New or worsening sleep-wake disturbance (SWD) can occur throughout the cancer trajectory. . The p... more New or worsening sleep-wake disturbance (SWD) can occur throughout the cancer trajectory. . The purpose of this article is to critically review available empirical evidence supporting the efficacy of interventions for SWD, highlighting new evidence since the 2006 and 2009 Putting Evidence Into Practice (PEP) SWD publications. . A systematic review of studies published from 2009-2017 was conducted to identify effective interventions for cancer-related SWD. The PEP weight of evidence classification schema was used to categorize the strength of evidence. . Cognitive behavioral intervention/approach is the only intervention that is recommended for practice. Mindfulness-based stress reduction and exercise interventions are likely to be effective but require more evidence. Pharmacologic interventions, relaxation, imagery, meditation, acupuncture, yoga, massage, and psychoeducation have insufficient evidence.
Sleep problems are common but often neglected in older adults, particularly in the context of can... more Sleep problems are common but often neglected in older adults, particularly in the context of cancer. Underlying mechanisms are poorly understood and interventions frequently lack a clear scientific basis. The objective of this report was to examine scientific content presented at a National Institutes of Health-sponsored U13 "Bedside to Bench" conference using a qualitative and iterative review procedure. Analysis of current scientific issues regarding sleep in older adults with cancer is needed to direct nurse scientists and clinicians toward research opportunities. A multistep review procedure for the analysis/synthesis of knowledge gaps and research opportunities was undertaken by oncology nurse scientists in attendance. Conceptual problems in this area include the lack of standard sleep terminology and absence of an overarching conceptual model. Methodological problems are inconsistent sleep/napping measurement and complex operational challenges in designing comprehensive yet feasible studies in older adults. Knowledge gaps in basic and clinical science relate to cellular and molecular mechanisms that underlie sleep and circadian rhythm disturbances, contribution of sleep to adverse outcomes, and impact of disturbed sleep during hospitalization and the transition from hospital to home. Focused and interdisciplinary research that advances conceptual and operational understanding of biological and behavioral determinants of sleep health in the aging cancer population can lead to more effective, safe, and targeted interventions for those with cancer-related sleep-circadian disturbances. Research that addresses current conceptual, methodological, and physiological issues can lead to more effective, safe, and targeted care for older adults with cancer-related sleep-circadian disturbances.
To obtain feasibility data on a self-management program to improve adherence with positive airway... more To obtain feasibility data on a self-management program to improve adherence with positive airway pressure (PAP) in individuals with newly diagnosed obstructive sleep apnea. A mixed-methods design assessed program effectiveness and participants' opinions on program ease-of-use. Structured interviews with the treatment group occurred one week and one month after initiation of PAP therapy. Participants (n = 14) completing the study demonstrated 64% adherence versus 58% of the controls. Ease of use was demonstrated. The PAP self-management program demonstrated ease of use and was found somewhat effective in improving PAP adherence. The book was useful in assisting participants by validating information obtained from their providers and developing an understanding of the consequences of not using PAP.
To describe the process of establishing a multisite team to conduct research with a multicultural... more To describe the process of establishing a multisite team to conduct research with a multicultural focus on fatigue. Articles, book chapters, personal experience. Teamwork facilitated development of a productive professional working group, sharing of resources, and data collection culminating in a research proposal for studying cancer-related fatigue in a multicultural population. Establishing a common goal by investing time, committing to the process, and establishing trust was the secret to effective team functioning. The prospect of multi-institutional collaboration has implications for oncology nurses in the areas of research and practice. Goals that could not be achieved easily in the setting of a single institution are reached more easily with multisite collaboration and teamwork.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1997
To determine the toxicity and immunologic activity of an antiidiotype melanoma vaccine that consi... more To determine the toxicity and immunologic activity of an antiidiotype melanoma vaccine that consists of monoclonal antibody I-Mel-2 (MELIMMUNE-2, IDEC Pharmaceuticals, La Jolla, CA) and an immunologic adjuvant SAF-m. Twenty-six patients with metastatic melanoma, 17 of whom had previously received chemotherapy, were given 2 mg of I-Mel-2 and either 100 micrograms (n = 6) or 250 micrograms (n = 20) of SAF-m. Antiidiotype vaccine was given intramuscularly (IM) biweekly for 4 weeks, and then bimonthly until disease progression. Human antimurine antibodies (HAMA), anti-I-Mel-2 antibodies, and specific antibody (Ab)3 against the melanoma epitope mimicked by the vaccine were titrated before treatment, biweekly from weeks 4 to 12, and every 4 to 8 weeks thereafter. Computed tomographic (CT) scans of the chest, abdomen, and pelvis and magnetic resonance imaging (MRI) of the brain were obtained before and bimonthly during treatment to evaluate responses. Elevated titers of human antimouse ant...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1994
