The recent announcement by the U.S. Preventive Services Task Force, a national panel of medical officials tasked with reviewing clinical data and making recommendations about preventive care, has generated considerable confusion about the role of mammography and threatens to undo years of beneficial public and physician education and behavior adaptation.
Since the news broke about the recommendation last month, our team of breast cancer specialists has been inundated by questions, concerns and comments from women.
Until 1990, the breast cancer death rate in the United States had remained unchanged for 50 years. With the introduction of screening mammography, there was an abrupt and sustained decrease in the breast cancer death rate by 30 percent over the past 20years. The new USPSTF guidelines threaten to reverse the significant progress that has been made over the past two decades.
The task force recommends against routine screening mammography for women ages 40-49. However, there is ample scientific evidence that women in their forties can expect an equivalent decrease in breast cancer mortality due to screening mammography as compared to women 50 and older. Population studies in Sweden have shown a 40 percent decrease in breast cancer mortality in women ages 40-49 who underwent screening.
The incidence of breast cancer rises steadily with age, but there is no dramatic increase at age 50. The probability of being diagnosed with breast cancer among women in their forties is 1.44 percent as compared with 2.63 percent among women in their fifties. Meanwhile it has been estimated that 40 percent of the years of life saved by screening can be attributed to women diagnosed under the age of 50.
The task force advises only those women in their forties who are at high risk to undergo screening. However, it should be emphasized that only 10 percent to 25 percent of breast cancers occur in women at high risk. The majority of breast cancers arise in women with no special risk factors.
Yearly screening may be especially important for younger women because they tend to have faster growing cancers. Lengthening the screening interval to two years will diminish the survival benefit for all women and ultimately contribute to more treatment related toxicity because more cancers will be diagnosed at a later stage.
Physical exam, whether practiced by a woman herself or her doctor, will always be complementary to any breast-imaging technique.
Women should remember to bring any changes to their doctor's attention regardless of how soon after a negative mammogram they occur. We can each cite many personal instances where a woman's self exam led her to a doctor for follow up, sometimes with life-saving consequences.
In conclusion, the breast specialists at the Center for Cancer Prevention and Treatment at St. Joseph Hospital do not support the revised screening mammography guidelines recently issued by the Task Force and strongly urge women 40 and older to continue annual screening mammography. Better yet, talk to your own doctor about your risk factors and make a decision together about your breast health. It could save your life.
Monday, March 22, 2010
Wednesday, March 17, 2010
Research Abstract and Commentary: Aromatherapy Massage
Effectiveness of Aromatherapy Massage in the Management of Anxiety and Depression in Patients with Cancer: A Multicenter Randomized Controlled Trial
Wilkinson SM, Love SB, Westcombe AM, Gambles MA, Burgess CC, Cargill A, Young T, Maher EJ, Ramirez AJ. Journal of Clinical Oncology, 25, 532-538.
PURPOSE: To test the effectiveness of supplementing usual supportive care with aromatherapy massage in the management of anxiety and depression in cancer patients through a pragmatic two-arm randomized controlled trial in four United Kingdom cancer centers and a hospice.
PATIENTS AND METHODS: 288 cancer patients, referred to complementary therapy services with clinical anxiety and/or depression, were allocated randomly to a course of aromatherapy massage or usual supportive care alone.
RESULTS: Patients who received aromatherapy massage had no significant improvement in clinical anxiety and/or depression compared with those receiving usual care at 10 weeks postrandomization (odds ratio [OR], 1.3; 95% CI, 0.9 to 1.7; P = .1), but did at 6 weeks postrandomization (OR, 1.4; 95% CI, 1.1 to 1.9; P = .01). Patients receiving aromatherapy massage also described greater improvement in self-reported anxiety at both 6 and 10 weeks postrandomization (OR, 3.4; 95% CI, 0.2 to 6.7; P = .04 and OR, 3.4; 95% CI, 0.2 to 6.6; P = .04), respectively.
