Showing papers in "European Journal of Cancer Care in 2015"
TL;DR: The evidence available suggests that the underlying framework of ACT offers an intervention model that is potentially more suited to the individualistic nature of cancer adjustment, within the context of wider cancer adjustment.
Abstract: Cancer is an illness affecting patients' physical and psychosocial well-being: high numbers report problematic levels of distress at many points through diagnosis, treatment and survivorship. Conclusive evidence for the long-term benefits of psychological interventions is lacking and this may be because (1) they employ a too limited scope of underlying therapeutic model; or (2) that they are too focused on improving psychopathological outcomes. Acceptance and Commitment Therapy (ACT) may add components not emphasised elsewhere and may provide a more suitable model of adjustment and coping. Following a comprehensive literature search a theoretical and conceptual discussion of the potential for ACT-based oncology interventions is presented. Only a small number of studies have purposively studied the application of ACT within the cancer setting, but this nonetheless presents useful pilot data. The data demonstrate potential clinical- and cost-effectiveness for a range of patients, including those with psychological comorbidity. Within the context of wider cancer adjustment, ACT offers an intervention framework to appropriately build upon the strong empirical base already established for Mindfulness within this specific patient population. The evidence available suggests that the underlying framework of ACT offers an intervention model that is potentially more suited to the individualistic nature of cancer adjustment.
167 citations
TL;DR: A qualitative systematic review and synthesis examining men's experience of and need for supportive care was presented in this article, highlighting the need for improved access to cancer specialist nurses throughout the care pathway, individually tailored supportive care and psychosexual support for treatment side effects.
Abstract: Prostate cancer is the second most common cancer in men worldwide, accounting for an estimated 1.1 million new cases diagnosed in 2012 (www.globocan.iarc.fr). Currently, there is a lack of specific guidance on supportive care for men with prostate cancer. This article describes a qualitative systematic review and synthesis examining men's experience of and need for supportive care. Seven databases were searched; 20 journal articles were identified and critically appraised. A thematic synthesis was conducted in which descriptive themes were drawn out of the data. These were peer support, support from partner, online support, cancer specialist nurse support, self-care, communication with health professionals, unmet needs (emotional support, information needs, support for treatment-induced side effects of incontinence and erectile dysfunction) and men's suggestions for improved delivery of supportive care. This was followed by the development of overarching analytic themes which were: uncertainty, reframing, and the timing of receiving treatment, information and support. Our results show that the most valued form of support men experienced following diagnosis was one-to-one peer support and support from partners. This review highlights the need for improved access to cancer specialist nurses throughout the care pathway, individually tailored supportive care and psychosexual support for treatment side effects.
138 citations
TL;DR: The lung cancer patients who completed the Psychological Wellness intervention reported improvements in psychological outcomes and decreases in stigma in the face of declining quality of life with patients reporting personal benefit from their own perspectives.
Abstract: People with lung cancer experience health-related stigma that is related to poorer psychosocial and quality of life outcomes. The present Phase 1 study applied mixed methods to test the acceptability of an acceptance-focused cognitive behavioural intervention targeting stigma for this patient group. Fourteen lung cancer patients completed a 6-week Psychological Wellness intervention with pre- and post-test outcome measures of psychological and cancer-specific distress, depression, health-related stigma and quality of life. In-depth interviews applying interpretative phenomenological analysis assessed participants' experiences of the intervention. Moderate to large improvements were observed in psychological (ηp (2) = 0.182) and cancer-specific distress (ηp (2) = 0.056); depression (ηp (2) = 0.621); health-related stigma (ηp (2) = 0.139). In contrast, quality of life declined (ηp (2) = 0.023). The therapeutic relationship; self-management of distress; and relationship support were highly valued aspects of the intervention. Barriers to intervention included avoidance and practical issues. The lung cancer patients who completed the Psychological Wellness intervention reported improvements in psychological outcomes and decreases in stigma in the face of declining quality of life with patients reporting personal benefit from their own perspectives. A randomised controlled trial is warranted to establish the effectiveness of this approach.
86 citations
TL;DR: Being younger, out of work (not retired), ever having had a feeding tube fitted, having a greater number of comorbidities and living alone were associated with higher levels of distress, concerns and unmet needs.
