End-user perceptions of a patient- and family-centred intervention to improve nutrition intake among oncology patients: a descriptive qualitative analysis

Background

People with cancer are at high risk of malnutrition. Nutrition education is an effective strategy to improve patient outcomes, however, little is known regarding the impact of family and/or carer involvement in nutrition education and requires investigation. The purpose of the study was to evaluate PIcNIC (Partnering with families to promote nutrition in cancer care) intervention acceptability from the perspective of patients, families and health care providers.

Methods

A descriptive qualitative study was undertaken at an inpatient and an outpatient hospital setting in Australia and an outpatient/home setting in Hong Kong. A patient-and-family centred intervention including nutrition education, goals setting/nutrition plans, and food diaries, was delivered to patients and/or families in the inpatient, outpatient or home setting. Semi-structured interviews were used to explore perceptions of the intervention. 64 participants were interviewed; 20 patients, 15 family members, and 29 health care professionals. Data were analysed using deductive and inductive content analysis.

Results

Two categories were identified; 1) ‘context and intervention acceptability’; and 2) ‘benefits of patient- and family-centred nutrition care’. Within each category redundant concepts were identified. For category 1 the redundant concepts were: the intervention works in outpatient settings, the food diary is easy but needs to be tailored, the information booklet is a good resource, and the intervention should be delivered by a dietitian, but could be delivered by a nurse. The redundant concepts for category 2 were: a personalised nutrition plan is required, patient and family involvement in the intervention is valued and the intervention has benefits for patients and families. Converging and diverging perceptions across participant groups and settings were identified.

Conclusions

In this paper we have described an acceptable patient- and family-centred nutrition intervention, which may be effective in increasing patient and family engagement in nutrition care and may result in improved nutrition intakes. Our study highlights important contextual considerations for nutrition education; the outpatient and home setting are optimal for engaging patients and families in learning opportunities.

Relationships Between the Usage of Televisions, Computers, and Mobile Phones and the Quality of Sleep in a Chinese Population: Community-Based Cross-Sectional Study

BACKGROUND

No study has comprehensively investigated the association between the usage of typical screen-based electronic media devices and sleep quality in a Chinese population with individuals in a wide range of ages.

OBJECTIVE

This study aimed to understand the characteristics of television (TV) viewing, computer usage, and mobile phone usage in a representative Chinese population in Macau and to examine their roles in predicting the variations in sleep quality.

METHODS

This cross-sectional study was an analysis of 1500 Macau residents aged 15 to 90 years based on a community-based health needs assessment study entitled, "Healthy Living, Longer Lives." Data collection was conducted in 7 districts of Macau from 2017 to 2018 through face-to-face interviews. The durations of daily TV viewing, computer usage, and mobile phone usage were recorded in a self-administered questionnaire. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality.

RESULTS

The prevalence of TV, computer, and mobile phone usage was 78.4% (1176/1500), 51.6% (769/1490), and 85.5% (1276/1492), respectively. The average daily hours of usage were 1.75 (1.62), 1.53 (2.26), and 2.85 (2.47) hours, respectively. Females spent more time watching TV (P=.03) and using mobile phones (P=.02) and less time on the computer (P=.04) as compared to males. Older adults were more likely to watch TV while young people spent more time using the computer and mobile phones (P for all trends<.001). The mean PSQI global score was 4.79 (2.80) among the participants. Females exhibited significantly higher PSQI scores than males (5.04 vs 4.49, respectively; P<.001). No linear association was observed between the PSQI score and the amount of time spent on the 3 electronic devices (P=.58 for PSQI-TV, P=.05 for PSQI-computer, and P=.52 for PSQI-mobile phone). Curve estimation showed significant quadratic curvilinear associations in PSQI-TV (P=.003) and PSQI-computer (P<.001) among all the participants and in PSQI-mobile phone among youths (age, 15-24 years; P=.04). After adjustment of the gender, age, body mass index, demographics, and lifestyle factors, more than 3 hours of TV viewing and 4 hours of computer usage or mobile phone usage was associated with 85% (95% CI 1.04-1.87; P=.008), 72% (95% CI 1.01-2.92; P=.045), and 53% (95% CI 1.06-2.22; P=.03) greater odds of having poor sleep quality (PSQI score>5), respectively.