To determine whether interferon alfa-2b (IFN-alfa; intron-A, Schering Corp, Kenilworth, NJ) can i... more To determine whether interferon alfa-2b (IFN-alfa; intron-A, Schering Corp, Kenilworth, NJ) can induce a remission in patients previously treated with active specific immunotherapy (therapeutic melanoma vaccine) without response. Eighteen patients with disseminated melanoma who had failed to respond to at least five injections of Melacine therapeutic melanoma vaccine (Ribi ImmunoChem Research, Inc, Hamilton, MT) were then treated IFN-alfa after a 4-week interval. IFN-alfa 5 or 6 x 10(6) U/m2 was self-administered three times a week subcutaneously by melanoma patients for at least 2 months. Computed tomographic (CT) scans of the chest, abdomen, and pelvis and magnetic resonance imaging of the brain were performed within 4 weeks before treatment as a baseline, and then at 2-month intervals during treatment to evaluate response. All 18 patients were HLA-typed before treatment. The frequency of cytolytic T-cell precursors (pCTL) in the blood had been measured weekly in 13 of the patient...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1994
To determine whether active specific immunotherapy with lysates of cutaneous melanoma cells, admi... more To determine whether active specific immunotherapy with lysates of cutaneous melanoma cells, administered with immunologic adjuvant DETOX (Ribi ImmunoChem Research, Inc, Hamilton, MT), is effective in shrinking a primary choroidal melanoma, in an elderly patient already blind in the nontumorous eye. An 81-year-old man was referred with a primary choroidal melanoma of the left eye, with virtual blindness of the right eye due to macular degeneration. He was begun on active specific immunotherapy with an experimental melanoma vaccine (melanoma theraccine) and DETOX on weeks 1, 2, 3, 4, and 6, respected after a hiatus of 2 weeks. After a response was noted, monthly injections were given. The patient had a significant shrinkage of his choroidal melanoma from a height of 4.2 mm to 2.4 mm within 2 months. This was sustained by continual treatment for 21 months until September 1991. After the patient failed to return for 9 months while recuperating from a stroke, the lesion regrew to a heig...
New or worsening sleep-wake disturbance (SWD) can occur throughout the cancer trajectory. . The p... more New or worsening sleep-wake disturbance (SWD) can occur throughout the cancer trajectory. . The purpose of this article is to critically review available empirical evidence supporting the efficacy of interventions for SWD, highlighting new evidence since the 2006 and 2009 Putting Evidence Into Practice (PEP) SWD publications. . A systematic review of studies published from 2009-2017 was conducted to identify effective interventions for cancer-related SWD. The PEP weight of evidence classification schema was used to categorize the strength of evidence. . Cognitive behavioral intervention/approach is the only intervention that is recommended for practice. Mindfulness-based stress reduction and exercise interventions are likely to be effective but require more evidence. Pharmacologic interventions, relaxation, imagery, meditation, acupuncture, yoga, massage, and psychoeducation have insufficient evidence.
Sleep problems are common but often neglected in older adults, particularly in the context of can... more Sleep problems are common but often neglected in older adults, particularly in the context of cancer. Underlying mechanisms are poorly understood and interventions frequently lack a clear scientific basis. The objective of this report was to examine scientific content presented at a National Institutes of Health-sponsored U13 "Bedside to Bench" conference using a qualitative and iterative review procedure. Analysis of current scientific issues regarding sleep in older adults with cancer is needed to direct nurse scientists and clinicians toward research opportunities. A multistep review procedure for the analysis/synthesis of knowledge gaps and research opportunities was undertaken by oncology nurse scientists in attendance. Conceptual problems in this area include the lack of standard sleep terminology and absence of an overarching conceptual model. Methodological problems are inconsistent sleep/napping measurement and complex operational challenges in designing comprehensive yet feasible studies in older adults. Knowledge gaps in basic and clinical science relate to cellular and molecular mechanisms that underlie sleep and circadian rhythm disturbances, contribution of sleep to adverse outcomes, and impact of disturbed sleep during hospitalization and the transition from hospital to home. Focused and interdisciplinary research that advances conceptual and operational understanding of biological and behavioral determinants of sleep health in the aging cancer population can lead to more effective, safe, and targeted interventions for those with cancer-related sleep-circadian disturbances. Research that addresses current conceptual, methodological, and physiological issues can lead to more effective, safe, and targeted care for older adults with cancer-related sleep-circadian disturbances.
