Maggie's centre's "living with cancer"

MAGGIE’S CENTRE’S “LIVING WITH CANCER”A CASE STUDY OF HEALING SPACES

HARSHEEN KAUR & HAFSA AMBREEN RESEARCH BOOK DRAFT 1

9.29.15

FIELD WORKWest London

FIELD WORKEdinburgh

FIELD WORKDundee

LABYRINTH

FIELD WORKFife

FIELD WORKGlasgow

FIELD WORKLanarkshire

BRIEFArchitectural

BRIEFMedical

SERVICESGeneral

LUN

G C

ANCE

R SU

PPORT GROUP G

ETTING STARTED FRIENDS + FAMILY C

OU

RSE SH

ARING STORIES HOW ARE YOU? WHERE NOW? CUP

OF T

EA

CANCER SUPPORT

SPECIALIST

LUN

G C

ANCE

R SU

PPORT GROUP G


OU

RSE SH


OF T

EA

CANCER SUPPORT

SPECIALIST

“In some cases, health care delivery directly con-

tributes to increased suffering. Providing support while also helping patients and their families to face upcoming harsh realities

is a delicate balancing act that needs to be further ex-

plored.”

LUN

G C

ANCE

R SU

PPORT GROUP G


OU

RSE SH


OF T

EA

CANCER SUPPORT

SPECIALIST

DETAILSArchitectural Details

NESTED SPACES

Edinburgh

LIGHT +AIRFLOW

West London

occupying the wallsurrouned by naturevisual interaction

wooden trallice shadowslike you’re in a forest

layers of filtering lightlayers of outdoor spaces

MOVEMENTAssessing Flows

12

3

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6

1

2

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3

4

45

4

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5

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Returning Patient

New Patient

Seeking Benefits AdviceWest London

12

3

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6

1

2

3

3

4

45

4

4

4

5

4

5

1

2

3

45

Returning Patient

New Patient

Seeking Benefits Advice

12

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6

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2

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3

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45

4

4

4

5

4

5

1

2

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45

Returning Patient

New Patient


Returning Patient

New Patient


33 4

5

65

5

4

34422

11 1

23

3

Edinburgh

Returning Patient

New Patient


33 4

5

65

5

4

34422

11 1

23

3

12

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6

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45

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Returning Patient

New Patient


Returning Patient

New Patient


1

111

1

1

2

3

22

3

33

43

2

4

5

6

7

4

Dundee

12

3

4

5

6

1

2

3

3

4

45

4

4

4

5

4

5

1

2

3

45

Returning Patient

New Patient


Glasgow

1

1

1

2

3

4

5

2

3

4

4

5

23

4

4

5

5

Returning Patient

New Patient


Glasgow

12

3

4

5

6

1

2

3

3

4

45

4

4

4

5

4

5

1

2

3

45

Returning Patient

New Patient


Returning Patient

New Patient


1 1

1

11

2

3

2

1

44

3

4

2

4

4

4 3

25 3

Fife

Returning Patient

New Patient


1 1

1

11

2

3

2

1

44

3

4

2

4

4

4 3

25 3

12

3

4

5

6

1

2

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45

4

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2

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Returning Patient

New Patient


LIT SEARCHSynthesis

Program Element / HealthDeterminant

Research Questions Indicators Data Sources Research Methods Notes

What is cancer survivorship and what are the metrics for evaluation? Literature Search

Unpack the Maggie 'system' into

PRACTICAL KNOWLEDGE

Courses and Workshops

Nutrition What is the impact of nutrition education on cancer survivorship? PubMed Literature Search, HealthPathway Diagram

Tai Chi What is the impact of Tai Chi on cancer survivorship?

Living with Stress Workshop What is the impact of stress management on cancer survivorship?

Meditation/Relaxation Classes What is the impact of meditation on cancer survivorship?

Friends and Family Course What is the impact on the family member of the person with cancer? Doeshow they feel/react impact the healing of the one diagnosed?

Benefits Advice What is the impact of financial well being on healing?

Talking Heads:Managing HairLoss

Does looking better make you feel better? Does that make you heal faster?

Lung Cancer Support Group(there are other like this forspecific diseases)

What is the impact of being around other people with the same disease asyou for healing?

EMOTIONAL SUPPORT

Talking to other visitors of thecenters

Impact of connecting with other visitors on healing?

Making a cup of tea Impact of doing things for yourself on healing?

Talking to Cancer SupportSpecialists

Impact of talking to a professional about what you're going through? Notreally a clinical psychological meeting but more informal

PSYCHOLOGICAL SUPPORT

Talking to Psychologist on staff What is the impact of talking to a psychologist on healing?

Relaxation workshops What is the impact of talking to a psychologist on healing?

Working with clinical staff

ENVIRONMENTArchitectural Details/ElementsDistance from hospital

Access to nature What is the impact of access to nature on healing?

Operable windows What is the impact of a breeze/fresh air on healing?

Views with seats to look What is the impact of therepeatic views on healing? (Visual nature)

Kitchen What is the impact of making tea/cooking on healing?