Abstract: The aim of this study was to identify the distress, unmet needs and concerns of head and neck cancer (HNC) survivors in the first 5 years after treatment. Two hundred and eighty HNC survivors from three Scottish health boards responded to a cross-sectional postal survey in 2011. Questionnaires included the Distress Thermometer, Patient Concerns Inventory (PCI) and an adapted version of the PCI to measure unmet needs. One-third of the survivors had moderate or severe levels of distress, and 74% had at least one unmet need. The most common concerns and unmet needs included oral and eating problems, fear of recurrence and fatigue. Multivariate analysis revealed that being younger, out of work (not retired), ever having had a feeding tube fitted, having a greater number of comorbidities and living alone were associated with higher levels of distress, concerns and unmet needs. The diversity of concerns and unmet needs identified in this study highlights the importance of holistic needs assessment as part of follow-up care for HNC survivors with tailoring of support for particular concerns. Specific information resources and self-management strategies are required to help HNC survivors with the practical and functional consequences of HNC treatment.
81 citations
TL;DR: PSQI questionnaire may be used to evaluate the sleep disorders in cancer patients and consistent use of multi-item measures such as PSQI with established reliability and validity would improve the understanding of difficulties experienced by cancer patients with chronic insomnia.
Abstract: Insomnia, poor sleep quality and short sleep durations are the most common problems seen in cancer patients More studies are needed about sleep disorders in cancer patients In our study, we aimed to investigate the prevalence of sleep disorders and the impact of these problems on the quality of life in cancer patients Pittsburgh Sleep Quality Index (PSQI) was given to a total of 314 patients The psychometric evaluation of the Turkish version of PSQI in cancer patients revealed that 127 (404%) patients had global PSQI scores >5, indicating poor sleep quality There was no statistically significant relationship between PSQI scores and sexuality, marital status, cancer stage and chemotherapy type (P > 005); while the patients with bone and visceral metastasis had much lower PSQI scores (P = 0006) Patients with Eastern Cooperative Oncology Group performance scores of 3 or more had also significantly lower PSQI scores (P = 002) In conclusion, PSQI questionnaire may be used to evaluate the sleep disorders in cancer patients Consistent use of multi-item measures such as PSQI with established reliability and validity would improve our understanding of difficulties experienced by cancer patients with chronic insomnia
77 citations
TL;DR: Improved survivorship education for health professionals may increase the number of patients receiving lifestyle advice, and improve their long-term outcomes.
Abstract: A healthy lifestyle following a cancer diagnosis is linked with better long-term outcomes. Health professionals can play an important role in promoting healthy lifestyles after cancer, but little is known about the factors that influence whether or not they give lifestyle advice. We conducted an online survey to examine levels of, and predictors of, health professionals' provision of lifestyle advice to cancer patients in the United Kingdom. The survey included questions on awareness of lifestyle guidelines for cancer survivors, current practices with regard to giving advice on smoking, diet, exercise, weight and alcohol, and perceived barriers to giving advice. Nurses, surgeons and physicians (N=460) responded to the survey. Many (36%) were not aware of any lifestyle guidelines for cancer survivors, but 87% reported giving some lifestyle advice; although this was lower for individual behaviours and often to 1.76, all P's<0.05). Not believing lifestyle would affect outcomes was associated with lower odds of giving lifestyle advice (all OR's<0.48, all P's<0.05). Improved survivorship education for health professionals may increase the number of patients receiving lifestyle advice, and improve their long-term outcomes.
74 citations
TL;DR: Five weeks of HIFT training was well-received and feasible for most cancer survivors, and effective for improving emotional functioning, body composition and functional movement.
Abstract: This pilot study investigated feasibility and preliminary efficacy of a high-intensity functional training (HIFT) group-exercise programme among adult cancer survivors within 5 years of last cancer treatment. Eight participants were assigned to a 5-week, 3 days/week HIFT intervention with four testing sessions and 12 workouts along with mobility and stretching exercises. Feasibility was assessed by initiation, adherence, and acceptability. Efficacy was determined by changes from baseline to post-test in health-related quality of life, body composition and functional movement. The recruitment rate was 80% and the adherence rate was 75%. Significant improvements were found for emotional functioning (P = 0.042) and body composition (lean mass +3.8 ± 2.1 kg, P = 0.008; fat mass -3.3 ± 1.0 kg, P = 0.001; body fat percentage -4.7 ± 1.2%, P < 0.001). Participants also significantly improved on five of seven functional movements: balance (P = 0.032), carrying a weighted object (P = 0.004), lower body strength and power (P = 0.009), aerobic capacity and endurance (P = 0.039), and perceived difficulty for flexibility (P = 0.012). Five weeks of HIFT training was well-received and feasible for most cancer survivors, and effective for improving emotional functioning, body composition and functional movement.
68 citations
TL;DR: One-to-one peer support programmes have the unique advantage of being a low-cost intervention approach, but also showing potential for relieving the health-care system by reallocating some aspects of the cancer care to community settings.
