Psychosocial interventions for patients with head and neck cancer

BACKGROUND

A diagnosis of head and neck cancer, like many other cancers, can lead to significant psychosocial distress. Patients with head and neck cancer can have very specific needs, due to both the location of their disease and the impact of treatment, which can interfere with basic day-to-day activities such as eating, speaking and breathing. There is a lack of clarity on the effectiveness of the interventions developed to address the psychosocial distress experienced by patients living with head and neck cancer.

OBJECTIVES

To assess the effectiveness of psychosocial interventions to improve quality of life and psychosocial well-being for patients with head and neck cancer.

SEARCH METHODS

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 17 December 2012.

SELECTION CRITERIA

We selected randomised controlled trials and quasi-randomised controlled trials of psychosocial interventions for adults with head and neck cancer. For trials to be included the psychosocial intervention had to involve a supportive relationship between a trained helper and individuals diagnosed with head and neck cancer. Outcomes had to be assessed using a validated quality of life or psychological distress measure, or both.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials, extracted data and assessed the risk of bias, with mediation from a third author where required. Where possible, we extracted outcome measures for combining in meta-analyses. We compared continuous outcomes using either mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI), with a random-effects model. We conducted meta-analyses for the primary outcome measure of quality of life and secondary outcome measures of psychological distress, including anxiety and depression. We subjected the remaining outcome measures (self esteem, coping, adjustment to cancer, body image) to a narrative synthesis, due to the limited number of studies evaluating these specific outcomes and the wide divergence of assessment tools used.

MAIN RESULTS

Seven trials, totaling 542 participants, met the eligibility criteria. Studies varied widely on risk of bias, interventions used and outcome measures reported. From these studies, there was no evidence to suggest that psychosocial intervention promotes global quality of life for patients with head and neck cancer at end of intervention (MD 1.23, 95% CI -5.82 to 8.27) as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This quality of life tool includes five functional scales, namely cognitive, physical, emotional, social and role. There was no evidence to demonstrate that psychosocial intervention provides an immediate or medium-term improvement on any of these five functional scales. From the data available, there was no significant change in levels of anxiety (SMD -0.09, 95% CI -0.40 to 0.23) or depression following intervention (SMD -0.03, 95% CI -0.24 to 0.19). At present, there is insufficient evidence to refute or support the effectiveness of psychosocial intervention for patients with head and neck cancer.

AUTHORS' CONCLUSIONS

The evidence for psychosocial intervention is limited by the small number of studies, methodological shortcomings such as lack of power, difficulties with comparability between types of interventions and a wide divergence in outcome measures used. Future research should be targeted at patients who screen positive for distress and use validated outcome measures, such as the EORTC scale, as a measure of quality of life. These studies should implement interventions that are theoretically derived. Other shortcomings should be addressed in future studies, including using power calculations that may encourage multi-centred collaboration to ensure adequate sample sizes are recruited.

A randomized controlled trial of a self-management psychosocial intervention for men with prostate cancer and their partners: a study protocol

BACKGROUND

Little is known about interventions to help men and their partners cope with the after effects of prostate cancer treatment. The lack of in-depth descriptions of the intervention content is hindering the identification of which intervention (or component of an intervention) works.

AIM

To describe the development and evaluation of the content of a self-management psychosocial intervention for men with prostate cancer and their partners.

DESIGN

A feasibility randomized controlled trial including structure, process, and outcome analysis.

METHODS

This 9-week intervention commences on completion of treatment and consists of three group and two telephone sessions. The intervention focuses on symptom management, sexual dysfunction, uncertainty management, positive thinking and couple communication. Forty-eight couples will be assigned to either the intervention or a control group receiving usual care. Participants will be assessed at baseline, immediately postintervention and at 1 and 6 months postintervention. Outcome measures for patients and caregivers include self-efficacy, quality of life, symptom distress, uncertainty, benefits of illness, health behaviour, and measures of couple communication and support. An additional caregiver assessment will be completed by the partner.