Domestic scale

Vernacular (sometimes)

Familiar objects (furniture) Impact of

Cozy

Unique What is the impact of thought provoking architecture on healing?

Surprising/ "wow" elements What is the impact of thought provoking architecture on healing?

Ease of access Does access have an impact on whether one heals?

Adaptable spaces Impact of

What is the impact of the Maggie's staff working with clinical staff from hospital?

Does the distance from the hospital and the centre has an affect on how the space is experienced? Does it affect the healing if it's too close or too far?

What is the effect of being in a domestic home vs hospital setting on healing?

Impact of vernacular architecture on how one feels in a space? Then healing?

SEARCH WORD MESH TERMS TOPICS

Maggies Centre* Spirituality

Imagination

Dreams

Pallative Care

ArchitectureDesign Cancer Care Facilities

Health Facilities

Facility Design and Construction

Cancer Neoplasms Therapy/ Thereaputic Use

Survivorship Survival Rate

Mortality*Health Knowledge, Attitudes, Practice

Continuity of Patient Care

*Delivery of Health Care / mt [Methods]

Ovid MedLine Mesh Words

# Words1 Neoplasms

2 Cancer*

3 Cancer* OR Neoplasms

4 survivorship.mp. or exp Survival Rate/

5 exp Cancer Care Facilities/

6 exp "Facility Design and Construction"/

7 exp Health Facilities/

8 Maggie's Centre*

9 Spirituality

10 Imagination

11 5 OR 6 OR 7

12 Facility Design and Construction OR Health Facilities

13 Cancer Care Facilities AND FDC OR HF

14 Spirituality AND Imagination

15 Cancer AND Survivorship AND CCF AND FDC OR H 3 AND 4 AND 13

16

17

18

19

20

Cancer Care Facilities OR Facility Design and Construction OR Health Facilities

TOPIC SEARCH WORDS USED DATABASE TITLE AUTHOR(S) LITERATURE TYPE DATE ACCES NOTES

MEDICALLung Cancer Support Groups Maggie's Centre* Science Direct Lanarkshire lung cancer information and support sessions: A new patient venture in collaboration with Maggie's Lanarkshire L. Irvine, E. McGuire, J. McPhelim, K. Bridge Journal 7/23/2015 Statistics (survey results) about the need/usefulness of support groups

Cancer Care Survivorship Mesh Group 15 Ovid MedLine The role of comprehensive cancer centers in survivorship care Wim H. Van Harten MD, PhD1,*,Angelo Paradiso Journal 7/23/2015

Survivorship + Anxiety Mesh Group 25 Ovid MedLine Evaluation of a cancer survivorship protocol: transitioning patients to survivors Curcio KR; Lambe C; Schneider S; Khan K. Clinical Nursing Journal 7/24/2015

Quality of Care + Effects Mesh Group 25 Ovid MedLine Understanding cancer patients' reflections on good nursing care in light of Antonovsky's theory. Kvale K; Synnes O. Empirical Study 7/24/2015

Meditation + Tai Chi Tai Ji Ovid MedLine Tai Chi and meditation-plus-exercise benefit neural substrates of executive function: a cross-sectional, controlled study. Hawkes TD; Manselle W; Woollacott MH. Controlled Study 7/24/2015

Tai Chi Trial Mesh Group 28 Ovid MedLine Feasibility and acceptability of a Tai Chi Chih randomized controlled trial in senior female cancer survivors. Campo RA; O'Connor K; Light KC; Nakamura Y..e Randomized Control Trial 7/24/2015

Tai Chi Trial Mesh Group 28 Ovid MedLine Regular Tai Chi Exercise Decreases the Percentage of Type 2 Cytokine–Producing Cells in Postsurgical Non–Small Cell Lung Cancer Survivors Wang, Ru PhD; Liu, Jing PhD; Chen, Peijie PhD; Randomized Control Trial 7/24/2015

Pallative Care Pallative Care Ovid MedLine Integrating palliative care into active cancer treatment. [Review] Mazanec P; Prince-Paul M. Review 7/24/2015 Has good citations of RCT in the article itself

Social Support Mesh Group 33 Ovid MedLine Does social support from family and friends work as a buffer against reactions to stressful life events such as terminal cancer? Ringdal GI; Ringdal K; Jordhoy MS; Kaasa S. Randomized Control Trial 7/24/2015

Health Care System Critique Mesh Group 33 Ovid MedLine Could the health care system contribute to suffering? In-depth study from the perspective of terminally ill cancer patients. Daneault S; Lussier V; Mongeau S; Hudon E; Paill Qualitative Research: Intervi 7/24/2015

Body Image/Physical Appearance Mesh Group 36 Ovid MedLine The relationship between body image, age, and distress in women facing breast cancer surgery. Miller SJ; Schnur JB; Weinberger-Litman SL; Mont Research: Questionare? 7/24/2015

Nurses knowledge of survivorship Mesh Group 15 OvidMedLine Oncology nurses' knowledge of survivorship care planning: the need for education. Lester, Joanne L; Wessels, Andrew L; Jung, Journal 7/30/2015