CONCLUSIONS

The mobile phone was the most popular screen-based electronic device used in the Macau population, especially among young people. "J" shape associations were observed between sleep quality and the duration of TV viewing, computer usage, and mobile phone usage, indicating that the extreme use of screen-based electronic devices predicted poorer sleep status, whereas moderate use would be acceptable.

Partners' experiences of living with men who have screening-detected abdominal aortic aneurysms: A qualitative descriptive study

AIM

To describe partners' experiences of living with men with a screening-detected abdominal aortic aneurysm (AAA).

BACKGROUND

Diagnosis of a chronic life-threatening disease affects the patients' as well as their partners' lives in different aspects. AAA, with rupture as the major consequence, is a life-threatening disease that can affect the whole family. Screening programmes for AAA have been introduced in several countries to reduce the mortality rate. Although the awareness of having an AAA influences the individuals' quality of life and well-being, it is still unclear how it affects their partners.

DESIGN

Qualitative descriptive design.

METHODS

Twenty-one partners of men with AAA were purposely selected to participate in individual semi-structured interviews between August 2017-February 2018 in Sweden. Data were transcribed and imported into NVivo-12^® . The data were analysed using qualitative content analysis. The study conforms to the COREQ checklist.

RESULTS

Three categories were identified: (a) experiencing the unexpected; (b) being reminded of fragility; and (c) balancing a changing relationship. The partners had a positive attitude towards the screening process and were pleased that their husbands were under surveillance. Nevertheless, at the same time, the diagnosis caused worries and questions. The AAA diagnosis was constantly in the minds of the partners, which sometimes affected and limited daily activities. Furthermore, ambivalent feelings towards surgical treatment were described. The partners tried to support their men and encouraged them to achieve a healthy lifestyle.

CONCLUSION

The partners' well-being and daily lives were impacted by the awareness of the screening-detected AAA. Different degrees of worry were the most common reaction and were pervasive in all three categories.

RELEVANCE FOR CLINICAL PRACTICE

The result highlights the need to review routines or develop new strategies to include the partners in the process of screening and offer supplementary support and information.

Development and validation of an evidence-based auricular acupressure intervention for managing chemotherapy-induced nausea and vomiting in breast cancer patients

BACKGROUND

Auricular therapy (AT) has been utilized as a promising complementary health approach to alleviating chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients. However, current evidence on AT for CINV management has been inconclusive, and relevant AT treatment protocols have varied considerably in the intervention dosage and acupoint formula without an evidence-informed intervention protocol tailored to CINV symptoms. This study aimed to develop an evidence-based AT intervention protocol for CINV management in breast cancer patients receiving chemotherapy.

METHODS

This study adopted the Medical Research Council Framework for Developing and Evaluating Complex Interventions (the MRC framework) to guide the AT intervention development process. The process consists of four steps: identification of the evidence base, identification of theories and practice standards, identification of cancer symptom characteristics, and modelling and validation. The preliminary AT intervention was then evaluated through a content validity study to identify its theoretical and practical appropriateness. The content validity index (CVI) was used to determine the consensus level of the panel.

RESULTS

A preliminary AT intervention protocol, including a true AT intervention and a sham AT intervention, was developed based on research evidence identified from five systematic reviews, the homuncular reflex theory, the zang-fu organs and meridian theory, relevant AT practice standards, and the natural symptom progress of CINV. The true AT was designed as a daily manual acupressure for five consecutive days. While the sham AT was designed with the same intervention duration and acupoint formula as the true AT without manual acupressure. The content validity study demonstrated excellent consensus among the expert panel to support the AT intervention as a theoretically and practically feasible program with the item-level CVI ranging from 0.83 to 1.0 and the scale-level CVI reaching 1.0.

CONCLUSION

This study followed the MRC framework to develop an evidence-based AT intervention for CINV management which is well supported by systematic review research evidence, AT theories and practice standards, CINV symptom characteristics, and expert panel consensus. The AT intervention would be further evaluated in a pilot randomised controlled trial to confirm its utility, feasibility and acceptability in clinical settings.

Docetaxel-Induced Peripheral Neuropathy in Breast Cancer Patients Treated with Adjuvant or Neo-Adjuvant Chemotherapy

Background

Docetaxel-induced peripheral neuropathy (PN) is typically manifested as sensory and motor neuropathy. This study aimed to investigate the incidence, duration, and risk factors of sensory and motor PN and their impact on health-related quality of life (HRQOL) among breast cancer (BC) patients during the first year since starting docetaxel-based chemotherapy.

