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Rebuilding self-confidence after cancer: a feasibility study of life-coaching. Support Care Cancer 2014; 23:651-9. [PMID: 25160492 DOI: 10.1007/s00520-014-2399-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cancer survivors often experience decreased self-confidence which impacts negatively on their ability to self-manage the practical, social and emotional problems frequently faced as they emerge from end of treatment. This was a feasibility study of a life-coaching intervention, designed to rebuild confidence of survivors and support transition to life after cancer treatment. METHODS A one group pre-test, post-test design was used, recruiting participants from community organisations. Eligibility criteria are as follows: <1 year of completion of primary cancer treatment, aged >18, no metastases, and no mental health problems. Participants received one individualised face-to-face and five telephone coaching sessions over 3 months. Outcome measures are as follows: New General Self-Efficacy Scale, Hope Scale, Personal Well-being Index, Assessment of Survivorship Concerns, Quality of Life in Adult Cancer Survivors, Hospital Anxiety and Depression Scale, Social Difficulties Index, and a goal attainment score. Interviews explored feasibility, acceptability and impact of life-coaching and research design. RESULTS Nine women and two men were recruited, representing varying cancer diagnoses. All outcome measures were sensitive to change and indicated positive trends post-intervention. Participant interviews indicated the intervention was well received and had a positive impact. Lessons were learnt about study design, recruitment and intervention delivery. CONCLUSIONS Life-coaching has a potential to enable cancer survivors to manage the transition to life beyond cancer and effect change on a range of outcomes. The intervention was feasible to deliver and acceptable to survivors at a time when many struggle to make sense of life. It merits further evaluation through a randomised controlled trial.
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Emery J, Doorey J, Jefford M, King M, Pirotta M, Hayne D, Martin A, Trevena L, Lim T, Constable R, Hawks C, Hyatt A, Hamid A, Violet J, Gill S, Frydenberg M, Schofield P. Protocol for the ProCare Trial: a phase II randomised controlled trial of shared care for follow-up of men with prostate cancer. BMJ Open 2014; 4:e004972. [PMID: 24604487 PMCID: PMC3948582 DOI: 10.1136/bmjopen-2014-004972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Men with prostate cancer require long-term follow-up to monitor disease progression and manage common adverse physical and psychosocial consequences of treatment. There is growing recognition of the potential role of primary care in cancer follow-up. This paper describes the protocol for a phase II multisite randomised controlled trial of a novel model of shared care for the follow-up of men after completing treatment for low-moderate risk prostate cancer. METHODS AND ANALYSIS The intervention is a shared care model of follow-up visits in the first 12 months after completing treatment for prostate cancer with the following specific components: a survivorship care plan, general practitioner (GP) management guidelines, register and recall systems, screening for distress and unmet needs and patient information resources. Eligible men will have completed surgery and/or radiotherapy for low-moderate risk prostate cancer within the previous 8 weeks and have a GP who consents to participate. Ninety men will be randomised to the intervention or current hospital follow-up care. Study outcome measures will be collected at baseline, 3, 6 and 12 months and include anxiety, depression, unmet needs, prostate cancer-specific quality of life and satisfaction with care. Clinical processes and healthcare resource usage will also be measured. The principal emphasis of the analysis will be on obtaining estimates of the treatment effect size and assessing feasibility in order to inform the design of a subsequent phase III trial. ETHICS AND DISSEMINATION Ethics approval has been granted by the University of Western Australia and from all hospital recruitment sites in Western Australia and Victoria. RESULTS of this phase II trial will be reported in peer-reviewed publications and in conference presentations. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12610000938000.