CONCLUSION: Aromatherapy massage does not appear to confer benefit on cancer patients' anxiety and/or depression in the long-term, but is associated with clinically important benefit up to 2 weeks after the intervention.
Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator
This randomized controlled trial contributes to the body of evidence about the effectiveness of complementary therapies in cancer, specifically the use of aromatherapy massage (AM). There have been complaints that the “evidence” about complementary therapies is weak or nonexistent. This gives little credence to providers who wish to use these therapies. This study gives strong evidence that in the short-term (two weeks after AM was completed) cancer patients who received AM had less anxiety than patients who did not receive AM. They did not have less depression or other symptoms (e.g., pain, fatigue, nausea and vomiting, global quality of life).
The study intervention was massage with essential oils delivered by massage therapists over 1 hour weekly for 4 weeks. Patients in the treatment group received at least one treatment. Patients in the control group received access to psychological support as part of their cancer care. Patients recruited to the study had been referred to complementary therapy services by a cancer health professional.
Of interest to hospital nurses is that in a pilot study of 57 patients receiving AM, patients showed significantly decreased average anxiety levels immediately after the treatment. This endpoint was not of interest to the researchers, but would be to hospital nurses. This means that immediately following a 1-hour massage with essential oils, patients had less anxiety – on average. No adverse effects from the AM were reported.
Wilkinson SM, Love SB, Westcombe AM, Gambles MA, Burgess CC, Cargill A, Young T, Maher EJ, Ramirez AJ. Journal of Clinical Oncology, 25, 532-538.
PURPOSE: To test the effectiveness of supplementing usual supportive care with aromatherapy massage in the management of anxiety and depression in cancer patients through a pragmatic two-arm randomized controlled trial in four United Kingdom cancer centers and a hospice.
PATIENTS AND METHODS: 288 cancer patients, referred to complementary therapy services with clinical anxiety and/or depression, were allocated randomly to a course of aromatherapy massage or usual supportive care alone.
RESULTS: Patients who received aromatherapy massage had no significant improvement in clinical anxiety and/or depression compared with those receiving usual care at 10 weeks postrandomization (odds ratio [OR], 1.3; 95% CI, 0.9 to 1.7; P = .1), but did at 6 weeks postrandomization (OR, 1.4; 95% CI, 1.1 to 1.9; P = .01). Patients receiving aromatherapy massage also described greater improvement in self-reported anxiety at both 6 and 10 weeks postrandomization (OR, 3.4; 95% CI, 0.2 to 6.7; P = .04 and OR, 3.4; 95% CI, 0.2 to 6.6; P = .04), respectively.
CONCLUSION: Aromatherapy massage does not appear to confer benefit on cancer patients' anxiety and/or depression in the long-term, but is associated with clinically important benefit up to 2 weeks after the intervention.
Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator
This randomized controlled trial contributes to the body of evidence about the effectiveness of complementary therapies in cancer, specifically the use of aromatherapy massage (AM). There have been complaints that the “evidence” about complementary therapies is weak or nonexistent. This gives little credence to providers who wish to use these therapies. This study gives strong evidence that in the short-term (two weeks after AM was completed) cancer patients who received AM had less anxiety than patients who did not receive AM. They did not have less depression or other symptoms (e.g., pain, fatigue, nausea and vomiting, global quality of life).
The study intervention was massage with essential oils delivered by massage therapists over 1 hour weekly for 4 weeks. Patients in the treatment group received at least one treatment. Patients in the control group received access to psychological support as part of their cancer care. Patients recruited to the study had been referred to complementary therapy services by a cancer health professional.
Of interest to hospital nurses is that in a pilot study of 57 patients receiving AM, patients showed significantly decreased average anxiety levels immediately after the treatment. This endpoint was not of interest to the researchers, but would be to hospital nurses. This means that immediately following a 1-hour massage with essential oils, patients had less anxiety – on average. No adverse effects from the AM were reported.