Abstract: The primary goal of this review was to determine whether one-to-one peer support programmes benefit cancer patients The secondary goal was to assess the quality of the research methodology and of the peer programme description as reported in original research studies MEDLINE and PsycINFO databases were systematically searched in order to identify relevant studies published between May 2007 and July 2014 Eligible articles were evaluated using pre-existing criteria based on the Consolidated Standards of Reporting Trials Statement Checklist This review included 13 studies: four randomised controlled trials, one non-randomised comparative study and eight one-group descriptive studies All studies reported high participant satisfaction with the peer support intervention, and the majority noted positive outcomes regarding psychological adjustment The quality of the description of the peer support programmes as well as the research methodology of the studies was rated as fair Methodological weaknesses included biased recruitment strategies and limited information regarding peer volunteers, non-users of peer support and those who withdrew from support programmes One-to-one peer support programmes have the unique advantage of being a low-cost intervention approach, but also showing potential for relieving the health-care system by reallocating some aspects of the cancer care to community settings Future research should address the methodological weaknesses in study design and reporting
64 citations
TL;DR: Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA, and the expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme.
Abstract: Despite consensus guidelines on best practice in the care of older patients with cancer, geriatric assessment (GA) has yet to be optimally integrated into the field of oncology in most countries. There is a relative lack of consensus in the published literature as to the best approach to take, and there is a degree of uncertainty as to how integration of geriatric medicine principles might optimally predict patient outcomes. The aim of the current study was to obtain consensus on GA in oncology to inform the implementation of a geriatric oncology programme. A four-round Delphi process was employed. The Delphi method is a structured group facilitation process, using multiple iterations to gain consensus on a given topic. Consensus was reached on the optimal assessment method and interventions required for the commonly employed domains of GA. Other aspects of GA, such as screening methods and age cut-off for assessment, represented a higher degree of disagreement. The expert panel employed in this study clearly identified the criteria that should be included in a clinical geriatric oncology programme. In the absence of evidence-based guidelines, this may prove useful in the care of older cancer patients.
58 citations
TL;DR: It is found that younger and very old, ethnic minority patients and women consistently reported worse experiences across questions, and initiatives to improve cancer patient experience across oncology services may be suitably targeted on patients at higher risk of poorer experience.
Abstract: Patient experience is a critical dimension of cancer care quality. Understanding variation in experience among patients with different cancers and characteristics is an important first step for designing targeted improvement interventions. We analysed data from the 2011/2012 English Cancer Patient Experience Survey (n = 69 086) using logistic regression to explore inequalities in care experience across 64 survey questions. We additionally calculated a summary measure of variation in patient experience by cancer, and explored inequalities between patients with cancers treated by the same specialist teams. We found that younger and very old, ethnic minority patients and women consistently reported worse experiences across questions. Patients with small intestine/rarer lower gastrointestinal, multiple myeloma and hepatobiliary cancers were most likely to report negative experiences whereas patients with breast, melanoma and testicular cancer were least likely (top-to-bottom odds ratio = 1.91, P < 0.0001). There were also inequalities in experience among patients with cancers treated by the same specialty for five of nine services (P < 0.0001). Specifically, patients with ovarian, multiple myeloma, anal, hepatobiliary and renal cancer reported notably worse experiences than patients with other gynaecological, haematological, gastrointestinal and urological malignancies respectively. Initiatives to improve cancer patient experience across oncology services may be suitably targeted on patients at higher risk of poorer experience.
58 citations
TL;DR: Two main reasons for participation were identified: personal hope for a cure and altruism; patients show adequate understanding of the information provided to them in the consent process and participation entails high patient satisfaction.
Abstract: It is necessary to carry out randomised clinical cancer trials (RCTs) in order to evaluate new, potentially useful treatments for future cancer patients. Participation in clinical trials plays an important role in determining whether a new treatment is the best therapy or not. Therefore, it is important to understand on what basis patients decide to participate in clinical trials and to investigate the implications of this understanding for optimising the information process related to study participation. The aims of this study were to (1) describe motives associated with participation in RCTs, (2) assess if patients comprehend the information related to trial enrolment, and (3) describe patient experiences of trial participation. Questionnaires were sent to 96 cancer patients participating in one of nine ongoing clinical phase 3 trials at the Department of Oncology, Uppsala University Hospital in Sweden. Eighty-eight patients completed the questionnaire (response rate 92%); 95% of these were patients in adjuvant therapy and 5% participated in clinical trials on palliative care. Two main reasons for participation were identified: personal hope for a cure and altruism. Patients show adequate understanding of the information provided to them in the consent process and participation entails high patient satisfaction.
TL;DR: There is need for targeted culturally sensitive awareness campaign to promote effectiveness of modern medicine and to encourage cautious use of traditional medicines in the treatment of cervical cancer.