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Affiliation(s)
- Jon Emery
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Carlton, Victoria, Australia
- Department of General Practice, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, Western Australia, Australia
| | - Juanita Doorey
- Department of General Practice, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Madeleine King
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Marie Pirotta
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Carlton, Victoria, Australia
| | - Dickon Hayne
- School of Surgery, The University of Western Australia, Western Australia, Australia
- Urology Department, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tee Lim
- Genesis Cancer Care, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Roger Constable
- Prostate Cancer Foundation of Australia, Perth, Western Australia, Australia
| | - Cynthia Hawks
- Urology Department, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Amelia Hyatt
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Akhlil Hamid
- Urology Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - John Violet
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Suki Gill
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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Health status and health resource use among long-term survivors of breast, colorectal and prostate cancer. GACETA SANITARIA 2014; 28:129-36. [DOI: 10.1016/j.gaceta.2013.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 09/04/2013] [Accepted: 09/09/2013] [Indexed: 11/22/2022]
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Cooper J. What is the cancer patient's own experience of participating in an occupational therapy-led relaxation programme? PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x13y.0000000081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Oeffinger KC, Argenbright KE, Levitt GA, McCabe MS, Anderson PR, Berry E, Maher J, Merrill J, Wollins DS. Models of cancer survivorship health care: moving forward. Am Soc Clin Oncol Educ Book 2014:205-213. [PMID: 24857078 DOI: 10.14694/edbook_am.2014.34.205] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The population of cancer survivors in the United States and worldwide is rapidly increasing. Many survivors will develop health conditions as a direct or indirect consequence of their cancer therapy. Thus, models to deliver high-quality care for cancer survivors are evolving. We provide examples of three different models of survivorship care from a cancer center, a community setting, and a country-wide health care system, followed by a description of the ASCO Cancer Survivorship Compendium, a tool to help providers understand the various models of survivorship care available and integrate survivorship care into their practices in a way that fits their unique needs.
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Affiliation(s)
- Kevin C Oeffinger
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Moncrief Cancer Institute, Fort Worth, TX; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Macmillan Cancer Support, London, UK; American Society of Clinical Oncology, Alexandria, VA
| | - Keith E Argenbright
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Moncrief Cancer Institute, Fort Worth, TX; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Macmillan Cancer Support, London, UK; American Society of Clinical Oncology, Alexandria, VA
| | - Gill A Levitt
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Moncrief Cancer Institute, Fort Worth, TX; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Macmillan Cancer Support, London, UK; American Society of Clinical Oncology, Alexandria, VA
| | - Mary S McCabe
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Moncrief Cancer Institute, Fort Worth, TX; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Macmillan Cancer Support, London, UK; American Society of Clinical Oncology, Alexandria, VA
| | - Paula R Anderson
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Moncrief Cancer Institute, Fort Worth, TX; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Macmillan Cancer Support, London, UK; American Society of Clinical Oncology, Alexandria, VA
| | - Emily Berry
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Moncrief Cancer Institute, Fort Worth, TX; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Macmillan Cancer Support, London, UK; American Society of Clinical Oncology, Alexandria, VA
| | - Jane Maher
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Moncrief Cancer Institute, Fort Worth, TX; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Macmillan Cancer Support, London, UK; American Society of Clinical Oncology, Alexandria, VA
| | - Janette Merrill
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Moncrief Cancer Institute, Fort Worth, TX; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Macmillan Cancer Support, London, UK; American Society of Clinical Oncology, Alexandria, VA
| | - Dana S Wollins
- From the Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas Southwestern Moncrief Cancer Institute, Fort Worth, TX; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Macmillan Cancer Support, London, UK; American Society of Clinical Oncology, Alexandria, VA
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Duffy S, Richards M, Selby P, Lawler M. Addressing cancer disparities in Europe: a multifaceted problem that requires interdisciplinary solutions. Oncologist 2013; 18:e29-30. [PMID: 24336123 DOI: 10.1634/theoncologist.2013-0438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sean Duffy
- Medical Directorate National Health Service England, Leeds, United Kingdom
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Kristiansen M, Adamsen L, Hendriksen C. Readiness for cancer rehabilitation in Denmark: protocol for a cross-sectional mixed methods study. BMJ Open 2013; 3:e003775. [PMID: 24253030 PMCID: PMC3840349 DOI: 10.1136/bmjopen-2013-003775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Rehabilitation is a key element in most cancer care policies in recognition of the often unmet physical, psychological and social needs among the rising numbers of patients with cancer. A systematic assessment of patients' needs and available rehabilitation services constitute the foundation for timely, comprehensive and coordinated cancer rehabilitation. This study aims to provide insight into the current organisation and practice of cancer rehabilitation in Denmark with special emphasis placed on the assessment of patients' needs and availability of services across the cancer treatment trajectory. METHODS AND ANALYSIS A cross-sectional design using a mixed methods approach will be used in order to analyse the readiness for cancer rehabilitation in different sectors and from differing perspectives. Substudy 1 consists of an electronic survey among the 98 Danish municipalities and focuses on the availability and use of cancer rehabilitation services for patients with all types of cancers. In substudy 2, a survey among the 19 surgical and 12 oncological departments involved in colorectal cancer treatment in Denmark is conducted in order to describe the current clinical practice regarding the assessment of rehabilitation needs and referral to services. Substudy 3 involves a retrospective clinical audit and semistructured interviews at four randomly selected surgical and oncological departments treating colorectal patients with cancer in order to elucidate current needs assessment practices. ETHICS AND DISSEMINATION The study was approved by the Danish Data Protection Agency and will be conducted in accordance with the principles of the Helsinki Declaration Representatives from municipalities and clinical practice are engaged in the design and execution of the study in order to ensure the usefulness of survey instruments, reflexive interpretation of data and transfer of implications into practice. RESULTS Published in international peer-reviewed scientific journals and presented at conferences, seminars and as short reports.
