Suzanne L. Dibble

To describe the experience and intensity of delayed nausea in women undergoing chemotherapy for breast cancer since the advent of the 5-HT3 antagonists. Multisite, longitudinal, descriptive. 7 outpatient oncology clinics situated in hospitals, 5 outpatient oncology clinics associated with major teaching universities, 27 private outpatient oncology practices, and 1 outpatient clinic located in a county hospital. Typical participants (N = 303) were 51.9 years old, Caucasian (79%), married or partnered (65%), born U.S. citizens (92%), heterosexual (96%), living with someone (83%), and high school graduates (82%). Baseline and poststudy questionnaires plus a daily diary of nausea through two cycles of chemotherapy (approximately two months) were used to collect data. The Rhodes Inventory of Nausea, Vomiting, and Retching was used to assess the nausea experience. Nausea. The worst nausea occurred on the third day after having chemotherapy for breast cancer. The types of oral antiemetics ordered for home use were changed between the two cycles of the study only 8% (n = 24) of the time. Younger, heavier women experienced more delayed nausea. Women who had a history of nausea with stress and women receiving cyclophosphamide experienced more delayed nausea during both time periods. Delayed nausea is a significant problem for women receiving chemotherapy for breast cancer. IMPLICATION FOR NURSING: Oncology nurses can use the results from this study to provide anticipatory guidance for patients undergoing chemotherapy for breast cancer.

To explore the impact of two one-hour lesbian-specific educational interventions by a lesbian physician on the cancer screening behaviors of lesbians. A pilot pre- and post-test intervention study. Two lesbian, gay, bisexual, and transgendered senior organizations in the San Francisco Bay Area (one urban, one suburban). 36 participants aged 50-81 (meanX = 60.2, SD = 6.48). The majority were Caucasian (86%), single (61%), living in urban areas (67%), employed (56%), and educated beyond high school (meanX = 15.47 years, SD = 2.90, range 9-21). Eleven percent (n = 4) did not have any health insurance and were not on Medicaid or Medicare. A lesbian physician led a one-hour, didactic, lesbian- specific educational program on cancer screening, including a review of current research findings with regard to lesbians' risk for cancer and 45 minutes of information on recommended cancer screening, followed by a 15-minute question-and-answer period. Participants completed a pre- and postintervention survey. Follow-up data were available for 22 women. Of the six women (27%) who had not focused their attention on breast screening behaviors for two years or more, one-third had obtained mammograms and half began performing monthly breast self-examinations. Of the four women (18%) who had not undergone a pelvic examination for three years or more, one obtained a pelvic examination. The women reported no changes in colorectal cancer screening behaviors. Some of these difficult-to-reach women changed their behavior in a very short period of time, supporting the need for a larger study to confirm these findings. A need exists to develop appropriate interventions for the underserved population of lesbians older than 50.

To compare the distribution of risk factors for developing ovarian cancer in lesbian and heterosexual women. Secondary analysis of a retrospective medical record review. Urban health clinic with special outreach to lesbians. Typical participant (N = 1,019) was 42.9 years old and white (70%). Most were without health insurance, and 99% were poor (< $15,780 annual income). The majority (58%, n = 586) described themselves as heterosexual; 42% (n = 433) said they were lesbian. Data were collected from medical records and analyzed using analysis of covariance and logistic regression techniques. Ovarian cancer risk factors (parity, exogenous hormone use, smoking, body mass index [BMI], and tubal ligation/hysterectomy). Lesbians had a higher BMI; heterosexual women had higher rates of current smoking and a higher incidence of the protective factors of pregnancy, children, miscarriages, abortions, and use of birth control pills. The results of this study indicate that lesbians may have an increased risk for developing ovarian cancer. A study designed specifically to explore the risk factors of lesbian and heterosexual women for developing ovarian cancer must be undertaken to confirm these findings. Differences in risk levels may exist for lesbians; therefore, healthcare providers must become comfortable asking questions about sexual orientation and behavior.

To compare differences in nausea experience and intensity in women undergoing chemotherapy for breast cancer between those receiving usual care plus acupressure training and treatment and those receiving only usual care. Single-cycle, randomized clinical trial. Outpatient oncology clinic in a major teaching medical center and a private outpatient oncology practice. Seventeen women participated in the study. The typical participant was 49.5 years old (SD = 6.0), Caucasian (59%), not married/partnered (76%), on disability (53%), born a U.S. citizen (76%), and heterosexual (88%); lived alone (59%); had at least graduated from high school (100%); and had an annual personal income of $50,000 or greater (65%). The intervention included finger acupressure bilaterally at P6 and ST36, acupressure points located on the forearm and by the knee. Baseline and poststudy questionnaires plus a daily log were used to collect data. Nausea experience measured by the Rhodes inventory of Nausea, Vomiting, and Retching and nausea intensity. Significant differences existed between the two groups in regard to nausea experience (p < 0.01) and nausea intensity (p < 0.04) during the first 10 days of the chemotherapy cycle, with the acupressure group reporting less intensity and experience of nausea. Finger acupressure may decrease nausea among women undergoing chemotherapy for breast cancer. This study must be replicated prior to advising patients about the efficacy of acupressure for the treatment of nausea.