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Focusing Patients on the "Can" in Cancer Diagnosis, Treatment, and Recovery

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Posted: 4/17/2009

Nurse researchers at the Johns Hopkins University School of Nursing (JHUSON) are helping to make cancer a word, not a sentence, for over 1.4 million Americans of every age, race, ethnicity, and income diagnosed with some form of cancer each year. Their innovative studies are examining cancer-related disparities in diagnosis and treatment across ethnic populations, identifying ways to encourage at-risk women to get screened for breast and cervical cancer, and identifying how exercise and methods that integrate mind and body can help improve the quality of life for individuals of all ages with all types of cancer.

Other researchers are assessing the effectiveness of combining standard cancer interventions and complementary or traditional therapies. Still others are looking at end-of-life issues for cancer patients and their families. And one PhD candidate is carrying on the legacy and the work of her former advisor, a senior nurse researcher who lost her own battle with cancer. The results of these and numerous other community-based studies by JHUSON faculty and graduate students are yielding new tools and knowledge to reduce the physical and emotional effects of cancer. Through their work, the nurse researchers at the JHUSON give hope and help to cancer patients and to those who love them.

Opening Minds and Doors to Cancer Screening
Community health researcher and JHUSON Associate Professor Haera Han, PhD, RN, is changing minds and health habits about preventive care through her research in the Korean American community. Based on early studies on which she was a research team member, she learned that Korean Americans generally did not avail themselves of preventive care. When in charge of health screening programs, she saw the problem first-hand. Since then, Han already has conducted community-based research programs designed to change both the data and the health-screening picture for Korean Americans. One such program has helped promote prostate and colorectal cancer screening among Korean American men. Most recently, she's been pushing back against the growing rates of breast cancer among Korean American women, a population already known to have the second highest incidence of cervical cancer among all U.S. women. "Unfortunately," Han points out, "with lives that can include 16-hour work days without weekend or holiday breaks, a lack of health insurance and limited English skills, mammograms and Pap smears simply aren't a high priority." Further, a significant number of first generation Korean American women adhere to traditional belief that one does not seek health care until the situation is acute. With a recent $2.7 million National Cancer Institute grant, she is testing tailored health messages combined with health literacy training to help Korean American women understand the benefits of breast and cervical cancer screening. Perhaps more important, the work is also assessing the effectiveness of a trained local lay community health worker to help local women navigate the screening process. The goal, she says, is to help develop a system of health empowerment and support that can last far beyond the study and affect future generations as well. Han says, "It is time to change the old ways of thinking about health care, and not just among Korean Americans. If we do prevention better, we can prevent many serious illnesses or catch them early when they're easier to treat. And prevention is always cost effective; it saves money and lives."

After Breast Cancer: The Work of Survivorship
When breast cancer treatment ends, surgery scars are beginning to fade, and chemotherapy is complete, women are ready to get back into the rhythm of life, a life put on hold by a cancer diagnosis. A patient becomes a survivor. Because that transition isn't always easy, JHUSON Assistant Professor Sharon Olsen, MS, RN, AOCN, and colleagues are developing a new care model and nurse education opportunities to ease that transition, thanks to funding from Susan G. Komen For the Cure, Maryland. Olsen notes, "When treatment for breast cancer is over, women need for their cancer doctors and primary care doctors to work together to help them adjust to their new normal.". Unfortunately, when a woman graduates from her breast cancer team, all too often, she's on her own. Her primary care providers may feel uncomfortable managing post-cancer issues, from "chemo brain" and sexuality concerns to osteoporosis and heart health risks. The survivor's questions and concerns may go unanswered in this service gap. Olsens work is helping to bridge that gap. To ease the transition from patient to survivor, she is working with researchers at the Johns Hopkins Medical Centers Breast Center and its Department of General Internal Medicine to design, implement and assess a model for survivorship care that can be exported to communities around the country. Such a model can give primary care providers the tools and confidence they need to address the unique needs of breast cancer survivors. With an emphasis on cross-discipline collaborative care, the model also demands a greater understanding of survivorship among both nurses and patients. One of the school's leading advocates for careers in cancer nursing, Olsen believes the program gives students the impetus they need to help change how care is provided not only to breast cancer survivors, but also to the 20 million women, men and children in the U.S. today who are surviving other forms of cancer.


A New Generation in Cancer Research Steps Up to Honor a Mentor
Nothing shakes the resolve of JHUSON doctoral candidate JingJing Shang, MSN, RN, OCN. Trained as an oncology nurse in China, she emigrated to the U.S. and the JHUSON, trading a clinical care for one in cancer research, overcoming language and cultural barriers, and ultimately becoming part of a JHUSON cancer research team exploring the effects of exercise on cancer treatment-related symptoms. Shang won a coveted scholarship from the American Cancer Society (ACS) to help support her planned doctoral dissertation. But then the head of the research team, Professor Victoria Mock, PhD, RN, FAAN, a long-time, and well-loved faculty member, and Shang's advisor and mentor, died, of cancer. Data collection and analysis stopped; but Shang had other ideas. With the blessing of the ACS and her new advisors, she changed dissertation topics to focus her dissertation on the unanalyzed data about cancer patient adherence to an exercise regimen. "Patients are more likely to exercise when there are family at home to encourage them," said Shang. That encouragement is important. For some patients, exercise and fatigue can become a vicious cycle. When tired, patients don't exercise; the less they exercise, the more likely they will lose their physical capacity in a long run. That's where family can help. Shangs work, still a few months away from presentation to her dissertation committee, suggests the effectiveness of a number of strategies such as family engagement and the creation of a schedule to help the patient pace his or her activities, to promote exercise adherence that can boost energy, and improve mood and physical function among cancer patients. Down the road, she hopes to extend the work begun by Dr. Mock to other populations, including an exploration of exercise strategies, such as tai chi, used by Chinese-American populations to combat chemotherapy-related fatigue.