Abstract: Use of traditional medicines for treatment of cancers has increased worldwide We used a qualitative approach to explore barriers to biomedical care and reasons for use of traditional medicines for the treatment of cervical cancer in Gulu, northern Uganda We carried out 24 focus group discussions involving men and women aged 18-59 years We employed content analyses technique in data analysis Traditional medicines were used mainly due to barriers to biomedical care for cervical cancer The barriers included health system factors, for example long distances to health facilities and unavailability of medicines; health workers' factors, for example negative attitudes towards patients and demands for bribes; individual patient's factors, for example inability to pay for medical care; and socio-cultural beliefs about superiority of traditional medicines and perceived greater privacy in accessing traditional healers Barriers to biomedical care and community beliefs in the effectiveness of traditional medicines encourage use of traditional medicines for treatment of cervical cancer but might hinder help-seeking at biomedical facilities There is need for targeted culturally sensitive awareness campaign to promote effectiveness of modern medicine and to encourage cautious use of traditional medicines in the treatment of cervical cancer
TL;DR: This paper highlights how men cope with disease and treatment and the strategies they employ to manage their diagnosis alongside daily life and reveals various strategies to deal with treatment-induced threats to their masculinity in the long term.
Abstract: Prostate cancer impacts on the daily lives of men, particularly their physical and emotional health, relationships and social life. This paper highlights how men cope with disease and treatment and the strategies they employ to manage their diagnosis alongside daily life. Twenty-seven men were interviewed at different stages in their disease pathway: nine men prior to radiotherapy, eight men at 6-8 months post radiotherapy and 10 men at 12-18 months post radiotherapy. A grounded theory approach was used to collect and analyse the data. Regardless of the point at which they were interviewed four areas emerged as important to the men: the pathway to diagnosis; the diagnosis; the impact of prostate cancer and its treatment on daily life; and living with prostate cancer. Prostate cancer was diagnosed using the prostate-specific antigen (PSA) test, rectal examination and biopsy. Many men did not understand the consequences of a high PSA reading before they undertook the test. Painful investigative biopsies were viewed as the worst part of the disease experience. Radiotherapy was considered less invasive than other treatments, although preparatory regimes were associated with stress and inconvenience. Men used various strategies to deal with treatment-induced threats to their masculinity in the long term.
TL;DR: This study of male cancer survivors' and cancer rehabilitation documents how masculine ideals may constitute barriers for participation in rehabilitation and provides insights about why men are underrepresented in rehabilitation.
Abstract: The aim was to describe male cancer survivors' barriers towards participation in cancer rehabilitation as a means to guiding future targeted men's cancer rehabilitation. Symbolic Interactionism along with the interpretive descriptive methodology guided the study of 35 male cancer survivors representing seven cancer types. Data were generated through a 5-month fieldwork study comprising participant observations, semi-structured individual interviews and informal conversations. The analyses revealed two overarching findings shedding light on male cancer survivors' barriers to rehabilitation: ‘Fear of losing control’ and ‘Striving for normality’. While ‘Fear of losing control’ signified what the men believed rehabilitation would invoke: ‘Reduced manliness’, ‘Sympathy and dependency’ and ‘Confrontation with death’, ‘Striving for normality’ was based on what the men believed rehabilitation would hinder: ‘Autonomy and purpose’, ‘Solidarity and fellowship’ and ‘Forget and move on’. This study of male cancer survivors' and cancer rehabilitation documents how masculine ideals may constitute barriers for participation in rehabilitation and provides insights about why men are underrepresented in rehabilitation. The findings can guide practice to develop research-based rehabilitation approaches focused on preserving control and normality. Further empirical evidence is needed to: (1) explore the conduct of health professionals' towards male cancer patients and (2) address gender inequalities in cancer rehabilitation.
TL;DR: In this paper, the authors used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision-making protocol.
Abstract: The aim of this study on shared decision-making in the doctor–patient encounter about surgical treatment for early-stage breast cancer, conducted in a regional cancer centre in France, was to further the understanding of patient perceptions on shared decision-making. The study used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision-making protocol. Data were analysed from a multi-disciplinary research perspective (social psychology and health economics). The triangulated data collection methods were questionnaires (n = 132), longitudinal interviews (n = 47) and observations of consultations (n = 26).
Methodological triangulation revealed levels of divergence and complementarity between qualitative and quantitative results that suggest new perspectives on the three inter-related notions of decision-making, participation and information. Patients' responses revealed important differences between shared decision-making and participation per se. The authors note that subjecting patients to a normative behavioural model of shared decision-making in an era when paradigms of medical authority are shifting may undermine the patient's quest for what he or she believes is a more important right: a guarantee of the best care available.