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Affiliation(s)
- Maria Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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Carr P. What Happens Next?: How Ovarian Cancer Forces a Woman into a New Draft of Her Life Script. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/02630672.2013.863376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A diagnosis of ovarian cancer has an impact on many areas of a woman's life which define her identity and life story. Women are forced to reconsider the future ‘scenes’ of their life scripts as they deal with the loss of fertility, a challenge to plans and existential threat. This paper considers this experience within the theoretical framework of the Self-Memory System. Alongside this theory, the author shares her use of dramatherapy tools applied to weekend residential courses run across the UK on four occasions to support women affected by ovarian cancer.
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109
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Glaser A, Levitt G, Morris P, Tapp J, Gibson F. Enhanced quality and productivity of long-term aftercare of cancer in young people. Arch Dis Child 2013; 98:818-24. [PMID: 23966026 DOI: 10.1136/archdischild-2013-304348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Long-term morbidity associated with survival from childhood cancer is well defined. Traditional models of hospital-based long-term aftercare are not sustainable and may not be necessary for all. A programme to support development and implementation of redesigned care pathways is reported. METHOD Application of service improvement methodologies to identify the case for change, to evidence development of, and test, new aftercare pathways. RESULTS Four models of aftercare were identified; traditional cancer centre-delivered medical follow-up, shared care with local hospitals or primary care, specialist nurse-led supported management and self-management. Key components required for successful implementation of risk-stratified care included; comprehensive information transfer with treatment summaries and care plans, provision of care coordinators, effective transition across services, remote monitoring systems, educating professionals, maintaining patient choice. CONCLUSIONS Adoption of risk-stratified evidence-based aftercare pathways, generated through application of service improvement methodologies, can result in the delivery of enhanced quality and productivity.
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Affiliation(s)
- Adam Glaser
- Department of Paediatric and Adolescent Oncology, Leeds Teaching Hospitals NHS Trust, , Leeds, UK
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110
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Bourke L, Homer KE, Thaha MA, Steed L, Rosario DJ, Robb KA, Saxton JM, Taylor SJC. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev 2013:CD010192. [PMID: 24065550 DOI: 10.1002/14651858.cd010192.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The beneficial effects of regular exercise for people living with or beyond cancer are becoming apparent. However, how to promote exercise behaviour in sedentary cancer cohorts is not as well understood. A large majority of people living with or recovering from cancer do not meet exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important. OBJECTIVES To assess the effects of interventions to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? What adverse effects are attributed to different exercise interventions? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with increased exercise behaviour? What behaviour change techniques are most often associated with increased exercise behaviour? SEARCH METHODS We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 8, 2012), MEDLINE, EMBASE, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro from inception to August 2012. We also searched the grey literature, wrote to leading experts in the field, wrote to charities and searched reference lists of other recent systematic reviews. SELECTION CRITERIA We included only randomised controlled trials (RCTs) that compared an exercise intervention with a usual care approach in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. DATA COLLECTION AND ANALYSIS Two review authors working independently (LB and KH) screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that cannot be safely excluded without assessment of the full text (e.g. when no abstract is available). All eligible papers were formally abstracted by at least two members of the review author team working independently (LB and KH) and using the data collection form. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we synthesised studies as a narrative. MAIN RESULTS Fourteen trials were included in this review, involving a total of 648 participants. Only studies involving breast, prostate or colorectal cancer were identified as eligible. Just six trials incorporated a target level of exercise that could meet current recommendations. Only three trials were identified that attempted to objectively validate independent exercise behaviour with accelerometers or heart rate monitoring. Adherence to exercise interventions, which is crucial for understanding treatment dose, is often poorly reported. It is important to note that the fundamental metrics of exercise behaviour (i.e. frequency, intensity and duration, repetitions, sets and intensity of resistance training), although easy to devise and report, are seldom included in published clinical trials.None of the included trials reported that 75% or greater adherence (the stated primary outcome for this review) of the intervention group met current aerobic exercise recommendations at any given follow-up. Just two trials reported six weeks of resistance exercise behaviour that would meet the guideline recommendations. However, three trials reported adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendation of 150 minutes per week. All three incorporated both supervised and independent exercise components as part of the intervention, and none placed restrictions on the control group in terms of exercise behaviour. These three trials shared programme set goals and the following behaviour change techniques: generalisation of a target behaviour; prompting of self-monitoring of behaviour; and prompting of practise. Despite the uncertainty surrounding adherence in many of the included trials, interventions caused improvements in aerobic exercise tolerance at 8 to 12 weeks (from 7 studies, SMD 0.73, 95% confidence interval (CI) 0.51 to 0.95) in intervention participants compared with controls. At six months, aerobic exercise tolerance was also improved (from 5 studies, SMD 0.70, 95% CI 0.45 to 0.94), but it should be noted that four of the five trials used in this analysis had a high risk of bias, hence caution is warranted in interpretation of results. Attrition over the course of these interventions is typically low (median 6%). AUTHORS' CONCLUSIONS Interventions to promote exercise in cancer survivors who report better levels of adherence share some common behaviour change techniques. These involve setting programme goals, prompting practise and self-monitoring and encouraging participants to attempt to generalise behaviours learned in supervised exercise environments to other, non-supervised contexts. However, expecting most sedentary survivors to achieve current guideline recommendations of at least 150 minutes per week of aerobic exercise is likely to be unrealistic. As with all well-designed exercise programmes in any context, prescriptions should be designed around individual capabilities, and frequency, duration and intensity or sets, repetitions, intensity or resistance training should be generated on this basis.
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Affiliation(s)
- Liam Bourke
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Primary Care and Public Health, Blizard Institute, Yvonne Carter Building, 58 Turner Street, London, UK, E1 2AB
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Jones L, Fitzgerald G, Leurent B, Round J, Eades J, Davis S, Gishen F, Holman A, Hopkins K, Tookman A. Rehabilitation in advanced, progressive, recurrent cancer: a randomized controlled trial. J Pain Symptom Manage 2013. [PMID: 23182307 DOI: 10.1016/j.jpainsymman.2012.08.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CONTEXT Two million people across the U.K. are living with cancer, often experienced as a long-term condition. They may have unmet needs after active treatment. Rehabilitation aims to address these needs, maximize psychological and physical function, and enable minimum dependency regardless of life expectancy. OBJECTIVES We aimed to test, in a randomized controlled trial, the clinical and cost effectiveness of a rehabilitation intervention for patients with advanced, recurrent cancer. METHODS We conducted a two-arm, wait-list control, randomized trial of a complex rehabilitation intervention delivered by a hospice-based multidisciplinary team vs. usual care for active, progressive, recurrent hematological and breast malignancies, with a follow-up at three months. The primary outcome was the psychological subscale of the Supportive Care Needs Survey (SCNS). Secondary outcomes were other domains of the SCNS, psychological status, continuity of care, quality of life, and resource use. RESULTS Forty-one participants were enrolled and 36 completed the trial. The primary outcome was significantly lower in the intervention arm (adjusted difference -16.8, 95% CI -28.34 to -5.3; P = 0.006). The SCNS physical and patient care subscales (-14.2, 95% CI -26.2 to -2.2; P = 0.02 and -7.4, 95% CI -13.7 to -1.1; P = 0.02, respectively) and self-reported health state (12.8, 95% CI 3.2 to 22.4; P = 0.01) also differed significantly. The incremental cost-effectiveness ratio was £19,390 per quality-adjusted life year. CONCLUSION This intervention significantly reduced the unmet needs of cancer survivors and it is likely that it is cost-effective. Despite small numbers, the main effect size was robust. We recommend implementation alongside evaluation in wider clinical settings and patient populations.