DISCUSSION

The main purpose of this feasibility study is to investigate the acceptability of the CONNECT programme to men with prostate cancer and their partners and to gain feedback from the participants and facilitators to make changes to and enhance the programme. Reasons why men do not want to participate will be collated to enhance recruitment in the future. We will also test recruitment strategies, randomization procedures, and the acceptability of the questionnaires. Ethical approval granted December 2010.

Issues and considerations when researching sensitive issues with men: examples from a study of men and sexual health

This article highlights some ethical considerations and practicalities that arose when conducting research with men in relation to decision making and seeking help for a sexually transmitted infection (STI). The aim of the study was to explore, using a grounded theory approach, the processes involved in making the decision to seek help. The main issues that arose were in relation to seeking permission and gaining approval, obtaining informed consent and susceptibility to harm. The interview itself and the concept of the researcher as a tool of data collection also gave rise to ethical issues. These issues have implications for the conduct of sensitive research with men and highlight the need for more overt reporting of the ethical issues and practical considerations that arise when planning and conducting research.

Changes and challenges to patients' lifestyle patterns following treatment for head and neck cancer

AIM

This paper is a report of a study to explore the changes and challenges to patients' lifestyles following treatment for head and neck cancer.

BACKGROUND

Head and neck cancer affects some of the most basic aspects of daily functioning, such as eating and speaking. There has been a rapid increase in the number of studies on the quality of life for people with head and neck cancer, but most studies have used quantitative methodology.

METHODS

Using a qualitative approach, data were collected in 2004 using semi-structured interviews with a purposive sample of 10 participants who had completed treatment 6-12 months earlier for head and neck cancer. A thematic analysis was employed to interpret the findings.

FINDINGS

Following thematic analysis seven broad themes were identified, five of which covered areas of changes and challenges to participants' lifestyles following treatment. These were: physical changes, concerns about cancer, work and day-to-day tasks, interpersonal relationships and social functioning. The concerns and challenges experienced following treatment were not limited to one aspect of an individual's lifestyle but spanned a number of the themes identified, highlighting the complexity of needs following treatment for head and neck cancer. The other two themes concerned personal attributes that facilitated or inhibited posttreatment coping and specific information needs in the posttreatment period.

CONCLUSION

Specific posttreatment concerns and challenges cannot be viewed as unitary or discrete aspects of life, but should be considered within a biopsychosocial context, to address patients' needs holistically.

Consumers? and professionals? perceptions of a breast cancer review clinic

AIM

This paper is a report of a study to explore the healthcare needs of women attending consultant-led breast cancer review clinics from their own perspectives, how these healthcare needs were being met, and healthcare professionals' perceptions of ways in which the service could be delivered more efficiently and effectively.

BACKGROUND

The value of routine medical follow-up both in terms of detection of recurrence and patient satisfaction has been questioned. However traditional, where routine follow-up continues, there are rising numbers of women with breast cancer attending review clinics.

METHODS

A qualitative approach was adopted, using non-participant observation during seven outpatient oncology/surgical breast review sessions. Interviews were carried out in 2005 with a convenience sample of 21 women clinic attenders, two outpatient nurses, three breast care nurses, four oncologists, three surgeons and an outpatient sister.

FINDINGS

Although women saw themselves as having returned to a precancer state, they still had fears of recurrence and a need for reassurance. This need was generally met through the review clinic but many psychosocial needs were unaddressed. However, nurses seemed to be under-used as a potential source of support. Medical and nursing staff perceived that women needed to be reviewed but acknowledged that appropriately prepared nurses could deliver a more holistic and efficient service.

CONCLUSION

The number of women with breast cancer requiring ongoing review is likely to increase, but the current review service is not meeting all their needs. A nurse-led follow-up service could be an attractive alternative to routine medical follow-up.

Never-ending making sense: towards a substantive theory of the information-seeking behaviour of newly diagnosed cancer patients

AIM

The aim of this paper was to report a study which explored the information-seeking behaviour of patients newly diagnosed with cancer in the immediate postdiagnosis period.

BACKGROUND

Information is an important tool for cancer patients. There is evidence that patients' information needs are not being adequately met and, in many cases, patients often do not recall much information at the time of diagnosis.

