Distress, uncertainty, and barriers to care are common experiences for patients with cancer and survivors. Yingzi Zhang, PhD, RN, of the School of Nursing at the University of Rochester in New York, and Jin Young Seo, PhD, WHNP-BC, RN, of Hunter College in New York, NY, reported on their research on quality of life (QOL) and access to care in vulnerable patient populations.
Uncertainty and Emotional Distress in Patients With Advanced Cancer and Family Caregivers
Both patients with advanced cancer and their family caregivers experience physical and psychological adverse events, such as distress, that impair QOL. Zhang conducted a study to examine the effects of uncertainty and emotional distress on patients’ and caregivers’ QOL, as individuals and as a dyad.
In the sample of 372 dyads, Zhang found that patients with lung cancer reported lower QOL than other patients, consistent with other studies.
“Patients with lung cancer experience significant symptom burden and interruption of daily lives,” Zhang said. Oncology nurses should “be aware of the negative influence of lung cancer diagnosis on patients’ QOL and help patients to manage uncertainty and distress related to the cancer experience.”
The findings indicated that for patients with advanced cancer, each person's own uncertainty rather than their caregiver's uncertainty exerted more negative influence on the individual's QOL, Zhang said. In addition, patient distress had a significant effect on both the individual's and caregiver's QOL, indicating that distress is a dyadic experience.
“Dyads who experience emotional distress may erode support provided to each other, which in turn adversely affects QOL. Psychosocial interventions for managing emotional distress should target both patients and their caregivers, which may produce a synergistic effect in improving QOL,” Zhang said.
An Education Program to Reduce Breast Cancer Risk in Korean Immigrant Women
Breast cancer is prevalent among the fast-growing Korean American (KA) population. However, they often experience barriers to effective screening and care.
“Alarmingly, Asian American women are more likely to receive a diagnosis in the advanced stages of disease, resulting in less response to treatment and a higher mortality rate,” Seo said. “KA women have among the highest breast cancer mortality rates and lowest screening rates of U.S. women across all racial or ethnic groups.”
According to Seo, factors contributing to low screening rates in KA women include:
- Being foreign born with limited English proficiency
- Lacking health insurance and a usual source of health care
- Holding traditional values and beliefs, such as traditional Korean medicine
“For oncology nurses must teach KA cancer survivors the importance of cancer surveillance and life-long follow-up care,” Seo said.
Seo and her research team developed a culturally tailored educational program to reduce breast cancer risk factors and increase screening rates among KA women. “Through in-person interviews and a program evaluation survey, we received positive feedback from participants who completed the 24-week educational program,” she said.
“Their overall satisfaction with our program was very high, and all of them reported that they would recommend our program to their neighbors or friends,” Seo continued. “They also reported positive behavioral changes in their lifestyles (eating healthy, being active, and losing weight). In addition, they reported an uptake in mammography and a positive attitude toward breast cancer screening.”
“Oncology nurses should target specific populations’ traditional health beliefs regarding breast cancer risk factors with multicomponent strategies to reduce structural and cultural barriers for breast cancer screening,” Seo said. “Collaboration with community organizations serving the target population, with expertise and community engagement strategies, is key to developing a successful community-based educational program.”