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Affiliation(s)
- Louise Jones
- Marie Curie Palliative Care Research Unit, UCL Mental Health Sciences Unit, University College London, London, United Kingdom.
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Samuel C, Faithfull S. Complementary therapy support in cancer survivorship: a survey of complementary and alternative medicine practitioners' provision and perception of skills. Eur J Cancer Care (Engl) 2013; 23:180-8. [DOI: 10.1111/ecc.12099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 12/15/2022]
Affiliation(s)
- C.A. Samuel
- Faculty of Health and Medical Sciences; University of Surrey; Guildford UK
| | - S. Faithfull
- Faculty of Health and Medical Sciences; University of Surrey; Guildford UK
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de Moor JS, Mariotto AB, Parry C, Alfano CM, Padgett L, Kent EE, Forsythe L, Scoppa S, Hachey M, Rowland JH. Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomarkers Prev 2013; 22:561-70. [PMID: 23535024 PMCID: PMC3654837 DOI: 10.1158/1055-9965.epi-12-1356] [Citation(s) in RCA: 499] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cancer survivors represent a growing population, heterogeneous in their need for medical care, psychosocial support, and practical assistance. To inform survivorship research and practice, this manuscript will describe the prevalent population of cancer survivors in terms of overall numbers and prevalence by cancer site and time since diagnosis. METHODS Incidence and survival data from 1975-2007 were obtained from the Surveillance, Epidemiology, and End Results Program and population projections from the United States Census Bureau. Cancer prevalence for 2012 and beyond was estimated using the Prevalence Incidence Approach Model, assuming constant future incidence and survival trends but dynamic projections of the U.S. population. RESULTS As of January 1, 2012, approximately 13.7 million cancer survivors were living in the United States with prevalence projected to approach 18 million by 2022. Sixty-four percent of this population have survived 5 years or more; 40% have survived 10 years or more; and 15% have survived 20 years or more after diagnosis. Over the next decade, the number of people who have lived 5 years or more after their cancer diagnosis is projected to increase approximately 37% to 11.9 million. CONCLUSIONS A coordinated agenda for research and practice is needed to address cancer survivors' long-term medical, psychosocial, and practical needs across the survivorship trajectory. IMPACT Prevalence estimates for cancer survivors across the survivorship trajectory will inform the national research agenda as well as future projections about the health service needs of this population.
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Affiliation(s)
- Janet S de Moor
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute/NIH, 6116 Executive Boulevard, Suite 404, Bethesda, MD 20892, USA.
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Knowles G, Haigh R, McLean C, Phillips HA, Dunlop MG, Din FVN. Long term effect of surgery and radiotherapy for colorectal cancer on defecatory function and quality of life. Eur J Oncol Nurs 2013; 17:570-7. [PMID: 23453570 DOI: 10.1016/j.ejon.2013.01.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/13/2013] [Accepted: 01/22/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE Survival from rectal cancer has improved substantially. Understanding the consequences of treatment is important to optimise patient support and minimise impact on daily life. We aimed to define the long-term prevalence of pelvic dysfunction following curative rectal cancer surgery (+/- radiotherapy) within the context of overall quality of life. METHODS We evaluated bowel, urinary and sexual function and quality of life using three validated questionnaires in patients treated for rectal cancer. This group was compared to patients undergoing abdominal surgery without pelvic dissection for colon cancer during the same time period. RESULTS The response rate was 57% (381/667) with a median time interval of 4.4 years. A subset of rectal patients documented persistent problems with faecal leakage (16%); requiring to alter daily activities (18%); always needing to wear a protective pad (17%); rarely or never emptying their bowels fully (31%); difficulty controlling the passage of gas (32%) and requiring to modify diet (30%). Altered bowel function was found to impact on overall quality of life. Men reported increased erectile function difficulties. Pre-operative radiotherapy was associated with increased defecation problems as was low level of anastomosis (≤6 cm). CONCLUSION In keeping with emergent evidence, this study has quantified the extent of late adverse effects with a sub-set of rectal cancer patients reporting persistent bowel function problems. The implications are now to consider current follow-up services and to 'trial' new models of comprehensive assessment and interventions in patients who are 'at risk' of experiencing late adverse effects of treatment.
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Affiliation(s)
- Gillian Knowles
- Edinburgh Cancer Centre, Lothian University Hospitals Division, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, Scotland, UK.