METHOD

Using a grounded theory approach, a theoretical sample of 27 newly diagnosed patients was interviewed in their own homes. Data were analysed using grounded theory analysis procedures.

RESULTS

A substantive theory describing the transitions from 'being traumatized' by the diagnosis, through a phase of trying to 'take it on', through to 'taking control' is tentatively offered. It provides a theoretical framework to understand newly diagnosed cancer patients' changing, varied and continuing needs and their efforts to regain some control over their lives. Their information-seeking behaviour seemed a journey of 'never-ending making sense' with ongoing discovery and new information needs as they struggled with the effects of the disease and treatments.

CONCLUSIONS

The processes and stages identified in this study provide nurses with a framework to assess the readiness of patients to receive information and to assist them in their efforts to regain some control over their disease and their lives.

RELEVANCE TO CLINICAL PRACTICE

Health professionals need to be aware of these stages, to be equipped to assess the need of individuals for information and support.

Information-seeking behaviour of men newly diagnosed with cancer: a qualitative study

AIM

This paper reports the findings of a study, which explored the information-seeking behaviour of men newly diagnosed with cancer.

BACKGROUND

There is worldwide recognition that there are significant differences in the way men and women react to and cope with illness, yet there seems to be a lack of research into men's information-seeking behaviours and how they get their information needs met. The needs of men with cancer has so far received less research attention than women.

METHODS

A qualitative approach, consisting of in-depth interviews, was used. A convenient sample of 13 men newly diagnosed with cancer and five healthcare professionals and four lay sources were recruited for this study.

RESULTS

Five themes emerged from the data. These were: 'experiencing discomfort in the healthcare setting', 'reliance on partners as information gatherers', 'reluctance to explore a range of information sources and support', 'unmet information needs' and 'getting back to normal'. Together, they provide a perspective on men's information needs and information-seeking behaviour.

CONCLUSIONS

Healthcare professionals should be aware that there may be gender differences in how patients cope with their cancer, how they seek information and what information needs they have. Further training and preparation in 'men's health' is recommended for all those working with men in cancer care.

RELEVANCE TO CLINICAL PRACTICE

Understanding how, when and in what circumstances men express their information needs will help healthcare professionals to develop strategies to meet these needs and other support needs of men with cancer.

The role of an outreach oncology nurse practitioner: a case study evaluation

Nurses have an extensive input into the care of cancer patients both in hospital and in the community and are central to the current movement to improve and streamline cancer services. Internationally there has been a move to employ highly skilled nurse practitioners in cancer care. This paper describes a single case study evaluating the role and work of an Oncology Nurse Practitioner (ONP). Multiple sources of data were used. Stage One involved collecting descriptive information about the post holder, her role and the types of patients cared for. Stage Two used a qualitative approach to explore how the post was established, its key features, its perceived advantages and disadvantages and the factors influencing its success. Findings show that all participants viewed the post positively and that such nurses can provide high-quality services in remote rural areas. The study found that to be successful the post holder needs appropriate personal attributes such as flexibility and communication skills and the ability to work independently as well as part of a team. The limitations of this study and the implications for the further development of nursing roles in oncology are discussed.

Attitudes to cancer of medical and surgical nurses in a district general hospital

The personal beliefs and attitudes of nurses can have serious implications for their practice. Yet there are a lack of studies on nurses' attitudes to cancer in the UK in general, and in Northern Ireland specifically. The need for such studies is further emphasized by the importance of nurses' role in the Cancer Units of district general hospitals, as proposed by the Calman-Hine Report (Department of Health 1995). The aim of this study was to assess the attitudes to cancer of medical and surgical nurses who care for cancer patients in one district general hospital in Northern Ireland. A questionnaire comprising the Cancer Attitude Scale (Corner 1993) was administered to 106 qualified nurses. The response rate was 68.9% (n=73). Responses to items on the Cancer Attitude Scale show that while generally these nurses held positive attitudes, a high proportion also held negative views about cancer. Of particular concern were their attitudes to the value of active treatments. The implications of these findings are discussed.