TL;DR: Barriers to mental health service use among distressed family caregivers of lung cancer patients are identified and findings suggest that interventions to improve caregivers' uptake of mental health services should address perceived barriers.
Abstract: Although family caregivers of patients with lung and other cancers show high rates of psychological distress, they underuse mental health services This qualitative study aimed to identify barriers to mental health service use among 21 distressed family caregivers of lung cancer patients Caregivers had not received mental health services during the patient's initial months of care at a comprehensive cancer centre in New York City Thematic analysis of interview data was framed by Andersen's model of health service use and Corrigan's stigma theory Results of our analysis expand Andersen's model by providing a description of need variables (eg psychiatric symptoms), enabling factors (eg finances), and psychosocial factors associated with caregivers' non-use of mental health services Regarding psychosocial factors, caregivers expressed negative perceptions of mental health professionals and a desire for independent management of emotional concerns Additionally, caregivers perceived a conflict between mental health service use and the caregiving role (eg prioritising the patient's needs) Although caregivers denied stigma associated with service use, their anticipated negative self-perceptions if they were to use services suggest that stigma may have influenced their decision to not seek services Findings suggest that interventions to improve caregivers' uptake of mental health services should address perceived barriers
TL;DR: The present study shows that hyponatraemia is a common electrolyte disturbance among hospitalised patients with cancer diagnoses and was a statistically significant independent factor associated with higher in-hospital mortality.
Abstract: Hyponatraemia is common in patients with cancer. The objectives of this study are to investigate the severity distribution of hyponatraemia and its association with mortality. We retrospectively reviewed medical records for patients admitted to a national centre for cancer care and research in Qatar between 2008 and 2012. A model was built through multivariate analyses to investigate the role of hyponatraemia in mortality. Patients were grouped into those who had moderate-severe hyponatraemia (Na < 130) and those who only had normal-mild hyponatraemia (Na ≥ 130). A total of 2048 patients were included in this study. Prostate (57.1%), pancreatic (50%), liver (49%) and lung (40.2%) cancers showed the highest frequency of moderate-severe hyponatraemia, while breast cancer showed the lowest frequency at 23.5%. In the multivariate analyses, patients with moderate-severe hyponatraemia (Na < 130 mmol/L) were 4.28 times more likely to die than those with normal-mild hyponatraemia (Na ≥ 130) (P < 0.05). The present study shows that hyponatraemia is a common electrolyte disturbance among hospitalised patients with cancer diagnoses. The severity of hyponatraemia was a statistically significant independent factor associated with higher in-hospital mortality. This is in accordance with the reported literature and emphasises the importance of early diagnosis and correction of hyponatraemia.
TL;DR: Not all communication between GPs and patients was positive suggesting communication skills training may be a priority and future research needs to focus on working with GPs to increase their role in the management of advanced cancer.
Abstract: The aim of this study was to explore patients' perspectives on the role of their general practitioner (GP) after an advanced cancer diagnosis. A qualitative research approach was used. Semi-structured interviews were conducted and data were analysed using a constant comparative methodology. Participants were eligible if they were diagnosed with advanced cancer and referred for palliative radiotherapy. Data saturation was achieved after 21 interviews. Key themes included (1) obtaining diagnosis and referral for advanced cancer treatment; (2) preference for specialist oncology care; (3) a preference for GP to act as an advocate; and (4) obtaining ongoing routine care from their GP. GP involvement in the patients' management was dependent on: time since diagnosis, GP's involvement in diagnosis and referral, doctor/patient relationship, additional chronic conditions requiring management, frequency of seeing oncologist and specialist recommendation to involve GP. Patients want GPs to have varying levels of involvement following an advanced cancer diagnosis. Not all communication between GPs and patients was positive suggesting communication skills training may be a priority. Patients wished to maintain continunity of care for their non-cancer related issues and healthcare of their family members. Future research needs to focus on working with GPs to increase their role in the management of advanced cancer.
TL;DR: Exercise and diet were the most popular SM interventions for cancer survivors and socio-demographic and cancer-related factors were associated with SM uptake.
Abstract: The study purpose was to examine self-management (SM) use among cancer survivors; and to explore variations in uptake of SM in survivorship and whether these differed in relation to age, income, gender, ethnicity, cancer type and treatment type. This is an important area for exploration as SM utilisation has the potential to impact on the health status, health behaviours and quality of life (QoL) of cancer survivors. A postal survey was conducted among 445 cancer survivors identified from a hospital in the West Midlands, UK. Demographic data were collected and respondents were asked to identify which practices across six SM categories - diet, exercise, complementary and alternative medicine (CAM), psychological therapies, support groups and spirituality/religion - they had used (if any). The findings indicate that the large majority (91%) had used some form of SM after their cancer treatment. Exercise (84%) and diet (56%) were the most popular SM interventions for cancer survivors and socio-demographic and cancer-related factors were associated with SM uptake. These findings can form the basis for designing and implementing appropriate SM interventions aimed at improving the health, well-being and QoL of cancer survivors.