Nutrition Therapy cancer care, therapy, neopla Web of Science Nutrition therapy in cachectic cancer patients. The Tight Caloric Control (TiCaCo) pilot trial Elisabeth De Waele, etc Randomized Control Trial 7/31/2015

Spirituality cancer care, therapy, neopla Web of Science "Oh, yeah, I'm getting closer to god": spirituality and religiousness of family caregivers ofcancer patients undergoing palliative care Bianca Sakamoto Ribeiro Paiva, etc Qualitative Research: Intervi 7/31/2015

Mindfulness "cancer" OR neoplasm* AND Science Direct Mindfulness-Based Cancer Recovery: An Adaptation of Mindfulness-Based Stress Reduction (MBSR) for Cancer Patients Michael Speca1, Linda E. Carlson1, Michael Seminal Study also RCT? 7/31/2015

Psychophysiological (psychotherapy) "cancer" OR neoplasm* AND Science Direct Psychophysiological aspects of cancer C Weinstock 7/31/2015

Psychology and Cancer "cancer" OR neoplasm* AND Science Direct Psychological interventions in the treatment of cancer A.David Feinstein, Ph.D 7/31/2015

Meditation and Relaxation "cancer" OR neoplasm* AND Science Direct 19 – Meditation and the Relaxation Response Richard Friedman,Patricia Myers,Herbert Ben Book chapter 7/31/2015

Mindfulness "cancer" OR neoplasm* AND Science Direct Mindfulness meditation in clinical practice Paul Salmon, etc. Some trial results 7/31/2015

Mindfulness Meditation "cancer" OR neoplasm* AND Science Direct Stress Reduction through Mindfulness Meditation Astin J.A. RCT 7/31/2015

Integrative Medicine "cancer" OR neoplasm* AND Science Direct Integrative Oncology: Complementary Therapies for Cancer Survivors Kathleen Wesa, MD, Jyothirmai Gubili, MS, , Research Summary 7/31/2015

Mindfulness and Stress Reduction "cancer" OR neoplasm* AND Science Direct "Mindfulness-based stress reduction and health benefits: A meta-analysis" Paul Grossman, a, ,Ludger Niemannb, Stefan Meta-analysis Study 7/31/2015

Complementary Thereapy Evaluation "cancer" OR neoplasm* AND Science Direct Who accesses complementary therapies and why?: An evaluation of a cancer care service M. Matthewsa, M. Glackina, C. Hughesb, Summary/Survey 7/31/2015

Meditation Therapy "cancer" OR neoplasm* AND Science Direct New Studies Support the Therapeutic Value of Meditation Bonnie J. Horrigan Summary of Studies 7/31/2015

Self Help "cancer" OR neoplasm* AND Science Direct Helping Patients to Help Themselves after Breast Cancer Treatment D.R. Fenlon∗, P. Khambhaita∗, M.S. Hunter† Summary of Studies 7/31/2015

Medical Devices Cancer Care Facilities AND Web of Science Thinking beyond the Cure: A Case for Human-Centered Design in Cancer Care Mullaney, Tara; Pettersson, Helena; Nyholm, Journal 7/31/2015 Study about medical devices and how (in certain cases) they can create more anxiety in patients and must now be reconsidered for patient care purposes

Yoga and Fatigue "cancer" OR neoplasm* AND Science Direct Effects of yoga on cancer-related fatigue and global side-effect burden in older cancer survivors Lisa K. Sproda, ,Isabel D. Fernandezb, etc, 4 Week Trial 7/31/2015

Mindfulness & Stress/Cortisol/etc "cancer" OR neoplasm* AND Science Direct Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatie Linda E Carlsona, b, Michael Specaa, b, etc. 8 Week Trial 7/31/2015

NATURE + HEALTHNature based research on health Mesh Group 22 OvidMedLine Nature-based experiences and health of cancer survivors Ray, Heather; Jakubec, Sonya L. Nursing Journal 7/24/2015

Forest Bathing and NK Cells Mesh Group 22 OvidMedLine A forest bathing trip increases human natural killer activity and expression of anti-cancer proteins in female subjects. Li, Q; Morimoto, K; Kobayashi, M; Inagaki,.....etc. Controlled Experiment 7/24/2015

DESIGNDesign of Maggie's Maggie's Centre* Ovid MedLine Maggie's Centres Edwin Heathcote British Medical Journal 7/23/2015 Talks about the importance of the sense of inspiration and imagination of Maggie's and how NHS can leard from that

Psychosocial Care Matrix Mesh Group 15 Ovid MedLine The cancer psychosocial care matrix: a community-derived evaluative tool for designing quality psychosocial cancer care delivery. Forsythe LP; Rowland JH; Padgett L; Blaseg K; Si Journal: Research 7/23/2015 "the psychosocial matrix can help centers systematically identify and develop steps to address gap areas in their capacity to meet these new standards. "