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Glaser AW, Fraser LK, Corner J, Feltbower R, Morris EJA, Hartwell G, Richards M, Wagland R. Patient-reported outcomes of cancer survivors in England 1-5 years after diagnosis: a cross-sectional survey. BMJ Open 2013; 3:bmjopen-2012-002317. [PMID: 23578682 PMCID: PMC3641492 DOI: 10.1136/bmjopen-2012-002317] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To determine the feasibility of collecting population-based patient-reported outcome measures (PROMs) in assessing quality of life (QoL) to inform the development of a national PROMs programme for cancer and to begin to describe outcomes in a UK cohort of survivors. DESIGN Cross-sectional postal survey of cancer survivors using a population-based sampling approach. SETTING English National Health Service. PARTICIPANTS 4992 breast, colorectal, prostate and non-Hodgkin's lymphoma (NHL) survivors 1-5 years from diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES Implementation issues, response rates, cancer-specific morbidities utilising items including the EQ5D, tumour-specific subscales of the Functional Assessment of Cancer Therapy and Social Difficulties Inventory. RESULTS 3300 (66%) survivors returned completed questionnaires. The majority aged 85+ years did not respond and the response rates were lower for those from more deprived area. Response rates did not differ by gender, time since diagnosis or cancer type. The presence of one or more long-term conditions was associated with significantly lower QoL scores. Individuals from most deprived areas reported lower QoL scores and poorer outcomes on other measures, as did those self-reporting recurrent disease or uncertainty about disease status. QoL scores were comparable at all time points for all cancers except NHL. QoL scores were lower than those from the general population in Health Survey for England (2008) and General Practice Patient Survey (2012). 47% of patients reported fear of recurrence, while 20% reported moderate or severe difficulties with mobility or usual activities. Bowel and urinary problems were common among colorectal and prostate patients. Poor bowel and bladder control were significantly associated with lower QoL. CONCLUSIONS This method of assessing QoL of cancer survivors is feasible and acceptable to most survivors. Routine collection of national population-based PROMs will enable the identification of, and the support for, the specific needs of survivors while allowing for comparison of outcome by service provider.
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Affiliation(s)
- Adam W Glaser
- Department of Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Corner J, Wagland R, Glaser A, Richards SM. Qualitative analysis of patients' feedback from a PROMs survey of cancer patients in England. BMJ Open 2013; 3:bmjopen-2012-002316. [PMID: 23578681 PMCID: PMC3641435 DOI: 10.1136/bmjopen-2012-002316] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study examined how free-text comments from cancer survivors could complement formal patient-reported outcome measures (PROMs), as part of the England PROMs survey programme for cancer. DESIGN A qualitative content analysis was conducted of responses to a single open-ended free-text question placed at the end of the cross-sectional population-based postal questionnaire. SETTING Individuals were identified through three UK Cancer Registries and questionnaires were posted to their home addresses. PARTICIPANTS A random sample of individuals (n=4992) diagnosed with breast, colorectal, non-Hodgkins lymphoma or prostate cancer at 1, 2, 3 and 5 years earlier. RESULTS 3300 participants completed the survey (68% response rate). Of these 1056 (32%) completed the free-text comments box, indicating a high level of commitment to provide written feedback on patient experience. Almost a fifth (19%) related experiences of excellent care during the treatment phase, with only 8% reporting negative experiences. This contrasted with experiences of care after primary cancer treatment where the majority were negative. Factors impacting negatively upon patient-reported outcomes included the emotional impact of cancer; poor experiences of treatment and care; comorbidities, treatment side effects, social difficulties and inadequate preparation for a wide range of sometimes long-lasting on-going physical and psychological problems. Mediating factors assisting recovery incorporated both professional-led factors, such as quality of preparation for anticipated problems and aftercare services, and participant-led factors, such as learning from other cancer survivors and self-learning through trial and error. The support of friends and family was also a factor in participants' outcomes. CONCLUSIONS This analysis of free-text comments complements quantitative analysis of PROMs measure's by illuminating relationships between factors that impact on quality of life (QoL) and indicate why cancer patients may experience significantly worse QoL than the general population. The data suggest more systematic preparation and aftercare for individuals to self-manage post-treatment problems might improve QoL outcomes among cancer survivors.