Methods

We reported a secondary analysis of longitudinal data on docetaxel-induced PN and HRQOL among 127 BC patients.

Results

Cumulative incidence rates of motor and sensory PN were 31.5 and 21.3%, while the median durations of motor and sensory PN were 6 and 13 weeks. A consistently significant risk factor for both PNs was a cumulative docetaxel dose of >300 mg/m². A significant interaction between sensory PN and time was found for physical and social functioning, while a significant motor PN and time interaction effect was identified for physical functioning only.

Conclusions

Motor PN was more common than sensory PN in BC patients treated with docetaxel. Both types of PN had a significant impact on physical functioning.

The effectiveness of acupressure in the management of depressive symptoms and in improving quality of life in older people living in the community: a randomised sham-controlled trial

Objective: The primary aim of the current trial was to assess the clinical effectiveness of acupressure in the management of depression in elderly people compared to patients receiving sham acupressure or standard care alone.Methods: Randomized sham-controlled trial of acupressure, sham acupressure and standard care alone in older patients with depression living in the community. Patients with a score>/=8 in the Geriatric Depression Scale were recruited for this study. Intervention/sham treatments were provided four times/week for three months. Assessments related to depressive symptoms (primary outcome), well-being, resilience, spirituality and quality of life domains were carried out at baseline, end of the intervention and three-months after the intervention.Results: 118 patients were randomized to intervention (n = 40), sham (n = 40) or control arm (n = 38), with 84 patients providing final analysis data. Significant reduction in mean score of depressive symptoms was found in the acupressure group (from 10.6 (sd = 0.03) to 7.7 (sd = 0.07), p < 0.001 at end of intervention and 8.7 (sd = 0.8), p = 0.002 at follow-up) and the sham acupressure group (from 10.5 (sd = 0.3) to 8.4 (sd = 0.8), p = 0.005) at end of intervention and 8.4 (sd = 0.8), p = 0.006 at follow-up but not in the control group (from 10.8 to 9.9, p = 0.20). Resilience (p = 0.02) and spirituality (p = 0.02) were also improved in the intervention group at the end of intervention assessment but this change was not sustained at follow-up. Mind-body-spirit well-being and social functioning were improved both at the end of intervention and follow-up in the experimental as well as sham group. The sham group showed additional improvements in daily functioning and environmental quality of life.Conclusions: Although acupressure improved outcomes, a placebo effect was evident. Acupressure may be an effective approach to manage depression in elderly patients, but more evidence is needed in the future before it can be recommended for practice as well as more clear elucidation of any placebo effects.

Symptom Clusters in Postchemotherapy Neutropenic Fever in Hematological Malignancy: Associations Among Sickness Behavior Symptom Cluster, Inflammatory Biomarkers of Procalcitonin and C-Reactive Protein, and Febrile Measures

CONTEXT

Little research has been conducted to investigate symptom clusters in postchemotherapy neutropenic fever (NF), their relationships with inflammatory biomarkers, and febrile outcome measures in patients with hematological malignancy, a population with high febrile rates incurring considerable costs to the health care system.

OBJECTIVES

The aim of the present study was to investigate these.

METHODS

One hundred four NF episodes were observed in patients with hematological malignancy who were enrolled in the study. Patient-reported symptoms were recorded using the M.D. Anderson Symptom Inventory. Inflammatory biomarkers of procalcitonin (PCT) and C-reactive protein (CRP), vital signs, blood specimens for cultures, blood cell counts, and biochemistry were also collected. Serious complications from NF were reviewed from medical records if documented. Exploratory factor analysis and Spearman's rank correlation were used in the data analysis.

RESULTS

Three symptom clusters-sickness behavior, chemotherapy neurotoxicity, and emesis-were identified by exploratory factor analysis. The factor score of the sickness behavior cluster was significantly correlated with CRP (P < 0.05), PCT (P < 0.01), and the highest (P < 0.05) and maximum increased in (P < 001) temperatures at the onset (first day) of neutropenic fever.

CONCLUSION

This study identified symptom clusters of sickness behavior, chemotherapy neurotoxicity, and emesis and highlighted significant associations between sickness behavior cluster, PCT, CRP, and febrile temperatures at the onset of postchemotherapy NF. These areas have lacked exploration in previous research. Monitoring and analyzing patient-reported sickness behavior symptoms, PCT, CRP, and temperature data would provide significant complementary data for the management and surveillance of postchemotherapy NF in hematological malignancy.