Design of Cancer Care Facilities Maggie's Centre* Science Direct Designing emotion-centred Product Service Systems: The case of a cancer care facility Patrick Keith Stacey, Bruce S. Tether Journal: Research 7/24/2015

Design of Cancer Care Facilities Maggie's Centre* Science Direct Caring through architecture Janet Fricker Journal 7/24/2015 “Architecture is a useful tool that can help people open up. Being in a good place lowers anxiety levels”

Design of Cancer Care Facilities "Cancer Care Facilties" (refin Web of Science First Care Health Care Facilities New Big Vision, Small Miracle Mark W Stavig and Eric Anderson Journal 7/30/2015

Design of Cancer Care Facilities Cancer Care Facilities AND Web of Science What evidence is there about the specific environmental needs of older people who are near the end of life and are cared for in hospices or similar institutions? A literature review Rigby, J.; Payne, S.; Froggatt, K. Journal 7/31/2015

Giving informatin (survivorship plan) to those with cancer reduced anxiety levels "Anxiety scores were lower one month after the intervention, and satisfaction with the protocol was high."

"The TCC intervention was found to be a feasible and acceptable modality for senior female cancer survivors." "Qualitative analyses indicated that the TCC group felt they received mental and physical benefits, whereas HEC group reported on social support benefits and information received."

": A 16-week Tai Chi exercise significantly diminished the magnitude of the decreased T1/T2 ratio in the natural course of recovery in a population of postsurgical non–small cell lung cancer survivors." + "Tai Chi may have a role in ameliorating the imbalance between humoral and cellular immunity, potentiating human immunity against tumors."

"The mixed findings may indicate that social support has only small effects on emotional functioning and stress reactions. Our results on the second assessment indicate, however, that social support might work as a buffer against reactions toward external stressful events such as terminal cancer."

"In some cases, health care delivery directly contributes to increased suffering. Providing support while also helping patients and their families to face upcoming harsh realities is a delicate balancing act that needs to be further explored."

"The results suggest that younger women, particularly those with poor body image, are at an increased risk for pre-surgical emotional distress. These women may benefit from pre-surgical interventions designed to improve body image or to reduce pre-surgical emotional distress."

"The Institute of Medicine has challenged oncology providers to address cancer survivorship care planning. Gaps in cancer survivorship knowledge are evident and will require focused education for this initiative to be successful."

"Eight nutrition therapy patients and 1 control patient were still alive after 2 years. Conclusions: Nutrition therapy based on patient-specific biophysical parameters helps to maintain body weight and induces a more optimal nutritional balance in cachectic cancer patients. Moreover, survival in cancer patients improved when their nutritional status, even partially, ameliorated."

"Much evidence has accumulated to suggest that the psychological treatment of cancer can sometimes be sucessfully adjunctive to (or even replace) the somatic. The therapy is primarily reeducative psychothereapy, not psychoanalysis." (369)

"The paper concludes by noting that while psychological approaches that influence disease course with cancer patients have yet to receive adequate investigation, palliative psychological interventions which might also have a beneficial effect on medical status are currently available."

"The relaxation response has been associated with improvements in many medical conditions including hypertension, cardiac arrhythmias, chronic pain, insomnia, side effects of cancer therapy, side effects of AIDS therapy, infertility, and preparation for surgery and X-ray procedures."

"he techniques of mindfulness meditation, with their emphasis on developing detached observation and awareness of the contents of consciousness, may represent a powerful cognitive behavioral coping strategy for transforming the ways in which we respond to life events. "

"Rigorous scientific research has produced evidence that acupuncture, massage therapy, music, and mind-body therapies effectively and safely reduce physical and emotional symptoms. These therapies provide a favorable risk-benefit ratio and permit cancer survivors to help manage their own care."

"Although derived from a relatively small number of studies, these results suggest that MBSR may help a broad range of individuals to cope with their clinical and nonclinical problems."

"Results suggest the complementary therapies provided by Action Cancer significantly improved clients' quality of life. Based on these findings the authors make a number of recommendations in relation to the use of complementary therapies by cancer patients."

" the meditation intervention group displayed significant improvement in the chronic pain acceptance questionnaire total score and activities engagement subscale (P = .008; P = .004) and SF-36 physical function (P = .03). The study authors concluded that an eight-week mindfulness-based meditation program is feasible for older adults with CLBP and may lead to improvement in pain acceptance and physical function."

"However, there is an inconsistency between policies that promote self-management and the way in which they are implemented [18]. It is unlikely that one type of intervention, or one kind of delivery, will be appropriate for all. There is a need then to develop a variety of options to suit varying needs."

"Participants in the YOCAS©® intervention arm reported significantly lower cancer-related fatigue, physical fatigue, mental fatigue, and global side-effect burden than participants in the standard care arm following the 4-week intervention period (p < 0.05)."

" MBSR program enrollment was associated with enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients, and resulted in possibly beneficial changes in hypothalamic-pituitary-adrenal (HPA) axis functioning. These pilot data represent a preliminary investigation of the relationships between MBSR program participation and hormone levels, highlighting the need for better-controlled studies in this area."

