NINR Research Update Oncology Nursing Society Hill Days September 6, 2017

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1 NINR Research Update Oncology Nursing Society Hill Days September 6, 2017 Director, National Institute of Nursing Research

2 Overview Topics NIH and NINR missions NINR scientific focus areas Research initiatives Training opportunities

3 NIH Mission NIH: Steward of Biomedical and Behavioral Research for the Nation NIH s mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.

4 NINR Mission To promote and improve the health of individuals, families, and communities To understand and manage wellness and health across the lifespan To improve quality of life for individuals and their caregivers

5 NINR Strategic Plan Advancing Science, Improving Lives: A Vision for Nursing Science Innovative Questions Broad Stakeholder Engagement

6 NINR s Areas of Research Scientific Focus Areas to Implement NINR s Strategic Plan Symptom Science Wellness Self-Management End-of-Life and Palliative Care

7 Symptom Science GI Cancer Patients with/without Targeted Therapy Experience Differences in Symptoms Lack of energy, cough, drowsiness, and sleep difficulties less frequent in patients receiving TT + chemo Dry mouth and changes in the taste of food less severe in patients receiving TT + chemo Most distressing symptoms were not always the most frequent nor severe Tantoy et al. J Gastrointest Oncol, 2017

8 Symptom Science Symptoms Contribute to Mobility Disabilities in Ovarian Cancer Patients Symptom-related mobility disability affects many ovarian cancer patients Pain, fatigue, abdominal bloating, numbness, and other symptoms affect mobility Interventions for these symptoms could enhance mobility and improve outcomes Campbell et al. Gynecol Oncol, 2017

9 Symptom Science Pain Experience Changes During the Menopause Transition Women reported gradual increases in bodily pain during the menopausal transition Bodily pain decreased in the years after the transition The changes in pain levels were statistically significant Lee et al. J Pain, 2017

10 Symptom Science Opioid Treatment May Affect the Rate of Healing in Chronic Wounds More rapid wound healing in patients who never received opioids Slower wound healing in patients receiving higher opioid doses Shanmugam et al. Wound Repair Regen, 2017

11 Symptom Science Inflammation May Be Associated with Radiation Therapy-Related Fatigue Patients with fatigue had higher levels of TRAIL, a molecular messenger associated with chronic inflammation TRAIL killed neuron cells selectively in laboratory experiments Feng et al. J Psychiatr Res, 2017

12 Wellness Nurse Staffing, Education, Work Environment Linked to Patient Outcomes Increasing nurses workload by 1 patient increased likelihood of inhospital death by 7% 7% decrease in likelihood of death for every 10% increase in number of nurses with bachelor s degrees Better outcomes with better nursing work environment Aiken et al. Lancet, 2014

13 Self-Management Life Expectancy Does Not Modify Older Adults Skin Cancer Treatment Choices Treatments for non-fatal skin cancers vary in invasiveness, cost, side effects, and outcomes The choice of treatment was the same, whether patients had long or short life expectancies Linos et al. J Am Geriatr Soc, 2016

14 Self-Management Out-of-Pocket Costs Create Substantial Burdens for Rural Breast Cancer Survivors As much as 30% of income can go to out-of-pocket posttreatment care Younger women and those with lower income bear the greatest burden Pisu et al. Cancer Med, 2017

15 End-of-Life and Palliative Care Cancer Type Plays a Role in Palliative Care Blood cancer patients are seen more often in acute care settings and less often at home or clinics than patients with solid tumors LeBlanc et al. J Pain Symptom Manage, 2016 Physical symptom screening and discussion of emotional and psychological needs were less frequent for blood cancer patients

16 End-of-Life and Palliative Care Patients with Incurable Lung Cancer Benefit from Early Integrated Palliative and Oncology Care Temel et al. J Clin Oncol, 2017 Worse outcomes with patients poor understanding of treatment goals or no discussion of end-of-life preferences Improved quality of life and depression symptoms in lung cancer patients with integrated palliative/oncology care

17 End-of-Life and Palliative Care Infovisuals to Engage Patients in Completing Advanced Directives Many people do not complete advance directives due to length and complexity of the documents Visual aids for medical information can enhance comprehension, recall, and interest Woollen et al. J Gerontol Nurs, 2016

18 End-of-Life and Palliative Care Interdependence between Caregivers and Patients with New Incurable Cancer Diagnoses Patients experience greater depressive symptoms; caregivers report greater anxiety symptoms Anxiety symptoms in caregiverpatient dyads are influenced by partners depressive symptoms Patients with non-spousal caregivers are at greater risk for depressive symptoms Jacobs et al. Ann Behav Med, 2017

19 End-of-Life and Palliative Care Increased Caregiver Burden Associated with Decreased Patient Survival Longer survival for unmarried, advanced cancer patients without caregivers than with caregivers Decreased patient survival with caregivers reporting greater demand burden Dionne-Odom et al. Cancer Med, 2016

20 Initiatives Keynote Speaker: Judy Woodruff, PBS NewsHour videocast.nih.gov

21 Initiatives Infrastructure for Large Scale Studies palliativecareresearch.org

22 NIH-Wide Initiatives

23 NIH-Wide Initiatives Pragmatic Clinical Trials Goals of the NIH Health Care Systems Collaboratory Provide a framework of implementation methods and best practices to enable participation of health care systems in clinical research Strengthen national capacity to implement costeffective, large-scale research studies Engage health care delivery organizations as research partners commonfund.nih.gov/hcscollaboratory

24 Training Opportunities

25 Training Opportunities NINR Methodologies Boot Camp Precision Health: from Omics to Data Science August 7-11,

26 Advancing Science, Improving Lives