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NPWH Position Statement on HBOC Risk Assessment
This item is part of a CNE course. The material is freely available in the Henderson Repository. The CNE course (and associated fee, if any) is not part of the Henderson Repository. To access the course please click on the applicable link on the CNE collection homepage: http://www.nursinglibrary.org/vhl/handle/10755/622566. Note the start and end dates for the course. If the links to the CNE collection homepage or course are invalid, the course has ended. The item record and file will remain as a permanent entry in the repository in its original collection.The National Association of Nurse Practitioners in Women’s Health (NPWH) supports the role of women’s health nurse practitioners (WHNPs) in providing hereditary breast and ovarian cancer (HBOC) risk assessment. At a minimum, HBOC risk assessment should include the woman’s personal cancer history; her maternal and paternal first-, second-, and third-degree relative cancer histories, with descriptions of the types of primary cancers and the ages of onset; any Ashkenazi Jewish ancestry; and the results of any cancer predisposition testing in any relative.This assessment should be reviewed and updated regularly. The goal of HBOC risk assessment is to identify women who may benefit from genetic counseling, genetic testing, enhanced surveillance, or other risk management strategies.WHNPs should be knowledgeable about indicators of an increased risk for HBOC, as put forth by the National Comprehensive Cancer Network (NCCN).Women assessedas being at increased risk should have access to genetic counseling by clinicians with training and expertise in cancer genetics. These specialists can provide genetictesting if indicated and desired, psychosocial support, and evidence-based management that depends on identified risk and genetic testing results—if such testing is done. Primary care providers with appropriate training and skills, including WHNPs, may provide HBOC genetic counseling and testing.An evidence-based protocol established according to guidelines provided by nationally recognized organizations such as NCCN must be followed to ensure that all recommended components of assessment, counseling, informed consent, appropriate testing, and follow-up are provided....
Descriptive Study of Cognitive Disturbances in Older Breast Cancer Survivors
This item is part of a CNE course. The material is freely available in the Henderson Repository. The CNE course (and associated fee, if any) is not part of the Henderson Repository. To access the course please click on the applicable link on the CNE collection homepage: http://www.nursinglibrary.org/vhl/handle/10755/622566. Note the start and end dates for the course. If the links to the CNE collection homepage or course are invalid, the course has ended. The item record and file will remain as a permanent entry in the repository in its original collection.Session presented on Sunday, November 8, 2015: Abstract: Breast cancer continues to be the number one cause of cancer in women over age 50, with a median age at diagnosis of 61 years. (ACS, 2013). Treatment advances have led to a significant increase in the number of breast cancer survivors; survival rates now range from 88% at 5 years to 78% after 15 years post diagnosis (ACS, 2013). A significant number of these women, 35% of early stage breast cancer (Stages I/II) and 61% of later stage breast cancer patients (Stages III/IV), receive chemotherapy (The National Cancer Database, 2008). Cognitive disturbances, often referred to as "chemobrain" are common among breast cancer survivors. Where most experience cognitive disturbances during treatment, many improve upon treatment termination, up to a fourth may experience persistent cognitive decline 1-year post treatment. Many describe these issues as related to declines in memory. In older patients, the likelihood of cognitive disturbances are even greater (Ahles, 2010) because they often have lower cerebral blood flow, and have additional comorbidities, including undetected neurodegenerative diseases. The purposes of this descriptive exploratory study are twofold: (1) examine how factors, both biological and functional, relate to cognitive function, in older breast cancer survivors who report persistent cognitive impairment, 12-36 months after completing their chemotherapy regimen and (2) characterize and compare the genetic and phenotypical profiles of breast cancer survivors to the profiles found in a neurologist verified sample of older adults diagnosed with mild cognitive impairment (MCI), pre MCI, and no MCI. Twenty older breast cancer survivors (10 with and 10 without measurable impairment, age 50 years and older) will complete a 4 day journal and complete questionnaires describing the impact of their treatment regimen on their ability to think and the strategies they use to adapt to their perceived deficits. Afterwards, they will come to the Neurocognitive Assessment Laboratory and undergo a comprehensive neurocognitive battery, including behavioral and electroencephalographic measures of memory functions, sleep, and cerebral oxygenation. Blood draws for inflammation, oxidative stress and neuroprotective factors (neuroglobin, antioxidant activity and brain derived neurotrophic factors) and genetic polymorphism (APOE, neuroglobin) will also be measured in order to compare these variables to equivalent data collected from adults without cancer. Data will be analyzed using thematic content analysis for the journals, schematic plots and t- tests for the measures of proinflammatory risk, neuroprotective factors and memory consolidation. Cross tabulation and chi-square will be used to compare genetic risk between samples. Each marker will be analyzed in a two-way ANOVA, sample by cognitive status, where the interaction will be used to test the differential relationship of the marker and cognitive status by cancer status. Results will be used to develop a larger, prospective study aimed at refining the recognition of women at greater risk for persistent cognitive decline and factors to ameliorate that risk. In addition to this, information gained from this study will facilitate the development of interventions to help women cope, adapt and even improve their cognitive functioning while on treatment....