Wednesday, March 03, 2010
Julie's picks from the Feb 2010 literature
Here are my picks from the recent literature on Nursing research and evidence based nursing. Staff at St. Joseph Hospital in Orange or CHOC may be able to access some of the full text via the library website. Staff may also request that Burlew Medical Library provide them with the full text. 1. Nursing pedagogy and the intergenerational discourse.(includesabstract); Earle V; Myrick F; Journal of Nursing Education, 2009 Nov; 48 (11): 624-30 (journal article) ISSN: 0148-4834 CINAHL AN: 2010467042
2. Smoking cessation interventions in cancer care: opportunities for oncology nurses and nurse scientists.(includes abstract); Cooley ME; Lundin R; Murray L; Annual Review of Nursing Research, 2009; 27:
243-72 (journal article - research, systematic review, tables/charts) ISSN: 0739-6686 CINAHL AN: 2010521100
3. Theories used in nursing research on smoking cessation.(includes abstract); O'Connell KA; Annual Review of Nursing Research, 2009; 27: 33-62 (journal article - research, systematic review, tables/charts)
ISSN: 0739-6686 CINAHL AN: 2010521092
4. Nurses' use of qualitative research approaches to investigate tobacco use and control.(includes abstract); Schultz ASH; Bottorff JL; McKeown SB; Annual Review of Nursing Research, 2009; 27: 115-44
(journal article - research, systematic review, tables/charts) ISSN: 0739-6686 CINAHL AN: 2010521095
5. Nursing interventions in tobacco-dependent patients with cardiovascular diseases.(includes abstract); Shishani K; Sohn M; Okada A; Froelicher ES; Annual Review of Nursing Research, 2009; 27: 221-42
(journal article) ISSN: 0739-6686 CINAHL AN: 2010521099
6. A review of research by nurses regarding tobacco dependence and mental health.(includes abstract); Sharp DL; Blaakman SW; Annual Review of Nursing Research, 2009; 27: 297-318 (journal article -
research, systematic review, tables/charts) ISSN: 0739-6686 CINAHL AN: 2010521102
7. Nursing research in tobacco use and special populations.(includes abstract); Browning KK; Baker CJ; McNally GA; Wewers ME; Annual Review of Nursing Research, 2009; 27: 319-42 (journal article - research, systematic review, tables/charts) ISSN: 0739-6686 CINAHL AN: 2010521103
8. Simulation-based learning in nurse education: systematic review.(includes abstract); Cant RP; Cooper SJ; Journal of Advanced Nursing, 2010 Jan; 66 (1): 3-15 (journal article - research, systematic review, tables/charts) ISSN: 0309-2402 CINAHL AN: 2010503799
9. Cultivating quality. Implementing surgical smoke evacuation in the operating room: a nurse-led initiative changes policy to provide health care workers and patients more protection.(includes abstract); Waddell
AWG; American Journal of Nursing, 2010 Jan; 110 (1): 54-8 (journal article - pictorial, review, tables/charts) ISSN: 0002-936X PMID: 20032670 CINAHL AN: 2010518193
10. Use of three evidence-based postoperative pain assessment practices by registered nurses.(includes abstract); Carlson CL; Pain Management Nursing, 2009 Dec; 10 (4): 174-87 (journal article - research,
tables/charts) ISSN: 1524-9042 PMID: 19944373 CINAHL AN: 2010508818
11. Music as a nursing intervention for postoperative pain: a systematic review.Engwall M; Duppils GS; Journal of PeriAnesthesia Nursing, 2009 Dec; 24 (6): 370-83 (journal article - research, systematic review,
tables/charts) ISSN: 1089-9472 PMID: 19962104 CINAHL AN: 2010513653
12. A literature review: factors that impact on nurses' effective use of the Medical Emergency Team (MET).(includes abstract); Jones L; King L; Wilson C; Journal of Clinical Nursing, 2009 Dec; 18 (24): 3379-90