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Affiliation(s)
- Jessica Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Adam Glaser
- Department of Paediatric Oncology, Leeds General Infirmary, Leeds, UK
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Follow-up programs for childhood cancer survivors in Europe: a questionnaire survey. PLoS One 2012; 7:e53201. [PMID: 23300889 PMCID: PMC3534070 DOI: 10.1371/journal.pone.0053201] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022] Open
Abstract
Background For many childhood cancer survivors follow-up care is important long after treatment completion. We aimed to describe the availability and characteristics of long-term follow-up programs (LTFU) across Europe, their content and aims, their problems, and to assess opinions on different models of LTFU. Methodology/Principal Findings We asked 179 pediatric oncology institutions in 20 European countries to complete an online survey on LTFU available at their institution. Of 110 respondents (62% response), 66% reported having LTFU for pediatric survivors, 38% for adult survivors of childhood cancer. Availability varied widely across European regions, from 9% of institutions in Northern Europe reporting LTFU for adult survivors to 83% of institution on the British Isles reporting LTFU for pediatric survivors. Pediatric and adult LTFU were usually located in pediatric hospitals and run by pediatric oncologists. Content of follow-up included screening for adverse outcomes and health education. Important problems included lack of time, personnel and funding. Most institutions without LTFU reported that they would like to offer a program (86%). Conclusion/Significance Despite general agreement on the need of follow-up care, there is still a lack of well-organized LTFU for survivors of childhood cancer across Europe.
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119
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Bourke L, Sohanpal R, Nanton V, Crank H, Rosario DJ, Saxton JM. A qualitative study evaluating experiences of a lifestyle intervention in men with prostate cancer undergoing androgen suppression therapy. Trials 2012; 13:208. [PMID: 23151126 PMCID: PMC3522551 DOI: 10.1186/1745-6215-13-208] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 10/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The severe iatrogenic hypogonadal state induced by medical castration used for treatment of prostate cancer is associated with adverse effects including fatigue, increased fracture risk, and a decrease in skeletal muscle function, which negatively impact quality of life. We have previously reported beneficial changes in healthy lifestyle behaviors, physical function and fatigue as a result of a novel combined exercise and dietary advice intervention (a lifestyle intervention) in men with prostate cancer on androgen suppression therapy (AST). The aim of this research was to conduct a qualitative evaluation of the lifestyle intervention in these men with advanced prostate cancer receiving androgen suppression therapy (AST). METHODS Twelve men with prostate cancer on AST took part in three focus groups in a UK higher education institution following the 12 week intervention. Sessions lasted between 45 and 60 minutes in duration. All discussions were audio-taped and transcribed. A framework analysis approach was applied to the focus group data. An initial coding framework was developed from a priori issues listed in the topic guide and extended and refined following initial familiarization with the focus group transcripts. Line by line indexing of the transcripts was undertaken iteratively to allow for the incorporation of new codes. Coded sections of text were grouped together (charted) into themes and subthemes prior to a further process of comparison and interpretation. RESULTS None of the participants involved in the trial were provided with information on how lifestyle changes might be beneficial to men with prostate cancer during the course of their standard medical treatment. We present novel findings that this intervention was considered beneficial for reducing anxiety around treatment and fear of disease progression. Men were supportive of the benefits of the intervention over conventional cancer survival discussion group arrangements as it facilitated peer support in addition to physical rehabilitation. CONCLUSIONS The benefits of lifestyle changes in men with prostate cancer are not well appreciated by care providers despite a range of benefits becoming apparent. Strategies to implement exercise and dietary interventions in standard care should be further evaluated. TRIAL REGISTRATION Current Controlled Trials ISRCTN88605738.
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Affiliation(s)
- Liam Bourke
- Department of Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AB, UK.