Compares the design of hospitals to that of a Maggie's and the associated emotional consequences of design decisions on the patients comfort and healing

Design challenge to create a sustainble, energery efficient hospital for an island of 2,287 people. Similar spacial ideas to a Maggie's, Living Buildings Design Challenge. Article goes through design process and logistical decisions

facility design for idea space needed for ppl age 65 + with one year prognosis. "...it should support patients' need for social interaction and privacy; it should support the caring activities of staff, family members and patients; and it should allow opportunities for spiritual expression"

“94.4% respondents stated Lung Cancer Support Sessions at the

Lanarkshire Maggie’s would be worthwile”

“77.8% reported interest in attending these sessions”

S28 Posters, 8th Annual BTOG Conference, 2010

2. Provide information and practical advice about coping with theeffects of mesothelioma and treatment.

Meetings to date: 19 meetings over 22 months were held prior to theaudit. 37 patients and 48 family members had attended the supportgroup. Median attendance 19 (range 10 36). Speakers attended for14 out of 19 meetings.Audit methodology: 60 survey questionnaires mailed to 24 patients(15 of these had previously attended the group). An additionalquestionnaire for family members to complete was enclosed.Questionnaires sent to 12 bereaved family members (attendees).Separate sections to complete for attendees and non-attendees.Audit aim: To evaluate the support group and identify areas forimprovement.Results: 30 responses (24 attendees, 5 non-attendees, 1 notanswered). All non-attendees aware of the support group. Reasonsfor non-attendance included difficulty in access and no perceivedsupport needs. Most attendees satisfied with location (87%),timing (92%) and structure (79%) of group. Most stated groupentirely (87%) or partly (8%) helpful. Meeting others in similarsituation, discussion topics and opportunity to speak with thefacilitators were cited as the most useful aspects.Conclusion: High satisfaction among attendees of the supportgroup. The views of patients/family members who do not attendthe support group remain unknown.

84 ‘Better safe than sorry’ improving practice by theintroduction of a PleurX catheter “Alert” card

J. Maguire1, L. Rutherford2, A. Robinson3. 1Palliative Care Team,NI Cancer Centre, BCH, Belfast, N Ireland, United Kingdom,2Palliative Care Team, NI Cancer Centre, Belfast City Hospital,Lisburn Road, Belfast, N Ireland, United Kingdom, 3Palliative CareTeam, Level 2, Bostock House, Royal Victoria Hospitals, GrosvenorRoad, Belfast, N Ireland, United Kingdom

Introduction: Recurrent pleural effusions can be a therapeuticchallenge for physicians and a source of continued morbidity forthe patient. The use of an indwelling pleural catheter is onesolution to this problem providing an innovative method of managingeffusions in a domiciliary setting, thereby relieving symptoms ofbreathlessness, affording the patients some control, reducing theneed for hospital admissions and overall improving quality of life.PleurX catheters have been used increasingly within the BelfastTrust since 2003 and training programmes have been establishedfor both community and hospital based staff. However during thistime the authors have been concerned about the potential misuse ofthese devices by staff unfamiliar with their use. Anecdotal evidenceand observations of practice have highlighted potentially seriousincidents where staff have attempted to use the wrong equipmentto carry out drainage procedures because of lack of knowledge aboutthe catheters and lack of information about whom to contact foradvice.Methods: A small working group was established comprised ofthe Lung Cancer Nurse Specialists and the Palliative Care NurseConsultant within the Belfast Trust, to design a small “Alert card”which patients can carry at all times, highlighting that they have apleural catheter in place and providing contact details for all the keyprofessionals involved. This was then taken to the NI Lung CancerNurses Forum for feedback and redesign. Other nursing and medicalcolleagues were also consulted with.Conclusion: Following discussions with the manufacturer the carddesign has been agreed and is ready to be introduced into practice.All patients who have an indwelling pleural catheter inserted willbe issued with one of these cards on discharge. Patient feedbackwill be obtained on the usefulness of the cards and an audit of theiruse will be carried out.

85 Lanarkshire lung cancer information and supportsessions: A new patient venture in collaboration withMaggie’s Lanarkshire

L. Irvine1, E. McGuire2, J. McPhelim3, K. Bridges4. 1RespiratoryDept, Monklands Hosp, Airdrie, Lanarkshire, United Kingdom,2Clinical Effectiveness, Monklands Hosp, Airdrie, Lanarkshire,United Kingdom, 3Respiratory Dept, Hairmyres Hosp, East Kilbride,Lanarkshire, United Kingdom, 4Respiratory Dept, Wishaw Hospital,Wishaw, Lanarkshire, United Kingdom

