the patient has to deal with difficulties in eating and swallowing that in turn lead to limited intake of food and liquids, causing severe malnutrition and secondary infections.
The pharmacological options available for the comprehensive management of xerostomia remain ineffective and with many presenting with low adherence among patients (i.e. pilocarpine, artificial saliva). The value of complementary and alternative (CAM) interventions such as thyme honey in the management of xerostomia has not been fully captured in the literature. The fact that an increased number of people will have to live with this side-effect during the treatment and soon after its completion, has created a more positive trend towards the value and effectiveness of CAM interventions both among patients and healthcare professionals.
Honey is one of products in nature’s arsenal that have been studied to an extent for the management of H&N cancer treatment adverse-effects, but not for xerostomia. Honey has many properties that can prospectively be of high value in managing xerostomia. For example, honey presence in the oral cavity can have a sialagogue effect by stimulating the salivary glands (i.e. minor salivary glands) to produce more saliva (Ganjre et al., 2015). Honey also has excellent antibacterial action due to the presence of phytochemicals (Anderson, 2006) and its acidic environment with a pH ranging from 3.2 to 4.5 (Bardy et al., 2008:1). The antibacterial properties of honey can be further fortified by those of thyme, which also has strong anti-inflammatory and pain-relief actions when used locally.
We have recently published the first study that was designed to explore the effectiveness of thyme honey in xerostomia (Charalambous et al 2017). This was a parallel randomised controlled trial with two equal arms, the experimental arm (thyme honey) and the control arm (saline). Seventy-two head and neck cancer patients receiving radiotherapy or/and chemotherapy or/and surgery were recruited for this trial. Patients in both arms followed the same administration protocol with thyme honey and saline respectively. Identical assessments at baseline, 1 month and 6 months following completion of the intervention were performed in both arms including the National Cancer Institute (NCI) xerostomia scale and the Xerostomia Questionnaire (XQ) additionally to weekly oral clinical assessments. The ClinicalTrials.gov Identifier for this study is NCT01465308. The study’s results demonstrated the safety and efficacy of Thyme honey in head and neck cancer patients for the management of treatment induced xerostomia. Thyme honey was found effective in reducing or stabilizing the severity of xerostomia grade and improving overall health related quality of life. Its positive effects on xerostomia grade increased over time. However, this being the first study exploring the safety and effectiveness of thyme honey in xerostomia, there is a need for further larger, multi-site and high quality studies to validate these findings.
Anderson I.Honey dressings in wound care. Nurs. Times, 102 (2006), pp. 40-42
Bardy, J.N. Slevin, L.K. Mais, et al. A systematic review of honey uses and its potential value within oncology care J. Clin. Nurs., 17 (2008), pp. 2604-2623
Charalambous, A. Charalambous M. Hermeneutic phenomenological interpretations of patients with head and neck neoplasm experiences living with radiation-induced xerostomia: the price to pay? Eur. J. Oncol. Nurs., 18 (2014), pp. 512-520.
Charalambous A, Lambrinou A, Katodritis N, Vomvas D, Raftopoulos V, Georgiou M, Paikousis L, Charalambous M. The effectiveness of thyme honey for the management of treatment-induced xerostomia in head and neck cancer patients: A feasibility randomized control trial, European Journal of Oncology Nursing, 27(2017), pp 1-8
Ganjre, A, K. Rahul, V. Pawar, N. Bagul, et al. Anti-carcinogenic and anti-bacterial properties of selected spices Implic. Oral Health Clin Nutr Res., 4 (2015), pp. 209-215.
Y. Li, J.M. Taylor, R.K. Ten, Haken. The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy. Int. J. Radiat. Oncol. Biol. Phys., 67 (3, 1) (2007), pp. 660-669.
February 2017: Personalised medicine
Personalised medicine aims to tailor treatment to the patient’s individual biology. Recent advances in genetic science are revolutionising cancer treatment. For the February Research News Update, Professor Theresa Wiseman shares an article from the journal Oncology.
+ Read the article