TL;DR: A range of existing models of follow-up, rehabilitation and support for people with head and neck cancer across the UK revealed specialist staff were open to new models of care and to more responsibility, with adequate training and supervision.
Abstract: Patterns of follow-up and survivorship care are changing in response to growing numbers of cancer survivors and an increasing recognition that traditional models are unsustainable and result in unmet needs. Clinicians have shown reluctance in changing conventional follow-up practices for patients with head and neck cancer. This study aimed to explore nurses' and allied health professionals' views and practices in relation to follow-up, holistic needs assessment and survivorship care in this patient group. An online survey of members of the British Association of Head and Neck Oncology Nurses was undertaken. The response rate was 43% (74 of 174). Findings revealed a range of existing models of follow-up, rehabilitation and support for people with head and neck cancer across the UK. Specialist staff were open to new models of care and to more responsibility, with adequate training and supervision. There were some gaps in the provision of comprehensive survivorship care and some specific areas of practice in which nurses lacked confidence, knowledge and skills, such as managing medications and complex symptoms. Further research is needed to develop and evaluate effective models of follow-up and support for a growing population of head and neck cancer survivors who have diverse and complex needs.
TL;DR: The wide variation in prevalence and range of problems experienced raises challenges for PROM development, and patients should be involved in consensus exercises to assist selection of items to ensure any instrument is complete and robust.
Abstract: Cancer patients undergoing chemotherapy experience a range of treatment-related problems, and variations in prevalence exist between treatment centres. A scoping review was undertaken to map reported rates of problem prevalence in the literature. This will inform development of a patient-reported outcome measure (PROM) to monitor prevalence and severity of problems over time and assist service providers optimise supportive care provision. Two databases (Embase and Medline) were searched from 2002 to 2013. Fifty one published papers and conference abstracts reporting problem prevalence rates were identified. The papers reported 98 different problems, from which a typology of 27 problem domains was developed, including both physical symptoms and psychosocial issues. The problem domains most often studied were nausea, vomiting and fatigue. This review reflects the chemotherapy-associated problems to which researchers attach the most importance. The range in reported prevalence across studies was very broad (e.g. nausea: 9–74%), with even less frequently studied problems showing high prevalence in some studies (e.g. gynaecological problems: up to 94%). The wide variation in prevalence and range of problems experienced raises challenges for PROM development. Patients should therefore be involved in consensus exercises to assist selection of items to ensure any instrument is complete and robust.
TL;DR: Higher levels of perceived advocacy for patient safety and psychological safety significantly decreased the frequency of withholding voice among healthcare professionals (HCPs) in oncology.
Abstract: Speaking up about patient safety is vital to avoid errors reaching the patient and to improve a culture of safety. This study investigated the prevalence of non-speaking up despite concerns for safety and aimed to identify predictors for withholding voice among healthcare professionals (HCPs) in oncology. A self-administered questionnaire assessed safety concerns, speaking up beliefs and behaviours among nurses and doctors from nine oncology departments. Multiple regression analysis was used to identify predictors for withholding safety concerns. A total of 1013 HCPs returned the completed survey (response rate 65%). Safety concerns were common among responders. Fifty-four per cent reported to recognise their colleagues making potentially harmful errors at least sometimes. A majority of responders reported at least some episodes of withholding concerns about patient safety. Thirty-seven per cent said they remained silent at least once when they had information that might have helped prevent an incident. Respondents believed that a high level of interpersonal, communication and coping skills are necessary to speak up about patient safety issues at their workplace. Higher levels of perceived advocacy for patient safety and psychological safety significantly decreased the frequency of withholding voice. Remaining silent about safety concerns is a common phenomenon in oncology. Improved strategies are needed to support staff in effective communication and make cancer care safer.
TL;DR: Effective management of lymphoedema may improve patient QOL and reduce interference with ADLs, and patient education at the time of surgical consent may improve self-efficacy and coping ability.