NHS Lanarkshire is continually striving to improve the servicesoffered to both patients and carers. Moore et al. 2009 cites thatthe impact of cancer on people and their families is increasinglyrecognized as significant and also under addressed. The lung cancerclinical nurse specialists, supported by Maggie’s Lanarkshire, areaiming to improve the support available to such patient group byconducting Lung Cancer Information and Support Sessions as a pilotproject. A patient and carer questionnaire was devised to develop apatient and carer reported needs assessment. This would be utilisedin setting the scheduled support sessions.Discussion: Lung cancer services are delivered on 3 acute sitesin NHS Lanarkshire. The socio-economic demographics of the sitesare significantly different; this often results in varying levels ofinformation seeking by patients and carers. Attempting to provideuniformity and service equity the decision was taken to hostInformation and Support Sessions as a pan Lanarkshire initiativerather than site specific. This was supported by Maggie’s Lanarkshirewho agreed to host the event. This was the first such collaborationwith Maggie’s and NHS Scotland.Method: Pilot sessions were arranged running on the 2nd Wednesdayof each month. A questionnaire was developed and administeredto patients and carers. The questionnaire was sent to all patientsdiagnosed with Lung Cancer who attended both Respiratory andOncology Clinics on all the 3 sites over the month of August2009. This was required to collect the necessary information onpatients’ views which would establish the content of the Informationand Support Sessions. The questionnaire was designed to captureinformation such as venue, time of day and length of the session.Information on session topics was requested to ensure it would meetpatients/Carers needs and expectations. The Clinical effectivenessdepartment provided full support.Results: 54 questionnaires were returned which is approx 10%of the annual incidence of lung cancer in NHS Lanarkshire.94.4% respondents stated sessions would be worthwhile and77.8% reported interest in attending sessions. Pilot support sessionsare currently underway with ongoing analysis after each session.This will provide information on sustainability, feasibility and therequirement for future similar sessions.

86 Post diagnosis home visits improve patient journey inlung cancer

M. Palmer, J. Phelps, J. Barber, D. Powrie. Heart and Chest Clinic,Southend University Hospital, Southend, Essex, United Kingdom

Introduction: Lung cancer is a diagnosis which has a huge impact onpatient and carers lives. It is recognised that patient recollectionof information given at the time of diagnosis in imperfect and maybe related to the shock of receiving a lung cancer diagnosis. Homevisits for all newly diagnosed patients were offered with the aimof supporting patients and reinforcing information given at firstconsultation.Method: Visits were carried out within a week of initial diagnosis.Patient satisfaction surveys were given to 52 patients following ahome visit.Results: 90% of patients reported that they understood theinformation given to them at diagnosis, 97% agreed or stronglyagreed that seeing the nurse at home helped increase understandingand 100% agreed or strongly agreed that it helped reduce anxiety.

“A 16-week Tai Chi exercise significantly diminished the magnitude of the decreased

T1/T2 ratio in the natural course of recovery in a population of postsurgical

non–small cell lung cancer survivors.”

“Tai Chi may have a role in ameliorat-ing the imbalance between humoral

and cellular immunity, potentiating hu-man immunity against tumors.”

Teresa D. Hawkes*, Wayne Manselle and Marjorie H. Woollacott

Tai Chi and meditation-plus-exercisebenefit neural substrates of executivefunction: a cross-sectional, controlled study

Abstract

Background: We report the first controlled study ofTai Chi effects on the P300 event-related potential, aneuroelectric index of human executive function. TaiChi is a form of exercise and moving meditation.Exercise and meditation have been associated withenhanced executive function. This cross-sectional,controlled study utilized the P300 event-relatedpotential (ERP) to compare executive network neuralfunction between self-selected long-term Tai Chi, med-itation, aerobic fitness, and sedentary groups. Wehypothesized that because Tai Chi requires moderateaerobic and mental exertion, this group would showsimilar or better executive neural function comparedto meditation and aerobic exercise groups. We pre-dicted all health training groups would outperformsedentary controls.Methods: Fifty-four volunteers (Tai Chi, n¼ 10; medita-tion, n¼ 16; aerobic exercise, n¼ 16; sedentary, n¼ 12)were tested with the Rockport 1-mile walk (estimated VO2

Max), a well-validated measure of aerobic capacity, andan ecologically valid visuo-spatial, randomized, alternat-ing runs Task Switch test during dense-array electroence-phalographic (EEG) recording.Results: Only Tai Chi and meditation plus exercisegroups demonstrated larger P3b ERP switch trial ampli-tudes compared to sedentary controls.Conclusions: Our results suggest long-term Tai Chi prac-tice, and meditation plus exercise may benefit the neuralsubstrates of executive function.

Keywords: aging, executive function, exercise effects oncognition, meditation, P3b, Tai Chi

DOI 10.1515/jcim-2013-0031Received July 19, 2013; accepted August 29, 2014; previouslypublished online October 8, 2014

Introduction

Health regimens that benefit executive function areunder active investigation. Such regimens include med-itation [1] and moderate exercise [2–5]. Tai Chi is anancient health practice from China, often recommendedby somatic therapists for relaxation and balance rehabi-litation [6, 7]. We report the first controlled study inves-tigating Tai Chi effects on the neural substrates ofexecutive function.