To obtain feasibility data on a self-management program to improve adherence with positive airway... more To obtain feasibility data on a self-management program to improve adherence with positive airway pressure (PAP) in individuals with newly diagnosed obstructive sleep apnea. A mixed-methods design assessed program effectiveness and participants' opinions on program ease-of-use. Structured interviews with the treatment group occurred one week and one month after initiation of PAP therapy. Participants (n = 14) completing the study demonstrated 64% adherence versus 58% of the controls. Ease of use was demonstrated. The PAP self-management program demonstrated ease of use and was found somewhat effective in improving PAP adherence. The book was useful in assisting participants by validating information obtained from their providers and developing an understanding of the consequences of not using PAP.
To describe the process of establishing a multisite team to conduct research with a multicultural... more To describe the process of establishing a multisite team to conduct research with a multicultural focus on fatigue. Articles, book chapters, personal experience. Teamwork facilitated development of a productive professional working group, sharing of resources, and data collection culminating in a research proposal for studying cancer-related fatigue in a multicultural population. Establishing a common goal by investing time, committing to the process, and establishing trust was the secret to effective team functioning. The prospect of multi-institutional collaboration has implications for oncology nurses in the areas of research and practice. Goals that could not be achieved easily in the setting of a single institution are reached more easily with multisite collaboration and teamwork.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1997
To determine the toxicity and immunologic activity of an antiidiotype melanoma vaccine that consi... more To determine the toxicity and immunologic activity of an antiidiotype melanoma vaccine that consists of monoclonal antibody I-Mel-2 (MELIMMUNE-2, IDEC Pharmaceuticals, La Jolla, CA) and an immunologic adjuvant SAF-m. Twenty-six patients with metastatic melanoma, 17 of whom had previously received chemotherapy, were given 2 mg of I-Mel-2 and either 100 micrograms (n = 6) or 250 micrograms (n = 20) of SAF-m. Antiidiotype vaccine was given intramuscularly (IM) biweekly for 4 weeks, and then bimonthly until disease progression. Human antimurine antibodies (HAMA), anti-I-Mel-2 antibodies, and specific antibody (Ab)3 against the melanoma epitope mimicked by the vaccine were titrated before treatment, biweekly from weeks 4 to 12, and every 4 to 8 weeks thereafter. Computed tomographic (CT) scans of the chest, abdomen, and pelvis and magnetic resonance imaging (MRI) of the brain were obtained before and bimonthly during treatment to evaluate responses. Elevated titers of human antimouse ant...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1994
To determine whether interferon alfa-2b (IFN-alfa; intron-A, Schering Corp, Kenilworth, NJ) can i... more To determine whether interferon alfa-2b (IFN-alfa; intron-A, Schering Corp, Kenilworth, NJ) can induce a remission in patients previously treated with active specific immunotherapy (therapeutic melanoma vaccine) without response. Eighteen patients with disseminated melanoma who had failed to respond to at least five injections of Melacine therapeutic melanoma vaccine (Ribi ImmunoChem Research, Inc, Hamilton, MT) were then treated IFN-alfa after a 4-week interval. IFN-alfa 5 or 6 x 10(6) U/m2 was self-administered three times a week subcutaneously by melanoma patients for at least 2 months. Computed tomographic (CT) scans of the chest, abdomen, and pelvis and magnetic resonance imaging of the brain were performed within 4 weeks before treatment as a baseline, and then at 2-month intervals during treatment to evaluate response. All 18 patients were HLA-typed before treatment. The frequency of cytolytic T-cell precursors (pCTL) in the blood had been measured weekly in 13 of the patient...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1994
To determine whether active specific immunotherapy with lysates of cutaneous melanoma cells, admi... more To determine whether active specific immunotherapy with lysates of cutaneous melanoma cells, administered with immunologic adjuvant DETOX (Ribi ImmunoChem Research, Inc, Hamilton, MT), is effective in shrinking a primary choroidal melanoma, in an elderly patient already blind in the nontumorous eye. An 81-year-old man was referred with a primary choroidal melanoma of the left eye, with virtual blindness of the right eye due to macular degeneration. He was begun on active specific immunotherapy with an experimental melanoma vaccine (melanoma theraccine) and DETOX on weeks 1, 2, 3, 4, and 6, respected after a hiatus of 2 weeks. After a response was noted, monthly injections were given. The patient had a significant shrinkage of his choroidal melanoma from a height of 4.2 mm to 2.4 mm within 2 months. This was sustained by continual treatment for 21 months until September 1991. After the patient failed to return for 9 months while recuperating from a stroke, the lesion regrew to a heig...
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Papers by Grace E Dean