Economic evaluation alongside a randomised controlled trial to assess the effectiveness and cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy

OBJECTIVE

To assess the cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy (CIPN) in Hong Kong.

METHODS

A within trial cost-utility analysis with the primary endpoint for the economic evaluation being the Quality Adjusted Life Year (QALY) and associated Incremental Cost Effectiveness Ratio (ICER) over 14 weeks of treatment. A secondary cost-effectiveness analysis was undertaken with the endpoint being change in pain as measured on the Brief Pain Inventory (BPI).

RESULTS

Eighty-seven patients were randomised to acupuncture or usual care. Acupuncture resulted in significant improvements in pain intensity (8- and 14-week mean changes compared to usual care of -1.8 and -1.8, respectively), pain interference (8- and 14-week mean changes compared to usual care of -1.5 and -0.9, respectively) and indicators of quality of life and neurotoxicity-related symptoms. However, in the economic evaluation there was little difference in QALYs between the two arms (mean change 0.209 and 0.200 in the acupuncture and usual care arms, respectively). Also, costs yielded deterministic ICERs of HK$616,965.62, HK$824,083.44 and HK$540,727.56 per QALY gained from the health care provider perspective, the societal perspective and the patient perspective, respectively. These costs are significantly higher than the cost-effectiveness threshold of HK$180,450 that was used for the base case analysis.

CONCLUSION

While acupuncture can improve symptoms and quality of life indicators related to CIPN, it is unlikely to be a cost-effective treatment for CIPN-related pain in health care systems with limited resources.

TRIAL REGISTRATION NUMBER

NCT02553863 (ClinicalTrials.gov) post-results.

Doctoral nursing education in east and Southeast Asia: characteristics of the programs and students' experiences of and satisfaction with their studies

BACKGROUND

The characteristics of nursing doctoral programs and the doctoral students' experience have not been thoroughly investigated. Hence, this study aimed to describe the characteristics of nursing doctoral programs in East and South East Asian (ESEA) countries and regions from the views of doctoral program coordinators, and to explore the students' experiences of and satisfaction with their doctoral nursing program.

METHODS

A cross-sectional survey was conducted using two self-designed questionnaires, one focusing on PhD program coordinators and the other on doctoral students. Characteristics of the nursing doctoral programs focused on program characteristics, faculty characteristics, career pathways for graduates, and challenges for nursing doctoral education. Doctoral students' assessment of study experiences included quality of supervision, doctoral training programs, intellectual/cultural climate of institutions, general facilities/support, and the overall study experience and satisfaction.

RESULTS

In the PhD coordinators survey, 46 institutions across nine ESEA countries and regions participated. More than half of nursing departments had academic members from other health science disciplines to supervise doctoral nursing students. The majority of graduates were holding academic or research positions in higher education institutions. Faculty shortages, delays in the completion of the program and inadequate financial support were commonly reported challenges for doctoral nursing education. In the students' survey, 193 doctoral students participated. 88.3% of the students were satisfied with the supervision they received from their supervisors; however, 79% reported that their supervisors 'pushed' them to publish research papers. For doctoral training programs, 75.5% were satisfied with their curriculum; but around half reported that the teaching training components (55.9%) and mobility opportunities (54.2%) were not included in their programs. For overall satisfaction with the intellectual and cultural climate, the percentages were 76.1 and 68.1%, respectively. Only 66.7% of the students felt satisfied with the facilities provided by their universities and nursing institutions.

CONCLUSION

Doctoral nursing programs in most of the ESEA countries value the importance of both research and coursework. Doctoral nursing students generally hold positive experiences of their study. However, incorporating more teaching training components, providing more opportunities for international mobility, and making more effort to improve research-related facilities may further enhance the student experience. There is also a need to have international guidelines and standards for quality indicators of doctoral programs to maintain quality and find solutions to global challenges in nursing doctoral education.

Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: a systematic review of reviews

BACKGROUND

Despite the significant benefits of palliative care (PC) services for cancer patients, multiple challenges hinder the provision of PC services for these patients. Low- and middle-income countries (LMICs) are witnessing a sharp growth in the burden of non-communicable diseases. There is a significant gap between demand and supply of PC in LMICs in current health services. This review aims to synthesise evidence from previous reviews and deliver a more comprehensive mapping of the existing literature about personal, system, policy, and organisational challenges and possible facilitators on the provision of PC services for cancer patients in LMICs.