Executive function, also known as executive atten-tion, has a number of key components, includingresponse inhibition, updating of working memory, andmental set shifting [13, 14]. A key neuropsychological testused to evaluate executive function is the Task Switchtest. It is used in combination with EEG event-relatedpotentials (ERPs) to evaluate both behavioral and neuralsubstrate levels of executive attention [8–12].

Event-related potentials (ERPs) are averaged EEGsignals time-locked to specific stimulus and responseevents recorded during performance of cognitive tasks[13]. These deflections are thought to index total neuralactivity in specialized microcircuits operating in parallelneural networks during task execution [9, 14]. ERPsoccur within specified time windows at specifiedelectrodes relative to experimentally defined events ofinterest (i.e. stimulus onset, trial type, button pressresponse onset, and trial by trial response time andaccuracy).

*Corresponding author: Teresa D. Hawkes, 711 Human PerformanceWing, Air Force Research Laboratory, Wright Patterson Air ForceBase, Dayton, OH; University of Oklahoma, 455 W. Lindsey St., DaleHall Tower 705, Norman, OK 73019, USA,E-mail: [email protected] Manselle, Marjorie H. Woollacott, University of Oregon,Eugene, OR, USA

J Complement Integr Med. 2014; 11(4): 279–288

Giving informatin (survivorship plan) to those with cancer reduced

anxiety levels “Anxiety scores were lower one month after the in-

400 August 2012 • Volume 16, Number 4 • Clinical Journal of Oncology Nursing

Kristin R. Curcio, RN, DNP, ANP-BC, GNP-BC, OCN®, Camille Lambe, RN, PhD, AOCN®, NP, Susan Schneider, RN, PhD, AOCN®, ACNS-BC, FAAN, and Kalsoom Khan, MD

This article describes the implementation and evaluation of a survivorship protocol for cancer survivors to improve knowledge about their disease and decrease anxiety. The study included a convenience sample of 30 cancer survivors at an outpatient community cancer center in the southeastern United States following completion of acute oncology treatment. One month after the survivorship protocol was delivered, knowledge about diagnosis, treatments, recom-mended follow-up, signs of recurrence, and late side effects increased. Anxiety scores were lower one month after the intervention, and satisfaction with the protocol was high. The results demonstrated that the survivorship protocol is a feasible method of educating cancer survivors, supporting the Institute of Medicine’s recommendation that strategies for delivering education

to cancer survivors are important. Survivors have additional needs that must be addressed following treatment, and a survivorship protocol can provide the knowledge survivors need to participate in their own health care.

Kristin R. Curcio, RN, DNP, ANP-BC, GNP-BC, OCN®, is a nurse practitioner at the Cone Health Regional Cancer Center in Greensboro, NC; Camille Lambe, RN, PhD, AOCN®, NP, is an assistant professor and Susan Schneider, RN, PhD, AOCN®, ACNS-BC, FAAN, is an associate professor, both in the School of Nursing at Duke University in Durham, NC; and Kalsoom Khan, MD, is a medical oncologist at the Cone Health Regional Cancer Center. The authors take full responsibility for the content of the article. The authors did not receive honoraria for this work. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or editorial staff. Curcio can be reached at [email protected], with copy to editor at [email protected]. (First submission July 2011. Revision submitted September 2011. Accepted for publication October 19, 2011.)

Digital Object Identifier:10.1188/12.CJON.400-406

n CNE Article

Evaluation of a Cancer Survivorship Protocol:Transitioning Patients to Survivors

© Oncology Nursing Society

Advances in cancer research, including early detec-tion, better supportive care, and more effective treatments, have led to people living longer with or after a cancer diagnosis (American Cancer Society, 2012; Centers for Disease Control and Prevention

[CDC], 2011; Rowland & Yancik, 2006). To date, more than 11 million cancer survivors are living in the United States, and that number is expected to double by 2030 (CDC, 2011). Most therapeutic modalities for cancer are beneficial and lifesaving, but are associated with adverse long-term and late sequelae, including physical and psychological side effects that may impact survivors’ quality of life (Aziz, 2007; Campbell, Mayer, Abernathy, & Carroll, 2008; Deimling, Bowman, Sterns, Wag-ner, & Kahana, 2005; Hudson et al., 2003; Leak, Mayer, & Smith, 2011; Oeffinger et al., 2006).

Cancer treatments are associated with specific long-term and late side effects that vary greatly depending on type of cancer and the treatment modalities involved (Earle, 2006). Reported physical effects include cognitive dysfunction (thinking and memory problems), fatigue, lymphedema, car-diotoxicity, pulmonary toxicity, and peripheral neuropathy (Aziz, 2007; Carver et al., 2007). Another concerning late side effect of cancer treatment is the development of secondary

malignancies. Research has shown that adults and children who have received chemotherapy or radiation therapy are at risk for developing a secondary malignancy (Chaudhary & Haldas, 2003; Maule et al., 2007).