Abstract: We assessed the impact of lymphoedema (defined as ≥ 10% limb volume change) on quality of life (QOL), ability to perform activities of daily living (ADLs) and coping in 277 melanoma patients. Limb volume was measured prospectively, pre-operatively and every 3-6 months for 18 months post-operatively using a perometer. Three questionnaires were administered to measure QOL, coping and impact on ADLs. Statistical analyses were conducted using longitudinal logistic regression models. At 18 months, the cumulative incidence of lymphoedema was 31% in patients with upper extremity nodal basin treatment and 40% in lower extremity nodal basin treatment patients. Patients with lower extremity lymphoedema reported lower QOL scores than those with upper extremity lymphoedema. Over 18 months, both groups with mild and moderate lymphoedema showed improvement in coping [odds ratio (OR): 6.67, 95% confidence interval (CI): 3.30-13.47] and performance of ADLs (OR: 7.46, CI: 3.38-16.47). Over the course of 18 months, men were found to have poorer coping scores than women (OR: 2.91, CI: 1.35-6.27). Lymphoedema was associated with improvement in coping over time (P = 0.08) and a higher reported interference with ADLs (OR: 2.53, CI: 1.29-4.97). Patient education about lymphoedema at the time of surgical consent may improve self-efficacy and coping ability. Effective management of lymphoedema may improve patient QOL and reduce interference with ADLs.
TL;DR: The evidence on this cohort was found to be limited, warrants further research, and exercises could possibly be used in the management of cancer-related fatigue in this cohort with due caution until more robust evidences are available.
Abstract: Cancer-related fatigue is a common, persistent and disabling side-effect of the cancer and its treatments. Exercise, once was contraindicated, is now the key non-pharmacological management for cancer-related fatigue. However, the role of exercise in lung cancer cohort is not clear. A computerised database search was undertaken using keyword search in the CENTRAL, PubMed, EMBASE, CINAHL, SPORTDiscus, AMED and Web of Science. Ten relevant articles were reviewed; the evidence on this cohort was found to be limited, warrants further research. However, the available evidence from other than lung cancer groups shows significant beneficial effects of exercises on cancer-related fatigue. Hence, exercises could possibly be used in the management of cancer-related fatigue in this cohort with due caution until more robust evidences are available.
TL;DR: Early hospital discharge after gynaecological surgery results in both enhanced recovery after surgery (ERAS) and high levels of patient satisfaction, according to this study.
Abstract: This study investigates the experience and satisfaction with care of fast-tracked gynaecological patients. The Sydney Gynaecological Oncology Group, New South Wales, Australia, has previously shown the benefits of a fast-track surgery programme for gynaecology patients with both complex benign gynaecological pathology and gynaecological malignancy. The question of whether these benefits translate into a positive experience for fast-tracked patients, in the context of their hospital stay and healthcare team care, has not been previously explored in detail. A self-administered satisfaction questionnaire incorporating the European Organisation for Research and Treatment of Cancer (EORTC) cancer in-patient satisfaction with care measure (INPATSAT-32) questionnaire with additional questions was administered to 106 gynaecology participants at Royal Prince Alfred Hospital. Participants reported high levels of satisfaction with patient care and support received from doctors, ward nurses and the hospital as a service and care organisation, within the context of a fast-track surgical programme. Early hospital discharge after gynaecological surgery results in both enhanced recovery after surgery (ERAS) and high levels of patient satisfaction.
TL;DR: Overall, patients with fewer personal resources report more attitudinal barriers and should be targeted for additional decisional support, especially among patients with non-metastatic disease.
Abstract: Patient participation in cancer clinical trials is low. Little is known about attitudinal barriers to participation, particularly among patients who may be offered a trial during an imminent initial oncology consult. The aims of the present study were to confirm the presence of proposed subscales of a recently developed cancer clinical trial attitudinal barriers measure, describe the most common cancer clinical trials attitudinal barriers, and evaluate socio-demographic, medical and financial factors associated with attitudinal barriers. A total of 1256 patients completed a survey assessing demographic factors, perceived financial burden, prior trial participation and attitudinal barriers to clinical trials participation. Results of a factor analysis did not confirm the presence of the proposed four attitudinal barriers subscale/factors. Rather, a single factor represented the best fit to the data. The most highly-rated barriers were fear of side-effects, worry about health insurance and efficacy concerns. Results suggested that less educated patients, patients with non-metastatic disease, patients with no previous oncology clinical trial participation, and patients reporting greater perceived financial burden from cancer care were associated with higher barriers. These patients may need extra attention in terms of decisional support. Overall, patients with fewer personal resources (education, financial issues) report more attitudinal barriers and should be targeted for additional decisional support.
TL;DR: This study highlights significant disparities between clinical practice and research-based evidence published in recent systematic reviews and guidelines on radiation-induced skin toxicity.
