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Posted: 5/6/2008

May is National Cancer Research Awareness Month, but for nurse researchers at the Johns Hopkins University School of Nursing (JHUSON), every month is cancer research month. Their innovative studies examine the integration of mind, body, and spirit to help improve the quality of life for individuals of all ages with all types of cancer. Their results not only reshape nursing practice and education but also create new nursing tools and skills that can help ease the physical and emotional effects of a cancer diagnosis for patients and those who love them.

Living with Cancer: Mind Does Matter

The connection between mind and body is not lost on Senior Associate Dean and researcher Anne Belcher, PhD, RN, AOCN, FAAN, and Professor Fannie Gaston-Johansson, PhD, RN, FAAN. They are two of a growing number of JHUSON faculty and researchers who have learned that how well you cope and adapt to a diagnosis of cancer affects how well you do as a cancer patient. Increasingly, both research and clinical practice 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.   Gaston-Johansson, who is the first African-American woman to be a tenured full professor at the Johns Hopkins University, is also a nurse on a mission. The [breast cancer] mortality rate for African American women is 32% higher than for Caucasian women, she points out. As Director of the JHUSON Center on Health Disparities Research, she is 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 is now working with the Winston-Salem State University's Exploratory Research Center of Excellence to help develop culturally appropriate interventions for African-American women in treatment for breast cancer. Contact Dr. Gaston-Johansson at 410-614-1684.

Her 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. Theres some evidence it boosts our immune system and, of course, it helps psychologically.

Belcher is currently working on a study aimed at understanding prostate cancer awareness among African American men, a population who are at greater than average risk for developing prostate cancer, the most commonly diagnosed cancer among men. Because diagnosis is often late in the illness, African American men also are twice as likely to die from prostate cancer as Caucasian men. Belchers JHUSON Center for Health Disparities supported pilot study will explore how much low-income African-American men know about prostate cancer risk and screening. She is now analyzing the data gleaned from a focus group of 6-10 homeless men and plans to develop and test an education/screening intervention for African-American men receiving care in community-based clinics. Contact Dr. Belcher at 410-614-4081.

Cancer Decision-Making Partnerships Key

JHUSON Associate Professor Marie Nolan, PhD, MPH, RN, a pioneer in research on end-of-life care, is challenging the long-held clinical notion that patients should make their own health care decisions at every stage of care. She has found that when confronted by terminal illness such as advanced cancer, most patients don't want to go it alone. Nolan led a multidisciplinary team of faculty and student researchers that followed 130 patients with advanced-stage cancer or another terminal illness, interviewing patient and family regularly over time, and interviewing each family after each patients death. While decision preferences vary widely, Nolan said most [patients] would opt to share decision-making with their physicians and loved ones. Over half (52%) would prefer to make decisions in concert with their physician; 44% would want to share options with family. Just over a third (34%) would prefer to make decisions independent of their physician. When unable to decide for themselves, patients would rely on their physicians input over their own wishes. However, they would weigh family opinion even more heavily than that of the doctor. Communication becomes paramount. Nolan suggests that patients discuss their choices with their families and, in turn, that families express those desires to health care providers. Nolan continues to explore how nurses can help open and maintain communication channels among the patient, family and treatment team to improve the quality of care and life. Contact Dr. Nolan at 410-614-1684.

The Next Research Generation: Managing Uncertainty, Improving the Quality of Life

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 JHUSON post-doctoral fellow Maya Shaha, PhD, RN, are going one step farther, 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. To contact Dr. Shaha, who currently is working in Switzerland, call Dr. Anne Belcher at 410-614-4081.