Studies also have demonstrated that survivors have more co-morbid conditions and chronic health problems (e.g., congestive heart failure, coronary artery disease, renal failure) than their healthy counterparts (Keating, Nørredam, Landrum, Huskamp, & Meara, 2005; Oeffinger et al., 2006; Yancik, Ganz, Varricchio, & Conley, 2001). Adult survivors of childhood cancers have re-ported having at least one domain of health status (e.g., general or mental health and cancer-related fear or anxiety) that was moder-ately or severely affected by their treatment (Hudson et al., 2003).

Survivors have an increased likelihood of not receiving rec-ommended care across a broad range of chronic medical condi-tions or recommended preventive services, particularly when followed only by an oncologist (Earle & Neville, 2004). When survivors receive care from a primary care provider (PCP) and an oncologist, they are more likely to engage in preventive health services and receive cancer screening services (Earle, 2006; Earle & Neville, 2004; Ganz, 2006). That underscores the need for improved communication between specialists and PCPs for optimal survivor care.

© Oncology Nursing Society. Unauthorized reproduction, in part or in whole, is strictly prohibited. For permission to photocopy, post online, reprint, adapt, orotherwise reuse any or all content from this article, e-mail [email protected]. To purchase high-quality reprints, e-mail [email protected].

“The Institute of Medicine has challenged oncology providers to address cancer

survivorship care planning. Gaps in can-cer survivorship knowledge are evident and will require focused education for

this initiative to be successful.”

“Much evidence has accumulated to suggest that the psychological

treatment of cancer can sometimes be sucessfully adjunctive to (or even replace) the somatic. The therapy is primarily reeducative psychothereapy, not psychoanalysis.” (369)

“Architecture is a useful tool that can help people open up. Being in a good place lowers

anxiety levels”

Cancer and Society

http://oncology.thelancet.com Vol 9 June 2008 521

issues: a chapter on privacy would have been a welcome addition to Blood Matters.

Nonetheless, there is much of merit here. Gessen has researched her subject assiduously, undertaking

dozens of interviews and unearthing some fascinating details. The Economist recently suggested that develop ments in our understanding of biology would have a similar impact on the 21st century, as knowledge of physics did

on the previous hundred years. After reading Blood Matters, few would disagree.

Talha [email protected]

DesignCaring through architectureUndoubtedly, the greatest challenge for Richard Rogers and his team at Rogers Stirk Harbour and Partners in designing the new Maggie’s Cancer Caring Centre, which opened in London at the end of April, was the unprepossessing site. Wedged on a sliver of land between the main artery of the Fulham Palace Road and Charing Cross Hospital’s emergency department, it is diffi cult to credit the oasis of tranquillity that has been created. Remarkably, in the building you hear the rain more than the roar of nearby traffi c.

Maggie Keswick Jencks—who died from breast cancer in July 1995—had a vision for a centre that would empower patients with cancer to get on with their lives. The resulting Maggie’s Cancer Caring Centres provide help, information, and support to people aff ected by cancer and their families. Today, there are fi ve Maggie’s Cancer Caring Centres in Scotland, and seven planned for England and Wales, of which the London centre is the fi rst to open. “The centres are about enabling people to help themselves in what ever way is right for them”, said Laura Lee, the chief executive, who was also Keswick Jencks’s oncology nurse.

The combination of good building and garden design was integral to Keswick Jencks, who had studied architecture and was married to the architectural writer Charles Jencks. As Maggie battled her cancer, the couple had a vision of a domestic, yet attractive environment that would boost the spirits of the patients. “Above all we wanted an environment

that was as distinct as possible from the institutional hospital setting”, explained Jencks.

The brief to Rogers Stirk Harbour for the London building was to create an uplifting environment.

“We wanted the centre to remind people of who they are and that cancer is just a component of what is going on in their lives, not the be all and end all”, commented Lee. “Architecture is a useful tool that can help people open up. Being in a good place lowers anxiety levels”.

Will Wimshurst, one of the architec-tural team, said the brief was completely diff erent from any thing he has encountered. “Normally briefs talk about square footage, and plant design, but this one talked about how they wanted people to feel in spaces. It was really inspirational.”

The feeling of tranquillity has been achieved by making a distinctive feature of the fl oating roof which sails over the outer walls. It serves a practical purpose, shielding the windows and inner courtyards from the looming view of the nearby Charing Cross Hospital. Low iron glass, with a lot of transparency, has been used where the roof meets the building to enhance the impression of a fl oating structure.

Entering the centre through the front door, there is no reception, just a kitchen area with a big farm-house-style table for visitors to sit round. Jencks calls this concept kitchenism—the intention to help people feel instantly at home. “The kettle is integral—on their second visit people

make their own cups of tea. Here at least they’re not passive recipients having yet more stuff done to them”, said Lee.

Part of the brief was to create as many corners as possible. Here architects took inspiration from Maggie’s own book on Chinese gardens. Birch doors have been installed that slide open to provide large spaces for meetings, or divide up into small areas for intimate

A patient, Namina Turay, with Sarah Brown, Nigella Lawson, and Laura Lee

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The kitchen area of the new Maggie’s Cancer Caring Centre, London, UK

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Maggie's centre's "living with cancer"

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Transcript of Maggie's centre's "living with cancer"