METHODS

A systematic review of reviews was performed following PRISMA guidelines. PubMed, EMBASE, SCOPUS, PsycINFO, Web of Sciences, CINAHL, and Cochrane Library databases were searched to identify review papers published between 2000 and 2018 that considered challenges and possible facilitators to PC provision. A modified socioecological model was used as a framework for analysing and summarising findings.

RESULTS

Fourteen reviews were included. The reviews varied in terms of aim, settings, and detail of the challenges and possible facilitators. The main challenges of personal and health care systems included knowledge deficits and misunderstandings from patients, families, the general public, and health care providers about PC; and inadequate number of trained workforce. Besides, limited physical infrastructure, insufficient drugs for symptom relief and lack of a comprehensive national plan for implementing PC were the core organisational and policy level challenges that were recognised. Furthermore, the main possible facilitators that were identified included provision of adequate training for health care providers and health education for patients, families and the general public to enhance their knowledge, beliefs, and attitudes to PC. Finally, involvement of policymakers and making drugs available for symptom relief should also be in place to improve the health care systems.

CONCLUSIONS

Understanding challenges to the provision of PC for people with cancer could help in the development of a PC pathway in LMICs. This knowledge could be used as a guide to develop an intervention programme to improve PC. Political influence and support are also required to ensure the sustainability and the provision of high-quality PC.

Dementia Literacy in the Greater Bay Area, China: Identifying the At-Risk Population and the Preferred Types of Mass Media for Receiving Dementia Information

Background: The aim of this cross-sectional study was to assess the dementia literacy of community-dwelling adults in four cities (Hong Kong, Guangzhou, Macau, and Zhuhai) of the Greater Bay Area of China, and to determine their mass media preferences for receiving dementia information. Methods: The survey was completed by 787 community-dwelling adults. Dementia literacy was indirectly measured using two validated scales-the 30-item Alzheimer's Disease Knowledge Scale and the 20-item Dementia Attitude Scale (DAS). Participants were also asked to indicate whether they wanted to receive dementia information via digital or traditional media. Chi-square tests, logistic regressions, and MANOVA analyses were conducted. Results: Unemployed or retired people had poor attitudes towards dementia and lower levels of knowledge about dementia. Single, cohabiting, or divorced people in Hong Kong and Macau had lower DAS scores than married people. Young people and those with a secondary education preferred to get their dementia information from social media. People with a tertiary education and employed people enjoyed searching government or hospital websites for information. Middle-aged, unemployed, or retired people tended to learn about dementia from television or radio. Conclusion: It is worth educating the public about dementia and developing strategies consistent with their preferences for types of mass media.

Supplemental prophylactic intervention for chemotherapy-induced nausea and emesis (SPICE) trial: Protocol for a multicentre double-blind placebo-controlled randomised trial

AIM

There is significant recent interest in the role of ginger root (Zingiber officinale) as an adjuvant therapy for chemotherapy-induced nausea. The supplemental prophylactic intervention for chemotherapy-induced nausea and emesis (SPICE) trial aims to assess the efficacy by reduced incidence and severity of chemotherapy-induced nausea and vomiting, and enhanced quality of life, safety and cost effectiveness of a standardised adjuvant ginger root supplement in adults undergoing single-day moderate-to-highly emetogenic chemotherapy.

METHODS

Multisite, double-blind, placebo-controlled randomised trial with two parallel arms and 1:1 allocation. The target sample size is n = 300. The intervention comprises four capsules of ginger root (totalling 60 mg of active gingerols/day), commencing the day of chemotherapy and continuing for five days during chemotherapy cycles 1 to 3. The primary outcome is chemotherapy-induced nausea-related quality of life. Secondary outcomes include nutrition status; anticipatory, acute and delayed nausea and vomiting; fatigue; depression and anxiety; global quality of life; health service use and costs; adverse events; and adherence.

RESULTS

During the five-month recruitment period from October 2017 to April 2018 at site A only, a total of n = 33 participants (n = 18 female) have been enrolled in the SPICE trial. Recruitment is expected to commence at Site B in May 2018.

CONCLUSIONS

The trial is designed to meet research gaps and could provide evidence to recommend specific dosing regimens as an adjuvant for chemotherapy-induced nausea and vomiting prevention and management.