Abstract: Radiation-induced toxicity is a common adverse side effect of radiation therapy. Previous studies have demonstrated a lack of evidence to support common skincare advice for radiotherapy patients. The aim of the current study was to investigate the management of radiation-induced skin toxicity across Europe and the USA. Where previous surveys have focused on national practice or treatment of specific sites, the current study aimed to gain a broader representation of skincare practice. An anonymous online survey investigating various aspects of radiotherapy skincare management was distributed to departments across Europe and the USA (n = 181/737 responded i.e. 25%). The UK was excluded as a similar survey was carried out in 2011. The results highlight the lack of consistency in both the prevention and management of radiation-induced skin toxicity. Recommended products are often not based on evidence-based practice. Examples include the continued use of aqueous cream and gentian violet, as well as the recommendations on washing restrictions during treatment. To our knowledge, this is the most extensive survey to date on the current management of radiation-induced skin toxicity. This study highlights significant disparities between clinical practice and research-based evidence published in recent systematic reviews and guidelines. Ongoing large prospective randomised trials are urgently needed.
TL;DR: It is demonstrated that PC patients receiving ADT may have selective reductions in EBPM performance but unimpaired TBPM performance and that these deficits may result from the changes of function and structure of the pre-frontal cortex induced by ADT.
Abstract: The primary purpose of this study was to evaluate the event-based prospective memory (EBPM) and time-based prospective memory (TBPM) in androgen-deprivation therapy (ADT)-induced cognitive impairment in patients with prostate cancer (PC). Participants included PC patients who had undergone ADT (ADT group, n = 43) or patients who did not undergo ADT (non-ADT group, n = 35), as well as age and education-matched healthy controls (HC group, n = 40). All participants were administered with a battery of neuropsychological tests including EBPM and TBPM tasks. Our results indicated that during the EBPM task, the ADT group obtained significantly lower scores than the non-ADT and HC group did, while no significant differences in the TBPM task scores were found among these three groups. Additionally, the ADT group demonstrated significantly lower scores in several cognitive tasks, including attention, memory, and information processing, when compared with the other two groups. This study demonstrated that PC patients receiving ADT may have selective reductions in EBPM performance but unimpaired TBPM performance and that these deficits may result from the changes of function and structure of the pre-frontal cortex induced by ADT.
TL;DR: Experts' opinions on OT interventions for RTW in BC patients in the Belgian context are explored, finding that they agree on the components but organisational barriers should be removed.
Abstract: An increasing number of patients are confronted with breast cancer (BC) and functional limitations after treatment. Occupational therapy (OT) is successful in return to work (RTW), but not yet available for BC patients. This paper explores experts' opinions on OT interventions for RTW in BC patients in the Belgian context. Primary data were topic-interviews with all heads of OT departments in Flemish University Hospitals (n = 5). Secondary data were four focus group interviews with care professionals in oncological rehabilitation (n = 41). All data were transcribed and thematic analysis was used. Integrated in multidisciplinary teamwork, OT interventions should have a holistic and client-centred approach, start early in the rehabilitation process, include workplace visits and contacts with relevant stakeholders, and use goal setting to start up tailor made rehabilitation, linking assessment of abilities and work. Occupational therapists are regarded as professionals who can effectively answer BC patients unmet needs regarding RTW due to their skill to bridge between care and workplace. According to the experts, OT interventions supporting RTW in BC patients are useful when integrated in regular healthcare. They agree on the components but organisational barriers should be removed, for example not providing reimbursement for including this type of support trough healthcare insurance.
TL;DR: The existence of perceived and objective deterioration of health-related fitness level, presence of moderate cancer fatigue and reduced perceived quality of life in colorectal cancer survivors compared with healthy controls is shown.
Abstract: The aim of the study is to determine the physical performance, quality of life and fatigue in colorectal cancer survivors compared with healthy controls. Twenty-three colorectal cancer survivors and 22 matched controls were recruited for this case–control study. Fitness level (muscle trunk flexor endurance test, 6-min walk test, chair sit and reach test and flamingo test) was assessed in both groups. Participants completed the European Organization of Research and Treatment of Cancer, the Quality of Life Questionnaire (QLQ-C30), the Piper Fatigue Scale (PFS) and the International Fitness Scale (IFIS). Significant differences between groups were found for all fitness parameters (P < 0.05). In addition, the anova revealed significant differences in all of the IFIS scores (P < 0.001), PFS (P < 0.01) and functioning scores of the QLQ-C30 (P < 0.05) between colorectal cancer survivors and the control group. The Mann–Whitney U-test showed a significant increase in symptom scores such as fatigue, dyspnoea and diarrhoea in the cancer survivors (P < 0.05). This study shows the existence of perceived and objective deterioration of health-related fitness level, presence of moderate cancer fatigue and reduced perceived quality of life in colorectal cancer survivors compared with healthy controls.