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Kent EE, Arora NK, Rowland JH, Bellizzi KM, Forsythe LP, Hamilton AS, Oakley-Girvan I, Beckjord EB, Aziz NM. Health information needs and health-related quality of life in a diverse population of long-term cancer survivors. PATIENT EDUCATION AND COUNSELING 2012; 89:345-52. [PMID: 23021856 PMCID: PMC4560240 DOI: 10.1016/j.pec.2012.08.014] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 08/06/2012] [Accepted: 08/29/2012] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To investigate health information needs and their association with health-related quality of life (HRQOL) in a diverse, population-based sample of long-term cancer survivors. METHODS We analyzed health information needs from 1197 cancer survivors 4-14 years post-diagnosis drawn from two cancer registries in California. Multivariable regression models were used to identify factors associated with endorsement of total number and different categories of needs. The relationship between number of needs and HRQOL and effect modification by confidence for obtaining information was examined. RESULTS Survivors reported a high prevalence of unmet information needs in the following categories: side effects & symptoms: 75.8%; tests & treatment: 71.5%; health promotion: 64.5%; interpersonal & emotional: 60.2%; insurance: 39.0%; and sexual functioning & fertility: 34.6%. Survivors who were younger, non-White, and did not receive but wanted a written treatment summary reported a higher number of needs. Number of information needs was inversely related to mental well-being, particularly for those with low confidence for obtaining information (P<0.05). CONCLUSION These patterns suggest disparities in access to important health information in long-term survivors and that affect HRQOL. PRACTICE IMPLICATIONS Findings suggest a need for tailored interventions to equip survivors with comprehensive health information and to bolster skills for obtaining information.
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Affiliation(s)
- Erin E Kent
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Bruce J, Thornton AJ, Scott NW, Marfizo S, Powell R, Johnston M, Wells M, Heys SD, Thompson AM. Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer. Br J Cancer 2012; 107:937-46. [PMID: 22850552 PMCID: PMC3464763 DOI: 10.1038/bjc.2012.341] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/06/2012] [Accepted: 07/07/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Few epidemiological studies have prospectively investigated preoperative and surgical risk factors for acute postoperative pain after surgery for breast cancer. We investigated demographic, psychological, pain-related and surgical risk factors in women undergoing resectional surgery for breast cancer. METHODS Primary outcomes were pain severity, at rest (PAR) and movement-evoked pain (MEP), in the first postoperative week. RESULTS In 338 women undergoing surgery, those with chronic preoperative pain were three times more likely to report moderate to severe MEP after breast cancer surgery (OR 3.18, 95% CI 1.45-6.99). Increased psychological 'robustness', a composite variable representing positive affect and dispositional optimism, was associated with lower intensity acute postoperative PAR (OR 0.63, 95% CI 0.48-0.82) and MEP (OR 0.71, 95% CI 0.54-0.93). Sentinel lymph node biopsy (SLNB) and intraoperative nerve division were associated with reduced postoperative pain. No relationship was found between preoperative neuropathic pain and acute pain outcomes; altered sensations and numbness postoperatively were more common after axillary sample or clearance compared with SLNB. CONCLUSION Chronic preoperative pain, axillary surgery and psychological robustness significantly predicted acute pain outcomes after surgery for breast cancer. Preoperative identification and targeted intervention of subgroups at risk could enhance the recovery trajectory in cancer survivors.
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Affiliation(s)
- J Bruce
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK.
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Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107:1195-202. [PMID: 22892390 PMCID: PMC3461160 DOI: 10.1038/bjc.2012.366] [Citation(s) in RCA: 301] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: There are currently two million cancer survivors in the United Kingdom, and in recent years this number has grown by 3% per annum. The aim of this paper is to provide long-term projections of cancer prevalence in the United Kingdom. Methods: National cancer registry data for England were used to estimate cancer prevalence in the United Kingdom in 2009. Using a model of prevalence as a function of incidence, survival and population demographics, projections were made to 2040. Different scenarios of future incidence and survival, and their effects on cancer prevalence, were also considered. Colorectal, lung, prostate, female breast and all cancers combined (excluding non-melanoma skin cancer) were analysed separately. Results: Assuming that existing trends in incidence and survival continue, the number of cancer survivors in the United Kingdom is projected to increase by approximately one million per decade from 2010 to 2040. Particularly large increases are anticipated in the oldest age groups, and in the number of long-term survivors. By 2040, almost a quarter of people aged at least 65 will be cancer survivors. Conclusion: Increasing cancer survival and the growing/ageing population of the United Kingdom mean that the population of survivors is likely to grow substantially in the coming decades, as are the related demands upon the health service. Plans must, therefore, be laid to ensure that the varied needs of cancer survivors can be met in the future.
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Affiliation(s)
- J Maddams
- King's College London, Thames Cancer Registry, 1st Floor, Capital House, 42 Weston Street, London SE1 3QD, UK.
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