A cross sectional study to determine the prevalence of cough and its impact in patients with lung cancer: a patient unmet need

BACKGROUND

There is absence of literature related to cough prevalence and its characteristics in lung cancer patients, with information deriving only from broader symptoms occurrence studies. The aims of this study were to provide a snapshot of the prevalence of all-cause-cough in lung cancer patients and to characterise cough in terms of its impact and severity.

METHODS

A cross-sectional study recruiting consecutive lung cancer patients over a pre-defined period of time and using cough-specific validated tools in a tertiary referral centre in the UK, including a cough severity VAS and the Manchester Cough in Lung Cancer scale (MCLCS).

RESULTS

Data was collected from 202 patients. All-cause cough prevalence was 57% (through VAS) both in the screened (N = 223) and research (N = 202) population or 67% (through the MCLCS), and cough severity was moderate at a mean of 32 mm (in a 100 mm VAS). Age, sex, smoking status, lung cancer histology, stage and comorbidities were not associated with cough prevalence. The only variable associated with lower cough reports was being 'on anticancer treatment'; fewer patients on treatment reported a cough (40%) compared to those off treatment (54%) (p = 0.04). The impact of cough (as measured by MCLCS) was also significant (mean score = 22). About 18% of patients felt moderate/severe distress from their cough and about 15% often or always reported disturbed sleep due to coughing. Half the patients felt their cough warranted treatment.

CONCLUSIONS

Cough is a common symptom in lung cancer with considerable impact on patients' lives. Cough presence and severity should regularly be assessed in clinical practice. There is an urgent need to focus on developing more potent antitussive treatments and improve the management of this complex and distressing symptom.

Correction to: Enteral and parenteral nutrition in cancer patients, a comparison of complication rates: an updated systematic review and (cumulative) meta-analysis

The appendices were incorrectly numbered in the original article. Please see below correcct appendices.

Enteral and parenteral nutrition in cancer patients, a comparison of complication rates: an updated systematic review and (cumulative) meta-analysis

INTRODUCTION

Weight loss in cancer patients is a worrisome constitutional change predicting disease progression and shortened survival time. A logical approach to counter some of the weight loss is to provide nutritional support, administered through enteral nutrition (EN) or parenteral nutrition (PN). The aim of this paper was to update the original systematic review and meta-analysis previously published by Chow et al., while also assessing publication quality and effect of randomized controlled trials (RCTs) on the meta-conclusion over time.

METHODS

A literature search was carried out; screening was conducted for RCTs published in January 2015 up until December 2018. The primary endpoints were the percentage of patients achieving no infection and no nutrition support complications. Secondary endpoints included proportion of patients achieving no major complications and no mortality. Review Manager (RevMan 5.3) by Cochrane IMS and Comprehensive Meta-Analysis (version 3) by Biostat were used for meta-analyses of endpoints and assessment of publication quality.

RESULTS

An additional seven studies were identified since our prior publication, leading to 43 papers included in our review. The results echo those previously published; EN and PN are equivalent in all endpoints except for infection. Subgroup analyses of studies only containing adults indicate identical risks across all endpoints. Cumulative meta-analysis suggests that meta-conclusions have remained the same since the beginning of publication time for all endpoints except for the endpoint of infection, which changed from not favoring to favoring EN after studies published in 1997. There was low risk of bias, as determined by assessment tool and visual inspection of funnel plots.

CONCLUSIONS

The results support the current European Society of Clinical Nutrition and Metabolism guidelines recommending enteral over parenteral nutrition, when oral nutrition is inadequate, in adult patients. Further studies comparing EN and PN for these critical endpoints appear unnecessary, given the lack of change in meta-conclusion and low publication bias over the past decades.

Dementia literacy in Western Pacific countries: A mixed methods study

OBJECTIVES

To examine levels of knowledge about dementia and attitudes towards dementia in low- and middle-income countries (LMICs), identify sources to turn to for help, and explore the relationship between knowledge and attitudes.

METHODS

This mixed methods study with both quantitative (a cross-sectional survey) and qualitative (focus group interviews) components was conducted in Cambodia, the Philippines, and Fiji in 2017-18. A survey was completed by the citizens of the three countries, and two focus group interviews were conducted in each country to generate a context-specific understanding of dementia literacy within the local LMIC setting. The quantitative component utilized the Alzheimer's Disease Knowledge Scale and the Dementia Attitude Scale, while knowledge, attitudes, and views on seeking help for dementia was discussed in the focus group interviews (qualitative component).