(journal article - research, systematic review, tables/charts, teaching materials) ISSN: 0962-1067 CINAHL AN: 2010472833
13. A collaborative protocol on oxytocin administration: bringing nurses, midwives and physicians together.Mandel D; Pirko C; Grant K; Kauffman T; Williams L; Schneider J; Nursing for Women's Health, 2009 Dec-2010 Jan; 13 (6): 480-5 (journal article - tables/charts) ISSN:
1751-4851 PMID: 20017777 CINAHL AN: 2010499698
14. Is nurse-managed blood glucose control in critical care as safe and effective as the traditional sliding scale method?(includes abstract); Adams G; Hunter J; Langley J; Intensive & Critical Care Nursing, 2009
Dec; 25 (6): 294-305 (journal article - research, systematic review, tables/charts) ISSN: 0964-3397 PMID: 19850481 CINAHL AN: 2010516840
15. Development and implementation of an oral care protocol for patients with cancer.(includes abstract); Sieracki RL; Voelz LM; Johannik TM; Kopaczewski DM; Hubert K; Steele-Moses SK; Clinical Journal of
Oncology Nursing, 2009 Dec; 13 (6): 718-22 (journal article - pictorial) ISSN: 1092-1095 PMID: 19948471 CINAHL AN: 2010497856
16. The effect on infected wound of topical silver and silver dressing: a view of evidence-based nursing PC6-37.Shiao C; Liu H; World Council of Enterostomal Therapists Journal, 2009 Oct-Dec; 29 (4): 29-30
(journal article - abstract, research, systematic review) ISSN: 0819-4610 CINAHL AN: 2010543560
17. Collaborating across services to advance evidence-based nursing practice.(includes abstract); Kenny DJ; Richard ML; Ceniceros X; Blaize K; Nursing Research, 2010 Jan-Feb; 59 (1): Supplement: S11-21 (journal article - tables/charts) ISSN: 0029-6562 PMID: 20010273 CINAHL AN:
2010518133
18. Design and validation of an instrument to measure nursing research culture: the Nursing Research Questionnaire (NRQ).(includes abstract); Corchon S; Watson R; Arantzamendi M; Saracíbar M; Journal of Clinical Nursing, 2010 Jan; 19 (1-2): 217-26 (journal article - research, tables/charts) ISSN: 0962-1067 CINAHL AN: 2010510245
19. The role of the CNS in achieving and maintaining Magnet® status.(includes abstract); Walker JA; Urden LD; Moody R; Journal of Nursing Administration, 2009 Dec; 39 (12): 515-23 (journal article -
research, tables/charts) ISSN: 0002-0443 PMID: 19955965 CINAHL AN: 2010503484
20. Registered nurses' application of evidence-based practice: a national survey.(includes abstract); Boström A; Ehrenberg A; Gustavsson JP; Wallin L; Journal of Evaluation in Clinical Practice, 2009 Dec; 15
(6): 1159-63 (journal article - research, tables/charts) ISSN: 1356-1294 CINAHL AN: 2010522845
21. Seeing through the clouds in evidence-based practice.(includes abstract); Russell-Babin K; Nursing Management, 2009 Nov; 40 (11): 26-33 (journal article - CEU, exam questions, pictorial, tables/charts)
ISSN: 0744-6314 PMID: 19901753 CINAHL AN: 2010497587
22. Evidence-based practice: step by step. The seven steps of evidence-based practice: following this progressive, sequential approach will lead to improved health care and patient outcomes.(includes abstract); Melnyk BM; Fineout-Overholt E; Stillwell SB; Williamson KM; American Journal of Nursing, 2010 Jan; 110 (1): 51-3 (journal article) ISSN: 0002-936X PMID: 20032669 CINAHL AN: 2010518192
23. Creating quality evidence summaries on a clinician's schedule.McGee S; Clark E; Journal of Nursing Administration, 2010 Jan; 40 (1): 7-9 (journal article - tables/charts) ISSN: 0002-0443 PMID: 20010371 CINAHL AN: 2010519062
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