RESULTS

A total of 476 participants completed the survey. Another 54 participants (39 females and 15 males) were invited to join six focus group interviews to express their views on dementia. Positive attitudes were noted despite the level of dementia knowledge was low. Families and religious figures were viewed as the sources for help. Controlling for demographics, country-specific predictors of positive attitudes towards dementia were found.

CONCLUSIONS

The involvement of family members and religious leaders in dementia education could enhance the recognition of dementia. Specific kinds of dementia knowledge should be targeted to educate the public in different countries.

Redefining chemotherapy-induced peripheral neuropathy through symptom cluster analysis and patient-reported outcome data over time

Background

Chemotherapy-induced peripheral neuropathy (CIPN) is common among cancer patients treated with neurotoxic chemotherapy agents. Better knowledge on symptom clusters of CIPN may help improve symptom management in clinical practice. This study aimed to identify symptom clusters of CIPN and to map their trajectories before initiation of chemotherapy to 12-month follow-up.

Methods

A secondary analysis of a longitudinal dataset was conducted using principal component approach. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaires Core 30 and CIPN 20 were used to measure symptom clusters of CIPN in patients with mixed cancer diagnosis across 10 time points over 12 months.

Results

Sample size in each assessment point ranged from 118 to 343 participants. Four CIPN symptom clusters were identified, including a clear sensory neuropathy symptom cluster, a mixed motor-sensory neuropathy symptom cluster, a mixed sensorimotor neuropathy symptom cluster, and a less clear autonomic neuropathy symptom cluster. The core symptoms in each symptom cluster were mostly stable while the secondary symptoms changed over time.

Conclusions

The analysis suggests that CIPN is predominantly a sensory neuropathy with no evidence of a pure motor dysfunction but with mixed motor-related and autonomic changes accompanying sensory dysfunctions over time. Future symptom management strategies can be designed based on the morphology of CIPN.

Psychometric assessment of the Chinese version of the Problems and Needs in Palliative Care questionnaire-short version in advanced cancer patients

BACKGROUND

To determine the validity, reliability and acceptability of the Mandarin Chinese version of the Problems and Needs in Palliative Care questionnaire-short version (PNPC-sv) for measuring problems and palliative care needs among patients with advanced cancer.

METHODS

This was a validation study using a forward- and backward- translation procedure, a panel of experts and a cross-sectional study design. The Mandarin Chinese version of the PNPC-sv was translated by four independent translators. The translated Chinese version was further reviewed by an expert panel to identify its content validity. A pilot test was conducted in 10 advanced cancer patients to preliminarily assess the face validity, readability and clarity of the pre-final version of the PNPC-sv. 178 patients with advanced cancer, regardless of their gender and types of cancer diagnosis, were further recruited through a convenience sampling from three tertiary hospitals in China to assess the psychometric properties of the PNPC-sv Mandarin Chinese version. Content validity was measured using the content validity index (CVI). Construct validity was estimated via confirmatory factor analysis and the contrasted groups approach. Concurrent validity was identified by analysing the correlations between the EORTC Quality-of-Life Questionnaire-Core 30 (EORTC QLQ-C30) and the PNPC-sv. Reliability of the PNPC-sv was examined with the internal consistency reliability and item-to-total correlations. Several closed-ended and open-ended questions were designed to explore its acceptability.

RESULTS

174 patients completed the questionnaires. High content and face validity were determined after the two rounds of assessment with the expert panel and the patients. An excellent CVI of 1.0 was achieved and patients rated the PNPC-sv as a useful instrument for assessing their problems and needs (mean score = 7.99, 0-10 scale) and reported the items were not particularly sensitive and easy to understand. The majority of the fit indexes meet the critical criteria, with the Chi-square divided by degrees of freedom (x2/df) being 1.58 and 2.05, and the root mean squared error of approximation (RMSEA) being 0.06 and 0.07 for the problem part and need-for-care part, respectively. In relation to the contrasted groups analysis, it clearly discriminated the differences on the sub-scores of Activities of Daily Life (ADL), spiritual and psychological problems and needs between male and female patients; ADL, physical, social and financial problems and needs between age groups; and autonomic problems and needs between patients with different cancer stages. Statistically significant correlations (p < 0.05) were detected between the PNPC-sv and the EORTC QLQ-C30 in the majority of the sub-scores (positive correlations) and total scores (negative correlations). The Cronbach's alpha of the total scale was 0.88 and 0.91 for the problem part and need-for-care part, respectively. The Cronbach's alpha of the subscales were generally above 0.70. Item-to-total correlations were generally acceptable, with the majority of the values being above 0.40. The PNPC-sv questionnaire was reported to be convenient and easy to understand, and the average time for completing was 11 min.

CONCLUSIONS

The Mandarin Chinese version of the PNPC-sv is a valid, reliable and user-friendly instrument for measuring problems and palliative care needs among patients with advanced cancer. Further research is needed to further examine its psychometric properties particular internal structure in a larger patient sample.

Risk factors for chemotherapy-induced peripheral neuropathy in patients receiving taxane- and platinum-based chemotherapy

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a significant and difficult to manage side effect of neurotoxic chemotherapies. Several risk factors for CIPN have been identified to date, but inconsistencies and methodological limitations exist in past research. Also, a limited number of potential risk factors has been investigated in the past.

AIM

The objective of this study was to assess the relative contribution of a wider range of risk factors in the development of CIPN.

METHODS

This analysis used the 6-month data after starting chemotherapy from a larger prospective observational study on CIPN risk, prevalence, and quality of life. Patients were assessed at recruitment for possible CIPN risk factors, including prior history of neuropathies, current/past infectious diseases; neurotoxic medication history; personal and treatment characteristics; smoking history, alcohol use, and vegetable/fruit intake. Neuropathy was assessed at 6-months after starting chemotherapy with the neuropathy (motor/sensory) items of the NCI-CTCAE scale and the WHO criterion for neuropathy. Data on symptom burden were also collected.

RESULTS

Data were available from 255 patients from three cancer centers in Hong Kong, Singapore, and UK. The use of different scales did not always identify the same predictor variables. Key risk factors in multivariate regression models included older age (highest OR = 1.08, p < 0.01 with the WHO scale), chemotherapy (platinum-based chemotherapy had OR = 0.20-0.27 in developing CIPN compared to taxane-based chemotherapy), history of neuropathy (for motor CIPN only, OR = 8.36, p < 0.01), symptom burden (OR = 1.06, p < 0.05), number of chemotherapy cycles received (OR = 1.19-1.24, p < 0.01), and alcohol intake (OR = 0.32, p < 0.05). In univariate analysis, the use of statins was implicated with CIPN (p = 0.03-0.04 with different assessments) and diabetes showed a trend (p = 0.09) in the development of CIPN.

CONCLUSION

This study confirmed the CIPN risk related to certain variables and identified new ones. This knowledge can assist with treatment decisions and patient education.

New-onset insomnia among cancer patients undergoing chemotherapy: prevalence, risk factors, and its correlation with other symptoms

STUDY OBJECTIVES

Although insomnia is common among cancer patients, its prevalence remains variable, and its risk factors and correlation with other cancer-related symptoms are not fully explored in the literature. This study aims to determine the prevalence and severity of insomnia as well as risk factors and sleep-related symptom clusters in a sample of cancer patients.

METHODS

A cross-sectional survey was conducted collecting data from 213 cancer patients undergoing chemotherapy (age = 53.1 ± 11.3 years, 60% female). Insomnia was measured using the Insomnia Severity Index, a sleep log, and Actigraph, while symptoms were assessed using the Memorial Symptom Assessment Scale and the Hospital Anxiety and Depression Scale. Quality of life was measured with the Functional Assessment of Cancer Therapy-General.

RESULTS

Of the participants, 42.8% reported insomnia, with 31.9% of those with insomnia reporting severe insomnia. Insomnia occurrence and severity were not correlated with the participants' characteristics, cancer-related or treatment-related factors, only with the participants' anxiety/depression scores. Principal component analysis showed that insomnia, depression, and anxiety formed a symptom cluster (p < 0.001). There was no difference between sleep parameters measured by Actigraphy in insomnia and non-insomnia participants.

CONCLUSION

This study demonstrated that the prevalence of insomnia was high and indicated a symptom cluster of insomnia, depression, and anxiety. Therefore, interventions to reduce this symptom cluster may benefit cancer patients who are trying to manage these symptoms.